Abstract
Nursing home residents are at heightened risk for morbidity and mortality following an exposure to a disaster such as a hurricane or the COVID19 pandemic. Previous research has shown that nursing home resident mortality related to disasters is frequently underreported. There is a need to better understand the consequences of disasters on nursing home residents and to differentiate vulnerability based on patient characteristics. To evaluate mortality and morbidity associated with exposure to Hurricane Irma, a Category 4 storm that made landfall on September 10, 2017, in Cudjoe Key, Florida, among short-stay (<90-day residence) and long-stay (≥90-day residence) residents of nursing homes. Cohort study of Florida nursing home residents comparing residents exposed to Hurricane Irma in September 2017 to a control group of residents residing at the same nursing homes over the same time period in calendar year 2015. Data were analyzed from August 28, 2019, to July 22, 2020. Residents who experienced Hurricane Irma were considered exposed; those who did not were considered unexposed. Outcome variables included 30-day and 90-day mortality and first hospitalizations after the storm in both the short term and the long term. A total of 61 564 residents who were present in 640 Florida nursing home facilities on September 7, 2017, were identified. A comparison cohort of 61 813 residents was evaluated in 2015. Both cohorts were mostly female (2015, 68%; 2017, 67%), mostly White (2015, 79%; 2017, 78%), and approximately 40% of the residents in each group were over the age of 85 years. Compared with the control group in 2015, an additional 262 more nursing home deaths were identified at 30 days and 433 more deaths at 90 days. The odds of a first hospitalization for those exposed (vs nonexposed) were 1.09 (95% CI, 1.05-1.13) within the first 30 days after the storm and 1.05 (95% CI, 1.02-1.08) at 90 days; the odds of mortality were 1.12 (95% CI, 1.05-1.18) at 30 days and 1.07 (95% CI, 1.03-1.11) at 90 days. Among long-stay residents, the odds of mortality for those exposed to Hurricane Irma were 1.18 (95% CI, 1.08-1.29) times those unexposed and the odds of hospitalization were 1.11 (95% CI, 1.04-1.18) times those unexposed in the post 30-day period. The findings of this study suggest that nursing home residents are at considerable risk to the consequences of disasters. These risks may be underreported by state and federal agencies. Long-stay residents, those who have resided in a nursing home for 90 days or more, may be most vulnerable to the consequences of hurricane disasters.
Highlights
Nursing home preparedness in the face of all hazard emergencies is a vital area of importance, given the demonstrated mortality within long-term care facilities associated with the coronavirus disease 2019 (COVID-19) pandemic
Among long-stay residents, the odds of mortality for those exposed to Hurricane Irma were 1.18 times those unexposed and the odds of hospitalization were 1.11 times those unexposed in the post 30-day period
The findings of this study suggest that nursing home residents are at considerable risk to the consequences of disasters
Summary
Nursing home preparedness in the face of all hazard emergencies is a vital area of importance, given the demonstrated mortality within long-term care facilities associated with the coronavirus disease 2019 (COVID-19) pandemic. Recent data show that nearly one-quarter of the US deaths related to COVID-19 have occurred in the long-term care setting.[1] Previous research involving nursing home residents exposed to hurricane disasters demonstrates how vulnerable they are to disaster situations.[2,3] Residents exposed to 1 of 4 Gulf of Mexico hurricanes (Katrina, Rita, Gustav, and Ike) showed significant increases in morbidity and mortality compared with nondisaster years. The number of deaths in the nursing home setting significantly exceeded those reported by health care officials using death certificate records.[2,3]. Despite this data spotlighting the vulnerability of nursing home residents to disasters, little is known about which residents are more susceptible to harm associated with exposure to a hurricane or other disaster. Studies of residents exposed to Hurricane Gustav found that posthurricane hospitalizations increased for the most functionally impaired residents and that death increased for those with dementia.[6,7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
