Rapid assessment of the needs and health status of older adults after Hurricane—Charley Charlotte, DeSoto, and Hardee Counties, Florida, August 27-31, 2004

Morbidity and Mortality Weekly Report, Sept 17, 2004 by B. Little, J. Gill, J. Schulte, S. Young, J Horton, L Harris, D Batts-Osborne, C. Sanchez, J. Malilay, T. Bayleyegn

On August 13, 2004, Hurricane Charley, a Category 4 storm with sustained winds of 145 mph, made landfall at a Gulf of Mexico barrier island in Florida, resulting in an estimated 31 deaths statewide and extensive property damage in Charlotte, DeSoto, and Hardee counties. The Florida Department of Health (FLDOH) requested that CDC conduct a rapid needs assessment of older adults (i.e., aged [greater then or equal to]60 years) because this vulnerable age group constitutes a substantial proportion of the population in the most severely affected counties (Charlotte County [43% older adult residents of 141,627 total population], DeSoto County [24% of 32,209], and Hardee County [18% of 36,938]) (1). This report summarizes the findings and recommendations from three rapid needs assessments in these Florida counties. Older adult residents experienced disruptions in both quality-of-life status and medical care for preexisting conditions (e.g., cardiovascular disease, diabetes, and physical disabilities). On the basis of these findings, recommendations were provided to FLDOH for immediate use in deploying resources for response to Hurricane Charley and in planning responses to future disasters.

The objectives of the assessment were to 1) characterize post-hurricane living conditions, 2) identify and evaluate immediate needs (e.g., access to basic services and health care), 3) provide recommendations for managing emergency response and recovery, and 4) provide expertise on disaster response and training on rapid needs assessment. Separate assessments were conducted in each county because Charlotte, DeSoto, and Hardee counties differ in population size, demographics, and socioeconomic status. Census blocks within each county were grouped into clusters of five and weighted by the number of housing units with an older adult resident (1). By using probability proportionate to housing units with an older adult resident, 30 clusters and several replacement clusters were selected without replacement in each county. The clusters were representative of 38,301 (Charlotte), 4,909 (DeSoto), and 3,134 (Hardee) housing units with an older adult resident.

Street maps of census blocks were printed and provided to 10 assessment teams. Teams consisted of volunteers (e.g., nurses and epidemiologists) from county health departments and FLDOH and CDC personnel. Teams began in the central area of each assigned cluster, chose a random direction in which to proceed, moved sequentially along roadways to identify individual housing units, and attempted to conduct an interview with a household representative at seven homes with an older adult resident in each cluster. Survey teams conducted interviews in Charlotte County on August 27, in DeSoto County on August 28, and in Hardee County during August 29-31.

Assessment teams administered a questionnaire to household respondents about 1) dwelling type and structural damage; 2) utilities and services (e.g., water, electricity, telephone, garbage, and transportation); 3) injuries and illnesses incurred since the hurricane; 4) the impact of the hurricane on home health-care services (e.g., meal service, dressing changes, and delivery of supplies such as oxygen) and social support networks (e.g., group memberships, church activities, and regular social activities); 5) access to food and finances for immediate needs; and 6) the use of disaster-relief services. Household respondents also were asked about whether any older adult household members had preexisting disabilities, impairments, or health conditions and whether the hurricane exacerbated these conditions or prevented receipt of routine care. EpiInfo 2002 was used for data entry, and weighted cluster analysis was conducted by using SAS and SUDAAN.

For immediate needs pertaining to public health and medical issues and general assistance (e.g., roof repair and yard cleanup), interviewers completed referral forms and forwarded them to local emergency management agencies or the Sarasota Health Recovery Team Operations Center (SHRTOC) for appropriate response.

Assessment teams obtained information from 198, 192, and 205 households in Charlotte, DeSoto, and Hardee counties, respectively (Table). Preliminary findings follow.

Charlotte County. Nearly 93% of households reported hurricane-related damage. Approximately 90% of households were in compliance with a public health advisory for drinking bottled water. One third of households reported a disruption in social support networks. Among households having at least one older adult household member with a preexisting medical condition, one third reported that at least one older adult's medical condition worsened because of the hurricane, and 28% of households reported that at least one older adult was prevented from receiving routine care for a preexisting condition.

DeSoto County. Nearly 48% of households surveyed were in mobile homes, and 19% of all households reported uninhabitable homes. Approximately 54% of households were still awaiting restoration of sanitation services at the time of the survey. Bottled (81%) and well (17%) water were the most common drinking water sources.