Disaster Preparedness for Veterans with Dementia and their Caregivers: An Educational Intervention Pilot

Background: Sensory, cognitive and physiologic changes in older adults can result in barriers to awareness, communication and help-seeking and help-finding during a disaster. Individuals with memory loss (dementia) are at risk of isolation and injury due to cognitive impairment. This Pilot was designed to address these complex needs among community-dwelling Veterans. Methods: A multidisciplinary Disaster Kit Pilot planning committee from several VA Palo Alto Healthcare System (VAPAHCS) geriatrics programs was created, utilizing a Plan-Do-Check-Act (PDCA) Quality Improvement process model to identify and evaluate Pilot tasks. Tasks included design of a disaster kit model with supplies, tools and information customized for cognitively-impaired Veterans/their caregivers, and pre and post-intervention self-report surveys on disaster preparedness. One-hundred and sixty eight (168) Veterans with dementia and 132 caregivers were identified within VAPAHCS geriatric caseloads. Results: The pre-intervention survey was mailed to 278 caregivers/Veterans in mid-2011, with a 26% response rate (71/278). Two-thirds of respondents (68%, n=48) reported not having a disaster kit and 26% (n=17) indicated no preparation for a disaster. The post-intervention survey (36% response, 44/123) revealed a substantial, positive shift in respondents' knowledge of key disaster preparation elements. Seventy-nine percent (79%, n=19) of respondents reported that they were prepared, with none reporting Not at All Prepared. Conclusions: Pre-intervention, few Veterans with dementia or caregivers reported that they were fully prepared for a disaster. Post-intervention, respondents reported much improved disaster preparation. Disaster preparedness in a vulnerable Veteran and caregiver population calls for anticipatory guidance and structured support such as that offered in this Pilot.