Elderly Population in Disasters

Abstract

Calamities within communities are unpredictable. Various interventions are appropriate during disaster response initiatives. Medical interventions include some of the vital response initiatives during disasters. There are eminent complications in the practice of geriatric medicine. The practice of geriatric medicine within disaster situations remain complicated (Smythe 1997, p. 53). There are eminent challenges in this practice. These include prescription and dispensation of medicine. Pharmacists and other clinical professionals face challenges in executing vital medical services. There are various considerations to be undertaken in the delivery of geriatric health services. Particularly, this is applicable within disaster situations. The health conditions of the elderly persons are important. They are more susceptible to risky conditions within the general environment. Apart from this, the elderly have compromised immune systems. These vulnerability factors may be attributed to their advanced age (Osgood 1992, p. 14). Therefore, great care must be taken to observe the clinical procedures involved in this practice.

Notably, there are few specialists within the field of disaster medicine. This is one of the challenges of geriatric medical intervention during disasters. There is a notable need for collective action and engagement of different sectors in the disaster response initiatives. Capacity building is important. Particularly, this is appropriate for the health care professionals. Additionally, other stakeholders should have adequate training and awareness on the concept of disaster management. Extensive investigations on prescription and dispensation of geriatric medical services in disasters are necessary (Pathy 2006, p. 124). This explains the basic focus of this research paper. In order to explicitly unearth the challenges eminent in this field, relevant investigations must employ strategic measures. These include the application of relevant procedures, methods and design. Ethical concerns must also be addressed adequately.

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Introduction with Overview of Pertinent Literature

A disaster refers to the sudden catastrophic occurrence that has the capacity to affect the entire community. Notably, disasters may severely disrupt the operations and processes within a particular society (Adelman & Legg 2009, p. 34). Normally, disasters have the potential to cause human, material or economic losses. Disasters also cause negative or detrimental impacts on the general environment. Usually, the disasters occur in a magnitude that surpasses the society’s capacity or competency to cope up with. They may not remedy the situation. In most disasters, the community may not be able to remedy the conditions using their own resources. Therefore, there is always an eminent need to have external assistance during massive disasters. Technological disasters are mostly caused by the anthropogenic activities. There are many other forms of disasters within this category. On the other hand, the natural disasters include those that are generated or propagated by the forces of nature (Beebe & Funk 2001, p. 56). The natural processes that can cause severe disasters within populations include earthquakes, volcanic processes and tectonic plate movements.

Indicatively, disasters may cause significant disruptions within the normal systems in a community. These disruptions always vary in accordance to the magnitude and type of disaster. There are several impacts of disasters on the general systems within any society. Disasters may hinder the processes involved in the medical supply systems. There are particular segments of the general population that are highly vulnerable to these disasters (Bowker, Price & Smith 2012, p. 45). For instance, the elderly persons lack the capacity to rescue themselves. Moreover, they do not have the physical strengths to counteract the severe impacts of any disaster. This is unlike the youthful generation. Instead, it is noteworthy to indicate that the elderly persons get more compromised by these disasters. Emergency response teams have always strived to investigate and implement or practice proper rescue procedures. Particularly, this is important to be practiced while responding to disasters within elderly populations (Warchal & Graham 2011, p. 40).

Basically, the description and dispensation of medication to elderly persons during disasters remain critical. It is increasingly becoming observable that the elderly persons need specialized medical attention during disaster response initiatives. Apart from this, the medical treatment considerations must be adequately addressed. This observation is applicable within the disaster response and mitigation plans. Observably, there are a lot of considerations in practicing geriatric medicine during disasters. This is largely attributed to the high level of susceptibility of the elderly population to the effects of disasters. It is widely indicated that small disasters always cause huge and intensive disasters (Fernandez, Byard, Lin, Benson & Barbera 2002, p. 70). The basic fact reinforcing this postulation is the capacity to handle all the emergent medical and social needs of the entire affected population.

