Strategies and Options for Identifying Vulnerable Older Adults
The following four methods for identifying vulnerable community-dwelling older adults were uncovered and researched during the development of CDC’s guide, Identifying Vulnerable Older Adults and Legal Options for Increasing Their Protection During All-Hazards Emergencies: A Cross Sector Guide for States and Communities:
- Characterizing the population
- Using geographic information systems (GIS)
- Building, using and maintaining registries
- Using shelter intake procedures to identify vulnerable older adults in the community
Officials at all jurisdictional levels need to understand the basic epidemiologic characteristics of the older adult population to plan appropriately for this group. These data can be used to plan the delivery of services, medications, durable medical equipment, and other materials needed to support this population during all phases of an emergency. Types of useful data include—
- Demographic characteristics, including the number of older adults and their age, sex, and race/ethnicity, as well as the size and types of cultural subgroups.
- Prevalence of chronic medical and behavioral health conditions, disabilities, and functional limitations.
- Prevalence of chronic conditions that require specific medications, durable medical equipment, or special medical care.
- Primary language and other languages spoken by significant portions of the population.
- The proportion of older adults who live in the community and the proportion who live in independent living, assisted living, or long-term care facilities.
- Residency patterns, including proportions that are permanent, seasonal, or periodic.
- The proportion of older adult who receive services through organizations such as the Aging Services Network, social service agencies, or home health agencies and the proportion of community-dwelling adults who do not receive services from any organizations.
Potential sources for these data include—
- Aging Services Network client databases (aggregated).
- Behavioral Risk Factor Surveillance System (BRFSS).
- Community surveys.
- Disease registries.
- Hospital discharge databases.
- Medicaid and Medicare databases.
- State data centers.
- Pharmacy databases.
- U.S. Census.
For more complete information, visit the Data Sources section of the Emergency Preparedness for Older Adults Web Portal on the CDC Healthy Aging Program Web site.
GIS is a group of science and technology tools that can integrate and manage geographic relationships and information. GIS helps users analyze spatially-referenced data and make informed decisions based on the association between the data and the geography. Although GIS technology can be applied to many public health areas, its ability to simultaneously map the location of populations at risk, community resources, and potential hazards makes it extremely valuable to emergency preparedness planning for vulnerable populations.
During the pre-event phase, GIS mapping is useful for identifying geographic areas with significant populations of older adults and the location of known individuals who may need help during an emergency. This demographic and location information can then be overlaid with data on potential hazards (e.g., volcanoes, flood plains, nuclear power plants, chemical manufacturing sites). The resulting map can help community emergency planners focus their educational and community awareness efforts on older adults in particular neighborhoods. It also can help them choose safer, more convenient locations for evacuation routes, shelters, transportation pick-up points, supply distribution sites, and other services that older adults may need during an emergency.
In the response and operations phase of emergency management, GIS technology can be used in real time to create a disaster or outbreak map that can provide critical information to first responders, the media, and the public and promote better decision making.
In the recovery and transition phase, it can be used to identify population shifts that are caused by migration, changes in topography from an event, and available resources.
For more complete information, visit the GIS Mapping section of the Emergency Preparedness for Older Adults Web Portal on the CDC Healthy Aging Program Web site.
In the context of emergency preparedness, the purpose of a registry is to identify before an event occurs those individuals who may need special attention or help before, during, or after an emergency. Registries can be based on the specific type of help a person needs (e.g., medical, transportation, other special needs), or they can be used for the broader purpose of identifying any person who might need any type of help during an emergency. Many jurisdictions also use registries as a way to provide information to older adults on how to prepare for emergencies.
Registries can be mandated by state law or local ordinances, or they may be developed by any government official in the normal course of duty, subject to enabling legal authority. Local ordinances may direct a local agency or office to develop and maintain a registry of people with special needs, although such authority is not required.
Local registries are often the product of collaborations between government entities, community groups, and social service providers.
To account for changes in place of residence, special needs, and other factors for people already registered, as well as for incremental additions, registries must be updated regularly. Keeping registries up-to-date is difficult because the number of potential registrants is always changing as people visit or move into or out of a given area. Methods for maintaining and updating registries include annual reminders to registrants to review their information. These reminders can be sent with utility bills or other mail that people are certain to open.
Registry development and maintenance requires sustained staffing and resources. Some jurisdictions fund registries through emergency response funds, while others rely on volunteers and community collaboration. Methods for collecting information on registrants may include—
- A Web form that people can use to submit and update their information.
- A central phone number that people can call to register.
- Social service workers or volunteers who collect information from clients when they apply for other public health services.
- Direct-mail registration forms that people can fill out and return.
Some older adults might be distrustful of providing personal information to an unknown entity. For this reason, registry officials may find it easier to collect personal information and register older adults in person at a senior center or through a known service provider, such as a home health care aide.
For more complete information, visit the Registries section of the Emergency Preparedness for Older Adults Web Portal on the CDC Healthy Aging Program Web.
Sheltering people affected by disasters is a key component of emergency management and response. The shelter intake process also can be an effective way for emergency management officials to identify older adults in the community who need special help. In November 2010, FEMA released its Guidance on Planning for Integration of Functional Needs Support Services in General Population Shelters [PDF–7.3M]. This publication provides guidance to emergency managers and shelter managers on how to meet access and functional needs of all people in general population shelters. Although FEMA’s Functional Needs Support Services (FNSS) guidance does not require new legal obligations, it emphasizes existing legal rights, such as accessibility and nondiscrimination.
Partnerships are critical in planning and operating shelters because the complex issues that arise during an emergency cannot be solved by one organization; the required activities are crosscutting. Groups that may be involved in shelter planning may include—
- Aging Services Network.
- Community service agencies (e.g., American Red Cross, United Way, Meals on Wheels, senior centers).
- Emergency management agencies.
- Faith-based organizations.
- Public health agencies.
The special needs of older adults may present certain challenges to shelter officials. For example, some older adults may be able to walk on their own, while others may need devices such as canes, crutches, or walkers. Some may be dependent on certain electrical equipment or need help with medical care, such as someone to give them their medication or a nurse to monitor their health.
Some older adults may be dependent on others to help them with routine care and activities of daily living, such as eating, walking, toileting, and personal hygiene.
Challenges to providing appropriate shelter to older adults include the need to—
- Respond to the continually changing and evolving nature of the specific event or hazard.
- Get the appropriate durable medical equipment.
- Provide a safe, secure environment that takes into account the potential for abuse and neglect of older adults because of their cognitive and physical impairments.
- Provide staff members who have been trained to care for the specific physical, cognitive, and emotional needs of older adults.
When planning for older adults, officials must ensure that shelter facilities meet the special needs of this population. For example, shelters must—
- Be accessible to people who need help or certain accommodations to perform routine care or activities of daily living (e.g., to use the bathroom, bathe, dress, groom, or get into and out of bed).
- Be accessible to people who have certain disabilities, such as those who use a wheelchair.
- Include signs and other forms of communication that can be understood by older adults.
- Include energy sources for electricity (i.e., generators), heating, and air conditioning.
For more complete information, visit the Sheltering section of the Emergency Preparedness for Older Adults Web Portal on the CDC Healthy Aging Program Web site.
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