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Elderly evacuation poorly done

National evacuation plans for vulnerable elderly people are so deficient it's infuriating, says one expert.

BY SUSAN KIM | BALTIM0RE | September 26, 2005

"We have spent how much on the Medicare prescription drug plan, yet we donít have a central database of peopleís medications?"

—Dr. Ayn Welleford

National evacuation plans for vulnerable elderly people are so deficient itís infuriating, says one expert.

"It seems to me that in this country, evacuation is not evacuation for vulnerable populations," says Dr. Ayn Welleford, associate professor and interim chair of the Department of Gerontology at Virginia Commonwealth University. "Why don't we have parallel evacuation plans for our vulnerable populations?"

There should be a national, central database evacuation plan for each different population in the U.S., she said. "I'm infuriated. I'm infuriated over the fact that we didn't do it right during Hurricane Katrina - and then again during Hurricane Rita."

Lack of general knowledge about aging is part of the problem she said - and improving evacuation plans for elderly people could stand to benefit everyone. "We're all going to be there," she said. "Truly, making things better for people who are at risk makes things better for all of us."

During evacuation of Houston preceding Hurricane Rita, a bus carrying elderly residents from a Houston nursing home caught fire, killing 24 people. The accident was tragic, agreed Welleford, who questioned why that vulnerable group was evacuated that way in the first place.

"Putting that many older people in a bus and trying to drive out of Houston in that situation? What is that? People have lost their common sense. People seemingly just aren't paying attention."

The health crisis in the Louisiana Superdome was also indicative of a failure to care for elderly people, among others, said Welleford.

"We have spent how much on the Medicare prescription drug plan, yet we donít have a central database of peopleís medications? Sitting at the Superdome, you can't find out anything about people - like what medications is she on?"

Having a central database of prescriptions would help public health officials in a post-disaster situation quickly learn a patient's needs. Often post-disaster patients - particularly traumatized ones - can't remember the names of their prescriptions. "They might say, 'I take this blue pill with my breakfast and this pink pill at night. You have these big, big issues. Then throw in some mild cognitive impairment. Throw in the stress of individuals at risk of losing everything they've collected over 85 years."

Combine being elderly with some other vulnerability factor - such as poverty - and evacuation, for many, becomes impossible. "People couldn't evacuate. They had no means of leaving. We have to look at issues of poverty," she said.

Just because people are old doesn't always mean theyíre frail, Welleford was quick to add - and it doesn't mean they won't be able to adapt to an evacuation plan that takes their needs into consideration.

"People tend to think older people don't deal well with change. But really they are some of the most resilient people around. Hardiness is a key characteristic of somebody late in life."

But changes have to be made in the way elderly people are evacuated, or physical and mental effects will continue to be negative.

Elderly people are more apt to get what Welleford terms "relocation stress syndrome."

"This is primarily looked at in late life as a concept of people moving from their home to some kind of long-term care facility," she explained.

During a disaster, elderly people are more vulnerable to this stress. "People in nursing homes are already at risk for the down side of relocation stress syndrome. When they're evacuated, a person may suffer from depression but it may exhibit itself in gastro-intestinal disorders. Or it may look like delirium. Unless people are trained to work with elders, they won't know."

When people are taken away from the only safe place they know, the stress can be enormous, said Welleford. "Think about people who are older and who have never left New Orleans, have never been in a helicopter, have never been in a boat. And we wonder why they exhibit what we call difficult behavior, or why they are combative. It's because they don't know who you are. Especially in late life, some people have a reduced level of freedom anyway. You sometimes have so little control over your environment."

Evacuation and disaster relief teams need to start including staff who are trained in the unique challenges of the elderly, Welleford said. "Being a trained health professional does not mean you know beans about aging. It's not a required part of training for most health professionals. There are so many things that make that a complicated situation. For example, people need to know how mental health needs present themselves differently among elders."

Part of an evacuation plan for elderly people needs to note what people require for assistance - "your cane, your walker, medications that you take, oxygen," said Welleford. "You can't sit in a car for 16 hours if you require oxygen. You can't go 16 hours without your medication if you're a diabetic. But how are people going to know? People die. This is about vulnerable elders. And this is about how you work with individuals who are vulnerable."

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