The University of Pennsylvania School of Nursing identified that illness, injury and death are increased in elderly populations during disaster situations. “Older adults often have visual and hearing deficits, making it more difficult to interpret their environments and precipitating increased stress” said lead author Pamela Cacchione, PhD, APRN, GNP, BC. “This stress can also exacerbate chronic illnesses, further precipitating delirium”.
The residents followed were evacuated during a severe summer storm and located in different facilities with different care providers and physical surroundings. The displaced residents experienced delirium, cognitive changes, hospitalizations and death according to research published in the Journal of Gerontological Nursing. The study found that more than half the residents followed were negatively affected by evacuation and showed signs of delirium within two weeks. Two participants were hospitalized and one died.
“Nurses in all care settings not just LTC sites, should be aware of the potential difficulties older adults may experience as a result of a natural disaster, especially when evacuations and relocations occur” researchers said. “Basic physical care, ongoing assessment of chronic conditions, medication management, the return to familiar surroundings and the return of valued objects should be facilitated as soon as possible”.
This study gives new meaning to the reality of “transfer trauma” which has recently come under attack as not a valid concern. Transfer trauma in the elderly can and often increases the risk of injuries related to falls, elopement, resistance to care and ongoing non-compliance. Elderly residents do not adapt well to changes in their environment as daily reminders and cues from home are not always available in our facilities. If the resident also suffers with cognitive impairment, transfer trauma increases the risk they will suffer a negative outcome.
As providers of care for this at risk population, it is our responsibility to be sure appropriate assessments and interventions are in place to assist residents in adjusting to their new home. What is your process? Do you have additional resources available for your at risk population? It may be time to discuss options with your interdisciplinary team.
Have you considered some low cost options such as a facility “concierge” (non skilled, non-certified assistant) to spend time with newly admitted residents for the first several weeks? How about the buddy system for new residents? Some facilities have a system where long-term residents volunteer to “buddy up” with a newly admitted resident. This process includes sharing meals, leisure activities or simply visiting the new resident in their room. Permanent caregivers and resident centered care have also proven to benefit this population however above all else, remember, talk to the resident! Even residents with cognitive impairment can communicate basic needs through verbal and non-verbal communication. Be alert, visit often and remember negative outcomes are more common within the first 30 days of admission. As always, should you need assistance with addressing this or any risk reduction program please feel free to contact your HealthCap Risk Manager for assistance.
Long-Term Care Living – www.ltlmagazine.com October, 2011