Safeguarding older adults with dementia, depression, and delirium in a temporary disaster shelter

Abstract

Natural disasters impact people of every age in the communities where they occur, with older adults being a vulnerable subset of the population. Most disaster shelter volunteer nurses are experienced in addressing common health needs of older adult clients such as diabetes, hypertension, and pulmonary disease. These nurses also have the requisite training to respond to more acute medical events, including the symptoms of a heart attack or stroke. They provide care and comfort to those suffering from the distress, anxiety, and fear caused by disasters. However, they may be less adept at triaging and caring for older adults with mental health conditions such as delirium, depression, or dementia. The trauma associated with a disaster and relocation will challenge cognitive abilities in those with dementia, may exacerbate existing depression, or lead to the onset of delirium, which is a medical emergency.Older adults experiencing these conditions are at risk for harm and deterioration with serious short and long-term consequences. Since disaster shelter volunteer health care staff may not be well-versed in distinguishing between dementia, depression, or delirium, behavior observation, and safety considerations are critical determinants of whether it is possible to support the older adult in the shelter environment or it is necessary to transition to a higher level of care. K E Y W O R D S delirium, dementia, depression, disaster, older adults, shelter 1 | INTRODUCTION Fires, floods, hurricanes, and earthquakes displace individuals from their home rendering them vulnerable. Many displaced people seek accommodations in temporary disaster shelters. Shelters typically match the demographics of the disaster-impacted community,including a proportionate number of older adults. 1 Older adults have complex medical histories, illnesses, medications, and medical device needs. 2 These individuals often have different physical and psychosocial needs than a younger population which require special care and attention. 3 The unfamiliar environment of a shelter is a significant stress factor for the older adult who has dementia or depression or is at risk for delirium-a vulnerability superimposed on the disaster vulnerability. The shelter environment may lack the supportive services vital to vulnerable older adults at increased risk for exploitation, victimization, self-care deficits, and inability to function. 4-6 Shelter staff may not be able to offer supportive interventions to this population quickly if they do not recognize and differentiate between dementia, depression, and delirium.Nurses, nurse practitioners, emergency medical technicians (EMTs), physician assistants, social workers, psychologists, and therapists play vital roles as disaster shelter volunteers. They provide direct care, resource navigation, and care coordination for clients with complex needs or vulnerabilities. These volunteers support shelter clients through the challenges of displacement, loss, grief, trauma, and uncertainty. It is essential for older adul...