Although depressive symptoms are frequently associated with disaster exposure, most studies on the mental health impact of disasters must rely on cross-sectional data and small samples. In October 2012, Hurricane Sandy struck the Eastern United States, killing 117 people and injuring countless others. We examined the patterns and trajectories of depressive symptoms over a 12-year period for older people exposed to Sandy using data that were collected starting in 2006 with several follow up assessment and after Hurricane Sandy.

Methods

A sample of 3,570 people aged 50-74 were recruited between 2006 and 2008 and their depressive symptoms were measured at time intervals using the Center for Epidemiological Studies Depression Scale, CESD. Also, exposure specific to the Hurricane was measured by asking participants if they felt: 1) in immediate physical danger during Hurricane Sandy, and 2) if they were distressed or fearful during Hurricane Sandy. The association of the exposure and CESD was then assessed.

Results/Outcomes

Four distinct groups were identified with average CESD scores of 2, 5, 11, and 16 respectively. The scores were relatively stable over time for all four groups except when exposure to Sandy was included in the comparison. At that time the group with the lowest depressive symptom scores had an increase in depressive symptoms contemporaneous to the disaster. This increase was temporary and their CESD scores returned in later assessments.

Conclusions

Exposure to a natural disaster was associated with an increase in depressive symptoms for those older adults with the lowest prospective CESD scores.

As older, more medically complex citizens remain at home, communities face an increased burden to serve them in a disaster. Recognizing the role of home based programs in supporting medically complex patients, accrediting agencies have increased their burden of responsibility for emergency preparedness and response. There is limited understanding of these programs’ preparedness and response in practice. This study aimed to assess the role of Veterans Health Administration (VA) Home Based Primary Care (HBPC) programs in supporting their patients around the Fall 2017 Hurricanes and Fires.

Methods

This study examines the experiences and responses of eleven VA HBPC programs to Hurricanes Harvey, Irma, Maria and the Northern California Fires. Forty phone interviews were conducted from April-August, 2018.

Outcomes

Total census of impacted HBPC programs was 3,418. No program reported loss of life due to the Hurricanes or Fires. Early preparedness was key to effective program response. Response activities included prompt tracking of patients. In the most affected areas, respondents noted limited resources to support basic patient needs. At sites where HBPC leadership was not integrated into the facility’s disaster response plan, respondents reported the desire to be better connected with emergency management.

Conclusion

Medically complex patients served by programs such as the VA’s HBPC program represent a subset of the population, yet have a major impact on healthcare resources that could be exacerbated by inadequate disaster preparedness. Understanding what is involved in actualizing the requirements of programs tasked with supporting their disaster preparedness activities can bolster effective community engagement.

Seniors are vulnerable during disasters and experience disproportionate morbidity and mortality rates. In communities with public and independent housing, seniors embody increased risks as well as opportunities for preparedness, response, recovery. Risks include chronic health conditions, cognitive and mobility impediments, technological and social isolation. Opportunities include understanding personal risk, knowledge of community resources, networks. These factors were demonstrated in a community-wide response to the senior public housing fire in September, 2018 where 189 seniors lived, many with significant functional needs and disabilities. Community partners, residents, businesses and military came together to assist victims and ensure that no lives were lost.

This experience is inspiring seniors in the same neighborhood to create their own preparedness and response plans.

Utilizing diverse community engagement for responding to a disaster and recovery, develop preparedness and response plans for seniors, in the diverse DC neighborhood that ranges from public housing to private multi-million dollar homes, that increases independence and community resilience and decreases negative impacts.

Methods

Expand community partner engagement in real life disaster preparedness, response and recovery planning, identify challenges, alternatives in serving low-technology residents and leverage volunteers to design, manage responses.

Engage non-traditional, diverse community partners to develop, maintain community programs, plans, while developing a volunteer corps with knowledge of community assets.

Results/ Outcomes

Emergency preparedness, response and recovery plans that address needs of individuals and community in high risk area of Washington, DC.

Conclusion

Action strategies, based on an actual disaster, increase engagement, expand training, exercises modifiable for individual communities.

Following devastating 2017 hurricanes where pre-emergency vulnerabilities translated into post-emergency recovery challenges for at-risk individuals, the Office of the Assistant Secretary for Preparedness and Response (ASPR) collaborated with the Administration on Community Living (ACL) to ensure that HHS addressed access and functional needs of older adults and people with disabilities.

ASPR sought local community input from impacted areas to produce a resource guide for aging and disability networks to increase their ability to plan for and respond to public health emergencies and disasters.

Methods

ACL subject-matter experts (SME) staffed the Aging and Disability Taskforce to assess programmatic impacts and set requirements for maintaining the health, wellbeing of older adults and people with disabilities impacted by disasters.

ACL stakeholders collaborated with national organizations representing aging and disability networks, conducted consultation and review and developed a virtual focus group with CBOs.

At completion, ASPR will disseminate to aging and disability networks, public health officials and emergency managers.

Results/ Outcomes

ASPR developed the “Capacity-Building Toolkit for Including Aging and Disability Networks in Emergency Planning” that provides a guide for community-based organizations (CBOs) that comprise the aging and disability networks to increase their ability to plan for and respond to public health emergencies and disasters. The Toolkit, available early 2019, also orients emergency managers and public health officials to understand the capabilities and expertise of the aging and disability networks for addressing access and functional needs.

Conclusion

The “Capacity-Building Toolkit” addresses access and functional needs and better connects local CBOs to emergency planning.