Principally, this must be considered during the managment of the elderly patients. There are many confused actions that might be encountered during the process of disaster response. For instance, the elderly people might be trying to move to other secure places. In this process, they might increasingly get susceptible to other secondary disasters and calamities. Therefore, geriatric medicine during disasters requires a comprehensive approach. There is need for a highly responsive and transformative medical team (Coakley 1981, p. 59). The triage process must also be conducted in regard to the highly compromised elderly individuals. Some of the basic considerations might also include the application of appropriate medical attention and services. Particularly, these processes must be observed during the critical phases such as the evacuation stage. These help in maintaining the elderly patients within stable and appropriate state of wellbeing. The clinicians involved in the medical rescue during disasters must be specially trained and briefed on the concept of geriatric medicine and disasters. Apart from this, the engagement and training of pharmacists is important. These medical personalities must operate as a team (Wilken, Bobroff & Minton 2012).

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Teamwork is important in the processes of prescription and medication. Additionally, individuals are more likely to execute basic medical services within shorter durations. This means that teamwork for medical practitioners during disasters increase the level of disaster mitigation and prevention of impacts. The basic principles applied within the critical care wards are very applicable and appropriate within the processes of handling elderly persons medically during disasters. The elderly persons require more prescriptions. This also applies to other non-prescription medicines (Cefalu & Schwartz 2007, p. 595). The trend is relative to all other age segments. Accordingly, they require considerable assistance in accessing and utilizing the available medications. The disaster conditions make this observation worse.

Processes involved in medication and regimen preparations are more intricate and complex. Injection refers to one of the important medical methodologies applied in the management of elderly persons. Other than these, the inhaled as well as the ocular preparations are important in the practice of geriatric medicine. Another important group of medications include the orally taken prescriptions. These may require additional input such as crushing or mixing with other liquids. These processes indicate the levels of complexities involved in the preparation of medication for elderly persons. It is important that the elderly persons have limited capacity to comply with basic prescriptions. Ideally, this situation is observable even within normal or disaster-free periods. There is a general observation that these people have severe events associated with drugs. This might be comparable to all other age groups within the general population. Basically, caution is necessary in the process of disaster managment.

There are many factors that might lead to the observation. Observably, most physicians and pharmacists do not recognize the particular types of medications that are more dangerous and not appropriate for the elderly persons (Cassel 2003, p. 45). There are several notable investigations within this domain. Consequently, these investigations have depicted diverse results. For example, some studies indicate that an almost average percentage of the severe adverse reactions to drugs observed within the elderly individuals can be effectively prevented. The application of new doses or therapeutic processes during disasters is not recommended (Sollitto 2012). Basically, this is because there is limited time for the required extra caution. There is an important need for the clinicians and pharmacists to exercise greater caution while handling these new therapies. During critical disaster events, the access or compliance to medication procedures and regimens may be worsened or exacerbated by diverse factors.

For instance, it is notable that during disasters, there is lack of important medical services. Notably, even some of the fundamental social services remain largely inaccessible (Heumann, Mccall & Boldy 2000, p. 67). The elderly persons are more prone and susceptible to disastrous conditions. This is because they lack the caregivers or personal caretakers that can usually look after them. Therefore, they are more likely to arrive at medical facilities or referral centres minus their personal medications. In addition, during disasters, the elderly persons might not be in a position to provide necessary and vital information regarding their medical history. Furthermore, they are always incompetent to describe their previously prescribed regimen without the assistance of the caregiver. These conditions make it tough for the pharmacists and other relevant clinicians to assess the basic medical demands of the elderly person (Settersten & Angel 2011, p. 45). They are also incapable of providing the most preferred or appropriate medication to the clients.

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Generally, there are evident disparities in the distribution and availability of medical personnel within most countries. Agreeably, this critical condition is widely notable within the developing nations. In overall situations, the shortage of the health care personnel that have geriatric training is eminent. This condition is more likely to enhance the likelihood of occurrence of severe effects of the prescribed drugs amongst the elderly persons (Mccoy & Paul 2011). An effective planning process is applicable in the comprehensive medical management of the elderly population in disasters. A clear inventory outlining basic guidelines for both the important inpatient together with outpatient regimens must be drafted. As indicated within some investigation, teamwork and inclusive participation of all relevant stakeholders is appropriate (Cress 2012 p. 112). For example, through participation, the visiting rescue team within a disaster location may achieve a lot.

