Transcript MODULE 1 Self Study Slides

Learning Module 1:
Special Considerations of
Older Adults
Special Considerations of
Older Adults
In a disaster or emergency situation,
older adults are particularly
vulnerable. This module describes
12 issues of concern for older
adults.
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12 Key Concerns of
Older Adults
1. Sensory deprivation
2. Delayed response time
3. Chronic Illness and medication use
4. Multiple loss effect
5. Mobility impairment
6. Memory disorder
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12 Key Concerns of
Older Adults
7. Hyper/hypothermia vulnerability
8. Issues pertaining to diversity
9. Generational Differences in
accepting assistance
10. Fear of victimization
11. Mental health stigma
12. Fear of loss of independence
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Sensory Deprivation
50% of individuals over age 65 have some
degree of hearing loss
Older adults with hearing impairments may not hear
warnings and not be prepared to deal with the
emergency situation including evacuation. Persons
with a hearing loss may appear disoriented and
confused.
Older adults are prone to developing age-related
diseases of the eye that impair vision.
Older adults may not smell smoke or feel heat when
touching or stepping on hot items.
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Sensory Deprivation Strategies
• Write directions in large font on
non-glare paper. Residents unable
to read should have individual
instruction.
• Shelters should have adequate
lighting.
• Encourage older adults to use and
clean their eyeglasses.
• When approaching older adults
with severe visual impairments,
identify yourself.
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Sensory Deprivation –
Strategies (cont.)
• The environment should be
organized with no clutter.
• Do not move older adults’
personal items and furniture.
• If the senior with a hearing aid
suddenly has problems hearing,
check the hearing aid batteries
and replace if necessary.
• Remember that adequate lighting
for you may not be adequate for
the older adult.
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Delayed Response Time
• Response time slows with aging  older adults need
more time to process new information. They may
respond more slowly to calls for disaster assistance.
They need more time to complete the evacuation
process.
• Experiences in past disasters show that older adults are
slower than the younger population to seek help in time
of disasters.
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Delayed Response Time Strategies
• Break information down into small parts.
• Approach older adults in a calm, unhurried
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manner.
Attempt to locate older adults who may not have
had time to evacuate.
Evacuation should be started as soon as possible
to allow for the extra time needed.
Provide for extra time in evacuation planning.
Realize that in an emergency there is a tendency
to hurry, and older adults are a group that you
can’t rush.
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Chronic Illness and
Medication Use
• The largest group suffering from chronic disease is
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adults over 65.
The most frequent chronic illnesses are arthritis,
hypertension, heart disease, and hearing impairments.
Chronic health problems can impair mobility and make it
difficult to evacuate.
Decreased health resources in disasters make it difficult
to maintain management of the chronic conditions.
Medications may: impair mental status, alter stress
response, cause weakness, affect heart rate, and alter
usual symptoms of biological agents in older adults.
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Chronic Illness and
Medication Use - Strategies
• Know the chronic problems affecting individuals.
• Older adults should keep a brief medical history
with them and have a summary of medical
records sent with them.
• To prevent dehydration which complicates chronic
conditions, efforts should be made to ensure
adequate hydration.
• For disaster preparedness older adults should
have a list of all the medications that they take,
including: Name of medication, reason for taking,
dose, schedule, prescribing physician
• Don’t forget over-the-counter medications
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Multiple Loss Effect
Loss is a universal experience that accompanies the
aging process.
These may include loss of:
• Relationships through the death of spouse and
friends
• Physical function, which results in loss of
independence
• Work role
• Physical attractiveness
• Control over their environment
• Health as a result of multiple chronic illnesses
• Sensory function
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Multiple Loss Effect Strategies
• Empathy can help the senior deal with the grief
associated with the loss. Empathy is the ability to
understand another person’s feelings and difficulties.
• To help individuals cope with loss you will need
strength. This requires that you have a positive belief in
yourself, can find meaning in life, and have confronted
your own mortality.
