To mark International Day for Disaster Reduction 2013 focusing on the theme of disability on 13 October, WHO, CBM, IFRC, IOM, UNICEF, UNISDR and partners are publishing a guidance note to highlight the needs of people with disabilities before, during and after emergencies.
People with disabilities are disproportionately affected in emergencies and experience particularly high rates of mortality in these contexts. Emergencies can increase vulnerability and also create a new generation of people experiencing disabilities due to injuries, poor basic surgical and medical care, emergency-induced mental health and psychological problems, and breakdown in support structures. People with disabilities may also have greater difficulty in accessing food, water, shelter, latrines and healthcare services in emergency situations.
Following the earthquake and tsunami in Japan in 2011, statistics showed that the fatality rate for people with disabilities was twice that of non-disabled people. Estimates from some countries suggest that up to one quarter of disabilities may be associated with violence and injuries. It is estimated that for every child killed as a result of violent conflict, three are injured and permanently impaired.
The Guidance Note on Disability and Emergency Risk Management for Health points out the health-related actions that are required to ensure that both mainstream and specific supports are available and accessible to people with disabilities before, during, and after emergencies. It outlines the minimum steps healthcare providers and other actors should take to ensure that specific support is available for people with disabilities and to ensure that disability is included in the development and implementation of health actions in all emergency contexts.
The Guidance Note is accessible through the following link – http://www.who.int/hac/techguidance/preparedness/disability. WHO seeks your assistance in ensuring effective dissemination and implementation of the guidance note through your respective organizations and networks. WHO and partners will be participating in the IDDR events in New York this week, and is taking steps to ensure the inclusion of disability in WHO support to risk assessments, capacity development, and emergency response and recovery activities at country level. Equally, the disability community is integrating emergency risk management into disability policy and practice. Member States have requested WHO to develop a global plan of action on disability which focuses on the roles of countries, WHO and other actors to improve health for people with disabilities. We will ensure that the plan includes action on strengthening emergency risk management as per the guidance note. Further information on International Day for Disaster Reduction 2013 is at – http://www.unisdr.org/2013/iddr/.
To contact WHO about the note and other activities to strengthen disability and emergency risk management for health, kindly contact Alana Officer – firstname.lastname@example.org – or Jonathan Abrams – email@example.com – for further information.
Disability and emergency risk management for health
Launch of a guidance note by WHO and partners
People with disabilities are disproportionately affected in emergencies and experience particularly high rates of mortality in these contexts. To mark International Day for Disaster Reduction 2013, CBM, the International Federation of Red Cross and Red Crescent Societies, the International Organization for Migration, the United Nations Children’s Fund, the United Nations Office for Disaster Risk Reduction and the World Health Organization release today a guidance note to highlight the needs of people with disabilities before, during and after emergencies.
Emergencies can increase the vulnerability of people with disabilities, as people with disabilities may be less able to escape from hazards; may lose essential medications or assistive devices such as spectacles or hearing and mobility aids; or may be left behind when a community is forced to evacuate. People with disabilities may also have greater difficulty accessing basic needs, including food, water, shelter, latrines and health-care services. Following the earthquake and tsunami in Japan in 2011, statistics showed that the fatality rate for people with disabilities was twice that of non-disabled people.
Emergencies also create a new generation of people with disabilities due to injuries, poor basic surgical and medical care, emergency-induced mental health and psychological problems and breakdown in support structures and preventive health care. Estimates from some countries suggest that up to one quarter of disabilities before, during and after emergencies may be associated with violence and injuries. It is estimated that for every child killed as a result of violent conflict, three are injured and permanently impaired.
The Guidance note on disability and emergency risk management for health is a short, practical guide that covers actions across emergency risk management, such as risk assessment, prevention, preparedness, response, recovery and reconstruction. Developed primarily for health actors working in emergency and disaster risk management at the local, national or international level, and in governmental or nongovernmental agencies, the guidance note points out the health-related actions that are required to ensure that both mainstream and specific support are available and accessible to people with disabilities in emergencies.
