Caring for Elders during a Natural Disaster: We Can Do Better-But Are We?

Article excerpt

As I write this, the waters of the Mississippi are lapping over the levees in Louisiana and Mississippi. It seems impossible that so many disasters could befall one area: following the devastation of hurricanes Katrina and Rita, there was Gustav, Ike, an oil spill, biblically fierce tornados and now a river that will not be contained. And it's not just this region. According to FEMA, the United States has experienced 381 disasters since Hurricane Katrina. Since 1954, every state has experienced a disasteran average of 34 per state. Everyone has a stake in disaster planning.

Some disasters happen in slow motion. Some happen quickly. Some are repeat offenders. But no matter the venue, the results will be exponentially more devastating to older adults. When it comes to needing to move quickly and strategically out of harm's way, frailty can instantly become a terminal condition. In New Orleans, older adults made up only 15% of the population, but accounted for more than 71% of the dead. In Japan, the images of crowds running for high ground, and the trail of older adults inexorably lagging behind, haunt us.

It is the most marginalized- older minority adults with few fiscal resourceswho bear a disproportionate burden in disasters. But disaster planning is challenging, not unlike playing multi-dimensional Sudoku. What works in one set of circumstances may not work in another.

Learning from Katrina

So what have we learned since Katrina? In a brave challenge, AARP issued a postKatrina report, We Can Do Better. It cited the failings of disaster preparedness at all levels that resulted in the death, devastation and long-term trauma for older adults that was Katrina's legacy. Six years later, are we doing better?

One of the major failings in the case of Katrina was a lack of coordination between federal, state and community entities. On the federal level, planning has made great strides. Legislatively, the Pandemic and All-Hazards Preparedness Act of 2006 opens the door for requiring organizations involved in disaster planning to include State Units on Aging with financial incentives. Another two laws- each enacted after Katrina- encourage greater coordination of services (National Response Framework, January 2008; Homeland Security Presidential Directive 8).

But in a discouraging development, a new FEMA directive issued November 2010, Guidance on Planning for Integration of Functional Needs Support Services in General Population Shelters, lacked input from the professional aging network. FEMA admirably sought membership in its workgroup from the disabilities network, and included the Administration for Children and Families. But the needs of older adults are not subsumed under these agencies. The prevalence of multiple chronic diseases and a high degree of frailty result in older adults having distinctly different risks and needs than the disabled population.

An elder who is evacuated maybe fully independent and functional on day one, with diabetes and hypertension well under control, but by day three, in the heat, noise and chaos of a shelter, can quickly become fatigued and dehydrated. Lack of proper medications or access to medical records can exacerbate issues. Add to the mix emergency meals typically high in salt, and suddenly both diabetes and hypertension spiral out of control.

Despite setbacks, there is progress. In May 2011, The New York Times ran this headline on a tornado story: "Government's Disaster Response Wins Praise from Those Affected." In that article, a victim whose house was in shambles is quoted saying, "It ain't like Katrina... we're getting help."

After Katrina, Shirley Laska, from the University of New Orleans Center for Hazards Assessment and Technology, organized an interdisciplinary group to identify and address problems with cross-systems evacuation for older adults. The evacuation of New Orleans in the face of Gustav demonstrated there had been vast improvements. …