Is Your Community “Geri-Proofed”?
As 2005 comes to an end, I can’t help but think of all of the natural disasters that have occurred throughout the world this year. As the year began, we watched with horror as the devastating effects of a tsunami unfolded in the Far East. While it seemed so distant and unreal, the death toll was unimaginable and the human suffering heart-wrenching. As the year progressed, many other natural disasters occurred throughout the world; perhaps none hit home as much as the devastating effects of the hurricanes that hit the southern United States. Visions of New Orleans still haunt those of us who watched with shock as flooding wiped out entire communities and killed the unprepared and vulnerable in a city that was left ill-equipped, despite years of warnings and unanswered requests for aid.
Many years ago, I was trained to assess and offer suggestions to “geri-proof” an older person’s home. This type of an assessment was concerned with the type of flooring, wax used, patterns on carpets, loose wires, uneven steps, availability of handrails and toilet facilities, among many other modifications that could help reduce falls and provide a safer environment to those in need. As communities, however, there is much we still need to consider to help make our communities safer places for older individuals.
Frail and vulnerable are two terms that are often used to describe persons of advanced age who walk a fine line between independence and dependency. Any subtle change in their environment, health status, or social network may very well result in a significant decline in function and places them at risk of premature death. Physicians are often focused on the biological or physiological reasons for this careful balance, and do their best to avoid stressing the situation with unnecessary testing, medication side effects, and other potentially life-altering treatments. This year, however, I was reminded of just how vulnerable and frail we all are in the balance of man versus nature, regardless of our age or status. The impact that the numerous hurricanes, tsunamis, earthquakes, and mudslides had on humanity around the globe this past year were somber reminders of this.
The elderly, however, were affected in greater numbers. In fact, 60% of the identified victims of the New Orleans tragedy were over age 60 and were either unable to evacuate or cope with the rising waters, whether directly or indirectly. We all heard with shock the results of a tragic bus trip attempting to evacuate ill nursing home residents in advance of storm waters; the bus itself was ill-fitted for the trip, and sparks ignited oxygen tanks, leading to an inferno and mass death. Elderly husbands and wives died after choosing to stay in their houses to face the impending storm surge rather than leave the homes they had lived in for decades. Was anyone present to help them leave or to even encourage them to do what was best?
The elderly have always had a more difficult time fending for themselves, and the higher death rate from nature’s fury comes as no surprise. More elderly persons die each year of hypothermia, for instance, unable to generate sufficient body temperature to survive. Physiological response to a challenge of cold temperatures is impaired with age for a variety of reasons, both normal and disease-related. Do not forget, however, the need for heating fuel, harder for someone living on social security to afford, or being able to fight for warmth in a shelter or from a subway grating. The elderly are indeed more vulnerable to nature’s furies.
Physicians should advise their aging and aged patients to consider life’s potential stresses and to have a plan to deal with them. For some, this may involve family intervention in times of need; others will need to know what they should do and who to call for help before it is too late. Physicians must take an active role as leaders in public health and advocate for the elderly. There is still much that can be done to make communities “geri-proofed”—or at least safer for when the next calamity arises. Happy Holidays to you all.
Send comments to Dr. Gambert at email@example.com.