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2013 WEBINAR SERIES STATE OF THE SCIENCE:

DEMENTIA EVALUATION AND MANAGEMENT AMONG DIVERSE OLDER ADULTS AND THEIR

FAMILIES

1 April 18, 2013

2013 WEBINAR SERIES STATE OF THE SCIENCE:

DEMENTIA EVALUATION AND MANAGEMENT AMONG DIVERSE OLDER ADULTS AND THEIR

FAMILIES Sponsored by Stanford Geriatric Educa4on Center in conjunc4on with American Geriatrics Society, California Area Health Educa4on Centers,

& Community Health Partnership

Please visit our website for more informa4on -‐ hBp://sgec.stanford.edu/ 2 April 18, 2013

GERIATRIC EMERGENCY PREPAREDNESS AND RESPONSE (GEPR) WEBINAR SERIES

SESSION ONE

DEMENTIA AND PREPAREDNESS PLANNING FOR ETHNIC ELDERS AND CAREGIVERS Thuan D. Ong, MD, MPH, Assistant Professor

Division of Gerontology and Geriatric Medicine University of Washington Donna Benton, PhD Assistant Professor

University of Southern California, Davis School of Gerontology Melen McBride, PhD, RN., FGSA, Associate Director, Emerita

Stanford Geriatric Educa4on Center

April 18 2013

This project is/was supported by funds from the Bureau of Health Professions (BHPr), Health Resources and Services Administra4on (HRSA), Department of Health and Human Services (DHHS) under UB4HP19049, grant 4tle: Geriatric Educa4on Centers,

total award amount: $384,525. This informa4on or content and conclusions are those of the author and should not be construed as the official posi4on or policy of, nor should any endorsements be inferred by the BHPr, HRSA, DHHS or the U.S. Government.

3



“Dementia and Preparedness Planning for Ethnic Elders and Caregiver”

Community Health Partnership CME Committee Members Disclosure Statements: Continuing Medical Education committee members and those involved in the planning of this CME Event have no financial relationships to disclose.

Stanford Geriatric Education Center Webinar Series Planner Disclosure Statements: The following members of the Stanford Geriatric Education Center Webinar Series Committee have indicated they have no conflicts of interest to disclose to the learners: Gwen Yeo, Ph.D. and Kala M. Mehta, DSc, MPH

Faculty Disclosure Statement: Our speakers have no financial relationships to disclose and will not discuss off label use and/or investigational use in their presentation

4

Melen McBride, PhD, RN, FGSA

Dr. Melen McBride, Associate Director, Emerita, and Ethnogeriatric Clinical Nurse Specialist at Stanford Geriatric Education Center (SGEC), School of Medicine, Stanford University, Palo Alto, CA. She has over two decades of experience in ethnogeriatrics, using internet technology. She designed the Cohort Historical Analysis Tool (CHAT) currently used in graduate psychology and nursing programs and has published in these areas. She provides leadership (since 2001) to infuse ethnogeriatrics into inter-professional emergency preparedness training of health professionals through the Geriatric Emergency Preparedness Response (GEPR) Collaborative of six HRSA funded GECs, one of which is SGEC, and co-coordinates the SGEC Faculty Development Program in Ethnogeriatrics and Health Literacy.

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National Association of Geriatric Education Centers Initiative Geriatric Emergency Preparedness, Response (GEPR) Collaborative

�  2001 – 02: National Association of Geriatric Education Center (NAGEC) surveyed GECs; presented position statement to HRSA on the need for geriatric emergency preparedness training

�  2004 – now: HRSA funded 6 GECs (CA, KY, MO, NY, OH, TX), initially called the Bioterrrorism Emergency Preparedness in Aging (BTEPA) , developed inter-professional training for health professionals; continues its work today as the GEPR Collaborative ~ Consortium of NYGEC, Ohio Valley Appalachia Regional GEC, University of Kentucky, Saint Louis University Gateway GEC of MO & ILL, Stanford GEC, Stanford University, Texas Consortium GEC, and University of New England, Maine GEC.

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National Association of Geriatric Education Centers Initiative Geriatric Emergency Preparedness, Response (GEPR) Collaborative

�  2010-2015: GEPR committed to offer inter-professional geriatric preparedness programs through GECs’ HRSA funded educational activities.