Self-Reported Increased Confusion or Memory Loss and Associated Functional Difficulties Among Adults Aged ≥60 Years — 21 States, 2011
May 10, 2013 / 62(18);347-350
Declines in cognitive function vary among persons and can include changes in attention, memory, learning, executive function, and language capabilities that negatively affect quality of life, personal relationships, and the capacity for making informed decisions about health care and other matters (1). Memory problems typically are one of the first warning signs of cognitive decline, and mild cognitive impairment might be present when memory problems are greater than normal for a person’s age but not as severe as problems experienced with Alzheimer’s disease (2,3). Some, but not all, persons with mild cognitive impairment develop Alzheimer’s disease; others can recover from mild cognitive impairment if certain causes (e.g., medication side effects or depression) are detected and treated (3). In 2012, the U.S. Department of Health and Human Services published the National Plan to Address Alzheimer’s Disease, calling for expanding data collection and surveillance efforts to track the prevalence and impact of Alzheimer’s and other types of dementia (4). To estimate the prevalence of self-reported increased confusion or memory loss and associated functional difficulties among adults aged ≥60 years, CDC analyzed data from 21 states that administered an optional module in the 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey. The results indicated that 12.7% of respondents reported increased confusion or memory loss in the preceding 12 months. Among those reporting increased confusion or memory loss, 35.2% reported experiencing functional difficulties. These results provide baseline information about the number of noninstitutionalized older adults with increased confusion or memory loss that is causing functional difficulties and might require services and supports now or in the future.
BRFSS consists of annual state-based telephone surveys of randomly selected noninstitutionalized U.S. adults aged ≥18 years regarding health practices and risk behaviors linked to chronic diseases, injuries, and preventable infectious diseases.* In 2011, all 50 states and the District of Columbia conducted the BRFSS survey by landline and cellular telephones, and the median survey response rate was 49.7%. In 2011, 21 states† included a 10-question optional cognitive impairment module§ in their BRFSS surveys. Because only seven of the 21 states conducted cell phone interviews in addition to landline telephone interviews, this analysis was restricted to landline respondents aged ≥60 years from the 21 states.¶ The median landline response rate among the 21 states was 53.4%, and the rates ranged from 37.4% in California to 66.0% in Nebraska.** This analysis was further limited to the 59,852 adults aged ≥60 years with nonmissing responses to the first question in the module.
Respondents who answered affirmatively to the question, “During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?” were categorized as reporting increased confusion or memory loss. Functional difficulties were identified among these persons if they responded, “always,” “usually,” or “sometimes” to one of two questions about whether confusion or memory loss interfered with their “ability to work, volunteer, or engage in social activities,” or caused them to “give up household activities or chores” that they “used to do.” Additional questions addressed the need for assistance, getting care or assistance from a family member or friend, and discussing increased confusion or memory loss with a health-care provider. Respondents who declined to answer, had a missing answer, or who answered “don’t know/not sure” were excluded from the analyses involving those variables.
Respondents were categorized by age group, sex, race/
ethnicity,†† education level, disability status,§§ veteran status, and employment status. BRFSS landline weights were used to adjust for the probability of selection and to reflect the total adult population in each state by age group, race/ethnicity, education level, marital status, and home ownership status. To account for the complex sampling design, weighted data were analyzed using statistical software.
In 2011, 12.7% of respondents reported increased confusion or memory loss during the preceding 12 months, and 35.2% of those persons reported functional difficulties (Table 1). The percentage reporting confusion or memory loss was significantly higher among the following: persons aged ≥85 years (15.6%) compared with those aged 60–64 years (12.0%) and 65–74 years (11.9%); Hispanics or Latinos (16.9%) compared with whites (12.1%); persons with less than a high school education (16.2%) compared with persons with more education; persons who reported they were disabled (20.2%) compared with persons who were not disabled (7.5%); and persons who were unable to work (28.3%) compared with those who were employed (7.8%), unemployed (16.4%), homemakers (11.8%), students (3.9%), and retirees (12.3%) (Table 1).
