Closing the Gaps: Advancing Emergency Preparedness, Response and Recovery for Older Adults
Closing the Gaps: Advancing Emergency Preparedness, Response and Recovery for Older Adults
Adapted Executive Summary
Older adults consistently experience the greatest proportion of casualties during and after emergencies in Canada, and internationally, when compared to younger age groups. [1], [2] For instance, in 1998, ice storms in Quebec resulted in widespread power outages that saw 600,000 people, including older adults, forced from their homes for safety. Such natural events also lead to high mortality among older persons due to a lack of available heating equipment, less optimal housing conditions, and poor coordination between emergency, health, and social services.[3]
In 2010, more than half of all deaths resulting from heat waves in Quebec were among persons aged 75 years or older.[4] The 2017 wildfire in British Columbia led to 14,000 individuals needing to be evacuated from their homes. This population of evacuees, many of whom were older adults with dementia, made this evacuation particularly difficult.[5] Again in 2017, older adults were the population hit hardest by the springtime floods in Québec.[6] Unfortunately, poorly coordinated protocols left them more vulnerable due to delays in initiating evacuation procedures. More recently, the COVID-19 pandemic in Canada led 80% of all recorded deaths occurring amongst older Canadians in long-term care settings.[7]
Several research studies have demonstrated that these poor outcomes are linked to physiological, age-related changes, such as impairments to sensory, cognitive and mobility disabilities; access and functional needs; social isolation and lack of access to familial and other social supports; having limited financial resources; and insufficient policies and procedures.[8], [9], [10] Furthermore, interruption to the timely provision of routine medical care is recognized as a likely contributor to mortality and morbidity associated medical complications during emergencies, especially in the immediate months following major natural disasters. The high proportion of deaths that occur in older-adult congregate living settings is further indicative of fundamental issues that will need to be addressed in these settings.
There is a diverse continuum of capacity amongst older adults, from reduced capacity due to physical and cognitive impairments, as noted above, to high capacity for active engagement in the community. Older adults themselves should be empowered to reach out and connect with their peers, particularly those who are more vulnerable, to support each other in anticipating and preparing for emergencies. The critical role of older adults who act as the sole or primary caregivers of other older adults, whether they are partners, family members, or friends, must also be recognized and supported.
There is a clear need to better support emergency preparedness for older Canadians living at home in the community or in congregate settings. In order to improve preparedness and response to emergencies, Canada needs greater consideration and adoption of evidence-informed, uniform and collaborative emergency management interventions. These efforts will require improved resources and capacity to meet the emergency needs of all older adults, regardless of the variety of circumstances and settings in which they may be living.
In 2018, to address these gaps in emergency and disaster preparedness and management, members of the American Red Cross Scientific Advisory Council (ARC SAC) and the American Academy of Nursing (AAN) Policy Expert Round Table on Emergency Preparedness for Older Adults agreed to conduct a scientific review of the latest evidence, current available legislation, and policies, in order to develop a set of recommendations that were then further reviewed and strengthened by a broader panel of experts in the fields of social work, education, public health, research, health policy, emergency management, geriatrics, and nursing. Through a rigorous consensus-based decision-making process, a comprehensive final set of 25 evidence-informed recommendations were developed and endorsed by this group.
This report is an extension and continuation of that work with an expanded focus that includes epidemics and pandemics. The COVID-19 pandemic has had its greatest impact on older adults in Canada and globally. In fact, 97% of Canada’s first 10,000 COVID-19 deaths have been amongst Canadians 60 years of age and older.[11] The challenges experienced by older Canadians has demonstrated the need for improvements in preparedness planning targeting one of the most vulnerable groups in our society. This report highlights areas of opportunities to better support older Canadians, their caregivers and the system more broadly, to be prepared before and successfully recover after an emergency.
