Managing Elderly Patient during Disasters

1 International Medical Strategic Approaches in Managing Elderly Patient during Disaster

The elderly people have special needs making them be prone to devastating consequences at times of disasters. These special needs are in terms of both physical and cognitive aspects. The elderly face many challenges and they need help in carrying out simple things such as eating, taking a shower, cleaning, dressing, and even attending to nature calls. They may also be having chronic disorders that need constant monitoring and support. With aging, the risk of developing cognitive impairment also increases. This is because of the elevated prevalence of dementias such as Alzheimer’s disease, Parkinson’s disease, and other neurodegenerative disorders in the elderly population.

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These people, therefore, may be having the brain disorders and altered personality, impairing their ability to recall, learn, think, and relate to others. Some of these conditions may be severe enough to cause complete memory loss. Helping these elders during disasters becomes a challenging task because some may often do not have the ability to control their impulses and may reject basic aids like health care, food, shelter, and toileting (Norris 2005).

Confusion, devastation, depression, anxiety, and stress are common conditions among frail elders hence the need for effective disaster response strategies. The increased vulnerability of this category of people to disasters is mainly due to physical decline, reduced sensory perceptions, and chronic illnesses, social and financial challenges (McGuire, Ford & Okoro 2007).

With aging, physical decline sets in. This may hinder these people’s ability to move, their visual and hearing capacity, hence placing them at a more vulnerable position during disasters. Their diet requirements also may vary from that of the others.

They therefore require special aid, for example mobility and hearing devices. Disaster response strategies must therefore consider the distinctive features of this segment of the population and customize assistance that can enhance their health and safety (Rosenkoetter et al. 2007; Alzaga, Varon, & Nanlohy 2005).

Physical Decline

3 The elderly people face a progressively deteriorating physical wellness like loss of balance, poor motor coordination, and loss of functional capabilities. With increase in age, mobility is hindered and basic duties such as eating, conversing and using devices decline. These physical impairments can be compounded by health issues. Physical impairment poses challenges during disasters to this population as they cannot move faster to escape or take cover. Disasters may affect life support machines, and this is likely to endanger the lives of the elderly, some of whom are dependent on the equipment. Movements may also be limited by disasters which may cause power disruptions. This can in turn affect the elderly who may not be able to get food and health care efficiently (Bankoff, Frerks, & Hilhorst 2004).

Reduced Sensory Perceptions With age advancement, sensory perceptions such as seeing, hearing and touch decline. Disasters cause displacement and evacuating the elderly who have diminished sensory perceptions can be difficult. Decreased sensory perceptions may also hinder evacuation as those affected can have difficulties in comprehending instructions during emergency (Aldrich & Benson 2008).

Chronic illnesses Many chronic illnesses are more prevalent in old age. The elderly therefore always need regular and ready access to medical care. However, in times of calamity accessing effective health care becomes difficult hence they cannot sustain proper treatment (Kilijanek & Drabek 1979).

Challenges in the Provision of Medical Care to the Elderly during Disaster

4 Medical emergency responses during calamities are geared towards increasing healthcare access. However, during disasters the healthcare systems also become strained. In providing health services during emergence situations, the casualties must be attended while at the same time addressing the special needs of the aged population, majority of them having chronic illnesses (Brown 2008). The possibility of receiving inappropriate health care is elevated during calamities. This is because these individuals often find themselves in health institutions when disasters occur. If they are suffering from neurological conditions, they may not express themselves clearly, hence they are given medical care without gaining enough medical history about them (Johnson 2008; Fernandez et al. 2002) Medical Strategic Approaches in Managing Elderly Patient during Disaster The degree to which a person prepares and adjusts to disaster may be related to different factors sometimes above the control of the victim. A person’s response to disaster is determined by factors such as the type of disaster, severity and duration of the incident, availability and effectiveness of warning systems, the person’s wellbeing, and the ease of accessing vital resources (Cohen & Mulvaney 2005; Knowles & Garrison 2006). Vulnerability to the effects of disasters is particularly increased in people who have medical conditions as they may be under medication or regularly need medical care. The aged people, care givers and the community have a role of making prior plans for disasters. Exclusion of the special needs of aging population in emergency planning is likely to result into costly and complicated health and psychological needs which are chronic. Formulating and implementing strategic policies

5 throughout emergency programs is instrumental to addressing the needs of the elderly (Hillier & Barrow 2008).

