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Yoon L, Ventrella J, Marcotullio P, Matte T, Lane K, Tipaldo J, Jessel S, Schmid K, Casagrande J, Elszasz H. NPCC4: Climate change, energy, and energy insecurity in New York City. Ann N Y Acad Sci 2024; 1539:241-276. [PMID: 38922917 DOI: 10.1111/nyas.15117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
This chapter of the New York City Panel on Climate Change 4 (NPCC4) report provides an overview of energy trends in New York City and the State of New York, as well as accompanying challenges and barriers to the energy transition-with implications for human health and wellbeing. The link between energy trends and their impact on health and wellbeing is brought to the fore by the concept of "energy insecurity," an important addition to the NPCC4 assessment.
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Affiliation(s)
- Liv Yoon
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Peter Marcotullio
- Department of Geography, Hunter College, CUNY, New York, New York, USA
| | - Thomas Matte
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kathryn Lane
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Jenna Tipaldo
- Department of Geography, Hunter College, CUNY, New York, New York, USA
| | - Sonal Jessel
- WE ACT for Environmental Justice, New York, New York, USA
| | - Kathleen Schmid
- Mayor's Office of Climate & Environmental Justice, New York, New York, USA
| | - Julia Casagrande
- Mayor's Office of Climate & Environmental Justice, New York, New York, USA
| | - Hayley Elszasz
- Mayor's Office of Climate & Environmental Justice, New York, New York, USA
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Gad L, Keenan OJ, Ancker JS, Unruh MA, Jung HY, Demetres MR, Ghosh AK. Impact of Extreme Weather Events on Health Outcomes of Nursing Home Residents Receiving Post-Acute Care and Long-Term Care: A Scoping Review. J Am Med Dir Assoc 2024; 25:105230. [PMID: 39208871 DOI: 10.1016/j.jamda.2024.105230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES To systematically examine the evidence of the association between extreme weather events (EWEs) and adverse health outcomes among short-stay patients undergoing post-acute care (PAC) and long-stay residents in nursing homes (NHs). DESIGN This is a scoping review. The findings were reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews checklist. SETTINGS AND PARTICIPANTS Studies published on short-stay PAC and long-stay residents in NHs. METHODS A literature search was performed in 6 databases. Studies retrieved were screened for eligibility against predefined inclusion and exclusion criteria. Studies were qualitatively synthesized based on the EWE, health outcomes, and special populations studied. RESULTS Of the 5044 studies reviewed, 10 met our inclusion criteria. All were retrospective cohort studies. Nine studies examined the association between hurricane exposure, defined inconsistently across studies, and PAC patients and long-stay residents in the NH setting in the Southern United States; the other study focused on post-flood risk among North Dakota NH residents. Nine studies focused on long-stay NH residents receiving custodial care, and 1 focused on patients receiving PAC. Outcomes examined were unplanned hospitalization rates and mortality rates within 30 and 90 days and changes in cognitive impairment. Nine studies consistently found an association between hurricane exposure and increased risk of 30- and 90-day mortality compared to unexposed residents. CONCLUSIONS AND IMPLICATIONS Of the EWEs examined, hurricanes are associated with an increased risk of mortality among long-stay NH residents and those admitted to hospice, and with increased risk of hospitalization for short-stay PAC patients. As the threat of climate-amplified EWEs increases, future studies of NH residents should evaluate the impact of all types of EWEs, and not solely hurricanes, across wider geographic regions, and include longer-term health outcomes, associated costs, and analyses of potential disparities associated with vulnerable populations in NHs.
