Abstract
Objectives
Nursing home residents are especially vulnerable to adverse outcomes after a hurricane.
Prior research suggests that emergency department (ED) visits increase among community-residing
older adults after natural disasters. However, little is known about the impact of
hurricanes on the large population of older adults residing in assisted living (AL)
settings, particularly the influence of storms on the rates and causes of ED visits.
We examined whether rates of ED use for injuries and other medical reasons increased
after Hurricane Irma in 2017 among AL residents in Florida.
Design
Retrospective cohort study.
Setting and Participants
Samples of 30,358 Medicare fee-for-service beneficiaries in 2016 and 28,922 beneficiaries
in 2017 who resided in Florida AL communities.
Measures
The number of injury-related and other medical visits per 1,000 person-days within
30 and 90 days of September 1 in 2016 and 2017. We adjusted for age, race, sex, and
chronic conditions using linear regression with AL fixed effects. We compared the
top 10 primary diagnoses resulting in an ED visit between 2016 and 2017.
Results
Adjusted rates of injury-related visits were 12.5% higher at 30 days but did not differ
at 90 days. Other medical visits were 12% higher at 30 days in 2017 than in 2016 and
7.7% higher at 90 days. Heart failure was a leading cause of ED visits within 90 days
of September 1 in 2017, unlike in 2016.
Conclusions and Implications
Increased attention should be paid to AL communities in disaster preparedness and
response efforts given the increased likelihood of ED visits following a hurricane.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-term care providers and services users in the United States, 2015-2016.Vital Health Stat. 2019; 3: 22-24
- The controversy inherent in managing frail nursing home residents during complex hurricane emergencies.J Am Med Dir Assoc. 2008; 9: 599-604
- Effects of Hurricane Katrina on nursing facility resident mortality, hospitalization, and functional decline.Disaster Med Public Health Prep. 2010; 4: S28-S32
- Regional impact of Hurricane Isabel on emergency departments in coastal southeastern Virginia.Acad Emerg Med. 2005; 12: 1201-1205
- Hurricane Sandy: Impact on emergency department and hospital utilization by older adults in Lower Manhattan, New York (USA).Prehosp Disaster Med. 2015; 30: 496-502
- Geographic distribution of disaster-specific emergency department use after Hurricane Sandy in New York City.Disaster Med Public Health Prep. 2016; 10: 351-361
- Vulnerability of older adults in disasters: Emergency department utilization by geriatric patients after Hurricane Sandy.Disaster Med Public Health Prep. 2018; 12: 184-193
- Experiences of assisted living facility staff in evacuating and sheltering residents during hurricanes.Current Psychology. 2015; 34: 506-514
- No calm after the storm: A systematic review of human health following flood and storm disasters.Prehosp Disaster Med. 2017; 32: 568-579
- Injury-related emergency department visits after Hurricane Maria in a Southern Puerto Rico hospital.Disaster Med Public Health Prep. 2020; 14: 63-70
- Home health service provision after Hurricane Harvey.Disaster Med Public Health Prep. 2020; 14: 56-62
- U.S. weather highlights 2017: An historic hurricane and wildfire season.Weatherwise. 2018; 3: 12-20
- The residential history file: Studying nursing home residents' long-term care histories.Health Serv Res. 2011; 46: 120-137
- Assisted living communities during Hurricane Irma: The decision to evacuate or shelter in place and resident acuity.J Am Med Dir Assoc. 2020; 21: 1148-1152.e3
- A methodology to identify a cohort of Medicare beneficiaries residing in large assisted living facilities using administrative data.Med Care. 2018; 56: e10-e15
- Assisted living expansion and the market for nursing home care.Health Serv Res. 2012; 47: 2296-2315
- Changes in long-term care markets: Assisted living supply and the prevalence of low-care residents in nursing homes.J Am Med Dir Assoc. 2020; 21: 1161-1165.e4
- State variability in the prevalence and healthcare utilization of assisted living residents with dementia.J Am Geriatr Soc. 2020; 68: 1504-1511
- Validation of an algorithm for categorizing the severity of hospital emergency department visits.Med Care. 2010; 48: 58-63
- A “Patch” to the NYU Emergency Department Visit Algorithm.Health Serv Res. 2017; 52: 1264-1276
- Emergency preparedness resources: Emergency management planning criteria.(Available at:)https://ahca.myflorida.com/MCHQ/Emergency_Activities/index.shtmlDate accessed: August 18, 2020
- Association between a temporary reduction in access to health care and long-term changes in hypertension control among veterans after a natural disaster.JAMA Netw Open. 2019; 2: e1915111
- Impact of Hurricane Sandy on hospital emergency and dialysis services: A retrospective survey.Prehosp Disaster Med. 2014; 29: 374-379
- Causes of excess deaths in Puerto Rico after Hurricane Maria: A time-series estimation.Am J Public Health. 2019; 109: 1050-1052
- Three-year follow-up after the great East Japan earthquake in the incidence of out-of-hospital cardiac arrest with cardiac origin.Circ J. 2018; 82: 919-922
- The great east Japan earthquake and out-of-hospital cardiac arrest.N Engl J Med. 2013; 369: 2165-2167
- Risk of cardiovascular disease after earthquake disaster.Circ J. 2018; 82: 650-651
- Characteristics of Medicare advantage and fee-for-service beneficiaries upon enrollment in Medicare at age 65.J Ambul Care Manage. 2016; 39: 231-241
- Healthcare use and costs in adult cancer patients with anxiety and depression.Depress Anxiety. 2020; 37: 908-915
Article info
Publication history
Published online: November 21, 2020
Footnotes
This work was supported by research awards from the National Institute on Aging (R01AG060581-03), the Veterans Health Administration (CDA 14-422), and the AHRQ T32 training grant (T32HS000011).
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
