ADDING DISASTER PREPAREDNESS TO GERIATRIC PATIENT CARE AGENDAS

It’s December and 2005 is winding down. Years from now, when we look back at 2005, I’m convinced that the series of natural disasters—the hurricanes, floods, and earthquakes—that struck in the last several months will be the events we remember most vividly.

Disasters like these leave a lasting impression because they remind all of us of how vulnerable we are. The images of the aftermath of Hurricane Katrina made this painfully clear to everyone. They also remind all of us of how very vulnerable older adults are. As geriatrics health care providers, we’re all too aware of how quickly our patients can transition from good health to frailty or death. A stroke or a hip fracture can be an instant ticket from vitality to dependency.

Natural disasters take a disproportionate toll on the old, who have fewer physiologic and social reserves. For example, about 60% of the nearly 500 victims of Katrina who had been identified by late October were older than 60 years. “The elderly were much more likely to be in hospitals and nursing homes, as well as possibly homebound and not able to access transportation in order to evacuate from the storm,” Louisiana Department of Health and Hospitals Spokesman Bob Johannessen told the Associated Press.

While some died in the flood waters because they’d been unable to escape the city, others died during the storm itself, and still others while trying to evacuate. When disaster strikes, the frail are too often left behind. Hurricane Rita took a heavy toll as well. Who can forget the two dozen nursing home residents who died while fleeing that hurricane, when the bus in which they were traveling caught fire? For those who are most dependent, even our best attempts to help are sometimes futile.

In addition to reminding us of how vulnerable we are, these disasters remind us of our potential for generosity, even heroism. Consider the many geriatricians, including Dr. Judy Salerno, the Deputy Director of the National Institute on Aging, and geriatric care providers who went to Louisiana and Texas to provide direct care to the elderly in the wake of Katrina and Rita. And the many, many more who contributed financially to related relief efforts.

Recently, the American Geriatrics Society (AGS) and the AGS’ Foundation for Health in Aging (FHA) contributed $20,000 to help re-establish the Louisiana State University (LSU) geriatrics fellowship program, which was uprooted by Katrina. The John A. Hartford Foundation pledged a matching $20,000 to support the program, which provided free care to a primarily indigent, minority population of older adults in the greater New Orleans area.

The LSU program was one of only two programs in Louisiana offering physicians fellowship training in geriatrics. It had been housed at New Orleans’ Charity Hospital, which was devastated by the hurricane and will close. AGS member and founder of the Louisiana Geriatrics Society, Charles Cefalu, MD, played a pivotal role in establishing the fellowship program at Charity. And, in the aftermath of the hurricane, he worked tirelessly to relocate it temporarily at Lafayette Charity Hospital in Lafayette, Louisiana. Funds from the AGS, FHA, and the Hartford Foundation will support the geriatrics program’s fellows and faculty, who will serve seniors throughout the community, which is now home to many older adults displaced by the hurricanes.

Based on my two decades in geriatrics, I wholeheartedly believe that the generosity and heartfelt concern these responses to disaster bespeak are hallmarks of those who have devoted their professional lives to the care of older persons. As we look forward to the coming year, I’d like to suggest that geriatrics care providers include disaster preparedness with the many items on our patient care agendas. The “what” and “when” of the next emergency are uncertain, yet it is certain that another natural disaster will strike, and older persons will be at the highest risk.

To help older adults and their loved ones prepare for disasters, the AGS has written an easy-to-understand, comprehensive emergency preparedness “tip sheet” for older adults. You can find it on the FHA website at www.healthinaging.org, and reproduce it for your patients for free.

We must prepare as best we can—and, as care providers, help our patients prepare as best they can—for events beyond our control. As 2005 closes, I extend my best wishes for a happy and safe new year.