Learning Module 1: Special Considerations of

Older Adults

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Special Considerations of Older Adults

In a disaster or emergency situation, older adults are particularly vulnerable. This module describes 12 issues of concern for older adults.

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12 Key Concerns of Older Adults

1. Sensory deprivation

2. Delayed response time

3. Chronic Illness and medication use

4. Multiple loss effect

5. Mobility impairment

6. Memory disorder

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12 Key Concerns of Older Adults

7. Hyper/hypothermia vulnerability

8. Issues pertaining to diversity

9. Generational Differences in accepting assistance

10. Fear of victimization

11. Mental health stigma

12. Fear of loss of independence

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Sensory Deprivation

50% of individuals over age 65 have some degree of hearing loss

Older adults with hearing impairments may not hear warnings and not be prepared to deal with the emergency situation including evacuation. Persons with a hearing loss may appear disoriented and confused.

Older adults are prone to developing age-related diseases of the eye that impair vision.

Older adults may not smell smoke or feel heat when touching or stepping on hot items.

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Sensory Deprivation - Strategies

• Write directions in large font on non-glare paper. Residents unable to read should have individual instruction.

• Shelters should have adequate lighting.

• Encourage older adults to use and clean their eyeglasses.

• When approaching older adults with severe visual impairments, identify yourself.

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Sensory Deprivation – Strategies (cont.)

• The environment should be organized with no clutter.

• Do not move older adults’ personal items and furniture.

• If the senior with a hearing aid suddenly has problems hearing, check the hearing aid batteries and replace if necessary.

• Remember that adequate lighting for you may not be adequate for the older adult.

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Delayed Response Time

• Response time slows with aging older adults need more time to process new information. They may respond more slowly to calls for disaster assistance. They need more time to complete the evacuation process.

• Experiences in past disasters show that older adults are slower than the younger population to seek help in time of disasters.

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Delayed Response Time - Strategies

• Break information down into small parts. • Approach older adults in a calm, unhurried

manner. • Attempt to locate older adults who may not have

had time to evacuate.• Evacuation should be started as soon as possible

to allow for the extra time needed. • Provide for extra time in evacuation planning.• Realize that in an emergency there is a tendency

to hurry, and older adults are a group that you can’t rush.

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Chronic Illness and Medication Use

• The largest group suffering from chronic disease is adults over 65.

• The most frequent chronic illnesses are arthritis, hypertension, heart disease, and hearing impairments.

• Chronic health problems can impair mobility and make it difficult to evacuate.

• Decreased health resources in disasters make it difficult to maintain management of the chronic conditions.

• Medications may: impair mental status, alter stress response, cause weakness, affect heart rate, and alter usual symptoms of biological agents in older adults.

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Chronic Illness and Medication Use - Strategies

• Know the chronic problems affecting individuals. • Older adults should keep a brief medical history

with them and have a summary of medical records sent with them.

• To prevent dehydration which complicates chronic conditions, efforts should be made to ensure adequate hydration.

• For disaster preparedness older adults should have a list of all the medications that they take, including: Name of medication, reason for taking, dose, schedule, prescribing physician

• Don’t forget over-the-counter medications

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Multiple Loss Effect Loss is a universal experience that accompanies the

aging process. These may include loss of:• Relationships through the death of spouse and

friends• Physical function, which results in loss of

independence• Work role• Physical attractiveness• Control over their environment• Health as a result of multiple chronic illnesses• Sensory function

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Multiple Loss Effect - Strategies

• Empathy can help the senior deal with the grief associated with the loss. Empathy is the ability to understand another person’s feelings and difficulties.

• To help individuals cope with loss you will need strength. This requires that you have a positive belief in yourself, can find meaning in life, and have confronted your own mortality.

• If, following the loss, older adults show signs of depression or Post Traumatic Stress Disorder they should be referred to a mental health provider as discussed in Module 2.

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Mobility Impairment

• At least 50% of older adults have mobility limitations. Many older adults have impaired balance, decreased strength, altered exercise tolerance, and limitations in performing activities of daily living. Mobility impairments can be complicated by chronic conditions and medications.

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Mobility Impairment - Strategies

• In times of evacuation, individuals with mobility impairment must be supplied with necessary assistive devices such as walkers, canes, and wheelchairs.

• When the power is off, specially designed evacuation chairs can be used.

• When in shelters, older adults with mobility impairments will require support so that they continue walking and moving. This helps prevent health complications.

• Older adults with impaired mobility will be at higher risk for falls. To prevent falls, older adults should be instructed to use their assistive devices and wear supportive footwear. The environment should be kept as free of clutter and as well-lit as possible.

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Memory Disorder

Memory disorders will make it difficult for the impaired senior to follow directions. The stress of the situation can result in increased confusion and/or agitated behaviors.

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Memory Disorder Angie Merchant, a nurse living near Baton Rouge,

described her parents’ assisted living community after Hurricane Katrina:

“The older adults who had dementia were totally lost and confused and agitated, not understanding the situation, and some tried to leave the building to go back home. One of them believed the end of the world was coming and struck up a loud song, walking rapidly around and singing to everyone, ‘Get out! It’s going to happen! And it’s going to happen soon!’ It was crazy, to say the least, but we did our best and (remarkably) kept a sense of humor through it all, although the situation was grave.”

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Memory Disorder - Strategies Tips for communication include:• Approach the older adult in a calm, straightforward, and

gentle manner. Treat them as adults.• Communicate at eye level to create a balance of power.• Begin conversations by introducing yourself.• Speak slowly and say individual words clearly.• Keep the pitch of your voice low.• Ask simple questions that require a choice of a yes/no

answer• Break instructions down into parts.• Give the older adult time to respond or to complete

tasks.• Try to stay calm and be patient.