They are able to identify the caregivers, search for and find the potentially affected categories of elderly persons. These initiatives also assist in the management of the processes involved in medical triage within a disaster situation. There are basic roles or obligations to be undertaken by the relevant pharmaceutical specialists within hospital settings (Thomas 2001, p. 91). They have to sustain the supplies of the drugs that are specifically meant for disaster. These drugs must be maintained in appropriate conditions for the elderly. Apart from these stated roles, these pharmacists must strive to develop systems that enable the admissibility of the elderly persons from disaster situations into the hospital. There are fundamental observations to be considered in the period of medication and hospitalization of these elderly patients. They must be provided with adequate time and chance of access to critical medications. These might include the medications that are taken on a daily basis (Goldstraw, Strivens, Kennett, Lie, Geddes & Thwaites 2012, p. 50). It is also appropriate for the relevant medical care providers to stock the least dosage tablets. The process might also consider other special formulations. Particularly, the formulations of frequently applied medications must be considered to ensure a complete presence of dosage.

Liquid preparations include some of the most commonly applied medications for the elderly persons. The scored and crushable pills also form important forms of the common medications that are generally applicable within these processes. There are other basic procedures that must be considered in the medical management of the elderly persons (Ito 2012, p. 78). The health care providers must ensure that they have an extra supply of the predominantly prescribed drugs. Principally, such vital supplies must be applicable within the outpatient medication systems. These might be used or needed by medically stable elderly patients or clients. They still need these important drugs even as they wait for their discharge. It is important for the health care providers to acquaint themselves with the basic principles and guidelines of prescriptions and drug administration.

Particularly, these processes must be observed and adhered to in relation or with regard to the basic principles of geriatric medicine (Miller 2009). The involvement of hospital administration, clinical departments and the general disaster response teams are important. The clinicians and other relevant personalities involved in disaster reduction and response must be adequately trained. The fundamental procedures and guidelines in geriatric prescriptions must be given adequate attention and emphasis. The methods of drug administration in geriatric medicine are very different from those utilized within other medical interventions. Therefore, the elderly persons within disaster points and locations must be treated and managed with explicit caution (Bowling & Ebrahim 2005, p. 76). Development of appropriate tools and training or capacity building manuals must be given priority. It is notable that the elderly population has increasingly been sidelined in most government and public policies. The accessibility of these policies and training manual is important.

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The development and exercise of drills on medical response and basic life support initiatives in disasters is vital. This is appropriate for all the response team members and other related stakeholders (Uscher-Pines 2009, p. 89). The provision of basic medical equipment and specialized gadgets for handling the elderly persons in disasters is important. This means that financial interventions and effective procurement approaches are appropriate. Particularly, this is applicable if safety concerns are to be addressed in the disaster situations. Depending on the level of severity of the impacts of a particular disaster, the medical prescriptions and drug administration might be done anywhere (Grimley Evans 2000, p. 164). However, it must be noted that there are other complex procedures that must be conducted within specialized destinations. Generally, prescription and dispensation of medicine for the elderly population in disaster situations involves a lot of considerations. There is need for additional investigations into the most appropriate mechanisms for handling these issues.

Research Aims or Objectives or Questions

The proposed research has specific objectives and goal. The study is focused in determining the major factors influencing the effective prescription and medication for the elderly. The disaster areas or situations remain as the context of the proposed study (Zellmer 2002, p. 71). Notably, there exists a lot of loopholes in the prescription and medication in the context of geriatric medicine during disasters. The research seeks to assess the efficiency of the prescription and dispensation of medication to the elderly persons during disaster situations. The aim of the research originates from the observation of lack of effective geriatric medical services. The investigation seeks to unearth the various limitations within the field of geriatric medicine in disaster situations.

