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When disaster strikes, the elderly die: What can be done to help?


December 19, 2017

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Nadine Demalleville, 80, had about five minutes to prepare to leave her home in the middle of the night. The Thomas fire had already consumed more than 200,000 acres of Southern California and was spreading fast. Demalleville could see it coming over the hill behind her single-wide mobile home in Carpinteria.

A former nurse who relies heavily on a wheelchair, she had no way to travel to the evacuation center more than 20 miles away at University of California Santa Barbara, and no family nearby to help her. She couldn’t even retrieve her cats, who had darted under a bed.

Luckily, her next-door neighbor knew she needed help and showed up to take her to safety.

Around 4 a.m. on Dec. 10, Demalleville arrived at the shelter carrying only her lunchbox full of her medications.

“The whole thing was so stressful,” she said. “Every part of my body is just exhausted.”

Natural disasters hit elderly people especially hard. Because older adults are more prone to physical or mental limitations that make it difficult to move quickly or leave their homes, they typically make up a disproportionate share of deaths in a natural disaster. Luckily for Demalleville, her home was spared. But that might not have been the case. And if it weren’t for her neighbor, she would have stayed home in danger’s path, Demalleville said.

That's what happened to some of the 42 people killed by rampant wildfires in northern California this fall. A preliminary report stated the average age of victims was 79. During Hurricane Katrina, more elderly died than any other age group. And half of the 117 individuals who died as a result of Hurricane Sandy were over age 65. It’s a worldwide phenomenon that included 65 percent of victims in the 2011 Japanese tsunami and one-third of the victims in a recent Philippines typhoon.

Stories of botched evacuations from senior facilities, and a photo of wheelchair-bound adults sitting waist-deep in water in Houston haunt the public.

But seniors living in care facilities are not those most at risk during a disaster. That distinction goes to elderly people who live alone and are most vulnerable, said Elaine Wethington, gerontology professor and co-director of the Cornell Institute for Translational Research on Aging at Cornell Medical School. Frailty, poor mobility, hearing, vision and memory problems that one easily manages on a regular day can imperil survival in an emergency.

While states like Florida and North Carolina and cities like Los Angeles work hard to ensure older people get the help they need during natural disasters, it is often those on the scene — volunteers, emergency response teams and attentive neighbors like Demalleville’s — that pull people away from disaster.

What can go wrong

Many old people who function well in normal circumstances find their situation falls apart in an emergency. Moving slowly due to arthritis at home is fine, but being unable to flee a falling tree or a raging fire can be fatal. If power goes out, a frail adult may not be able to open the garage door manually to drive away — if driving is an option.

Carmen Colleen MacReynolds, 82, and Donna Mae Halbur, 80, were two victims of the northern California fires who died in their cars, trapped inside their garages, the Los Angeles Times reported.

Just carrying a gallon of water — 8.34 pounds— and an emergency kit can strain someone who is fragile. Plus, the oxygen tank, wheelchair or other assistive devices that make life easier end up making life so much harder in a fire or earthquake.

Inadequate nutrition, dehydration, lack of crucial medications and mental challenges like confusion or dementia are life-altering in such a crisis.

“There are so many different factors that vary by context, but adults at the oldest ages, with multiple vulnerabilities —such as frailty, pain that limits mobility, low income or disability — and who live alone are the more vulnerable to natural disasters,” said Wethington. “Unless they have a plan with family or friends to check in on them or to help them evacuate or cope with the aftermath of a disaster, they may be under a great deal of threat.”

There are other factors, too, like reluctance to leave home. People who have lived in hurricane country, for instance, may not recognize their own age-related limitations or the fact that not all storms are equal. “I rode out Ivan in 2004” isn’t a reason not to fear the next big hurricane.

Forty percent of people who are 65 or older have a disability; 90 percent have a chronic medical condition, and 73 percent have two chronic conditions or more, according to Robbie Spears, a city-wide disabilities coordinator for Los Angeles.

While Spears sees "quite a bit of resiliency” in the aging population, that doesn't lessen the fact that they may need help when disaster strikes.

Physical challenges are amplified in any disaster, whether the wildfires now raging in California or an ice storm in the Midwest. Floods, earthquakes, major snowstorms and power outages, prolonged heatwaves and other weather-related events can be catastrophic unless the elderly have a plan in place and friends and relatives to help them implement it.

Government planning

A number of states and localities have learned lessons from past events and have made plans to assist older adults when crisis looms. Florida has a disaster management pro focused specifically on the elderly. Wethington said many Florida localities even make specific plans for evacuation with every older adult in anticipation of a hurricane.

Each of North Carolina’s 16 Area Agency on Aging offices works with local counties to manage a registry of older people. It’s voluntary, but individuals or their worried kin can add them to it for basic advance safety checks in disasters they know are coming, like hurricanes. Joe Breen, section chief with the Division of Aging and Adult Services in Raleigh, said the registry provides a chance to help people prepare and survive. “Some might need help evacuating because they don’t drive or have no relatives close by or lack capacity to put together a suitcase.”