�  2010-2015: Three members of the Collaborative formed a national consortium to provide a Webinars Series on Geriatric Emergency Preparedness hosted by Stanford GEC. The Ohio Valley Appalachia Regional GEC, University of Kentucky, the University of New England, Maine GEC, and Stanford GEC has offered four session and will have two more this year and six others on various topics in geriatric preparedness through the SGEC/GEPR Webinar Series program.

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8

National Consensus

The Centers for Public Health Preparedness (CPHP), 2007 (http://www.cdc.gov/phpr/cphp/centers.htm)

When resources are stretched thin, the needs of vulnerable populations are left unmet in all phases of preparedness.

9

Learning Objectives

�  Identify risk factors that heighten the vulnerability of ethnic elders specific to the Hispanic/Latino American and Vietnamese American elders with dementia and relate these factors to preparedness planning.

�  Differentiate the unique needs of Hispanic/Latino and Vietnamese elders with dementia and their caregivers that are important to developing a plan for disaster preparedness and recovery.



10

Learning Objectives (con4nued)

�  Identify at least one helpful strategy in emergency preparedness planning and response that clinicians and service providers can adapt to increase safety and survival of the cognitive impaired ethnic elders and their caregivers during a disaster.

�  Identify at least one gap in evidence-based, culturally appropriate services for preparedness planning and recovery specific to elders with dementia from Hispanic/Latino and Vietnamese communities.

11

Background

�  2007 CPHP Report on vulnerable populations. �  Vulnerability defined “the inability to access and use the

standard resources offered in disaster preparedness and planning, response, and recovery”

�  Eight vulnerable populations: ethnic and racial communities, older adults, children, the disabled, mentally ill, rural communities, economically disadvantaged, and Spanish speaking populations

12

Background

�  2012 CDC Guide “Identifying Vulnerable Older Adults a nd Legal Options for Increasing Their Protection During All-Hazards Emergencies: A Cross-Sector Guide for States and Communities”

�  “vulnerable older adults”: require additional help in an emergency such as those with limited English proficiency (LEP)

�  “at risk individuals”: for persons who have major difficulty in accessing needed public health and medical services after an emergency event (Office of the Assistant Secretary for Preparedness and Response [ASPR])

�  “four functional needs”: CMIST, an acronym for Communication, Medical care, Independence, Supervision, and Transportation.



13

Background

�  2012 CDC Guide “Identifying Vulnerable Older Adults and Legal Options for Increasing Their Protection During All-Hazards Emergencies: A Cross-Sector Guide for States and Communities”

�  “special needs populations” populations with additional needs before, during, and after an event including but not limited to the CMIST functional areas (FEMA)

�  “Individuals in need of additional response assistance may include those who have disabilities; who live in institutionalized settings; who are elderly; who are children; who are from diverse cultures; who have limited English proficiency or are non-English speaking; or who are transportation disadvantaged.” (FEMA)

14

Ethnogeriatrics Emergency Preparedness

The func4onal needs of ethnic elders who have demen4a fall into almost all of these

classifica4ons of vulnerability.

There are many gaps in scien4fic knowledge about culturally appropriate geriatric preparedness

for all-‐hazards emergencies.

Donna Benton, PhD

Dr. Donna Benton is assistant research professor at the University of Southern California, Davis School of Gerontology and Executive Director for the Caregivers Support Program based at USC. Her major research is on elder abuse and is widely published in this area. She works closely with the LA County Area Agency on Aging and the CA Commission on Aging.

15



Thuan D. Ong, MD, MPH

�  Dr. Thuan D. Ong, Assistant Professor, Division of Gerontology and

Geriatric Medicine, University of Washington is board cer4fied in Internal Medicine and Geriatric Medicine. His teaching and supervisory responsibili4es involved interns, residents, and fellows in internal medicine, geriatrics, and hospice care. His research ac4vi4es involve the development of depression educa4on resources for Vietnamese American older adults, assessment for hospice admissions and development of physician home visit program for internal medicine residents. Dr. Ong received the HRSA Geriatric Academic Career Award (2010-‐2015) and has completed in 2012, the SGEC Faculty Development Program in Ethnogeriatrics and Health Literacy.

