Seniors, Disaster Mortality, and End-of-Life Care

  • Maggie GibsonEmail author


There is growing evidence that a constellation of factors related to life stage, including health, social processes, and environmental ecology, create circumstances that lead to disproportionate mortality risk for older adults in disasters. There is a related risk that the palliative care needs of seniors who are already at the end stage of life or who die in the aftermath of a disaster can become lost when there is a sudden surge of people requiring acute intervention or a shortage of resources. This chapter is directed to the pressing need to facilitate the integration of palliative care practices within emergency preparedness and disaster response for seniors.


Elderly Disasters Death Palliative care Emergency planning 


  1. 1.
    UNISDR W. UN System Task Team on the post-2015 UN Development Agenda Thematic Think Piece: disaster risk and resilience. May 2012. Accessed 7 Apr 2014.
  2. 2.
    Phillips SJ, Knebel A, editors. Mass medical care with scarce resources a community planning guide. AHRQ Publication No. 07-0001. Rockville, MD: Agency for Healthcare Research and Policy; 2001.Google Scholar
  3. 3.
    Frahm KA, Brown LM, Gibson M. The importance of end-of-life care in nursing home settings is not diminished by a disaster. Omega. 2011;64(2):143–55.PubMedGoogle Scholar
  4. 4.
    WHO Collaborating Centre for Research on the Epidemiology of Disasters (CRED). Emergency Events Database EM-DAT. Accessed 30 Aug 2012.
  5. 5.
    U.S. Geological Survey (USGS). U.S. Geological survey: natural hazards. Accessed 5 Dec 2012.
  6. 6.
    Public Safety Canada. Canadian Disaster Database. Accessed 30 Aug 2012.
  7. 7.
    World Health Organization. Global Health Observatory: information on estimation methods. Accessed 30 Aug 2012.
  8. 8.
    Doocy S, Rofi A, Moodie C, Spring E, Bradley S, Burnham G, et al. Tsunami mortality in Aceh Province, Indonesia. Bull World Health Organ. 2007;85(2):273–8.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Donnelly A. Q&A: how the experts calculate the death toll in disasters. National Post; 17 Mar 2011.Google Scholar
  10. 10.
    The Associated Press. Old people suffer abandonment, cold in wake of tsunami. 2011. Accessed 12 Sept 2012.
  11. 11.
    The Associated Press. Haiti’s dying elderly say ‘nobody cares’. 2010. Accessed 12 Sept 2012.
  12. 12.
    HelpAge International. Humanitarian response for older people in Haiti: three months on. 2010.Google Scholar
  13. 13.
    Robine JM, Cheung SL, Le Roy S, Van Oyen H, Griffiths C, Michel JP, et al. Death toll exceeded 70,000 in Europe during the summer of 2003. C R Biol. 2008;331(2):171–8.PubMedCrossRefGoogle Scholar
  14. 14.
    D’Ippoliti D, Michelozzi P, Marino C, de’Donato F, Menne B, Katsouyanni K, et al. The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environ Health. 2010;9:37.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Schaffer A, Muscatello D, Broome R, Corbett S, Smith W. Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis. Environ Health. 2012;11(1):3-069X-11-3.Google Scholar
  16. 16.
    Klinenberg E. Heat wave a social autopsy of disaster in Chicago. Chicago: University of Chicago Press; 2002.CrossRefGoogle Scholar
  17. 17.
    Bartels SA, VanRooyen MJ. Medical complications associated with earthquakes. Lancet. 2012;379(9817):748–57.PubMedCrossRefGoogle Scholar
  18. 18.
    Naghii MR. Public health impact and medical consequences of earthquakes. Pan Am J Public Health. 2005;18(3):216–21.CrossRefGoogle Scholar
  19. 19.
    Rosenkoetter MM, Covan EK, Cobb BK, Bunting S, Weinrich M. Perceptions of older adults regarding evacuation in the event of a natural disaster. Public Health Nurs. 2007;24(2):160–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Brunkard JG, Namulanda G, Ratard R. Hurrican Katrina deaths, Louisiana, 2005. Disaster Med Public Health Prep. 2008;2(4):215–23.PubMedCrossRefGoogle Scholar
  21. 21.