Basically, the study seeks to examine the various medical personnel involved in these processes (Gallo 2006, p. 112). Some segment of sampled elderly persons might also provide critical information. The proposed investigation also intends to reveal the disparities that exist in the dispensation of the geriatric medication within disaster prone areas. It is critical to assess the capacities of the various medical care providers. Therefore, another vital objective is to identify the potential weaknesses within the geriatric medicine. Particularly, this relates to the disaster responses team. The following are some of the questions for the proposed study:

  1. What are the capacity limitations notable within medical teams involved in the prescription and dispensation of medication for the elderly during disasters?
  2. What are the basic challenges affecting the elderly persons during disasters in relation to prescription and medication?

Proposed Design, Methods, Procedures

Purposive sampling technique is applicable in the proposed study. This is because of the variation in the distribution of medical personnel specialized in geriatric medicine. Certain segment of the elderly population must also be involved in the study. This is because they have the capacity to provide the required information. Particularly, they must be targeted to reveal information or their perception on the medical management procedures during disasters. Random sampling of the already purposively sampled population must be done. Basically, this process is critical. This is because random sampling enables an equal representation chance for all purposively selected participants (Fowler 2002, p. 22). The sample size will be considerably small. There are limitations such as financial inadequacies that might play a significant role in lowering the sample size.

The application of empirical strategies in the determination of the sample size in the proposed study is critical. The application of these empirical processes shall be important (Snyder & Christmas 2003, p. 43). This is because the proposed sample population is supposed to be not more than five thousand. It is important to note both the inclusion as well as exclusion approaches. The basic inclusion criterion to be applied in the proposed study is eminent. This depends on whether the participants to be enrolled form part of the elderly population or not. On the other hand, the medical professionals involved in the prescription and dispensation of medication must be included. This is because they are the group meant to be assessed in terms of the present competencies in handling geriatric conditions during disasters (Fulde 2009, p. 77). These include some of the criteria that must be applied in the enrolment of participants. Generally, the application of qualitative and quantitative investigative strategies must be considered in the proposed research.

The combination of the two approaches remains critical. As indicated by other studies and investigators, the strategy reinforces the process of triangulation. In this mixed systems, it is important to ensure the application of appropriate study instruments. For instance, structured questionnaires must be developed. Basically, these questionnaires shall be used in gathering quantitative information (Troy 2005, p. 61). There is a notable capacity of the mixed system of approach to provide in depth data and quality results. Observably, this approach has been applied within diverse investigative domains. This is due to its ability to provide appropriate outcomes and reflective data. The proposed study approach requires a properly defined research aims and objectives. Apart from these, an explicit definition of the basic research questions is necessary. Other than the structured surveys, it is vital to recognize the significance of unstructured interviews. To reinforce the qualitative strategies, semi-structured interviews must be applied in the study (Hucker 2001, p. 56). There are other notable qualitative approaches to be applied in the proposed investigation. Focus group discussions as well as key informant approaches might be applied.

Principally, the qualitative approaches are important in diverse ways. For example, they enable the investigators to examine some of the intrinsic views about the subject of investigation. The key informant interviews must explicitly target the important participants. These are participants who are regarded to have critical information about the issues under investigation. They have the capacity to provide information that is lacked by the normal lay man. Some of the clinicians, pharmacists and other departmental managers may be categorized as key informants. It is important to establish discussion groups during the administration of most qualitative tools. However, it is important to note that the key informant interviews have to be conducted in person-to-person (Rai & Mulley 2007, p. 36). The process shall involve the establishment of candid conversations between the investigators and the key informants. The proposed study shall initiate contact with the regional disaster management committees or groups. This is because they are key informants. They have the capacity to provide essential information regarding disaster and issues of geriatric medicine.