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Affiliation(s)
- Laila Gad
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Olivia J Keenan
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark Aaron Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Hye-Young Jung
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Michelle R Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | - Arnab K Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
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Yang Z, Huang W, McKenzie JE, Yu P, Wu Y, Xu R, Ye T, Ju K, Zhang Y, Huang Y, Guo Y, Li S. The association of adverse birth outcomes with flood exposure before and during pregnancy in Australia: a cohort study. Lancet Planet Health 2024; 8:e554-e563. [PMID: 39122324 DOI: 10.1016/s2542-5196(24)00142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Exposure to floods might increase the risks of adverse birth outcomes. However, the current evidence is scarce, inconsistent, and has knowledge gaps. This study aims to estimate the associations of flood exposure before and during pregnancy with adverse birth outcomes and to identify susceptible exposure windows and effect modifiers. METHODS In this cohort study, we obtained all the birth records occurring in Greater Sydney, Australia, from Jan 1, 2001, to Dec 31, 2020, from the New South Wales Midwives Data Collection and in the Brisbane metropolitan region, Australia, from Jan 1, 1995, to Dec 31, 2014, from the Queensland Health Perinatal Data Collection. For each birth, residential address and historical flood information from the Dartmouth Flood Observatory were used to estimate the numbers of days with floods during five exposure windows (Pre-1 was defined as 13-24 weeks before the last menstrual period [LMP], Pre-2 was 0-12 weeks before the LMP, trimester 1 [Tri-1] was 0-12 weeks after the LMP, trimester 2 [Tri-2] was 13-28 weeks after the LMP, and trimester 3 [Tri-3] was ≥29 weeks after the LMP). We estimated the hazard ratios (HRs) of adverse birth outcomes (preterm births, stillbirths, term low birthweight [TLBW], and small for gestational age [SGA]) associated with flood exposures in the five exposure windows using Cox proportional hazards regression models. FINDINGS 1 338 314 birth records were included in our analyses, which included 91 851 (6·9%) preterm births, 9831 (0·7%) stillbirths, 25 567 (1·9%) TLBW, and 108 658 (8·1%) SGA. Flood exposure in Pre-1 was associated with increased risks of TLBW (HR 1·06 [95% CI 1·01-1·12]) and SGA (1·04 [1·01-1·06]); flood exposure during Tri-1 was associated with increased risks of preterm births (1·03 [1·002-1·05]), stillbirth (1·11 [1·03-1·20]), and SGA (1·03 [1·01-1·06]). In contrast, flood exposures during Pre-2 and Tri-3 were associated with reduced risks. INTERPRETATION Exposures to floods in Pre-1 and Tri-1 are both associated with increased risks of adverse birth outcomes, and the risks increase with a higher exposure. Upon planning for conception and prenatal care, individuals and health practitioners should raise awareness of the increased risks of adverse birth outcomes after experiencing floods. FUNDING The Australian Research Council and the Australian National Health and Medical Research Council.
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Affiliation(s)
- Zhengyu Yang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne E McKenzie
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Pei Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yao Wu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ke Ju
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yiwen Zhang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yujia Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, China
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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DRESSER CALEB, JOHNS ZACHARY, PALARDY AVERY, McKINNON SARAH, BREAKEY SUELLEN, ROS ANAMVIAMONTE, NICHOLAS PATRICEK. Toward a Climate-Ready Health Care System: Institutional Motivators and Workforce Engagement. Milbank Q 2024; 102:302-324. [PMID: 38228577 PMCID: PMC11176402 DOI: 10.1111/1468-0009.12687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024] Open
Abstract
Policy Points The US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate-ready US health care system. Health care workers have numerous profession-specific and role-specific opportunities to address the causes and impacts of climate change. Policies must address institutional barriers to change and create incentives aligned with climate readiness goals. Institutions and individuals can support climate readiness by integrating content on the health care implications of climate change into educational curricula.