• If, following the loss, older adults show signs of
depression or Post Traumatic Stress Disorder they
should be referred to a mental health provider as
discussed in Module 2.
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Mobility Impairment
• At least 50% of older adults
have mobility limitations. Many
older adults have impaired
balance, decreased strength,
altered exercise tolerance, and
limitations in performing
activities of daily living. Mobility
impairments can be complicated
by chronic conditions and
medications.
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Mobility Impairment Strategies
• In times of evacuation, individuals with mobility
impairment must be supplied with necessary
assistive devices such as walkers, canes, and
wheelchairs.
• When the power is off, specially designed evacuation
chairs can be used.
• When in shelters, older adults with mobility
impairments will require support so that they continue
walking and moving. This helps prevent health
complications.
• Older adults with impaired mobility will be at higher
risk for falls. To prevent falls, older adults should be
instructed to use their assistive devices and wear
supportive footwear. The environment should be kept
as free of clutter and as well-lit as possible.
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Memory Disorder
Memory disorders will make it difficult for the
impaired senior to follow directions. The stress
of the situation can result in increased
confusion and/or agitated behaviors.
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Memory Disorder
Angie Merchant, a nurse living near Baton Rouge,
described her parents’ assisted living community after
Hurricane Katrina:
“The older adults who had dementia were totally lost and
confused and agitated, not understanding the situation,
and some tried to leave the building to go back home.
One of them believed the end of the world was coming
and struck up a loud song, walking rapidly around and
singing to everyone, ‘Get out! It’s going to happen! And
it’s going to happen soon!’ It was crazy, to say the least,
but we did our best and (remarkably) kept a sense of
humor through it all, although the situation was grave.”
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Memory Disorder - Strategies
Tips for communication include:
• Approach the older adult in a calm, straightforward, and
gentle manner. Treat them as adults.
• Communicate at eye level to create a balance of power.
• Begin conversations by introducing yourself.
• Speak slowly and say individual words clearly.
• Keep the pitch of your voice low.
• Ask simple questions that require a choice of a yes/no
answer
• Break instructions down into parts.
• Give the older adult time to respond or to complete
tasks.
• Try to stay calm and be patient.
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Memory Disorder –
Strategies (cont.)
Things Not To Do:
• Don't argue with the person.
• Don't order the person around.
• Don't tell the person what he
or she can't do.
• Don't be condescending.
(Treat them as adults)
• Don't talk about other
residents in front of them.
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Hyper/hypothermia
Vulnerability
A normal aging change is the decreased
ability to regulate body temperature.
Chronic illness in older adults may
include circulatory problems.
Changes in their sense of touch can
decrease their awareness of
temperature changes.
Some of the medications taken by older
adults affect temperature control.
For example, hypothermia may be
worsened with the use of medications.
Alcohol particularly inhibits
temperature regulation.
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Hyper/hypothermia
Vulnerability - Strategies
• Hyperthermia or body temperature above 104° F can
be prevented by insuring that older adults receive
adequate hydration.
• Monitor residents’ hydration and encourage fluids.
• Have at least 1 gallon of drinking water per resident.
• Encourage layered clothing that can be removed when
temperatures rise or fall.
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Hyper/hypothermia
Vulnerability - Strategies
• Hypothermia or body temperature
below 95˚ F can be prevented by
dressing residents in layers,
gloves and scarves. Hats and
warm socks will prevent excessive
heat loss.
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Issues Pertaining to Diversity
Cultural and language barriers make some
older adults especially vulnerable to the effects
of disasters. Religious and cultural
backgrounds affect the manner in which older
adults view services and government
agencies. Services provided to the majority
groups may not be appropriate for minority
groups.
Language barriers are a major obstacle
to delivering services to some older adults.
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Issues Pertaining to Diversity Strategies
• Hire bilingual and bicultural staff.
• Staff should have multicultural training to
insure that needs of minority older adults are
met with sensitivity.