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17

Reference

�  Centers for Disease Control and Prevention. Identifying Vulnerable Older Adults and Legal Options for Increasing Their Protection During All-Hazards Emergencies: A Cross-Sector Guide for States and Communities. Atlanta: U.S. Department of Health and Human Services.

�  2012 U.S. Department of Health and Human Services. Office for At-Risk Individuals, Behavioral Health, and Human Services Coordination (ABC). Fact Sheet. March 2009. www.phe.gov/Preparedness/planning/abc/Documents/ABC.pdf

�  Federal Emergency Management Agency. Guidance on Planning for Integration of Functional Needs Support Services in General Population Shelters. Washington, DC: U.S. Department of Homeland Security; 2010. www.fema.gov/pdf/about/odic/fnss_guidance.

18

Learning Objec4ves

�  Iden4fy risk factors that heighten the vulnerability of ethnic elders specific to the Hispanic/La4no American and Vietnamese American elders with demen4a and relate these factors to preparedness planning.

�  Differen4ate the unique needs of Hispanic/La4no and Vietnamese elders with demen4a and their caregivers that are important to developing a plan for disaster preparedness and recovery.



19

Learning Objec4ves (con4nued)

�  Iden4fy at least one helpful strategy in emergency preparedness planning and response that clinicians and service providers can adapt to increase safety and survival of the cogni4ve impaired ethnic elders and their caregivers during a disaster.

�  Iden4fy at least one gap in evidence-‐based, culturally appropriate services for preparedness planning and recovery specific to elders with demen4a from Hispanic/La4no and Vietnamese communi4es.

20

High Risk Popula4ons During Disasters

�  High risk popula4ons [Enarson E & Walsh S 2007]

◦  Older adults ◦  Low-‐income ◦  Low health-‐literacy ◦  Persons with disabili4es ◦  Medically dependent ◦  New immigrants and cultural minori4es ◦  Children and youth

�  Many of these aBributes cluster together hence exacerba4ng risk

21

Emergency Preparedness: Layers of Complexity

�  Older adults �  Demen4a �  Vietnamese Iden4ty �  Emergency Preparedness �  Meaning and Process ◦  Cultural ◦  Community ◦  Individual



22

Case Study: Hurricane Katrina, New Orleans, 2005

�  Over half of evacuees seen in medical units were ≥65y/o.

�  Of the approximately 1,200 who died ◦ Nearly 75% were >60y/o ◦  50% were ≥75y/o

Baylor College of Medicine. Recommendations for best practices in the management of elderly disaster victims. Available at: http://www.bcm.edu/pdf/bestpractices.pdf. Last accessed February 18, 2013.

23

Predisposing Characteris4cs of Older Adults

�  Chronic health condi4ons

Source: http://savingjapan.net/2011/01/17/the-

anniversary-of-the-1995-great-hanshin-earthquake-is-today/

Kario K et al. Increased coronary heart disease mortality after the Hanshin-Awaji earthquake among the older community on Awaji island. J Am Geriatri Soc 1997; 45: 610-13

24 Kario K et al. Earthquake-induced potentiation of acute risk factors in hypertensive elderly patients: possible triggering of cardiovascular events after a major earthquake. J Am Coll Cardiol 1997; 29: 926-33.



25

General Characteris4cs of Older Adults That May Magnify Impact of Stressors (Disasters) �  Chronic health condi4ons �  Physical limita4ons �  Sensory impairment �  Fixed incomes �  Paucity of social support �  Age-‐related changes

26 Hanse A et al. The effect of heat waves on mental health in a temperate Australian city. Environ Health Perspect 2008; 116: 1369-75.

86⁰F

27

General Characteris4cs of Older Adults That May Magnify Impact of Stressors (Disasters) �  Chronic health condi4ons �  Physical limita4ons �  Sensory impairment �  Fixed incomes �  Paucity of social support �  Age-‐related changes �  Cogni4ve impairment



28

Demen4a and Impact on Emergency Preparedness �  Impact on emergency preparedness dependent on: ◦ Disease severity ◦  Primary residence

Func4onal Assessment Staging Tool (FAST)* Severity Stage Assessment

Adult w/o cogni4ve decline (MMSE=29-‐30) 1 No difficul4es, either subjec4vely or objec4vely.