Among those reporting increased confusion or memory loss, significant differences in the percentage with functional difficulties were found among the same demographic groups, although in some cases the patterns differed. For example, the percentage with functional difficulties was significantly higher among adults aged 60–64 years (44.7%) compared with 65–74 years (29.0%) and 75–84 years (32.6%) and among blacks or African Americans (61.6%) compared with whites (29.1%) and Asians/Native Hawaiians or Other Pacific Islanders (16.2%) (Table 1). By state, the percentage reporting increased confusion or memory loss ranged from 6.4% in Tennessee to 20.0% in Arkansas. Among those with increased confusion or memory loss, the percentage with functional difficulties ranged from 21.3% in Wisconsin to 52.2% in West Virginia (Table 2).
Among persons reporting increased confusion or memory loss, those with functional difficulties were significantly more likely than those without functional difficulties to report needing help (81.0% compared with 38.2%), getting help from a family member or friend (46.5% compared with 6.0%), and discussing their increased confusion or memory loss with a health-care provider (32.6% compared with 12.1%). In addition, those who reported functional difficulties were more likely to report being unable to work (32.8% compared with 9.6%) (Table 3).
Age is the best-known risk factor for Alzheimer’s disease (the most common cause of dementia), and more than 90% of cases occur in persons aged ≥60 years (2). Research shows that Alzheimer’s disease causes changes in the brain years and even decades before the first symptoms appear, and a better understanding about normal age-related cognitive decline could provide important insights for future prevention efforts (1,2). A systematic review found that among the primary care populations studied, as many as 66% of all dementia cases were undiagnosed, with the majority of missed cases classified as mild to moderate (5).Missed or delayed diagnosis impedes the ability to identify and intervene for treatable causes and to provide timely and accurate information and resources to patients and their families.
Public health surveillance provides the ability to track and monitor trends and identify health disparities to understand the magnitude of the problem, plan for future resource and service needs, inform interventions, and guide research efforts. However, public health surveillance of dementia is limited and complicated by methodologic challenges associated with identifying cases in the community (6). For these reasons, one suggestion is that public health surveillance of these conditions be broadly focused and address outcomes related to functional impairment rather than etiology (6). BRFSS provides an opportunity to respond to the national call for expanded surveillance efforts by tracking self-reported confusion or memory loss that is currently causing functional difficulties among noninstitutionalized adults and could progress to a more serious state of impairment.
The BRFSS results for 21 states described in this report indicate that 12.7% of persons aged ≥60 years report increased confusion or memory loss in the preceding year, and among these persons, 35.2% report functional difficulties. The findings show that increased confusion or memory loss generally increased with age, but the percentage reporting functional difficulties among persons aged 60-64 years was as great as among persons aged ≥85 years and greater than among persons aged 65–84. These findings suggest a need for future studies to examine the relationship of age and functional difficulties caused by increased confusion or memory loss. For example, younger persons might face challenges obtaining diagnostic testing because health-care professionals might not suspect symptoms, or access to employer-sponsored benefits could be placed in jeopardy if employed persons lose their jobs or are unable to work (7).
Among persons reporting functional difficulties, only 32.6% report discussing their symptoms with a health-care provider. Early and accurate diagnosis provides opportunities for individuals and families to initiate financial planning, develop advance directives, enroll in clinical trials and anticipate care needs. Some causes for cognitive decline are reversible (e.g., depression, infections, medication side effects, or nutritional deficiencies), but they can be serious and should be treated by a health-care provider as soon as possible (2). Misperceptions about dementia-related conditions might lead to delayed diagnosis (4), and understanding cultural beliefs and public perception is important for meeting national goals for increasing awareness. For example, studies conducted with diverse groups of older adults found that terminology used to describe brain health and beliefs about cognition varied among racial/ethnic populations (9). Increased confusion or memory loss and functional difficulties were reported among all racial/ethnic groups in this analysis, with persons identifying themselves as black or African American reporting the highest levels of functional difficulties compared with other groups.
Among those reporting increased confusion or memory loss and functional difficulties, 81.0% report needing assistance, and only 46.5% report getting help from a family member or friend. The need for care could precede or follow a diagnosis of dementia and escalates over time (8). Care could be provided by family members and friends or through paid services. Understanding who is at risk for requiring care now or in the future can help with anticipating needs and associated costs.