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Affiliation(s)
| | | | | | - SARAH McKINNON
- School of Health and Rehabilitation SciencesMGH Institute of Health Professions
| | - SUELLEN BREAKEY
- School of Nursing, MGH Institute of Health Professions
- Center for Climate Change, Climate Justice, and HealthMGH Institute of Health Professions
| | | | - PATRICE K NICHOLAS
- School of Nursing, MGH Institute of Health Professions
- Center for Climate Change, Climate Justice, and HealthMGH Institute of Health Professions
- Massachusetts General Hospital Center for the Environment and Health
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Bell SA, Inloes JB, Donnelly J, Wasserman M, Wyte-Lake T. Improving Nursing Home Disaster Readiness Through Implementation Science. J Am Med Dir Assoc 2024; 25:617-622. [PMID: 36931322 DOI: 10.1016/j.jamda.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 03/15/2023]
Abstract
As large-scale disasters continue to become increasingly common worldwide, nursing homes, whose residents are more vulnerable to disaster-related health and psychosocial shocks, and their staff, are carrying progressively more responsibility for health care readiness practices. Implementation science is a research discipline that seeks to improve uptake of evidence-based practices, such as health care readiness planning, and thus has potential to improve nursing home care delivery during and after disasters. We describe the limited field of existing evidence-based strategies in the peer-reviewed literature that seek to advance health care readiness in the nursing home setting and illustrate how implementation science can better support health care readiness planning for nursing homes. We rest on 3 main themes: (1) implementation science frameworks can strengthen nursing home staff engagement around health care readiness; (2) implementation science can support tailoring of emergency preparedness plans to individual nursing homes' unique needs; and (3) implementation science can advance the integration of nursing homes into local, state, and federal health care readiness planning initiatives. Finally, research is urgently needed to both generate and disseminate implementation strategies that increase uptake of evidence-based health care readiness practices in the nursing home setting.
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Affiliation(s)
- Sue Anne Bell
- University of Michigan School of Nursing, Department of Systems, Populations, and Leadership, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Jennifer B Inloes
- University of Michigan School of Nursing, Department of Systems, Populations, and Leadership, Ann Arbor, MI, USA
| | - John Donnelly
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; University of Michigan Medical School, Department of Learning Health Sciences, Ann Arbor, MI, USA; VA QUERI Center for Evaluation and Implementation Resources and HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Michael Wasserman
- California Association of Long Term Care Medicine, Newbury Park, CA, USA
| | - Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center, Office of Patient Care Services, US Department of Veterans Affairs, Los Angeles, CA, USA
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Hua CL, Patel S, Thomas KS, Jester DJ, Kosar CM, Peterson LJ, Dobbs D, Andel R, Dosa DM. Evacuation and Health Care Outcomes Among Assisted Living Residents After Hurricane Irma. JAMA Netw Open 2024; 7:e248572. [PMID: 38669016 PMCID: PMC11053374 DOI: 10.1001/jamanetworkopen.2024.8572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance Evacuation has been found to be associated with adverse outcomes among nursing home residents during hurricanes, but the outcomes for assisted living (AL) residents remain unknown. Objective To examine the association between evacuation and health care outcomes (ie, emergency department visits, hospitalizations, mortality, and nursing home visits) among Florida AL residents exposed to Hurricane Irma. Design, Setting, and Participants Retrospective cohort study using 2017 Medicare claims data. Participants were a cohort of Florida AL residents who were aged 65 years or older, enrolled in Medicare fee-for-service, and resided in 9-digit zip codes corresponding to US assisted living communities with 25 or more beds on September 10, 2017, the day of Hurricane Irma's landfall. Propensity score matching was used to match evacuated residents to those that sheltered-in-place based on resident and AL characteristics. Data were analyzed from September 2022 to February 2024. Exposure Whether the AL community evacuated or sheltered-in-place before Hurricane Irma made landfall. Main Outcomes and Measures Thirty- and 90-day emergency department visits, hospitalizations, mortality, and nursing home admissions. Results The study cohort included 25 130 Florida AL residents (mean [SD] age 81 [9] years); 3402 (13.5%) evacuated and 21 728 (86.5%) did not evacuate. The evacuated group had 2223 women (65.3%), and the group that sheltered-in-place had 14 556 women (67.0%). In the evacuated group, 42 residents (1.2%) were Black, 93 (2.7%) were Hispanic, and 3225 (94.8%) were White. In the group that sheltered in place, 490 residents (2.3%) were Black, 707 (3.3%) were Hispanic, and 20 212 (93.0%) were White. After 1:4 propensity score matching, when compared with sheltering-in-place, evacuation was associated with a 16% greater odds of emergency department visits (adjusted odds ratio [AOR], 1.16; 95% CI, 1.01-1.33; P = .04) and 51% greater odds of nursing home visits (AOR, 1.51; 95% CI, 1.14-2.00; P = .01) within 30 days of Hurricane Irma's landfall. Hospitalization and mortality did not vary significantly by evacuation status within 30 or 90 days after the landfall date. Conclusions and Relevance In this cohort study of Florida AL residents, there was an increased risk of nursing home and emergency department visits within 30 days of Hurricane Irma's landfall among residents from communities that evacuated before the storm when compared with residents from communities that sheltered-in-place. The stress and disruption caused by evacuation may yield poorer immediate health outcomes after a major storm for AL residents. Therefore, the potential benefits and harms of evacuating vs sheltering-in-place must be carefully considered when developing emergency planning and response.