    Dosa D, Feng Z, Hyer K, Brown LM, Thomas K, Mor V. The effects of Hurricane Katrina on nursing home facility resident mortality, hospitalization and functional decline. Disaster Med Public Health Prep. 2010;4(S1):S28–32.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Otani J. Older people in natural disasters. Melbourne: Kyoto University Press and Trans Pacific Press; 2010.Google Scholar
  23. 23.
    Okie SD. Pou and the hurricane–implications for patient care during disasters. N Engl J Med. 2008;358(1):1–5.PubMedCrossRefGoogle Scholar
  24. 24.
    World Health Organization. WHO definition of palliative care. Accessed 30 Aug 2012.
  25. 25.
    Kirk TW, Mahon MM. National Hospice and Palliative Care Organization (NHPCO) position statement and commentary on the use of palliative sedation in imminently dying terminally ill patients. J Pain Symptom Manage. 2010;39(5):914–23.PubMedCrossRefGoogle Scholar
  26. 26.
    Davies E, Higginson IJ, editors. Better palliative care for older people. Geneva: World Health Organization; 2004.Google Scholar
  27. 27.
    Johnstone MJ. Organization position statements and the stance of “studied neutrality” on euthanasia in palliative care. J Pain Symptom Manage. 2012;44(6):896–907.PubMedCrossRefGoogle Scholar
  28. 28.
    Kehl KA. Moving toward peace: an analysis of the concept of a good death. Am J Hosp Palliat Care. 2006;23(4):277–86.PubMedCrossRefGoogle Scholar
  29. 29.
    Seale C. Media constructions of dying alone: a form of ‘bad death’. Soc Sci Med. 2004;58(5):967–74.PubMedCrossRefGoogle Scholar
  30. 30.
    Waldrop DP, Meeker MA. Communication and advanced care planning in palliative and end-of-life care. Nurs Outlook. 2012;60(6):365–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Lloyd-Williams M, Kennedy V, Sixsmith A, Sixsmith J. The end of life: a qualitative study of the perceptions of people over the age of 80 on issues surrounding death and dying. J Pain Symptom Manage. 2007;34(1):60–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Clarke A, Seymour J. “At the foot of a very long ladder”: discussing the end of life with older people and informal caregivers. J Pain Symptom Manage. 2010;40(6):857–69.PubMedCrossRefGoogle Scholar
  33. 33.
    Kirchhoff KT, Hammes BJ, Kehl KA, Briggs LA, Brown RL. Effect of a disease-specific advance care planning intervention on end-of-life care. J Am Geriatr Soc. 2012;60(5):946–50.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Collins LG, Parks SM, Winter L. The state of advance care planning: one decade after SUPPORT. Am J Hosp Palliat Care. 2006;23(5):378–84.PubMedCrossRefGoogle Scholar
  35. 35.
    Downar J, Luk T, Sibbald RW, Santini T, Mikhael J, Berman H, et al. Why do patients agree to a “do not resuscitate” or “full code” order? Perspectives of medical inpatients. J Gen Intern Med. 2011;26(6):582–7.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Brown LD. Stealing on insensibly: end of life politics in the United States. Health Econ Policy Law. 2012;7(04):467.PubMedCrossRefGoogle Scholar
  37. 37.
    Wolff J. Dementia, death and advance directives. Health Econ Policy Law. 2012;7(4):499.PubMedCrossRefGoogle Scholar
  38. 38.
    Stone SC, Abbott J, McClung CD, Colwell CB, Eckstein M, Lowenstein SR. Paramedic knowledge, attitudes, and training in end-of-life care. Prehosp Disaster Med. 2009;24(6):529–34.PubMedGoogle Scholar
  39. 39.
    Devereaux AV, Dichter JR, Christian MD, Dubler NN, Sandrock CE, Hick JL, et al. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26–27, 2007, Chicago, IL. Chest. 2008;133(5 Suppl):51S–66.PubMedCrossRefGoogle Scholar
  40. 40.