Wide variation observed among the 21 states might be the result of different cultural or other factors and indicates the importance of state-based data on this subject. Understanding cultural and social contexts is important when communicating public health messages (8). Future studies of state-specific data examining associations between increased confusion or memory loss and potential risk factors for dementia such as cardiovascular disease, diabetes, depression, or physical inactivity (3)might provide more insights that could also help explain the variations observed across states.
The findings in this report are subject to at least five limitations. First, data are self-reported, not validated by any clinical measurement, and might be subject to recall bias. Second, the survey design is cross-sectional, and causality of specific diseases or conditions cannot be inferred. Third, although questions underwent multiple rounds of cognitive testing to ensure that respondents understood the questions, given misperceptions surrounding dementia (4,7,8), respondents might provide the most “socially acceptable” answer, which could vary by race/ethnicity or geography, and could account in part for the variability observed among states. For example, blacks or African Americans might be less likely than whites to report cognitive decline (10). Furthermore, whether increased confusion or memory loss interferes with a respondent’s ability to accurately describe functional difficulties is unknown. Fourth, these results might underestimate confusion or memory loss and functional difficulties because BRFSS does not include residents of nursing homes or other facilities where a high percentage of people with cognitive impairment reside, and results were limited to landline telephone survey responses and did not include cell phone respondents. Finally, response rates among the 21 states were low and varied widely, ranging from 37.4% to 66.0%.
In May 2012, The U.S. Department of Health and Human Services released the National Plan to Address Alzheimer’s Disease (4), which includes a call to strengthen data and surveillance efforts. CDC’s Healthy Brain Initiative is working with the Alzheimer’s Association and numerous other national, state, and local partners to develop a set of public health actions to promote cognitive health as a vital, integral, component of public health and also to address issues related to cognitive impairment for persons living in the community and their care partners (i.e., informal and paid caregivers and health-care providers). This report provides a baseline estimate of the extent of self-reported increased confusion or memory loss and functional difficulties occurring in the preceding year among noninstitutionalized persons aged ≥60 years who might require services and supports now or in the future. The findings underscore the need to facilitate timely discussions with health-care and service providers so that linkages can be made to accurate information and needed services.
STEADI (Stopping Elderly Accidents, Deaths & Injuries) Tool Kit for Health Care Providers
Did you realize that one out of three people 65 and older falls each year?
The good news is that health care providers can help reduce their patients’ chances of falling and of suffering serious injuries like hip fractures and traumatic brain damage.
CDC’s Injury Center created the STEADI Tool Kit for health care providers who see older adults in their practice who are at risk of falling or who may have fallen in the past. The STEADI Tool Kit gives health care providers the information and tools they need to assess and address their older patients’ fall risk.
Geriatric Emergency Preparedness and Response Workshops: An Evaluation of
Knowledge, Attitudes, Intentions, and Self-Efficacy of Participants
Robert Ellis Roush and Sandra Kay Tyson
DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS 2012;6 385-392 http://www.dmphp.org/cgi/content/abstract/6/4/385?etoc
This research evaluated the knowledge and utilization intentions of participants of a geriatric emergency preparedness and response (GEPR) continuing education program that was designed to provide this training.
NEW YORK – Five tools new to help people who are deaf, hard of hearing or blind are being used for Hurricane Sandy disaster response by the Federal Emergency Management Agency.
At New York disaster recovery centers, survivors who are blind or have low vision are using text-to-speech software and a variety of magnifiers to access FEMA information. Survivors who are deaf or hard of hearing are offered enhanced listening devices, iPad 3s with real-time-video remote sign language interpreting apps, and captioned phones to get disaster recovery information accessible to them.
These five assistive technology tools are part of a kit that costs FEMA less than $4,000. For price comparison, a single sign-language interpreter at one disaster recovery center can cost more than $400-a-day. (Federal law mandates that equal access to effective communication be available the entire time that a recovery center is open, usually eight hours daily.) On-site interpreters are available upon request, but for immediate access, interpreters are provided via on-line Wi-Fi and cellular connections, similar to the use of Skype.
