Older adults are particularly vulnerable in a disaster or a pandemic. This increase in risk is multifactorial, and includes intrinsic factors such as underlying physiologic alterations associated with aging, a diminished physiologic reserve, visual and hearing impairment, impaired mobility, and frailty, a clinical phenotype associated with a reduced ability to overcome stressors. Other factors impacting older adults are extrinsic and include the need for prescription medications, inadequate social supports and social isolation, food insecurity and low economic status, all of which are associated with an increased risk of morbidity in older adults during a disaster or pandemic.1 Triage, care, and rehabilitation of older adult victims of disasters or pandemics must consider these issues in developing care plans.
Half of the deaths from Hurricane Katrina were in adults age 75 and older,2 and an estimated 95% of those who died after the Great East Japan earthquake in March 2011 were above age 60.3 The risk of severe illness and mortality from the recent COVID-19 pandemic has disproportionately afflicted older adults. In 2019, it was estimated that more than 703 million persons were aged 65 or older, 1 in 11 of the world’s population. By 2050, it is expected that 1 in 6 will be aged 65 or greater. Older adults comprise an increasingly larger proportion with increasing longevity, particularly in industrialized nations. This is particularly true in higher income nations across North America, Europe, and East Asia; however, the population is aging most rapidly in Eastern and South-Eastern Asia, Latin America, and the Caribbean.4
Older adults are often defined by age thresholds. Commonly, age 65 to 74 years defines the “young-old,” 75 to 84 years, the “old-old,” and 85+ years, the “oldest-old.” Women currently predominate in the oldest categories although this gap is narrowing. These definitions may be useful to categorize phenomena seen at different decades of life, while understanding that heterogeneity in physiology and functional ability is greatest during these years of life.
During a disaster or pandemic, older adults may be among the first to be affected. They have greater social and environmental susceptibility to the effects of a disaster and significant barriers to their ability to seek help and medical care. Older adults requiring acute medical care may have an atypical presentation of injury, disease, response to medications or treatment, and unanticipated complications causing delayed recovery and increased mortality. Intrinsic and acquired physiologic changes of aging, concurrent conditions, complex clinical decision-making, frailty, and disability all contribute to the challenges in providing medical care for older adults during a disaster or pandemic, the topic of this chapter.
HEALTH CARE RESOURCE ALLOCATION DURING DISASTERS
Disasters and pandemics require specific and extensive health care resources such as medications, equipment, critical care beds, and treatments. When the supply falls below that required to provide care for a population, or the cost rises ...