Program for veterans with dementia increases disaster preparedness in home-based care setting

In Brief

A multidisciplinary group developed a disaster preparedness program for veterans with dementia and caregivers served by Veterans Affairs Palo Alto Healthcare System. The program distributed disaster kits and provided education while using quality improvement processes to evaluate effectiveness along the way. Three months after implementation, more veterans with dementia were engaged with preparedness information and ready for a disaster.

Background

Public health planners must consider a diverse population in their preparedness efforts, tailoring projects to particular needs as funding allows. Dementia as a risk factor during and after disaster has been noted especially following recent hurricanes and infrastructure loss. Dementia is defined as memory impairment with one or more impairments to cognitive function, and like many other risk factors, can be worsened when structural support and care-giving services are disrupted or no longer present.

Specific issues
  • Physiologic risk. Cognitive impairment in people with dementia can place them at risk of injury or loss of independence if they suffer reduced awareness, communication skills, or ability to seek help during a disaster.
  • Lack of community-based planning. In general, few comprehensive planning efforts at the community level exist to help people with dementia survive a disaster.
  • Increasing prevalence of dementia. In the next 50 years, the prevalence of dementia is forecasted to double in people aged 75 to 80 years and quadruple in people aged older than 85.
The practice

A multidisciplinary group spearheaded by Veterans Affairs Palo Alto Healthcare System (VAPAHCS) developed a disaster preparedness pilot program for veterans with dementia and their caregivers.

The goal of the program was to educate veterans with dementia and their caregivers about basic components of disaster preparedness in their homes and neighborhoods. Planners also wanted to provide caregivers with information about behavioral health and how older adults might respond to a disaster so that caregivers could have the tools they need to reduce patients' stress levels.

The pilot program was delivered to veterans who resided in a community-dwelling setting served by VAPAHCS. The program consisted of:

  • Interviews with 12 caregivers to identify veterans' and caregivers' knowledge of and engagement with disaster preparedness as well as their preferences for receiving information
  • Creation of a disaster kit containing emergency supplies, tools, and information designed for an elderly and cognitively impaired veteran and his/her caregiver. The disaster kit for veterans included a bracelet whistle, hand sanitizer, a face mask, a flashing reflector light, a first aid kit, a notepad and marker, safety education handouts about earthquakes from the California Department of Aging, and an identification album. The album was intended to be completed with a photo of the veteran, a copy of health insurance cards, a completed contact card, and a copy of healthcare directives. Caregivers received a kit containing all of the above items and a crank radio and flashlight.
  • Fundraising for the $12,000 needed to assemble and distribute disaster kits
  • A pre- and post-survey of 10 questions each to determine the effect of the program. The survey was developed at a 6th-8th-grade reading level.

Planners used the"Plan-Do-Check-Act" quality improvement model, which allowed them to gain knowledge, identify things that needed to be done, and adjust processes throughout the project. Planners delivered disaster kits and provided education around disaster preparedness to 132 caregivers from VA geriatric clinics and 168 veterans with dementia living in a VA community.

What made this practice possible?
  • A multidisciplinary committee and education team. Planning, kit assembly, and education were provided by a team comprising a geriatric research education and clinical center nurse specialist and geriatric physician, a research health science specialist, a registered nurse practitioner in VA home-based primary care, the clinical registered nurse director of the VAPAHCS adult day healthcare program, and a PhD/registered nurse fellow in advanced geriatrics.
  • Thorough pre-program research. Conducting interviews with veterans' caregivers before implementing the program assured planners that they were meeting a documented need and helped them determine which supplies and educational tactics would be most useful.
  • Funding and development. The team was able to cover all direct costs of the project via internal fund-raising and external charitable donations from Craig Newmark (the entrepreneur behind Craigslist and craigconnects.org), the American Legion Auxiliary Unit, EPA 472, and Mission City Charities, Inc.
Results
  • Increased engagement. Based on a comparison between the pre- and post-intervention survey, 100% of veterans (versus 97% before the program) found it important to prepare for a disaster after the educational program.
  • Increased preparedness. Approximately 93% of veterans and caregivers had written names and contact information for themselves (versus 84% before the program), and 98% had a disaster kit ready to be used when needed (versus 31% before the program).

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