“The tools were selected after considering many options that would work in the aftermath of a disaster,” says Marcie Roth, director of FEMA’s Office of Disability Integration and Coordination.
“We’ve been engaging the real experts, people who use these tools on a regular basis, as our planning partners,” she explains. “We are so far ahead of where we were, even a year ago, but that doesn’t mean that we’re there yet. We’re in a position where we’re using for the first time some of the most advanced technology in one of the worst disasters. This is a great teachable moment, but we have to make sure no one falls through the cracks in this learning curve.”
The five new tools at each disaster recovery center are:
iPad 3 – this device has many apps to provide enlarged text for people with low vision, picture symbols for people with low literacy or communication disabilities, immediate access to sign language interpreters for people who are deaf and many other tools for immediate communication access
Magnifying Readers – Enlarges text for people with low vision
Enhanced Listening Devices – improves the clarity of sound for people who are hard of hearing, especially helpful for older adults in noisy settings like a Disaster Recovery Center.
Live Video Interpreting – provides immediate access to sign language interpreters standing by at a remote location to provide access to people who are deaf.
Captioned Phones – provide real-time voice-to-text for people who can speak on the phone but cannot hear the caller on the other end.“We’re not working for people with disabilities,” adds Marcie Roth, “we’re working with people with disabilities.”
San Diego’s Area Coordinator System: A Disaster Preparedness Model for US Nursing Homes
Sarah C. Blake, David H. Howard, Hilary Eiring, and Scott Tarde
DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS 2012;6 424-427 http://www.dmphp.org/cgi/content/abstract/6/4/424?etoc
“….San Diego County collaborated to form a model for nursing home emergency preparedness. This report describes the model, known as the area coordinator system, and discusses its strengths and limitations, and whether it ought to be replicated in other areas of the country.”
Current Tobacco Use and Secondhand Smoke Exposure Among Women of Reproductive Age — 14 Countries, 2008–2010
November 2, 2012 / 61(43);877-882
“……To examine current tobacco use and SHS (Secondhand Smoke ) exposure in women aged 15–49 years, data were analyzed from the 2008–2010 Global Adult Tobacco Survey (GATS) from 14 low- and middle-income countries: Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam. The results of this analysis indicated that, among reproductive-aged women, current tobacco smoking ranged from 0.4% in Egypt to 30.8% in Russia, current smokeless tobacco use was <1% in most countries, but common in Bangladesh (20.1%) and India (14.9%), and SHS exposure at home was common in all countries, ranging from 17.8% in Mexico to 72.3% in Vietnam. …..Prevalence of current smoking was ≤2.3% in Bangladesh, China, Egypt, India, Thailand, and Vietnam and >10% in Brazil, Poland, Russia, Turkey, Ukraine, and Uruguay. ……..”
DO NOT get in the “triangle of life”:In recent years, an e-mail has been circulating which describes an alternative to the long-established “Drop, Cover, and Hold On” advice. The so-called “triangle of life” and some of the other actions recommended in the e-mail are potentially life threatening, and the credibility of the source of these recommendations has been broadly questioned (see links at left).
The “triangle of life” advice (always get next to a table rather than underneath it) is based on several wrong assumptions:
buildings always collapse in earthquakes (wrong- especially in developed nations, and flat “pancake” collapse is rare anywhere);
when buildings collapse they always crush all furniture inside (wrong- people DO survive under furniture or other shelters);
people can always anticipate how their building might collapse and anticipate the location of survivable void spaces (wrong- the direction of shaking and unique structural aspects of the building make this nearly impossible) ; and
during strong shaking people can move to a desired location (wrong- strong shaking can make moving very difficult and dangerous).
Some other recommendations in the “triangle of life” e-mail are also based on wrong assumptions and very hazardous. For example, the recommendation to get out of your car during an earthquake and lay down next to it assumes that there is always an elevated freeway above you that will fall and crush your car. Of course there are very few elevated freeways, and laying next to your car is very dangerous because the car can move and crush you, and other drivers may not see you on the ground!