NL older adult w/ very mild memory loss (MMSE=29) 2 Complains of forgeqng loca4on of objects. Subjec4ve word finding difficul4es.

Early demen4a (MMSE=25) 3 Decreased job func4on and organiza4onal capacity, driving to new loca4ons.

Mild (MMSE=20-‐23) 4 Decreased ability to perform complex tasks that require planning (e.g., finances, shopping)

Moderate 5 Requires assistance in choosing proper clothing to wear for the day, season, or occasion.

Moderately severe MMSE = 0-‐9

6A B C D E

Improperly puqng on clothes (requires assistance or cuing). Unable to bathe properly (e.g., adjus4ng bath water temperature). Unable to handle mechanics of toile4ng (e.g., properly wiping). Urinary incon4nence. Fecal incon4nence.

Severe

MMSE = 0

7A B C D E F

Speech limited to ½ dozen different words or fewer during avg day. Speech limited to single intelligible word. Ambulatory ability lost (cannot walk w4hout personal assistance) Unable to sit up independently. Loss of social smile. Unable to hold head up.

*Score is highest consecutive level of disability Reisberg, B. Functional Assessment Staging (FAST). Psychopharmacology Bulletin. 1988:24: 653-659.

30

Can Individuals with Demen4a Remember Disasters? �  Kobe, Japan earthquake on January 17, 1995 �  7.2 magnitude, >6,300 deaths �  51 subjects, mean age=74y, MMSE=17, ADAS=26 �  MRIs given auer earthquake �  Semi structured interviews 2 months later

Ikeda M et al. Amnestic people with Alzheimer’s disease who remembered the Kobe earthquake. Br J Psychiatry 1998 172: 425-8



31

Emo4onal Memory is Present in Individuals with Alzheimer's Disease �  Fear reinforces memory reten4on of an event.

�  Experience of a catastrophe induce strong mental reac4ons

Ikeda M et al. Amnestic people with Alzheimer’s disease who remembered the Kobe earthquake. Br J Psychiatry 1998 172: 425-8

32

Vietnamese Culture: Generaliza4ons

�  Beliefs ◦  Folk religion ◦  Confucianism/Taosim ◦  Buddhism ◦  Catholicism/Chris4anity

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33

Vietnamese Culture: Generaliza4ons

�  General Characteris4cs ◦ Diverse socioeconomic/educa4on levels ◦ Mostly monolingual, with regional dialects ◦  Emphasis on filial piety ◦  Trust in authority figures ◦ Mul4ple traumas: physical, emo4onal, psychological

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34

Vietnamese Culture and Demen4a

�  “Normal aging”[Braun et al. 1996]

�  S4gma, shame, self-‐isola4on [Braun et al. 1996] [Hinton L et al. 2005] ◦  Asian Americans (53%) endorsed “Alzheimer’s is a form of insanity more than Anglos (16%) [Ayalon L & Arean PA. Int J Geriatr Psychiatry 2004]

◦  “Loss of face” [ Yang L. Singapore Medical Journal 2007]

◦  Cultural idioms �  Confused, crazy, loss of intellect/mind

Liu D et al. Reexamining the relationships among dementia, stigma, and aging in immigrant Chinese and Vietnamese family caregivers. J Cross Cult Gerontol 2008; 23: 283-99.

35

Vietnamese Explanatory Models of Demen4a

Tran JU & Hinton L. SGEC Webinar Series No.6: Assessment of dementia and caregiving for Vietnamese Elders. June 9, 2010

36

Perceived Barriers to Mental Health Services Following a Disaster

Rodriguez JJ & Kohn R. Use of mental health services among disaster survivors. Curr Opin Psychiatry 2008; 21: 370-78



37

Older Vietnamese-‐Americans: Vietnam War

�  Trauma & PTSD con4nue to affect mental health of displaced Vietnamese from the Vietnam War ◦  50% of Vietnamese compared to 19% of Australian-‐born popula4on

[Silove D et al. Trauma, PTSD and the longer-term mental health burden amongst Vietnamese refugees. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 467-76.]