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Affiliation(s)
- Cassandra L. Hua
- Department of Public Health, University of Massachusetts, Lowell
| | - Sweta Patel
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
| | - Kali S. Thomas
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Massachusetts
| | - Dylan J. Jester
- Women’s Operational Military Exposure Network Center of Excellence, VA Palo Alto Health Care System, Palo Alto, California
| | - Cyrus M. Kosar
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
| | - Lindsay J. Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Czech Republic
| | - David M. Dosa
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Salas RN, Burke LG, Phelan J, Wellenius GA, Orav EJ, Jha AK. Impact of extreme weather events on healthcare utilization and mortality in the United States. Nat Med 2024; 30:1118-1126. [PMID: 38424213 DOI: 10.1038/s41591-024-02833-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.
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Affiliation(s)
- Renee N Salas
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard Global Health Institute, Cambridge, MA, USA.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Laura G Burke
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, USA
| | - Jessica Phelan
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, Center for Climate and Health, Boston, MA, USA
| | - E John Orav
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ashish K Jha
- Brown University School of Public Health, Providence, RI, USA
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Carlson B, Kohon JN, Carder PC, Himes D, Toda E, Tanaka K. Climate Change Policies and Older Adults: An Analysis of States' Climate Adaptation Plans. THE GERONTOLOGIST 2024; 64:gnad077. [PMID: 37379518 DOI: 10.1093/geront/gnad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVES As climate change drives more frequent and intense weather events, older adults face disproportionate impacts, including having the highest mortality rates from storms, wildfires, flooding, and heat waves. State governments are critical in deploying local resources to help address climate change impacts. This policy study analyzes states' climate adaptation plans to assess the methods through which they address the impact of climate change on older adults. RESEARCH DESIGN AND METHODS This study uses content analysis to analyze available climate change adaptation plans for all U.S. states for strategies designed to increase the resilience of older adults to the impacts of climate change. RESULTS A total of 19 states have climate adaptation plans, of which 18 describe older adults as a population group with specific health impacts and risk factors. There are 4 categories of adaptation strategies for older adults that includes communications, transportation, housing, and emergency services. State plans vary in terms of the risk factors and adaptation strategies included. DISCUSSION AND IMPLICATIONS To varying degrees, states' climate change adaptation planning addresses health, social, and economic risks specific to older adults, as well as strategies for mitigating those risks. As global warming continues, collaborations between public and private sectors and across regions will be needed to prevent negative outcomes such as forced relocation and other social and economic disruptions as well as disparate morbidity and mortality.