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Memory Disorder – Strategies (cont.)

Things Not To Do:• Don't argue with the person. • Don't order the person around. • Don't tell the person what he

or she can't do. • Don't be condescending.

(Treat them as adults)• Don't talk about other

residents in front of them.

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Hyper/hypothermiaVulnerability

A normal aging change is the decreased ability to regulate body temperature.

Chronic illness in older adults may include circulatory problems.

Changes in their sense of touch can decrease their awareness of temperature changes.

Some of the medications taken by older adults affect temperature control.

For example, hypothermia may be worsened with the use of medications. Alcohol particularly inhibits temperature regulation.

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Hyper/hypothermia Vulnerability - Strategies

• Hyperthermia or body temperature above 104° F can be prevented by insuring that older adults receive adequate hydration.

• Monitor residents’ hydration and encourage fluids.• Have at least 1 gallon of drinking water per resident. • Encourage layered clothing that can be removed when

temperatures rise or fall.

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Hyper/hypothermia Vulnerability - Strategies

• Hypothermia or body temperature below 95˚ F can be prevented by dressing residents in layers, gloves and scarves. Hats and warm socks will prevent excessive heat loss.

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Issues Pertaining to Diversity

Cultural and language barriers make some older adults especially vulnerable to the effects of disasters. Religious and cultural backgrounds affect the manner in which older adults view services and government agencies. Services provided to the majority groups may not be appropriate for minority groups.

Language barriers are a major obstacle

to delivering services to some older adults.

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Issues Pertaining to Diversity - Strategies

• Hire bilingual and bicultural staff. • Staff should have multicultural training to

insure that needs of minority older adults are met with sensitivity.

• Written materials in the language of the minority older adults must be used.

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Generational Differences in Accepting Assistance

Older adults may not request aid because of the stigma linked with certain types of assistance considered to be “welfare.”

Older adults also express concern that receipt of disaster aid may impact their Social Security income.

Older adults who lived through the Great Depression of the 1930s may hesitate to ask for aid because they believe others may need it more than they do.

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Generational Differences in Accepting Assistance - Strategies

• Special targeted outreach to older adults needs to be planned.

• Programming for older adults needs to demonstrate and incorporate respect and understanding for their unique life-views. Because older adults are responsible for caring for themselves, an important strategy is self-preparation. Older adults and their families should be reminded of this responsibility.

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Fear of Victimization

Older adults express a high level of fear regarding criminal victimization.

Con-artists who follow major disasters frequently focus their efforts on vulnerable older adults. Typically, con-artists try to scam older adults into signing contracts for expensive home repairs, accept payment and skip town. Older women living alone are particularly prey to these con-artists.

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Fear of Victimization - Strategies

• Educational programs which provide realistic information to older adults about victimization may allay some of their fears in this area.

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Mental Health Stigma

Studies show that older adults have negative attitudes toward and lack of knowledge regarding mental health issues and aging.

Mental illness is seen as socially unacceptable by many older adults. This stigma may prevent older adults from getting treatment.

Many older adults have negative impressions of mental health services and thus do not utilize them.

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Mental Health Stigma - Strategies

• Education can be an effective way to deal with the perceived stigma of the use of mental health services.

• Relief workers and crisis counselors can work with older adults in times of disaster to help them locate services and to cope with grief.

• Linking of mental health services and physical health services also works to remove the stigma of mental health services.

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Fear of Loss of Independence

Most older adults are fiercely protective of their independence and want to live independently.

The fear of being sent to a “nursing home” or a higher level of can can be a barrier to seeking assistance during times of disaster.

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Fear of Loss of Independence - Strategies

Sensitivity on the part of disaster workers is the most important strategy.

Workers need to be aware of this fear and should reassure older adults that their role is to assist in providing services, and not to assist in LTC placement.

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Other Fears of Older Adults in Disasters/Emergencies

In disaster or emergency situations, older adults may have several other fears that affect how they respond:

• Fear of Evacuation

• Family Concerns

• Concerns about Medical Treatment and Security

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Fear of Evacuation

Concerns about mobility impairments, medication needs, medical equipment, nursing care.

Fear of impending disaster/emergencysituation

Lack of knowledge of facility’s evacuation plan

Fear of the unknown – “Where am I going and will my family be able to find me?”

Fear of transportation – “How can I get on the bus with my wheelchair?”

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Family Concerns

• LTC organizations should have a notification system for families of residents

• LTC staff need to keep family members informed.

Families can also develop their own disaster plan which should be communicated to the resident.

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Concerns about Medical Treatment, Security

• Residents and family members should be told of the specific plans for managing medical conditions.

• Reassure families that medication will be sent with the resident and that equipment such as oxygen will be available.

The key to allaying resident and family concerns about disaster/emergency events is COMMUNICATION.

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Difficult Ethical Decisions

When do the safety needs of the

community take precedence over the

rights of the individual?

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Triage

The brief clinical assessment thatdetermines the time and sequence inwhich patients are seen and cared for inthe emergency situations.

Questions that LTC staff will need to resolve: Who will receive care?

Will older adults receive their fair share?

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Guidelines for Ensuring Ethical Treatment

How will staff at your organization ensure ethical treatment of older adults?

• Which co-morbid diseases should be considered for all patients, regardless of age?

• How should resources for persons on life-sustaining treatments be considered?

End of Module 1 Slides