38

Older Vietnamese-‐Americans and Cohort Analysis: Impact on Emergency Preparedness

Years Historical Events: Vietnamese American Age

55-‐65 65-‐75 75-‐85 85+

1990 •  ↑ immigra4on of elders as "followers of children.“

•  Stereotyped as freeloaders receiving special benefits.

•  Vic4ms of an4-‐refugee sen4ments.

Young adults & Middle aged

Middle aged & Young Old

Young old & Old

Old

1980 •  Con4nued influx of immigrants. •  Immigra4on, 2nd wave, many auer long

periods in refugee camps •  Increased diversifica4on of popula4on.


Middle aged & Young Old

Young Old & Old

Old

1970 •  1st wave: former elite South Vietnamese. •  2md wave: diverse cross sec4on from

unified Vietnam. •  1979-‐80, 100K Vietnamese enter the U.S. •  1975, 130K Vietnamese refugees to U.S. •  1975 -‐ fall of Saigon

Adolescents & Young Adults


Middle aged & Young old

Young old & Old

[Yeo et al. Cohort analysis as a tool in enthnogeriatrics. 1999. Stanford Geriatric Education Center.]

39

Vietnamese Culture: Emergency Preparedness

�  Impact – Frame of reference ◦  Floods from typhoons ◦  Earthquakes ◦  Tsunamis [Ca VT & Xuyen ND. Tsunami risk along Vietnamese coast. J Water Resources Environ Engineering 2008; 23:

24-‐33]

�  Supers44ons ◦  Belief or prac4ce based on the opera4on of supernatural or magical forces [Corsini RJ. Dic4onary of psychology. 2002]

�  Fatalis4c �  Beliefs



40

Is The Threat Real?

Flooding in Thach Thinh district. October 6, 2007. Flooding in central and northern regions. S

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41

Case Study: Hurricane Katrina, New Orleans, 2005

�  42% Vietnamese refugees and immigrants �  1/3 living below poverty line [U.S. Census Bureau 2000] �  2nd forced displacement �  7month post-‐Katrina structured interviews & self reported sociodemographic ◦  Impact of Event Scale-‐Revised (IES-‐R) ◦  SF36 version 2 ◦  History of Trauma4c Event Exposure Scale ◦  Perceived Social Support Scale Chen AC et al. Hurricane Katrina: prior trauma, poverty, and health among Vietnamese-American survivors. Int Nurs Rev 2007; 54: 324-31.

42

Vietnamese Americans & Hurricane Katrina

�  Greater the impact of prior trauma, the poorer physical health

�  Higher the financial hardship, the poorer mental health �  Less acculturated Vietnamese had greater PTSD symptoms and poorer physical health

Chen AC et al. Hurricane Katrina: prior trauma, poverty, and health among Vietnamese-American survivors. Int Nurs Rev 2007; 54: 324-31.



43

Lessons Learned: Vietnamese Americans in Hurricane Katrina �  Low levels of PTSD ◦  ‘it is harder leaving from your culture. Hurricane is nothing. In the hurricane, you have your family with you all the 4me.’

�  Support came from family, friends, church �  Language proficiency an integral barrier to access �  Many evacuated with religious leaders ◦  Proficient in Vietnamese & English language

Chen AC et al. Hurricane Katrina: prior trauma, poverty, and health among Vietnamese-American survivors. Int Nurs Rev 2007; 54: 324-31.

44

Possible Needs of Frail Older Adults �  Func4onal impairments ◦  Mobility ◦  Sensory impairments ◦  Environmental modifica4ons

�  Dietary needs ◦  Dysphagia diets ◦  Nutri4onal content

�  Pre-‐exis4ng medical condi4ons ◦  Access to medica4ons ◦  Access to medical equipment (eg. oxygen, catheters) ◦  Access to medical records and contact informa4on

�  Update assessments annually �  Enroll in MedicAlert with those with cogni4ve impairment

45

SWiFT: Triage Tool for Vulnerable Older Adults

�  Seniors Without Families Team (SWiFT) �  13 item rapid needs assessment �  Social worker and medical personnel �  Piloted during Hurricane Katrina �  3-‐10 minutes

Dyer CB et al. SWiFT: a rapid triage tool for vulnerable older adults in disaster situations. Disaster Med Public Health Preparedness. 2008; 2(suppl W): S45-50.