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Affiliation(s)
- Bryant Carlson
- Institute on Aging & OHSU-PSU School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Jacklyn N Kohon
- Institute on Aging, Portland State University, Portland, Oregon, USA
- Research Center for Sustainability and Environment, Shiga University, Shiga, Japan
| | - Paula C Carder
- Institute on Aging & OHSU-PSU School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Dani Himes
- Institute on Aging, Portland State University, Portland, Oregon, USA
| | - Eiji Toda
- Institute on Aging, Portland State University, Portland, Oregon, USA
| | - Katsuya Tanaka
- Research Center for Sustainability and Environment, Shiga University, Shiga, Japan
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Haverhals LM, Manheim C, Vega Lujan D. Experiences of Veterans, Caregivers, and VA Home-Based Care Providers before, during, and Post-Hurricane Ian. Geriatrics (Basel) 2024; 9:10. [PMID: 38247985 PMCID: PMC10801461 DOI: 10.3390/geriatrics9010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
On 28 September 2022, Hurricane Ian pummeled parts of south Florida. Disaster and climate change research has shown that disasters exacerbate inequalities, especially amongst older and physically vulnerable people. Florida has a large population of Veterans managing multiple chronic health conditions and receiving long-term care in-home from Veterans Health Administration (VA) programs, including Home Based Primary Care and Medical Foster Home. To describe how VA staff provided high quality care during and after the hurricane, and how Veterans and caregivers accessed needed healthcare and supports post-hurricane, we conducted a site visit to Lee County, Florida area in May 2023, conducting N = 25 interviews with VA staff, Veterans, and caregivers. Findings from qualitative thematic analysis showed that while some Veterans and caregivers experienced significant challenges during and after the hurricane, including displacement and difficulty accessing oxygen, they felt highly supported by VA care teams. Staff efforts post-hurricane focused on improving care coordination in anticipation of future disasters, especially around communicating with Veterans and their caregivers, and a VA workgroup formed to implement changes. As climate change causes more severe hazard events, lessons learned from this project can better support healthcare staff, older adults, and their caregivers before and after major disasters.
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Affiliation(s)
- Leah M. Haverhals
- Denver-Seattle Department of Veterans Affairs (VA) Center of Innovation for Veteran-Centered & Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA; (C.M.); (D.V.L.)
- Health Care Policy & Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Chelsea Manheim
- Denver-Seattle Department of Veterans Affairs (VA) Center of Innovation for Veteran-Centered & Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA; (C.M.); (D.V.L.)
| | - Deisy Vega Lujan
- Denver-Seattle Department of Veterans Affairs (VA) Center of Innovation for Veteran-Centered & Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA; (C.M.); (D.V.L.)
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Yang Z, Huang W, McKenzie JE, Xu R, Yu P, Ye T, Wen B, Gasparrini A, Armstrong B, Tong S, Lavigne E, Madureira J, Kyselý J, Guo Y, Li S. Mortality risks associated with floods in 761 communities worldwide: time series study. BMJ 2023; 383:e075081. [PMID: 37793693 PMCID: PMC10548259 DOI: 10.1136/bmj-2023-075081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To evaluate lag-response associations and effect modifications of exposure to floods with risks of all cause, cardiovascular, and respiratory mortality on a global scale. DESIGN Time series study. SETTING 761 communities in 35 countries or territories with at least one flood event during the study period. PARTICIPANTS Multi-Country Multi-City Collaborative Research Network database, Australian Cause of Death Unit Record File, New Zealand Integrated Data Infrastructure, and the International Network for the Demographic Evaluation of Populations and their Health Network database. MAIN OUTCOME MEASURES The main outcome was daily counts of deaths. An estimation for the lag-response association between flood and daily mortality risk was modelled, and the relative risks over the lag period were cumulated to calculate overall effects. Attributable fractions of mortality due to floods were further calculated. A quasi-Poisson model with a distributed lag non-linear function was used to examine how daily death risk was associated with flooded days in each community, and then the community specific associations were pooled using random effects multivariate meta-analyses. Flooded days were defined as days from the start date to the end date of flood events. RESULTS A total of 47.6 million all cause deaths, 11.1 million cardiovascular deaths, and 4.9 million respiratory deaths were analysed. Over the 761 communities, mortality risks increased and persisted for up to 60 days (50 days for cardiovascular mortality) after a flooded day. The cumulative relative risks for all cause, cardiovascular, and respiratory mortality were 1.021 (95% confidence interval 1.006 to 1.036), 1.026 (1.005 to 1.047), and 1.049 (1.008 to 1.092), respectively. The associations varied across countries or territories and regions. The flood-mortality associations appeared to be modified by climate type and were stronger in low income countries and in populations with a low human development index or high proportion of older people. In communities impacted by flood, up to 0.10% of all cause deaths, 0.18% of cardiovascular deaths, and 0.41% of respiratory deaths were attributed to floods. CONCLUSIONS This study found that the risks of all cause, cardiovascular, and respiratory mortality increased for up to 60 days after exposure to flood and the associations could vary by local climate type, socioeconomic status, and older age.
