Disaster Preparedness and Older Adults

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1 Disaster Preparedness and Older Adults Maria D. Llorente MD Professor of Psychiatry Georgetown University School of Medicine Associate Chief of Staff, Washington DC VAMC

2 Members of the AAGP Disaster Preparedness Task Force Kenneth M. Sakauye Joel E. Streim Gary J. Kennedy Paul D. Kirwin Maria D. Llorente Susan K. Schultz Shilpa Srinivasan

3 Grant funding: Disclosures Department of Veterans Affairs HSR&D: Memantine v. Vitamin E v. placebo in treatment of Alzheimers Disease. The study received memantine from Forrest Pharmaceuticals

4 Disaster An encounter between forces of harm and a human population in harm s way, influenced by the ecological context, in which demands exceed the coping capacity of the affected community Schultz et. al. 2006, 2007

5 Characteristics of Disasters Extraordinary magnitude of harm Ecological disruption Disproportionate impact on vulnerable communities Demands for response that exceed the community s ability to cope Necessity for outside assistance Schultz et. al. 2006, 2007

6 On average, a disaster occurs in the world each day TORNADOES EARTHQUAKES FLOODS SHOOTING SPREE TERRORISM

7 Deadliest Natural disasters since 1980 Location Disaster Date Death Toll Horn of Africa Drought ,000 Haiti Earthquake 2010? K Southeast Asia Tsunami ,841 Bangladesh Cyclone ,866 Myanmar Cyclone ,366 Mozambique Drought ,000 China Earthquake ,476 Pakistan Earthquake ,338 Europe Heat wave ,720 Iran Earthquake ,000 Venezuela Flood ,000 Centre for Research on Epidemiology of Disasters (CRED)

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9 Factors that determine whether MH consequences will occur Nature of Disaster Nature of Exposure and severity of harm Individual Vulnerabilities Unique vulnerabilities of elderly

10 Psychosocial Consequences of Disasters Psychosocial outcomes are shaped by the nature of the disaster Disasters with 2 or more of the following features result in the greatest behavioral impact: Extensive injury, threat to life or loss of life Extreme and widespread damage to property Destruction of social support and ongoing financial problems Human intentionality Norris et al. 2002

11 Psychosocial Consequences of Disasters Psychosocial outcomes are shaped by the nature of the disaster Acts of mass violence appear to produce more severe impairment in a higher proportion of survivors than do natural disasters Human intentionality, unpredictability, unfamiliarity, lack of preventability, societal disruption Lack of control Norris et al. 2002; Butler et al. 2003

12 Psychosocial Outcomes Psychiatric Conditions - PTSD - Depression - GAD - Panic Non-specific Distress Symptoms Health Problems Chronic Living Problems Loss of Psychosocial Resources

13 Psychosocial consequences of disasters Most people will report non specific distress, health problems, chronic problems in living (domestic violence increases), resource loss Most people improve with time A minority of survivors continue to be distressed long after the event Risk factors for adverse outcomes: more severe exposure, female gender, middle age, ethnic minority group, prior psychiatric problems, and poor psychosocial resources

14 Hurricane Andrew South Florida, August 24, 1992

15 Hurricane Andrew South Florida, August 24, 1992

16 ANDREW: High Impact Storm 25% of highly exposed residents of Dade County met criteria for PTSD 6 months later Many people felt less positive about the quality of social relationships than they had felt before the storm perceptions of social support may be affected by disaster experience Perilla et.al. 2002

17 Hurricane Katrina New Orleans, August 24, 2005

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19 Katrina: High impact storm One year later, 6.4% prevalence of suicidal ideas in general population Increase in serious mental illness by 89%, PTSD by 32% Elderly disproportionately affected with highest health decline, mortality and suicide rates Weisler RH, et al Mental Health and Recovery in the Gulf Coast After Hurricanes Katrina and Rita. Journal of the American Medical Association 2006; 296: Wang PS, et al.: Mental Health Service Use Among Hurricane Katrina Survivors in the Eight Months After the Disaster. Psychiatric Services 2007;58(11): Kessler RC, Galea S, Gruber MJ, Sampson NA, Ursano RJ, Wessly S: Trends in Mental Illness and Suicidality After Hurricane Katrina. Molecular Psychiatry 2008 Apr; 13(4): Epub 2008 Jan 8.

20 Risk of long-term MH sequelae Based on degree to which the person was affected (personal injury, loss of property) and proximity to greatest area of destruction Compared to younger group, most studies suggest elderly have lower rates of MH consequences 70-90% of older adults report experiencing at least one lifetime traumatic event Fewer than 2% of >10,000 PTSD studies between 1980 and 2008 focused on elderly