Disaster Planning for the Elderly Survivor

 

                                                                                                                                        Raquel E. Cohen (2006)

 

        Evidence of special needs of the elderly is well documented in all disasters.  The catastrophic result of Hurricane Katrina (Gulf Region 2005) resulted in the highest statistical figures of elderly fatality in the US.  Awareness of the variables that promote the problems of this “at risk population” is well documented in the literature.  Among them an important concept is their functional status which comprises a number of capacities affecting the behavior necessary for survival before, during and after a disaster.

 

        This focus on function could be a good and practical measure to ascertain the capacity and needs of this population, taking into consideration the variability of each individual to take care of themself, deal with the necessary preparations, evacuation, living in a shelter, returning to a damaged house or neighborhood, reorganizing their lives, and in general dealing with the aftermath of a disaster. The question to ask is whether they can deal with these activities by themselves or whether family members, agencies or government emergency programs need to develop specific assistance programs. If the latter, the questions which follow are how many, what resources will be needed, how would helpers acquire their training, and what should be the content of this training?

 

EVALUATION AND MANAGEMENT OF FUNCTIONAL STATUS

 

        Questioners need to be selected and used before the hurricane season in order to develop a “functional profile” of the elderly population in Dade County.  Once that base line of functional status is developed, managers need to select an approach that will mitigate the traumatic effects of the different activities they will have to undertake. After documenting these procedures, a pilot project in an area of Dade County should be attempted, and the functioning of that group should be followed during the hurricane season in order to fine-tune the documentation so as to extend this research to other sites.

 

PROPOSED BASELINE DEVELOPMENT INSTRUMENT

 

1.   Issues of functional status

 

2.   Evaluation and management

 

a.   Function: A persons ability to perform tasks and fulfill social roles associated with daily living

b.  Independence vs. vulnerability: Function decline influenced by disease/disorder (physiologic deregulation)

c.   Variability in rate of change/organ/individual

d.  Changes more evident under stress

                                                                       i.      systems most evident

                                                                    ii.      react or recover

                                                                 iii.      generally stable at base line but disregulation increases under situation of stress

                                                                  iv.      homeostasis needs vs.  challenges to homeostasis

                                                                     v.      how much can be tolerated

                                                                  vi.      what type of stressors (shelter conditions in  evacuation)

                                                               vii.      results may be imperceptible, but may affect the elderly due to lower reserve capacity

                                                            viii.      more adaptability, the better person will do

 

3.   How do we assess

 

a.   Basic activities of daily living: taking care of themselves (eat, hygiene, plan)

b.  Independence-instrumental-manage household

c.   Need to develop simple test to ascertain level of function of different components (remember: different systems will loose function in different rates)

d.  Methods to assess

                                                                       i.      Series of questions (ability to phone, clean, make decisions, drive, etc.)

                                                                    ii.      Observation (gait, speed, ability to get up and down, get up and walk, etc.)

 

4.   Functional Continuum

 

a.   Stages that will guide intervention

                                                                       i.      Independence at home

                                                                    ii.      Independence vs. interdependence

                                                                 iii.      Semi-dependent: community group living

                                                                  iv.      Dependence(partial to full): institution or hospital

 

b.  Disaster gives an insult to elderly individuals’ declining function

                                                                       i.      How much and by what means

                                                                    ii.      How do we structure the system to help minimize impact (especially in shelters)

                                                                 iii.      Premise: change in functional status could depend on the conditions of the shelter and how elderly are treated

                                                                  iv.      What is the future pathway of elderly leaving the shelter and how much more medication will they need