Seniors & Disasters

The pharmacist can serve as an essential care provider for elders when disasters occur.

Not so long ago, Hurricane Sandy’s winds battered the entire East Coast, threatening devastation. She ultimately delivered that devastation. Bathtubs full of water, potential projectiles moved indoors, ice in the freezer, prescriptions refilled early—many people hoped these actions ahead of what became known as “Superstorm Sandy” would hold us until life returned to semi-normal. Our trepidation underscored this point—every disaster, even those the experts warn us about, is unpredictable in terms of its arrival, the damages it causes—and the health care needs it creates.

In any disaster’s aftermath, days may pass without electricity or telecommunications. Residents in the disaster zone focus on immediate needs:maintaining or finding shelter, food, and water, and mitigating injuries and infection. Seniors who are at increased risk of hardship in disasters often fail to prepare adequately.^1,2 A total of 60% of Hurricane Katrina’s victims were 61 years or older. And after September 11, 2001, New York City’s elders waited for up to 7 days for help. Emergency preparedness planning for seniors must be a high priority forealth care providers, and pharmacists should assist with preparation and postdisaster relief. Table 1^3-5 explains why elders are a target population for aid.

Each disaster’s specific challenges—and the magnitude of the crisis that follows—create situations that call for specialized survival and pharmacy skills.⁵ Because pharmacists are so visible and accessible, they are positioned to help. With a number of recent disasters to draw on, here’s what you need to know about disasters, the elderly, and responding to their special needs.

Anticipating Trouble, Acknowledging Crisis

During the crisis period, health care providers must determine and appreciate patients’ compromised living environment and the health care system’s limitations. Table 2⁵ lists common problems. During the March 2011 tsunami in Japan, for example, responders dealt with acute injuries first. Chronic conditions were triaged to a lower priority. When chronic issues could be addressed later, many patients had lost their medical and pharmaceutical records, so identifying their medications was difficult.

This is a common outcome when disaster occurs without warning, or when warning is broadcast but people are skeptical and choose not to prepare. Japan’s health care workers found that some patients missed all doses of their medications from the day the tsunami struck and for many days after. Previously well-controlled patients developed systolic blood pressure values greater than 200 mm Hg and hypoglycemic syncope. Japanese pharmacists in pharmacies and in outreach locations—attuned to the right questions to ask—were key in determining the medications patients needed, a role they continue to fill even today.⁴

When disasters destroy housing— and that includes earthquakes, tsunamis, hurricanes, and tornadoes—some senior patients take shelter in vehicles. It’s important to remind elders that sheltering and sleeping in motor vehicles increases the risk for venous thromboembolism. They need to remember that exercising periodically—walking, stretching, moving around—can prevent blood clots.⁴

Some new technologies help greatly during a disaster. During the tsunami, social networking sites were powerful ways to spread information.⁴ During Hurricane Sandy, Connecticut Light & Power texted progress reports to customers’ cell phones so they could see their progress. Unfortunately, it is younger people who are more likely to use these technologies. Communicating updates with seniors is critical.

All pharmacists can help locally. To start, educational programs by pharmacists can increase levels of preparedness for and defuse concerns about disasters. Pharmacists also can educate elders about preparedness for potential disasters specific to their location. For example, pharmacists on the East Coast might provide brochures about hurricane preparedness. There’s no reason to reinvent the wheel—state and federal agencies as well as nonprofits such as the Red Cross often produce communications targeted at senior citizens. This simple intervention requires little specialized training. Greater involvement, however, is more complicated.

Responding to distant disasters in your professional role and in the most efficient way requires more than good intentions. It requires personal preparation and training.

Pharmacists involved in disaster response need to stay physically fit and must have within easy reach a wardrobe (protective clothing) and equipment (protective gear, tents) suitable for environmentally stressed locations. Pharmacists must also maintain current vaccinations and have their affairs in order (coverage at work, current last will and testament, child care) so they can leave at a moment’s notice.⁵ Pharmacists can contribute more by obtaining their qualifications to administer cardiopulmonary resuscitation and immunizations.

Stress is inevitable.⁵ Most crises demand decisive action in unfamiliar environments with little help. Pharmacists can expect to work long shifts, be intimidated or overwhelmed, experience periods of boredom, struggle with limited drug selection, and worry when there is no replacement when they eventually head home.⁶ (The boredom aspect may surprise you but often responders have to wait for direction, transport, supplies, and even access to patients.)

Committing to Help

Disaster assistance opportunities for pharmacists are available at the local, state, regional, and national levels (Sidebar). The lead agency, be it the government, the Red Cross, or some other entity, expects health care responders to know their disaster readiness roles.

End Note

Getting involved after a disaster is an extremely fulfilling opportunity for pharmacists. Helping to accommodate frail elders’ needs for health services is a function for which pharmacists are well suited.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

References

• O’Brien N. Issue brief: emergency preparedness for older people. http://web1.ctaa.org/webmodules/webarticles/articlefiles/Emergency_Preparedness_for_Older_People.pdf. Accessed October 25, 2012.
• State & County QuickFacts: Rhode Island. US Census Bureau website. http://quickfacts.census.gov/qfd/states/44000.html. Accessed October 25, 2012.
• Feret B, Bratberg J. Pharmacist-based intervention to prepare residents of assisted-living facilities for emergencies. J Am Pharm Assoc. 2008;48:780-783.
• Hashimoto T, Sato H. Earthquake, tsunami, and pharmaceutical care in eastern Japan. J Am Pharm Assoc. 2011;51:568.
• Pincock LL, Montello MJ, Tarosky MJ, Pierce WF, Edwards CW. Pharmacist readiness roles for emergency preparedness. Am J Health Syst Pharm. 2011;68:620-623.
• Ferris D. Pharmacist’s assistance after Haiti earthquake. Am J Health Syst Pharm. 2010;67:1138-1141.