Strategies that have been developed to help the elderly population during disasters include prior planning and training, communication and coordination, team work, transport arrangements, incorporating care givers in formulating and implementing emergency policies, and utilization of community data to locate residential places of the elderly (Henderson, Roberto & Kamo 2010).

Planning Medical disaster response units must make early plans that make sure that during disasters, the elders are evacuated with their health data, drugs and assistive devices. Cognitive and behavioral assessment plans should also be done early so that their ability to do simple activities is established. Studies show a great number of people who die following evacuation from disasters are drawn from the elderly population. A high proportion of the deaths may be natural, mostly due to underlying medical conditions, but the disaster response mechanisms are significant catalysts of the high mortality (Henderson, Roberto & Kamo 2010; Sinclair, Morley & Vellas 2012).

To reduce the burden of treating the casualties and chronic illnesses in the elderly, exhaustive medical plans must be put in place. The health sector must recognize the complexity of providing treatment and diversify the services to include home based care and outpatient care (Bolin & Klenow 1982). Important medical services such as dialysis must be delivered to these people, hence need for effective planning. Medical aid should extend beyond the disaster period, as it has been shown that chronic illnesses are exacerbated by environmental variables such as calamities

6 hence take a longer period to heal. The elderly are unlikely to seek mental treatment following disaster as this is seen to be personal and spiritual deficit. The health personnel should design approaches that can help in reaching the elderly and providing them with mental health care (Legome & Shockley 2011).

Communication and Coordination Chronic conditions can develop into worse complications in the event of a disaster. This is exacerbated by unavailability of basic needs such as clean water and proper diet, poor weather conditions and increased exposure to infectious agents.

Enhanced communication is significant in alleviating this suffering (Fernandez et al.

2002). Adequate and frequent communication with the elderly helps in identifying their needs early before the occurrence of a disaster. Proper coordination is essential in identifying the elderly and collecting information about their health status. Plans that ensure that the elderly consistently have access to medical treatment must be incorporated into emergency programs (Rodriguez, Kennedy & Ressler 2007).

Enhanced communication of the health care providers and various agencies has led to increased sensitization about disaster issues.

Community and humanitarian agencies have information critical in identifying the elderly people having chronic medical conditions. Through improved communication, this information can be utilized in the provision of medical care in case of disasters. The approach of using available agencies and resources is instrumental in tracing elders more at risk and making appropriate preparations (Morrow 1999; Novak 2009).

Transportation

7 Transportation requirements are also necessary in times of disasters. Physical limitations of the aged people may complicate the transportation of elderly to places where they can receive medical care. Arrangements should be made so that those people who resist being moved to central points for medical relief are provided the necessary help at places of their convenience. Transporting of medical services from the usual location to centers where the elderly are sheltered also increases access to medical care (Fjord & Manderson 2009).

Training Medical training and support programs should be incorporated in emergency preparedness. The people should be informed of the medical services available and where to obtain them. The training and support programs must be availed pre, during and post disaster period (Penner & Wachsmuth 2008).

8 List of References Aldrich, N & Benson, WF 2008, ‘Disaster preparedness and the chronic diseases needs of vulnerable older adults’, Preventing Chronic Disease: Public Health Research, Practice and Policy, vol. 5, no. 1, pp. 1-7.

Alzaga, A, Varon, J & Nanlohy, S 2005, ‘Natural catastrophes: Disaster management and implications for the acute care practitioner’, Critical Care and Shock, vol. 8, no. 1, pp. 1-5.

