Emergency Preparedness a Challenge for Older Americans: Better
Disaster Plans Needed for Seniors
Second in a series on public health preparedness in conjunction with APHA's National Public Health
Week. The event, to be held April 2-8, has a theme of "Take the First Step! Preparedness and Public
Health Threats: Addressing the Unique Needs of the Nation's Vulnerable Populations."
Carmel Dyer remembers seeing elderly evacuees wandering around Houston's Astrodome in late summer
2005, many of them adrift in delirium and confusion, not knowing where they were or how they had
In the mass Gulf Coast evacuations to escape Hurricane Katrina's destruction, many elderly people got
separated from their loved ones and caregivers and landed in a sports stadium hundreds of miles from
home without a familiar face to advocate on their behalf.
As part of a medical team from the Harris County, Texas, Hospital District, Dyer, MD, FACP, said she
met elderly evacuees so disoriented they weren't able to give health workers their medical histories. Some
were unable to walk themselves to the bathroom, while others had lost their glasses and hearing aides and
could not read signs or hear announcements explaining where to go for help. Some evacuees were simply
much too sick to be lying on a cot in a stadium. But despite the fact that evacuees ages 65 and older were
making up more than 55 percent of those seeking help at the Astrodome medical clinic, Dyer said, there
was no tool health workers could use to quickly and easily identify older people in need and alone among
the masses of evacuees.
"Nobody thinks about older people in these sorts of situations," said Dyer, currently the division director
for geriatric medicine in the Department of Internal Medicine at the University of Texas Health Science
Center in Houston. "But their needs are just heightened in emergency situations."
According to an AARP-commissioned survey, about 13 million people ages 50 and older say they will
need help evacuating in the event of a natural disaster, and about half said they'll need that help from
someone outside of their households. Once evacuated, many older people will face unique challenges and
require more assistance than the rest of the adult population. Some older adults may need to go to special-
needs shelters, created specifically for evacuees with disabilities and serious medical conditions, but not
every state has planned for such shelters, nor are they necessarily required to. Such gaps in emergency
planning present a unique opportunity for public health professionals and their allies to hone their
preparedness and prevention messages to target older residents and pass on lessons learned from previous
disasters. Still, it is inevitable that particularly vulnerable populations will fall unnoticed through the
cracks, leading experts in the field to create new and innovative tools–sometimes through months of study
and research and sometimes in the midst of unthinkable tragedy.
Back at the Astrodome, health workers did just that, Dyer told The Nation's Health. Knowing that the
Houston stadium was now home to hundreds of people who desperately needed to be transferred to
medical facilities–some of whom could die if left unnoticed–a team of gerontological professionals came
together to form the Seniors Without Families Triage, otherwise known as SWiFT. The team quickly
developed a screening tool to assess the needs of frail elderly people who were without a family member
or caregiver to speak up for them. Using the one-page tool, volunteer nurses and social workers combed
through the Astrodome, identifying the sickest people and transferring them to appropriate nursing
facilities, Dyer said. Having been tested and tweaked amid the worst circumstances, Dyer and her
colleagues are now spreading the word about the triage tool and urging policy-makers to ensure their
emergency plans account for older people. In fact, in 2006, the tool caught the eye of U.S. Sen. Herb
Kohl, D-Wisc., who sent a brochure about the triage tool to emergency preparedness units in every state,
"(Geriatricians) should be at the table giving advice during emergency planning," she said. "We're trying
to provide care, we're trying to teach and we also have to have time to serve our communities. But we
need many more of us because this is just one example where the lack of geriatricians really hurts public
Unfortunately, the August 2005 Gulf Coast hurricanes exposed that the needs of older residents haven't
been incorporated effectively into state and local emergency plans, according to Tom Nelson, AARP's
chief operating officer. In Katrina's aftermath, AARP provided $3.5 million in grants to local Gulf Coast
organizations to support them in responding to elderly people's needs, part of which went toward
assessing what worked and what did not during the emergency response. A few months following Katrina
in December 2005, AARP convened a diverse gathering of government officials, emergency response
experts, relief organizations and aging advocates to discuss lessons learned from assisting older people in
disasters and found that "we can do better," Nelson told The Nation's Health. In fact, many of the
meeting's different stakeholders found that they had never talked with each other before–even though
their knowledge and skills would overlap significantly in an emergency, he said.
"Older people's needs have not been well integrated (into emergency plans)," Nelson said. "It's been out
of sight, out of mind. So the vulnerable elderly, those in nursing homes, in assisted living facilities or
those living on their own have been forgotten. This has become very, very evident in the Gulf states
during the hurricanes."
As AARP works with state policy-makers to shore up preparedness activities, such as creating special-
needs registries so that emergency officials are aware of older persons who need help, advocates must
also work to help older residents prepare for themselves. If older residents decide to stay home, or "shelter
in place," during an emergency, Nelson said, they should prepare enough supplies–including
prescriptions–for up to five days, keeping in mind that they may lack electricity. Anything needed for
daily living, such as eyeglasses, hearing aides, special medical equipment and medical records, should
also be added to an emergency supply kit, as well as a list of medications a person takes, a list of health
conditions and contact information for a person's primary health care provider. Another key to emergency
preparedness is communicating such plans to family members and caregivers, especially if older people
are unable to transport themselves away from a disaster.
