by Kim Krisberg

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.

Jerry Broderson, 73, sits inside Houston’s Astrodome in 2005in the wake of Hurricane Katrina. New plans are being made to assist seniors in the event of emergencies and disasters. Photo by David Portnoy, courtesy Getty Images

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, Dyer noted.

"(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 health."

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,

New Orleans resident Mary Elizabeth Johnson, 80, who was displaced by Hurricane Katrina, looks over her FEMA trailer home in October 2005. Photo by Robyn Beck, courtesy AFP/Getty Images

"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 people)."

Emergency workers in Mustang, Okla., talk to an older resident about assistance in the wake of wildfires in January 2006. Photo by Bob McMillan, courtesy FEMA

"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.

Punta Gorda, Fla., residents Kay Protheroe, left, and Betty Tootill embrace after sharing a donated meal at a community center following an August 2004 hurricane that left thousands homeless. Photo by Mario Tama, courtesy Getty Images

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 themselves.

"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."

For more on older adults and emergency preparedness, visit www.aoa.gov/eldfam/disaster_assistance/disaster_assistance.asp  or www.aarp.org.  

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