46

47 Dyer CB et al. SWiFT: a rapid triage tool for vulnerable older adults in disaster situations. Disaster Med Public Health Preparedness. 2008; 2(suppl W): S45-50.

48

Recommenda4ons: Emergency Preparedness Planning for Frail Older Adults �  Hand-‐held two way radios for communica4on �  Assess and address the needs of older adults’ caregivers ◦  Respite needs to fulfill other roles

�  Urinary incon4nence supplies ◦  Adult pads ◦  Gloves ◦  Cleaning supplies

�  Medica4ons �  Nutri4onally balanced meals �  Appropriately textured foods �  ABen4on to sensory impairment �  Lanyard: Photo ID, primary language, medica4on list, medical problems, PMD, func4onal

limita4ons, family/friend contacts



49

Conclusion

�  Emergency preparedness requires understanding of ◦  The individual ◦  The community an individual lives in in ◦  Their beliefs and percep4on of threat

Donna Benton, Ph.D

Dr. Donna Benton is currently an assistant research professor of gerontology at the University of Southern California (USC) -‐ Andrus Gerontology Center . She is Director for the Family Caregiver Support Program at USC Davis School of Gerontology. She works on issues

related to caregivers, demen4a and elder abuse.

50

51

Learning Objec4ves

�  Par4cipant will beBer understand the needs of La4no and African American caregivers for emergency prepara4on.

�  Par4cipant will be able to iden4fy gaps in services for La4no and African American caregivers in their community.



52

Who is a caregiver?

�  A caregiver is an unpaid individual (a spouse, partner, family member, friend, or neighbor) involved in helping someone with ac4vi4es of daily living, and/or medical tasks and care.

�  65.7 million caregivers (29% of the U.S. adult popula4on) provide care to someone who is ill, disabled or aged. ◦  43.5 million of adult family caregivers care for someone 50+ years of age

53

Caregivers at Home

�  Caregivers perform medical & nursing tasks. �  Provided ac4vi4es of daily living (ADL's) supports (e.g., personal hygiene, dressing/undressing, or geqng in and out of bed) or

�  Instrumental ac4vi4es of daily living (IADL's) (e.g., taking prescribed medica4ons, shopping for groceries, transporta4on or using technology) supports

�  Combina4on of all of the above

54

Caregivers and Technology �  Caregivers are significantly more likely than other internet users to search for health informa4on on behalf of the person they are helping.

�  Caregivers under 50 are more likely to use caregiving technology.

�  Racial and ethnic minori4es 50+ are likely to rate technology as helpful (compared to non-‐minori4es of same age)

�  Caregivers more tech savvy, with most using cell phone and having internet access or seeking social support and medical informa4on



55

African American Caregivers �  Na4onal study on caregivers suggest that African-‐American caregivers were on average older than their counterparts (48.0),

�  More likely to be single or never married �  More than half of African-‐American caregivers find themselves "sandwiched" between caring for an older person, and a younger person under age 18

�  Caring for more than one older person. �  More likely to live with the care recipient �  About 66 percent are employed full or part-‐4me.

56

La4no/Hispanic Caregivers

�  12 percent of adults are family caregivers �  La4no/Hispanic caregivers more likely to rate their health as fair or poor compared to others

�  Need family focused interven4ons �  Language appropriate materials

57

What would you suggest?

�  A 58 year old La4na is caring for her mother with demen4a. The caregiver works part-‐4me from 9-‐1pm. The caregiver lives with her mother, who s4ll is able to walk but ouen forgets to turn off the stove if she cooks. The mother also answers the phone but does not always remember who called.

�  The daughter want to make an emergency plan, what would you suggest?