In South Jordan, Utah, local authorities use a voluntary list of people with special needs to determine which roads to plow first when it snows. The same list can be used in emergencies to check up on those individuals, said South Jordan emergency manager Aaron Sainsbury.

But registries aren’t always a perfect solution. Many people don’t like to have their names on a government list. Los Angeles County used to have a voluntary registry for people with special needs, but suspended the operation because it only captured a couple thousand out of the county’s 10 million people, said Spears. Some worry it creates an expectation that responders will come to your house first.

“That’s a dangerous expectation,” said Spears. “We want to try not to encourage the idea that you should sit back and wait for the police and fire to show up.”

Registries that are not voluntary can create privacy concerns. For example, for the ongoing Creek and Skirball fires in Los Angeles, emergency managers used data from the Department of Health and Human Services that track people who have Medicare and use a medical device. With this information, they created a map of homes that might need additional assistance and gave it to first responders on site. But because of privacy laws, the map must be destroyed within the week, said Spears.

The difficulties don’t diminish the need for emergency planning and personal intervention. Sometimes even government help takes the form of staffers and volunteers stepping in at ground zero. Ashley Chambers, director of communication at the Florida Department of Elder Affairs, says the state’s agencies coordinate on emergency planning and implementation, as well as education campaigns to help citizens know what they need to do, but staffers sometimes take direct action to help individuals.

Breen echoed that. In anticipation of Hurricane Matthew’s flooding in 2016, one of the local North Carolina AAAs sent county staff to an area where flooding was predicted to personally help seniors pack and arranged transportation so they could get to shelters or loved ones elsewhere. Chambers, in Florida, has seen government staff stand in line at Publix to get an oxygen tank for an elderly person who couldn’t do it.

In predictable disasters in many communities, like where it’s expected roads will close due to a major ice storm, Meals on Wheels clients are given extra meals that won’t need refrigeration or cooking, for example.

Such help, though, benefits the elderly who are on the local government’s radar. The 82-year old who still drives his wife to the store, who is alert and doesn’t participate in any programs for the elderly, is likely to be on his own, Breen said. That situation can deteriorate quickly.

Panic, stress and sorrow raise the stakes.

“Nursing homes and other living facilities for older adults have disaster plans. The things we can do to help is to keep track of who may have a greater need for help and have a plan to get that help to them after a disaster. It's a tall order, but it boils down to knowing and helping your neighbors,” Wethington said.

At times, the most important thing a government can do is remind its citizens to know their neighbors and help them.

Community and self-reliance

Even without a disaster, limited budgets and too few hands mean communities from Utah to Florida must use volunteers to deliver Meals on Wheels or help track the well-being of those who are disabled, frail or simply alone.

Churches and social groups play an important role in that, assembling a willing corps of helpers. Nationwide, thousands of employers allow staff a certain number of paid hours a week or month to provide such community service. Chambers said she delivers meals on Fridays at lunchtime through such a program.

Disasters amplify the need for helping hands. Despite the efforts of cities to plan for and provide help in emergencies, there are often not enough resources to get to everyone in need. In northern California's Santa Rosa fire, which claimed 42 lives, many of them seniors, there was simply not enough time for firefighters to go door to door and rescue people.

In West Jordan, Utah, the fire department has 19 people on duty on any given day and 113,000 residents.

“The math doesn’t work,” said West Jordan’s Deputy Fire Chief Reed Scharman. “You can’t go to everyone’s house.”

That’s why community emergency response teams and attentive neighbors are so important.

“Make sure you know your neighbors. That is the first line of defense,” said Cory Lyman, emergency management director for the Salt Lake City Mayor’s Office.

Authorities in Herriman, Utah, which experienced a 4,300-acre wildfire in 2010 and a smaller fire in 2012, said they rely heavily on their community emergency response team to help their neighbors during an evacuation. In Herriman, volunteer “block captains” are each responsible for about 10 houses.

The community teams coordinate well with the LDS wards and stakes, which typically have emergency preparedness representatives of their own. Often, those who volunteer as block captains are encouraged to do so by their church, said Monty Johnson, operations director for the city of Herriman.

Individual preparations matter, too. And people can help friends and neighbors who are nearby as they complete their own plans.

Some advice is targeted to seniors but is important for others, too:

• Have a list of medications and important contacts readily available. Have extra medications on hand.

• Know your local support network and talk to them about your needs and plans. Often, seniors don’t have family nearby and have to rely on others.

• Plan for pets, too. Many seniors are devoted to their cats or dogs and won’t leave dangerous situations if they can’t take Fido or Fluffy with them. In predicted weather-related events, that can be arranged in advance.

• Have supplies ready to go to make evacuation easy, but also have supplies in case a situation forces you to shelter in place.

“We encouraged those who are senior to be on good terms with their neighbors,” said Scharman. “You don’t want to be the grouchy old guy on the corner, because you need people to help you.”

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