Bankoff, G, Frerks, G & Hilhorst, D 2004, Mapping vulnerability: Disasters, development and people, Earthscan, Sterling, VA, Bolin, R & Klenow, DJ 1982, ‘Response of the elderly to disaster: An age-stratified analysis’, International Journal of Aging and Human Development, vol. 16, pp. 283-297.

Brown, L 2008, ‘Issues in mental health care for older adults after disasters’, Generations, vol. 62, pp. 3121-3132.

Cohen SS & Mulvaney, K 2005, ‘Field observations: Disaster medical assistance team response for Hurricane Charley, Punta Gorda, Florida, August 2004’, Disaster Management and Response, vol. 3, no. 1, pp. 22-28.

Fernandez, LS, Byard, D, Lin, CC, Benson, S & Barbera, J 2002, ‘Frail elderly as disaster victims: Emergency management strategies’, Prehospital and Disaster Medicine, vol. 17, no. 2, pp. 67-74.

Fjord, L & Manderson, L 2009, ‘Anthropological perspectives on disasters and disability: an introduction’, Human Organization, vol. 68, no. 1, pp.64–72.

Gibson, MJ 2006, ‘We can do better: Lessons learned for protecting older persons in disaster’, AARP Report, viewed 31 August 2012 <http://assets.aarp.org/rgcenter/>

9 Henderson, TL, Roberto, KA & Kamo, T 2010, ‘Older adults' responses to Hurricane Katrina: Daily hassles and coping strategies’, Journal of Applied Gerontology, vol. 29, no. 1, pp. 48-69.

Hillier, S, & Barrow, G 2008, Aging, the individual and society, 8th ed, Wadsworth, Florence, KY. Johnson, M 2008, ‘Our guest editor talks about disasters and older adults’, Generations, vol. 31, p. 4.

Kilijanek, TS & Drabek, T 1979, ‘Assessing long-term impacts of a natural disaster: A focus on the elderly’, The Gerontologist, vol. 19, no. 6, pp. 555–565.

Knowles, R & Garrison, B 2006, ‘Planning for the elderly in natural disasters’, Disaster Recovery Journal, vol. 19, no. 4, viewed 31 August 2012 <http://www.drj.com/articles/fall06/1904-07.html> Kohn, R, Levav, I, Garcia, ID, Machuca, ME & Tamashiro R 2005, ‘Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country’, International Journal of Geriatric Psychiatry, vol. 20, pp. 835–845.

Legome, E & Shockley, WL 2011, Trauma: A comprehensive emergency medicine approach, Cambridge University Press, New York, NY. MacCann, DGC 2011, ‘A review of hurricane disaster planning for the elderly’, World Medical & Health Policy, vol. 3, no. 1, Article 2 McGuire LG, Ford, ES, Okoro, CA 2007, ‘Natural disasters and older U.S. adults with disabilities: Implications for evacuation’, Disasters, vol. 31, no. 4, pp. 49–56.

Morrow, BH 1999, ‘Identifying and mapping community vulnerability’, Disasters, vol. 23, no. 1, pp. 1-18

10 Norris, M 2005, Assessing nursing homes' responses to Katrina, viewed 31 August 2012 <http://www.npr.org/templates/story/story.php?storyId=4854893&ps=rs> Novak, M 2009, Issues in aging, 2nd ed, Pearson Education, Boston, MA. Penner, S & Wachsmuth, C 2008, ‘Disaster management and populations with special needs’, Public Administration and Public Policy, vol. 138, pp. 427-444.

Rodriguez, H, Kennedy, JP & Ressler, E (eds.) 2007, Handbook of disaster research, Springer, New York, NY. Rosenkoetter, MM, Covan, EK, Cobb, B, Bunting, S & Weinrich, M 2007, ‘Perceptions of older adults regarding evacuation in the event of a natural disaster’, Public Health Nursing, vol. 24, pp. 160–168 Sinclair, JA, Morley, EJ & Vellas, B 2012, Pathy’s principles and practice of geriatric medicine, 5th ed, John Wiley & Sons, West Sussex.