    Miller MA, Viboud C, Olson DR, Grais RF, Rabaa MA, Simonsen L. Prioritization of influenza pandemic vaccination to minimize years of life lost. J Infect Dis. 2008;198(3):305–11.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Tabery J, Mackett III CW. University of Pittsburgh Medical Center Pandemic Influenza Task Force’s Triage Review Board. Ethics of triage in the event of an influenza pandemic. Disaster Med Public Health Prep. 2008;2(2):114–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Downar J, Seccareccia D, Associated Medical Services Inc. Educational fellows in care at the end of life. Palliating a pandemic: “all patients must be cared for”. J Pain Symptom Manage. 2010;39(2):291–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Grudzen CR, Richardson LD, Morrison M, Cho E, Morrison RS. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17(11):1253–7.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Van Tricht M, Riochet D, Batard E, Marinage A, Montassier E, Potel G, et al. Palliative care for patients who died in emergency departments: analysis of a multicentre cross-sectional survey. Emerg Med J. 2012;29(10):795–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Stys JC. Improving home-based hospice understanding and use of the National Incident Management System for emergency and disaster preparation and response. Home Healthc Nurse. 2010;28(6):375–81.PubMedCrossRefGoogle Scholar
  46. 46.
    Pope TM, Palazzo MF. Legal briefing: crisis standards of care and legal protections during disasters and emergencies. J Clin Ethics. 2010;21(4):358–67.PubMedGoogle Scholar
  47. 47.
    Rosoff PM. Should palliative care be a necessity or a luxury during an overwhelming health catastrophe? J Clin Ethics. 2010;21(4):312–20.PubMedGoogle Scholar
  48. 48.
    Runkle JD, Brock-Martin A, Karmaus W, Svendsen ER. Secondary surge capacity: a framework for understanding long-term access to primary care for medically vulnerable populations in disaster recovery. Am J Public Health. 2012;102(12):e24–32.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Lugosi CI. Natural disaster, unnatural deaths: the killings on the life care floors at Tenet’s Memorial Medical Center after Hurricane Katrina. Issues Law Med. 2007;23(1):71–85.PubMedGoogle Scholar
  50. 50.
    Wilkinson A, Matzo M, Gatto M, Lynn J. Palliative care. In: Phillips SJ, Knebel A, editors. Mass medical care with scarce resources: a community planning guide. AHRQ Publication No. 07-0001. Rockville, MD: Agency for Healthcare Research and Quality; 2007. p. 101–16.Google Scholar
  51. 51.
    Ahronheim JC, Arquilla MSJB, Greene RG. Elderly populations in disasters: hospital guidelines for geriatric preparedness. New York: Department of Health and Mental Hygiene; 2009.Google Scholar
  52. 52.
    Brymer M, Jacobs A, Layne C, Pynoos R, Ruzek J, Steinberg A, Vernberg E, Watson, P, (National Child Traumatic Stress Network and National Center for PTSD). Psychological First Aid: Field Operations Guide, 2nd Edition. July, 2006. Accessed 8 Apr 2014.
  53. 53.
    Brown LM, Frahm KA, Hyer K, Gibson M. Psychological first aid: field operations guide for nursing homes. 2nd Edition, 2011. Accessed 7 Apr 2014.
  54. 54.
    Mitchell T, Eilkinson E. Disaster risk management in post-2015 policy frameworks. Briefing paper 75; 2012.Google Scholar
  55. 55.
    United Nations International Strategy for Disaster Reduction. Towards a post-2015 framework for disaster risk reduction. Geneva: UNISDR; 2012.Google Scholar
  56. 56.
    Hirdes JP, Ljunggren G, Morris JN, Frijters DH, Finne Soveri H, Gray L, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Porzio G, Aielli F, Verna L, Aloisi P, Guadalupi F, Cannita K, et al. Home care for cancer patients after an earthquake: the experience of the “L’Aquila per la Vita” Home Care Unit. J Pain Symptom Manage. 2011;42(3):e1–4.PubMedCrossRefGoogle Scholar
  58. 58.
    United Nations International Strategy for Disaster Reduction. Hyogo framework for action 2005–2015: building resilience of nations and communities to disasters. New York: UNISDR; 2005.Google Scholar
  59. 59.
    Central Intelligence Agency. The world factbook. 2012. Accessed 27 Aug 2012.
  60. 60.
    U.S. Geological Survey (USGS). Earthquakes with 1,000 or more deaths since 1900. 2012. Accessed 27 Aug 2012.
  61. 61.
    Blake ES, Gibney EJ. The deadliest, costliest, and most intense United States tropical cyclones from 1851 to 2010 (and other frequently requested hurricane facts). NOAA Technical Memorandum NWS NHC-6; 2011.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Veterans Care ProgramSt. Joseph’s Health Care LondonLondonCanada

Personalised recommendations