58

Disaster Preparedness Class for Caregivers

�  Three telephone conference calls ◦  All in English but one presenter able to present in Spanish

�  Used materials from LA City Area Agency on Aging �  Provided caregiver focused 4ps for prepara4on �  Evalua4on: simple survey asking pre and post call knowledge and planning for emergencies

59

Examples for Caregiver Focused C.A.L.M.#

�  Have ICE* that includes that you are Caregiver �  Dual registra4on of self and care receiver �  More focus on medica4on and special diet needs in kits �  Have local emergency responders (fire fighters) know about the caregiving situa4on

�  Have easy access to medical informa4on by family and friends who are caregivers?

�  An4cipate changes in cogni4on during an emergency # Caregivers are Learning More; *In Case of Emergency

60

Evalua4on Results: Pre-‐Post Survey �  There were 23 caregivers on three Preparedness phone calls. ◦  20% were La4no, 80% English (African American and non-‐minority) ◦  40% returned the evalua4on of 4 ques4ons

�  Evalua4on asked ◦  Do you feel beBer prepared, did you know less pre talk, can you develop a plan, can you talk to others ◦  100% of those surveys (English and Spanish) agreed that they were more prepared, knew less pre than post, can make a plan and are beBer able to talk with others.

�  This was a selec4ve, very quick survey but suggest it is a good topic for caregivers.



Prac4ce Tips for Care Professionals

� Work with local emergency responders to collaborate on adding content or a power point slide specific to diverse ethnic caregivers and other caregivers

�  Have presenta4ons available for limited English speakers

� Use low-‐tech informa4on access like phone and local talks

61

# Caregivers are Learning More 62

hBp://www.deep.med.miami.edu/x21.xml

�  “Disaster Preparedness Guide: Plan, Prepare, Prac4ce, Protect”; “Cuando el Desastre LLega, estas preparado?Preparando a lo familia ante un Desastre”

A comprehensive guide to preparing one’s self and their family for a disaster wriBen fully in Spanish. Includes various checklists for what materials to have during a disaster, emergency contacts for Broward and Miami regions, and what one should know auer the disaster occurs. The guide is completely free and downloadable.


Resources: Spanish and English �  Just in Case: Emergency Preparedness for Older Adults and Caregivers

�  This 12-‐page fact sheet provides step-‐by-‐step informa4on on how older adults should prepare for a disaster/emergency. It includes helpful checklists, contact lists, and a medica4on list that can be filled in.

�  hBp://aoa.gov/AoARoot/AoA_Programs/HCLTC/Caregiver/docs/SpanishDisasterReadiness.pdf Spanish

�  hBp://aoa.gov/AoARoot/AoA_Programs/HCLTC/Caregiver/docs/Just_in_Case030706_links.pdf English




Resources: Spanish and Other Languages

�  hBp://www.healthyroadsmedia.org/topics/emergencies.htm has audiovideos on preparedness topics

�  Na4onal Resource Center on Diversity Preparedness, a clearinghouse of informa4on on emergency preparedness in culturally diverse communi4es.

�  hBp://www.diversitypreparedness.org/ �  hBp://www.diversitypreparedness.org/Resources/23/resourcetypeid-‐-‐7782/

65

References �  The Na>onal Alliance for Caregiving and AARP (2009), Caregiving in the U.S., Bethesda, MD: Na>onal Alliance for Caregiving. Washington, D.C.

�  Alzheimer's Associa>on, 2011 Alzheimer's Disease Facts and Figures, Alzheimer's and Demen>a , Vol.7, Issue 2.

�  Fact Sheet : Selected Caregiver Sta4s4cs Family Caregiver Alliance with funding provided by the Administra4on on Aging (AoA). Copyright © 2012 Family Caregiver Alliance. All rights reserved.

�  Home Alone: Family Caregivers Providing Complex Chronic Care, AARP with United Health Hospital Fund October 2012

�  hBp://aging.lacity.org/emergency-‐preparedness/

66

References

�  Pew Research Center's Internet & American Life Project, Family Caregivers Online, July 2012. Caregivers in the U.S.

�  e-‐connected Family Caregiver: Bringing Caregiving into the 21st Century . Na>onal Alliance for Caregiving with United Health Care, 2011

�  Pew Research Center's Pew Internet & American Life Project: Family Caregivers Online: The Internet is an Integral Part of the Lives of People who Care for Loved Ones, July 2012



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