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 gotten there.
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 policymakers 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, Dyer noted. …