Using standard clinical assessments for home care to identify vulnerable populations before, during, and after disasters


  • Alexandra I.T. van Solm, PhD
  • John P. Hirdes, PhD, FCAHS
  • Leslie A. Eckel, PhD(c), RSW
  • George A. Heckman, MD, FRCPC
  • Philip L. Bigelow, PhD



vulnerable populations, disasters, emergency management, frail elderly, interRAI


Objectives: Several studies have shown the increased vulnerability of and disproportionate mortality rate among frail community-dwelling older adults as a result of emergencies and disasters. This article will discuss the applicability of the Vulnerable Persons at Risk (VPR) and VPR Plus decision support algorithms designed based on the Resident Assessment Instrument- Home Care (RAI-HC) to identify the most vulnerable community-dwelling (older) adults.

Design: A sample was taken from the Ontario RAI-HC database by selecting unique home care clients with assessments closest to December 31, 2014 (N = 275,797). Statistical methods used include cross tabulation, bivariate logistic regression as well as Kaplan-Meier survival plotting and Cox proportional hazards ratios calculations.

Results: The VPR and VPR Plus algorithms, were highly predictive of mortality, long-term care admission and hospitalization in ordinary circumstances. This provides a good indication of the strength of the algorithms in identifying vulnerable persons at times of emergencies.

Conclusions: Access to real-time person-level information of persons with functional care needs is a vital enabler for emergency responders in prioritizing and allocating resources during a disaster, and has great utility for emergency planning and recovery efforts. The development of valid and reliable algorithms supports the rapid identification and response to vulnerable community-dwelling persons for all phases of emergency management.

Author Biographies

Alexandra I.T. van Solm, PhD

Emergency Management Coordinator Region of Waterloo, Kitchener, Ontario, Canada

John P. Hirdes, PhD, FCAHS

Professor, University of Waterloo, School of Public Health and Health Systems, Waterloo, Ontario, Canada

Leslie A. Eckel, PhD(c), RSW

Knowledge Exchange Associate, University of Waterloo, School of Public Health and Health Systems, Waterloo, Ontario, Canada

George A. Heckman, MD, FRCPC

Associate Professor, University of Waterloo (Schlegel Research Chair in Geriatric Medicine), School of Public Health and Health Systems, Waterloo, Ontario, Canada

Philip L. Bigelow, PhD

Associate Professor, University of Waterloo, School of Public Health and Health Systems, Waterloo, Ontario, Canada


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