Three Years Later … Remembering and Learning from Katrina
Article Outline
Barbara Resnick, PhD, CRNP, FAAN, FAANP
Barbara Resnick, PhD, CRNP, FAAN, FAANP, with invited comments from Jocelyn A. Farrar, DNP, ACNP-BC, CCRN
Hurricane Katrina is now 3 years behind us. I wanted to use this 3-year anniversary to acknowledge those who cared for older adults during that time and to consider what we have learned from that experience so that we can better prepare for future disasters. The article by Jacqueline Rhoads, PhD, ACNP-BC, ANP-C, GNP, CCRN, and Andrea Clayman, MSN, APRN, GNP-BC, ANP-C, provides some firsthand learned experiences from Katrina and suggestions for how to prepare for disasters in long-term care facilities in the future. We each must ask ourselves, if a disaster happened tomorrow, would we be ready in our own facilities? I work in an 8-floor continuing care retirement community, and I often ponder how we would manage and respond, despite protocol, practice sessions, and drills, if there were a national disaster, a facility-based fire, or other type of disaster. What are the best practices for evacuation, sheltering, and long-term recovery? How can we best prepare? I turned to an expert nurse colleague, Jocelyn A. Farrar, DNP, ACNP-BC, CCRN, who focused her Capstone project on best practices around sheltering older adults. I share with you her comments in the following paragraphs.
The appropriate and safe sheltering of older adults during times of manmade and natural disasters has recently evolved as a significant issue of concern for disaster management and health care professionals. The defining moment for this important issue appears to be related to the devastation of New Orleans by Hurricane Katrina in 2005. Following the hurricane, more than 10,425 individuals were evacuated from hurricane-ravaged New Orleans to the shelter at the Houston Astrodome/Reliant Astrodome Complex in Houston, Texas. Of those, 56% were over age 65 years.1 Unexpectedly, many of these previously healthy older adults arrived in a severely debilitated state, many experiencing mental status changes due to dehydration, infection, or the exacerbation of preexisting mental health disorders or dementia. Hearing, visual, and mobility deficits contributed to their inability to follow directions or navigate the shelter to seek care. Medical care for chronic conditions such as diabetes, hypertension, cancer, and heart disease was inadequate. No formal processes had been put into place in advance of the storm to ensure that older adults without family, or those who could not advocate for their own needs, received the necessary food, water, medications, or treatment. Of the 72 deaths investigated by the Harris County, Texas, medical examiner, 59% were older than 60 years. The most common causes of death were complications resulting from chronic conditions such as atherosclerotic cardiovascular disease, hypertension, congestive heart failure, cerebrovascular accident, renal failure, diabetes mellitus, acute myocardial infarction, asthma, organic brain syndrome, dementia, and cancer.2
Unfortunately, the negative consequences of inadequate disaster management are not limited to the events following the 2005 U.S. hurricane season. The mortality and morbidity experienced by older adults residing in disaster shelters and emergency refugee camps worldwide is well documented in the national and international literature.2, 3, 4 Deleterious outcomes for these elders are attributed to substandard shelter processes that include inappropriate evacuation, inadequate and unsafe environmental conditions, staff having no experience caring for older adults, and inadequate resources for or interruptions in lifesaving medical and psychiatric regimens for premorbid conditions.
There is a gap between current sheltering practices and best practices that places this vulnerable population at high risk for preventable disaster-related consequences.4 Leaders in disaster management, sheltering, geriatrics, and injury prevention concur that evidence-based sheltering practices must be adopted to address modifiable risk factors and to reduce the vulnerability and enhance the resiliency of older adults. To achieve this goal, leaders in emergency planning and disaster management must proactively incorporate age-appropriate interventions into sheltering practice. This includes the development of special needs shelters that incorporate injury prevention interventions, such as falls prevention and mobility assistance; ongoing management of preexisting conditions; support for elders who cannot advocate for themselves; altered communication systems for those who are visually or hearing impaired; priority queuing distribution systems to fast track access to food, water, and other resources; and strategies to prevent fraud and abuse. Shelter registration and tracking systems are needed to identify the most vulnerable elders and expedite access to family, pets, and caregivers. A cadre of geriatric experts, including physicians, nurse practitioners, nurses, social workers and elders themselves must be involved in the development of practice guidelines and training programs for first responders, shelter staff, and others who will be caring for this unique older population. These specialty teams can also play a key role in managing the care of older adults during the sheltering experience. Following the disaster event, shelter discharge planning processes must be developed to ensure that the elder is returned to a safe and appropriate environment. Additionally, well-designed, outcome-focused research must be performed to document the efficacy of shelter-related injury prevention initiatives. This requires the development of a national database to provide accurate input and retrieval of shelter-related variables of interest.
Emergency and disaster planners must collaborate with appropriate agencies and with older adults themselves when developing processes or practices that address sheltering needs. To ensure that the voice of the older adult is heard, representatives of organizations such as the Agency on Aging (AoA), the National Organization on Disabilities (NOD), and the American Association of Retired Persons (AARP) must have a routine seat on federal, state, local, and tribal emergency management and shelter operations committees.
Remembering Hurricane Katrina provides us with a perfect opportunity to reevaluate our disaster plans, review what literature there is on best practices, and encourage research in this area to help with future disaster response activities. There are never good outcomes in disaster situations, and our goal should be to help the older adults for whom we care remain safe, free from acute medical problems or the exacerbation of underlying chronic illnesses. Although it is not realistic to hope that such disasters will not happen again, we can learn and prepare ourselves, our facilities, our residents, our patients, and their families for how to respond, what to expect, and how to cope with these devastating events. I thank my colleagues Drs. Farrar and Rhoads and Ms. Clayman for providing us with these useful recommendations and thoughts around the 3-year anniversary of Hurricane Katrina.
References
- Hurricane Katrina: medical response at the Houston Astrodome/Reliant Center Complex. South Med J. 2005;99:933–939
- . Recommendations for best practices in the management of elderly disaster victims. 2006 http://www.ama-assn.org/ama1/pub/upload/mm/415/best_prac_elderly.pdfCited May 22, 2008
- Older adults as disaster victims: management strategies. Prehosp Disaster Med. 2002;17:67–74
- . Older people in disasters and humanitarian crises: guidelines for best practice. 2005 http://www.helpage.org/resources/manuals#1118336526-0-1-0Cited May 22, 2008
PII: S0197-4572(08)00192-4
doi:10.1016/j.gerinurse.2008.06.001
© 2008 Mosby, Inc. All rights reserved.