"The importance of good communication goes all across the board," said Irma Tetzloff, a regional office
liaison and disaster preparedness coordinator at the U.S. Administration on Aging. "Communication is
just key to how well things go and means working with older people themselves, working with first
responders, working with state officials and also with people who are providing services (to older
Tetzloff said a big focus of AoA's preparedness activities are elderly people who live in their homes.
Networking with community groups that serve older people, such as Meals on Wheels and senior centers,
is key to identifying such people and getting them onto official registries. The nation's 655 Area Agencies
on Aging, 11,000 senior centers and 29,000 senior service providers are not only the most knowledgeable
in pinpointing homebound elderly who need assistance in emergencies, but can help reinforce
preparedness messages to the older population, Tetzloff said. And better preparedness plans can also help
mitigate the difficult recovery phase, which can be much harder and take much longer for older people.
It's especially hard if an older person's caregiving system is in disarray after a disaster, Tetzloff noted, and
it's very hard to build that system back up, even if it's done piecemeal.
"This is something we have to constantly improve upon because we learn from each experience we have,"
she said. "The events are always different, it's never the same twice."
New Tools Emerging for Local Responders
While every disaster is different, a common thread weaves its way through most, if not all, emergencies:
vulnerable residents with few social contacts can easily be left behind.
In the wake of the Sept. 11, 2001, terrorist attacks and the 2003 blackout that left millions in the Northeast
without power for days, emergency responders were able to contact New York City residents who
received home care under Medicaid, as they were on an official list. Such lists, however, may overlook
socially isolated adults without social service connections, including those who are trapped and
vulnerable after a disaster.
To identify such people, researchers with the International Longevity Center's World Cities Project are
creating an "index of vulnerability" that can help pinpoint geographic areas with high concentrations of
older, vulnerable populations and, in turn, find older residents who aren't on anyone's list, according to
Michael Gusmano, co-director of the World Cities Project and an assistant professor of health policy and
management at Columbia University's Mailman School of Public Health. In collaboration with the Paris
Health Observatory–which witnessed more than 2,000 deaths, mostly among older people, during the
city's 2003 heatwave–the World Cities Project pinpointed eight factors that are likely to be correlated with
social isolation, such as poverty or disability. Gusmano and his colleagues are now using those factors to
create a mapping technique to identify neighborhoods at high risk for social isolation.
"We want to encourage policy-makers to use this as a planning tool and we hope it will generate a
discussion on the local level about what areas need attention," Gusmano told The Nation's Health. "Let's
think geographically about needs and how to effectively target resources."
With growing numbers of older people living in large cities–almost 1 million people 65 and older live in
New York City alone–identifying older, vulnerable residents is, more and more, becoming an important
issue for emergency planners, Gusmano noted. Another World Cities Project pilot project is now under
way to identify two New York City neighborhoods where there seems to be a mismatch between the
needs of older residents and the actual number of residents who take advantage of available community
services. A goal of the project is to bring together neighborhood stakeholders, such as those from health
care organizations, housing groups and religious institutions, to share experiences and identify the best
methods for identifying vulnerable populations and bring them into the fold.
"There's an assumption that older people are being taken care of because of the large number of social
programs...but I don't think advocates for older people are included enough in the (emergency planning)
conversation," Gusmano said.
However, in some states, natural disasters are an unfortunate and inevitable reality of daily life and, as
such, emergency planners are ahead of the national curve in reaching out to older populations.
"Florida is in the weird position that we're oddly lucky to have a lot of experience," said Liz Gutierrez,
human services branch manager with the Miami-Dade County Office of Emergency Management and
Homeland Security. "We're confident that we're moving in the right direction, but we still have a lot of
work to do."
In Florida, every county is required to maintain a special-needs registry and every resident who needs
assistance with daily living activities can sign up, Gutierrez said. Such residents can then be located
during an emergency and brought to a special-needs shelter that's equipped with extra medical supplies
and specialized foods and staffed by nurses and medical providers. In Miami-Dade County, applications
to sign up for the special-needs registry are offered in English, Spanish, Creole and Braille and people can
also sign up via phone. With only about 2,000 people in the Miami-Dade registry, Gutierrez said officials
are "realistic that there's probably still a lot of folks that aren't aware of it."
To raise awareness, Gutierrez and her colleagues are using multiple community pathways to reach older
residents where they live and play. Miami-Dade officials are working with elderly housing communities,
senior centers, home health agencies and physicians, asking them to speak with their clients and patients
about making preparedness plans and the availability of special-needs shelters. Other outreach involves
working with churches to help them develop elder hotlines and phone trees and training service
organizations, such as Meals on Wheels, on how to continue vital services in a disaster's wake. Still,
Gutierrez said, many residents, even if they are listed in a registry, will decide not to leave their homes
during an emergency, which means it's even more important that older adults know how to prepare for
"It's critical that people of any age think about what they need to prepare," she said. "And it's much easier
done when the weather is nice outside."
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