By John Hirdes
and Sandy van Solm
University of Waterloo
The combination of an aging population with increases in natural disasters has had deadly consequences for seniors.
Quebec health authorities estimated that as many 70 people died as a result of the 2018 heat wave with a humidex of over 40C. Most heat-related deaths in Montreal involved seniors with chronic conditions.
And who can forget 2017’s viral images of older adults in flooded Texas nursing homes? Or people fleeing Fort McMurray wildfires in 2016? Unfortunately, there are many recent disasters to draw from with a tragic pattern of outcomes.
Research done after Hurricane Katrina, Hurricane Sandy and the 2003 European heat wave shows that the majority of deaths and injuries resulting from natural disasters involve older adults. This is particularly worrisome because our population is aging. One in four Canadians will be over 65 years of age within 20 years.
Why are seniors most at risk?
Older adults living in their own homes are more likely to be harmed in a disaster because of physical frailty, disability and social isolation. They often have needs that make them more vulnerable and less able to cope with the physical and mental challenges posed by disasters.
They may be unable to walk, climb stairs or make decisions without help from others. Their vision and hearing may be impaired. They may need oxygen or medications to survive. Or they may have all of these problems. When they live alone or their caregivers are overwhelmed, their risk of dying or being hospitalized is even greater.
Most Canadians want to stay in their own home as they age. And more government funding for home care helps older adults with complex needs to live at home for longer. That’s good news – but we can’t forget to ensure seniors get the help they need when disaster strikes.
You might think solutions are in place to locate and assist vulnerable persons during disasters. That’s only partially the case.
Some organizations and local governments maintain registries to help first responders, but these voluntary systems depend on vulnerable people signing up themselves. In reality, most people simply don’t self-register, the voluntary registries become out of date quickly and there is no scientific basis for their design. That means these registries are typically of little help when real disasters strike.
So what’s the solution?
Fortunately, we may not have to start from scratch. Many older Canadians with frailty living at home already have some government-funded help through home care. If they do, a care co-ordinator would have done an assessment to help understand what kind of assistance they need.
For example, the assessment considers whether the senior needs help taking their medications, if they use a wheelchair, if they’re alone most of the day or if they have trouble remembering things. Since these assessments are updated routinely, the information stays current.
This is the same information needed during an emergency. It can tell us who needs help, where they live and what kind of help they need when a storm is coming, floodwaters rise or fire strikes.
Work has already begun to try to systematize such data and make it count in an emergency. We led an international team of researchers and partner organizations to create and implement the interRAI Vulnerable Persons at Risk (VPR) algorithm using routinely collected home care assessment information. And it has a proven track record.
During the 2011 Christchurch, New Zealand, earthquake, government agencies and first responders used an early version of VPR to co-ordinate their response to the disaster. Since then, New Zealand and Canadian researchers have collaborated to refine the algorithm for use anywhere these assessments have been implemented in the world.
Most Canadian regions have already done the hard work to implement the interRAI system. Eight provinces and territories use a common home-care assessment system. The Canadian Institute for Health Information (CIHI) has incorporated VPR into their national standards for home care software systems. And the Region of Waterloo is the first in Canada to implement VPR as a disaster management tool for vulnerable persons.
So what’s left to be done?
Governments, home-care agencies and first responders must work together to be ready to use VPR the next time disaster strikes. It could be a matter of life and death.
Seniors don’t have to be helpless in the face of disaster. Help is only an algorithm away.
John Hirdes is a professor in the School of Public Health and Health Systems at the University of Waterloo, a network investigator with Canadian Frailty Network, the senior Canadian fellow and a board member of interRAI, an international consortium of researchers from over 35 countries. Sandy van Solm, PhD, is the co-ordinator of emergency management at the Region of Waterloo. She completed her doctorate on the interRAI VPR at the University of Waterloo.
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