Sampling processes are critical. Particularly, they are most appropriate for empirical investigations. Therefore, it is vital to employ significant sampling strategies for the proposed investigation. The proposed study must apply purposive sampling for effective data collection and results. The proposed study is set to employ a general cross-examination approach in the investigation of the outlined research questions (Jarrett, Rockwood & Carver 1995, p. 1062). Basic empirical procedures must be applied in the proposed study. For instance, an appropriate mathematical formula must be applied in the computation of the study sample size. The will be an eminent application of various statistical approaches in testing the reliability as well as validity of various variables. Other important processes to be observed include personal observations. The proposed study must apply robust empirical approaches for data analysis. Structured questionnaires will be administered both to the elderly persons and the medical practitioners (Zhang, Shi, Wang & Liu 2012, p. 65). It is important to note that the clinicians and the pharmacists must be assessed differently. This is due to the fact that they have different roles in the management of elderly patients.

Generally, prescription and dispensation services are rightfully left for the pharmacists. Those providing care to the elderly include some of the important participants. They have vital information regarding the elderly persons. These might include information about their medical history and nature of complication in their health. The data collection tools to be applied in the proposed study will target diverse issues (Mindell & Hopkins 2003, p. 74). Some tools will focus in testing the knowledge of the pharmacists concerning the appropriate medication for the elderly. Others might also aim to investigate the efficiency of the basic processes. As part of the observatory assessments, the application of drills and simulation processes in the proposed study will be critical. The drills are to be conducted for hypothetical situations of disaster. The observations are critical because they help in the identification of existing gaps (Toner, Mierswa & Howe 2010, p. 17). It is important to note the gaps existing in the processes of disaster response and the practice of geriatric medicine.

Proposed Data Analysis or Evidence Analysis or Reflective Analysis Techniques or Processes

Data analysis is an important stage in the research process. Basically, it plays a significant role in determining the type of information drawn from an investigation. The proposed research applies both the qualitative and the quantitative approaches (Lane, Sorondo & Kelly 2003, p. 248). The basic implication is that during data analysis, these approaches have to be considered. Therefore, the analysis of the raw data has to be done both qualitatively and quantitatively. The application of qualitative analysis techniques shall entail a lot of considerations. For instance, descriptive essays and literature indicating the various notable trends will be applicable. The qualitative description or analysis approaches are also important in the presentation of observational factors. As already outlined, there will be an evident application of observation techniques during the data gathering processes. The observed information must be adequately recorded and analyzed qualitatively.

Analysis of the information contained in the recorded individual stories from the study is possible through the use of descriptive essays (Gosney, Harper & Conroy 2012, p. 111). The proposed study must also incorporate the quantitative approaches in the analysis of data. The utilization of quantitative procedures in data analysis will involve the integration of diverse approaches. For instance, there must be diverse mathematical applications. The use of important statistical approaches in the analysis of quantitative data is important. The proposed study will apply the statistical package for social sciences, SPSS in the analysis of the quantitative data. This is a basic statistical analysis technique that has been increasingly applied in the processes of data management. This approach shall provide the notable disparities within the significant ratios and percentages. There is set to be an eminent use of quantitative bar graphs, charts as well as proportionate circles. These are basic quantitative data presentation mechanisms that have been used in various investigations (Rubin & Babbie 2010, p. 40).

It is imperative to indicate the complementing role of these two procedures or mechanisms of data analysis. Indicatively, both the qualitative and quantitative approaches have the capacity to complement one another. For instance, for the proposed study, qualitative descriptions will be applied in the reinforcement of quantitatively analyzed data (Moini 2010, p. 81). Quantitative analysis may involve the application of tabulations and distribution tables. Various statistical approaches including the analysis of variance and regression analysis must be applied (Wongpakaran & Wongpakaran 2012, p.15). Apart from these, the application of correlation analysis might be appropriate. Particularly, this is applicable in the determination of the level of association of important variables that have been identified in the investigation. The development of appropriate matrix in the analysis of qualitative information remains applicable in the proposed study. Such matrices have been widely applied in the process of data analysis. The proposed methodology for data managment must follow a clear and logical approach. Observably, this is important in delivering concise outcomes or results from the investigation. The investigators will apply logical data presentation strategies in the reporting of the outcomes of the proposed study.