To adapt the recommendations for the Canadian context, the Canadian Red Cross (CRC) and the National Institute on Ageing (NIA) agreed to collaborate on an identical consensus-based development process employed by the ARC and AAN. The Canadian process resulted in 29 evidence-informed expert recommendations. This paper presents those recommendations and the rationale for improving emergency preparedness, response, and recovery interventions for older adults across Canada. In order to achieve a collaborative approach to improving emergency management nation-wide, the recommendations are categorized across six relevant emergency management domains:
1) Individuals and unpaid caregivers;
2) Community-based services and programs;
3) Health care professionals and emergency response personnel;
4) Care institutions and organizations;
5) Legislation and policy; and
6) Research.
The intention of these recommendations is to provide interventions that can bridge the existing gaps in emergency preparedness, response and recovery, and facilitate better outcomes for older adults across Canada. The full report and recommendations will be made available on December 15, 2020. Stay tuned!
[1] Fernandez, L. S., Byard, D., Lin, C.-C., Benson, S., & Barbera, J. A. (2002, April/June). Frail elderly as disaster victims: Emergency management strategies. Prehospital and Disaster Medicine, 17(2), 67-74. doi:10.1017/s1049023x00000200
[2] Mokdad, A. H., Mensah, G. A., Posner, S. F., Reed, E., Simoes, E. J., & Engelgau, M. M. (2005, November). When chronic conditions become acute: Prevention and control of chronic diseases and adverse health outcomes during natural disasters. Preventing Chronic Disease, 2 (Spec No), A04.
[3] Plouffe, L., Kang, I., & Kalache, A. (2008). Older persons in emergencies: An active ageing perspective. Geneva: World Health Organization. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/43909/9789241563642_eng.pdf;jsessionid=AFE8166AA285B415FFF227043787123B?sequence=1
[4] Bustinza, R., Lebel, G., Gosselin, P., Belanger, D., & Chebana, F. (2013). Health impacts of the July 2010 heat wave in Quebec, Canada. BMC Public Health, 1-7.
[5] BBC News. (2017, July 10). British Columbia wildfires - 14,000 evacuated as fires spread. Retrieved from https://www.bbc.com/news/world-us-canada-40546628
[6] Roslin, A. (2018, November 19). Retrieved from Zoomer: https://www.everythingzoomer.com/health/2018/11/19/seniors-natural-disaster-relief/
[7] Canadian Institute for Health Information. (2020). Pandemic Experience in the Long-Term Care Sector: How Does Canada Compare with Other Countries? Toronto: Canadian Institute for Health Information. Retrieved from https://static1.squarespace.com/static/5c2fa7b03917eed9b5a436d8/t/5f071dda1fbff833fe105111/1594301915196/covid-19-rapid-response-long-term-care-snapshot-en.pdf
[8] Al-Rousan, T. M., Rubenstein, L. M., & Wallace , R. B. (2014, March). Preparedness for natural disasters among older US adults: A nationwide survey. American Journal of Public Health, 104(3), 506-511. doi:10.2105/AJPH.2013.301559
[9] Fernandez, L. S., Byard, D., Lin, C.-C., Benson, S., & Barbera, J. A. (2002, April/June). Frail elderly as disaster victims: Emergency management strategies. Prehospital and Disaster Medicine, 17(2), 67-74. doi:10.1017/s1049023x00000200
[10] Killian, T. S., Moon, Z. K., McNeill, C., Garrison, B., & Moxley, S. (2017, February ). Emergency preparedness of persons over 50 years old: Further results from the health and retirement study. Disaster Medicine and Public Health Preparedness, 80-89. doi: 10.1017/dmp.2016.162
[11] Grant, K. (2020, October 27). Grim milestone: Canada marks 10,000 COVID-19 deaths as country battles second wave. The Globe and Mail. Retrieved 2020, from https://www.theglobeandmail.com/canada/article-canada-exceeds-10000-covid-19-deaths/?utm_medium=Referrer:+Social+Network+/+Media&utm_campaign=Shared+Web+Article+Links