• Written materials in the language of the
minority older adults must be used.
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Generational Differences in
Accepting Assistance
Older adults may not request aid because of the stigma
linked with certain types of assistance considered to
be “welfare.”
Older adults also express concern that receipt of disaster
aid may impact their Social Security income.
Older adults who lived through the Great Depression of
the 1930s may hesitate to ask for aid because they
believe others may need it more than they do.
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Generational Differences in
Accepting Assistance - Strategies
• Special targeted outreach to older adults
needs to be planned.
• Programming for older adults needs to
demonstrate and incorporate respect and
understanding for their unique life-views.
Because older adults are responsible for
caring for themselves, an important
strategy is self-preparation. Older adults
and their families should be reminded of
this responsibility.
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Fear of Victimization
Older adults express a high level of fear
regarding criminal victimization.
Con-artists who follow major disasters frequently
focus their efforts on vulnerable older adults.
Typically, con-artists try to scam older adults
into signing contracts for expensive home
repairs, accept payment and skip town. Older
women living alone are particularly prey to
these con-artists.
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Fear of Victimization Strategies
• Educational programs which provide
realistic information to older adults about
victimization may allay some of their fears
in this area.
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Mental Health Stigma
Studies show that older adults have negative attitudes
toward and lack of knowledge regarding mental health
issues and aging.
Mental illness is seen as socially unacceptable by many
older adults. This stigma may prevent older adults from
getting treatment.
Many older adults have negative impressions of mental
health services and thus do not utilize them.
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Mental Health Stigma Strategies
• Education can be an effective way to deal with the
perceived stigma of the use of mental health services.
• Relief workers and crisis counselors can work with older
adults in times of disaster to help them locate services and
to cope with grief.
• Linking of mental health services and physical health
services also works to remove the stigma of mental health
services.
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Fear of Loss of Independence
Most older adults are fiercely protective of
their independence and want to live
independently.
The fear of being sent to a “nursing home”
or a higher level of can can be a barrier to
seeking assistance during times of
disaster.
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Fear of Loss of Independence Strategies
Sensitivity on the part of disaster workers is
the most important strategy.
Workers need to be aware of this fear and
should reassure older adults that their role is
to assist in providing services, and not to
assist in LTC placement.
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Other Fears of Older Adults in
Disasters/Emergencies
In disaster or emergency situations, older adults
may have several other fears that affect how
they respond:
• Fear of Evacuation
• Family Concerns
• Concerns about Medical Treatment and
Security
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Fear of Evacuation
Concerns about mobility impairments, medication needs,
medical equipment, nursing care.
Fear of impending disaster/emergency
situation
Lack of knowledge of
facility’s evacuation plan
Fear of the unknown – “Where am I going and will my
family be able to find me?”
Fear of transportation – “How can I get on the bus with
my wheelchair?”
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Family Concerns
• LTC organizations should have a notification system for
families of residents
• LTC staff need to keep family members informed.
Families can also develop their own disaster plan
which should be communicated to the resident.
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Concerns about Medical
Treatment, Security
• Residents and family members should be told of the
specific plans for managing medical conditions.
• Reassure families that medication will be sent with the
resident and that equipment such as oxygen will be
available.
The key to allaying resident and family concerns about
disaster/emergency events is COMMUNICATION.
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Difficult Ethical Decisions
When do the safety needs of the
community take precedence over the
rights of the individual?
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Triage
The brief clinical assessment that
determines the time and sequence in
which patients are seen and cared for in
the emergency situations.
Questions that LTC staff will need to resolve:
Who will receive care?
Will older adults receive their fair share?
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Guidelines for Ensuring Ethical
Treatment
How will staff at your organization ensure ethical
treatment of older adults?
• Which co-morbid diseases should be considered for all
patients, regardless of age?
• How should resources for
persons on life-sustaining
treatments be considered?
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End of Module 1
Slides