There are several initial processes that must be observed prior to the analysis of the collected data. Some of these include data entry and coding procedures. In addition, the data cleaning processes are important (Brody 2012). These are some of the procedures undertaken by the investigators to enhance the proper managment of available data. The analysis of vital information available from other sources is important. These sources might include external information, related to the topic of study. Comparisons also form critical components of the data analysis procedures. The proposed investigation will apply comparison in the analysis of the various elements or factors influencing the subject of investigation (Roe & Webb1998, p. 66). The proposed study is also focused in the examination and application of other alternative methodologies. Generally, an effective data management system must be applied in the analysis stage of the investigation. The already analyzed data must be presented through diverse statistical methodologies. This is important to provide the viewers or consumers of the information with a wide base of options. These options are critical in the comprehension of the analyzed information.

Overview of Ethical Issues

Ethical issues must be comprehensively addressed in all studies. The proposed study seeks to dwell on a very sensitive area. The field of geriatric medicine requires a comprehensive consideration of all ethical concerns. This is because it involves the elderly population (Kreimer & Arnold 2003, p. 56). Analytically, it is observable that most elderly persons suffer from different complications. These are mostly associated with their advanced age. Foremost, the concept of informed consent must be adequately addressed in the proposed study. The enrolled participants will be adequately briefed on the basic principles and objectives of the research. These include the clear explanations of the aims, objectives, and benefits of the intended investigation. Apart from ensuring appropriate disclosure to the elderly persons, the relevant clinicians must also be informed appropriately. It is important to address the concept of benefit and risks to be encountered in course or after the investigation.

Notably, some groups of the elderly persons might not be in a position to provide full informed consent (Farsi, Dehghan-Nayeri, Negarandeh & Broomand 2010, p. 10). In such cases, it would be necessary to involve the care providers. However, it might also be appropriate to consult the immediate neighbours and relatives. These initiatives are important in diverse ways. For instance, the care providers have critical information regarding the history and experiences of these elderly persons (Shi 2008, p. 61). Apart from this, they might also have their Biodata. This notification may also be applicable to the relatives of the incapacitated elders. Basically, full disclosure of the study focus by the research assistants involved in the study is important. No participants must be enrolled without full and legal consent. The investigator must realize the significance of observing these principles in the course of the study. The proposed study must also meet the various legal requirements within the study area. This should be ensured through the use of proper introductory letters that explain the importance and focus of the proposed study (Hogan & Burstein 2007, p. 60).

Forced proscription of the study participants is illegal. However, the proposed study shall not engage in the inducement of the intended participants. This is important because the inducement methodology is more likely to adversely affect the study results. For instance, the induced respondents might distort the quality of the intended data. This might occur by the provision of falsified information to the various interviewers. Confidentiality refers to the other ethical concern to be addressed by the proposed study. Care must be taken to guarantee the participants full confidentiality during the process of providing the informed consent. Ideally, certain information required from the participants might be very sensitive. This requires a lot of privacy and confidentiality to be observed (Lewin 2011, p. 72). Therefore, the proposed research must assure the participants that their names shall be confidential. It is important to assure non-disclosure of the information. This is because it helps to build the appropriate confidence among the intended participants of the proposed study.

Identified Impact/Outcomes

The outcomes of a study are very important. This is because they reflect on the solution strategies and methodologies for improvement. The outcomes of this proposed study largely depend on the focus of the investigation. This explains why it is necessary to ensure that the research objectives are comprehensively stated. The outcomes of the proposed study must identify the various points of weaknesses eminent in the study topic (Coppola 2011, p. 78). There must be an adequate articulation and presentation of the targeted concerns. There must be a clear presentation of issues regarding the challenges encountered by the elderly patients. Apart from these, the needs and various gaps eminent on the side of emergency geriatric medical response team must be presented. Proper presentation of the outcomes or identified impacts is important. This enables various consumers of the information from the findings to be able to gain a comprehensive understanding. The outcomes must also be presented in a neat and factual manner (Moini 2009, p. 90). Discussions on the analyzed data have to focus on solution of the challenges. Arguably, the content of the outcomes remain more versatile. Indicatively, these are the fundamental reasons for undertaking an investigation.

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