Disaster preparedness among nurses caring for older adults: a systematic review

Older adults are disproportionately affected during disasters because of multimorbidity, frailty, functional dependency, and reliance on continuous healthcare and social support services. Nurses play a central role in maintaining safety, continuity of care, communication, and clinical coordination during emergencies. However, disaster preparedness in geriatric care settings remains inconsistently developed and has often been examined through a narrow pandemic-related infection prevention and control lens rather than through comprehensive disaster nursing competency frameworks.

This systematic review aimed to synthesize quantitative evidence on the levels, determinants, and key competency domains of disaster preparedness and response among nurses caring for older adults. The review also examined whether existing evidence reflects published disaster nursing and public health competency frameworks or remains concentrated in selected preparedness domains.

A systematic review of quantitative studies was conducted in accordance with PRISMA 2020. PubMed, CINAHL, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed English-language studies published between January 2020 and December 2025. Eligible studies examined disaster preparedness, emergency response, infection prevention and control, organisational readiness, workforce preparedness, or continuity of care among nurses or healthcare staff working in older adult care settings. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklist, and findings were synthesized narratively because of clinical, methodological, and outcome heterogeneity.

Fifteen studies met the inclusion criteria. Overall preparedness was generally moderate but uneven across competency domains. Preparedness was strongest in infection prevention and control, whereas broader disaster response competencies, including emergency decision-making, interprofessional coordination, psychosocial support, continuity of care, recovery planning, and system-level readiness, were less consistently assessed and less developed. Organisational determinants, particularly leadership support, structured training, staffing capacity, emergency protocols, and resource availability, were associated with stronger preparedness.

Disaster preparedness among nurses caring for older adults is characterized by a clear competency imbalance, with greater emphasis on pandemic-related infection control than comprehensive all-hazard disaster preparedness. Strengthening geriatric-specific, competency-based, and system-oriented preparedness frameworks is essential to improve patient safety, continuity of care, workforce readiness, and health-system resilience, particularly in resource-limited and crisis-affected settings.