2009-11-25:  In the midst of an economic, financial and fiscal crisis in Ireland … the country has recently been hit by a Major Flood Emergency in the West and South … extending inland almost to the centre.  The emergency will continue over the next few days.

There appears to be no central co-ordination of the response to this National Emergency.  No public guidance or other announcements have been published in the national media.

Further to the full page advertisement promoting the National Older & Bolder Campaign, which was printed on Page 7 of The Irish Times (2009-11-19) … the contents of World Health Organization (WHO) Fact Sheet: ‘Older Persons in Emergencies’, drafted following the 2006 Lebanon Humanitarian Crisis, are both appropriate and particularly relevant for Ireland now …

When dealing with older people in emergencies, a number of issues which might affect them will require special consideration.  Apart from specific chronic disease and disability related issues, two major factors contribute to increased vulnerability of older people in emergencies: the ‘normal’ challenges of physical ageing and social loss, and the ‘environmental’ challenges.  In a crisis, minor impairments which do not interfere with daily functioning in the normal environment can quickly become major handicaps that overwhelm an individual’s capacity to cope.  For instance, an older person with arthritic knees and diminished vision, living alone in a high-rise apartment with no family members or friends nearby, can become incapable of getting food or water or of fleeing danger, and may be overlooked by neighbours.

Specific Issues

There are several specific issues that affect older people, separately or in combination, and which can impact on their ability to respond or react in an emergency.  Awareness of these specific issues by all those giving aid, or surrounding them, will improve interactions.  Knowledge of the age profile in an affected community, as an emergency response is prepared, will help to ensure that older people at risk are identified and that appropriate supplies and services are provided on-site.

The specific issues affecting older people are:

1.   Sensory Deficits (especially vision and hearing)

• reduced awareness ;
• difficulty accessing and comprehending visual and auditory information, and responding appropriately ;
• reduced mobility and risk of disorientation.

2.   Slower Comprehension and Retention of Information (especially new, complex or rapidly delivered information)

• difficulty accessing information ;
• difficulties in understanding and acting on risks, warnings, directions ;
• reduced capacity for self-protection and avoidance of harm ;
• disorientation in unfamiliar environments ;
• greater risk for abuse and exploitation ;
• provision of information in more accessible and structured formats.

3.   Less Efficient Thermoregulation

• greater susceptibility to hypothermia, hyperthermia and dehydration ;
• appropriate shelter, clothing and food, as well as adequate fluid intake.

4.   Reduced Functional Ability (poorer balance and reduced speed, psycho-motor co-ordination, strength and resistance)

• reduced mobility and risk of being housebound ;
• increased risk of falling ;
• decreased capacity for self-protection and harm-avoidance ;
• difficulty getting basic necessities and accessing health facilities, e.g. local clinics ;
• increased vulnerability to abuse and exploitation.

5.   Difficulties in Urinary Continence

• need for adequate toilet facilities and continence supplies.

6.   Oral Health & Dental Problems

• easy-to-eat soft food and fluids may be necessary.

7.   Changes to Patterns of Digestion 

• need for smaller, more frequent portions of easily-digestible, nutrient-dense food and adequate fluids.

8.   Increased Body Fat Composition, with Decreased Muscle Mass and Metabolic Rates

• greater sensitivity to certain medications with potential adverse effects on functional ability and cognition.

9.   Greater Prevalence, and Co-Morbidity of Ageing-Related Chronic Disease and Disability (e.g. coronary heart disease, hypertension, stroke, cancers, diabetes, chronic obstructive pulmonary disease, osteoarthritis, osteoporosis, cognitive impairment)

• need for condition-specific medications, treatments, medical device and assistance aids (oxygen, crutches, walkers, wheelchairs, glasses) ;
• higher risk for adverse drug reactions.

10.  Weaker and Smaller Social Networks (e.g. widowed, living alone, minimal contact with neighbours, dispersion of family)

• reduced awareness and comprehension of the situation ;
• greater risk of social isolation, neglect, abandonment, abuse and exploitation.

11.  Heavy Reliance on Care and Support by Very Few Family Members

• when essential family support is disrupted, physical and psychological functioning can deteriorate rapidly ;
• reunification with family is particularly important.

12.  Psycho-Social Issues

• reactions to loss of home, family and possessions can be more acute for older people who cannot rebuild their lives ;
• resistance to leaving, and grieving, may be strong.

13.  Reliance of Other Family Members on Older People

• older people often care for other dependent adults and children and may require resources for others as well as themselves.

Last but not least: Older People should not be considered solely as a Special Needs Group.  From numerous accounts of natural disaster and armed conflict situations, it is known that their knowledge of the community, previous experiences with such events, and position of respect and influence within their families and communities are critical resources in dealing effectively with emergencies.

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