Consider Special Needs of Elderly in Planning Disaster Response

Despite frequent physical frailty and lack of resources, older adults are often more mentally resilient in coping with disasters than younger people are.

At a symposium at the American Association for Geriatric Psychiatry (AAGP) annual meeting in March in Savannah, Ga., geriatric psychiatrists offered advice on how mental health professionals can help older people prepare for and respond to disasters so that the disaster's adverse impact on those with age-related vulnerabilities will be minimized.

Whether natural or manmade, disasters occur almost every day somewhere in the world. They overwhelm communities and disrupt normal lives. Elderly individuals' unique vulnerabilities expose them to additional harm beyond that of other adults, Maria Llorente, M.D., said at the symposium. For example, older people generally have more physical impairments, including visual and hearing deficits. When electricity is cut off or streets are filled with debris after a flood or earthquake, older people with poor eyesight are more likely to get injured. In addition, many retirees live on fixed incomes and have limited financial means. They may not be able to stock up on canned foods and emergency supplies before a storm hits.

Llorente is a professor of psychiatry at the University of Miami School of Medicine and chief of psychiatry at the Miami Veterans Affairs Healthcare System.

Nonetheless, “our seniors are extremely resilient,” Llorente said. Studies have shown that elderly individuals are no more likely than those of other ages to suffer from posttraumatic stress disorder after a disaster; in some cases they demonstrate better psychological recovery. As many older adults have had prior experience in coping with disasters or adversities, they may be more prepared than younger people and better able to offer advice and guidance to people around them, she pointed out.

As communities and mental health professionals devise disaster-preparedness plans, they should not neglect or underestimate the special needs of the elderly, Llorente and other speakers emphasized.

After Hurricane Katrina hit in 2005, “there was one viable hospital in the city of New Orleans and one viable hospital in the suburbs,” said Kenneth Sakauye, M.D., a professor of psychiatry and director of geriatric psychiatry at the University of Tennessee Health Science Center in Memphis. Like much of the rest of the health care infrastructure, psychiatric services were devastated in New Orleans.

And it is the elderly who are particularly likely to be affected by the loss of the health care infrastructure, Llorente noted, as many have chronic illnesses that need continued medical attention. At emergency departments around Houston after Katrina, the most common problems seen in New Orleans evacuees were, as expected, scrapes, cuts, and other physical injuries, while the second most common problem was getting prescription refills, she said. For most of these patients, their medical records had been lost or destroyed in the storm. “This presented enormous problems” for local emergency departments, she said.

Therefore, Llorente recommended that clinicians should help elderly patients who have chronic illnesses prepare a record of their diagnoses and ongoing prescriptions to keep safely with other important documents, thus minimizing postdisaster disruption to treatment access and crucial medical information.

Despite the resilience of many elderly individuals, they are also susceptible to increased stress and reactivity to stress during and after a disaster. Llorente pointed to research data documenting a spike in heart-attack and stroke rates immediately following a disaster, especially in elderly people who already had underlying cardiovascular disease.

Frontline responders should be trained to anticipate and meet the specific needs of older adults, according to Llorente. In Florida, for example, some shelters are set up for people with special needs, such as people who need dialysis or continual medical attention. Clinicians can devise contingency plans if the primary plan falls short and screen older patients for disaster preparedness and special needs long before a disaster hits, she suggested.

To help older adults and their family members and caregivers, AAGP's Disaster Preparedness Task Force has developed a brochure, “Older Adults and Disaster: Preparedness and Response.”

The AAGP brochure is posted at <www.gmhfonline.org/gmhf/consumer/disaster.html> or available from the Geriatric Mental Health Foundation at (301) 654-7850.