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Affiliation(s)
- Zhengyu Yang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Wenzhong Huang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Tingting Ye
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Armstrong
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China
- Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China
| | - Eric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
| | - Joana Madureira
- Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
- EPIUnit - Instituto de Saude Publica, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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Jester DJ, Peterson LJ, Andel R, Dosa DM. Winter Storm Uri Reduced Availability of Daily Direct-Care Nurse Staff in Texas Nursing Homes. J Appl Gerontol 2023; 42:2148-2157. [PMID: 37172107 PMCID: PMC10524538 DOI: 10.1177/07334648231175428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
We examined the effect of Winter Storm Uri on daily direct-care nurse staffing levels in 1,173 Texas nursing homes (NHs) from February 13th to 19th, 2021. We used data from Payroll-Based Journaling and the Care Compare website. Linear mixed effects models were used to estimate the linear and non-linear change in staffing. During Winter Storm Uri, Texas NHs experienced a linear decrease in daily staffing levels with subsequent non-linear increase for registered nurses (RNs; p < .001) and certified nursing assistants (CNAs; p < .001), and staffing increased linearly for licensed practical nurses (LPNs; p < .001). Compared to 1 week before the storm, Texas NHs reported lower staffing levels across all three types of staff, but most dramatically among LPNs and CNAs. In supplemental analyses, urban and lower quality NHs fared slightly poorer than rural and higher-quality NHs. Winter storms pose a particular challenge to NHs and their ability to maintain direct-care nurse staffing levels.
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Affiliation(s)
- Dylan J. Jester
- Women’s Operational and Military Exposure Network (WOMEN), War Related Illness and Injury Study Center (WRIISC), VA Palo Alto Health Care System
| | - Lindsay J. Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
- Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
| | - David M. Dosa
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI
- School of Public Health, Brown University, Providence, RI
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI
- Warren Alpert School of Medicine, Brown University, Providence, RI
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12
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Huang W, Gao Y, Xu R, Yang Z, Yu P, Ye T, Ritchie EA, Li S, Guo Y. Health Effects of Cyclones: A Systematic Review and Meta-Analysis of Epidemiological Studies. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:86001. [PMID: 37639476 PMCID: PMC10461789 DOI: 10.1289/ehp12158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND More intense cyclones are expected in the future as a result of climate change. A comprehensive review is urgently needed to summarize and update the evidence on the health effects of cyclones. OBJECTIVES We aimed to provide a systematic review with meta-analysis of current evidence on the risks of all reported health outcomes related to cyclones and to identify research gaps and make recommendations for further research. METHODS We systematically searched five electronic databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) for relevant studies in English published before 21 December 2022. Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we developed inclusion criteria, screened the literature, and included epidemiological studies with a quantitative risk assessment of any mortality or morbidity-related outcomes associated with cyclone exposures. We extracted key data and assessed study quality for these studies and applied meta-analyses to quantify the overall effect estimate and the heterogeneity of comparable studies. RESULTS In total, 71 studies from eight countries (the United States, China, India, Japan, the Philippines, South Korea, Australia, Brazil), mostly the United States, were included in the review. These studies investigated the all-cause and cause-specific mortality, as well as morbidity related to injury, cardiovascular diseases (CVDs), respiratory diseases, infectious diseases, mental disorders, adverse birth outcomes, cancer, diabetes, and other outcomes (e.g., suicide rates, gender-based violence). Studies mostly included only one high-amplitude cyclone (cyclones with a Saffir-Simpson category of 4 or 5, i.e., Hurricanes Katrina or Sandy) and focused on mental disorders morbidity and all-cause mortality and hospitalizations. Consistently elevated risks of overall mental health morbidity, post-traumatic stress disorder (PTSD), as well as all-cause mortality or hospitalizations, were found to be associated with cyclones. However, the results for other outcomes were generally mixed or limited. A statistically significant overall relative risk of 1.09 [95% confidence interval (CI): 1.04, 1.13], 1.18 (95% CI: 1.12, 1.25), 1.15 (95% CI: 1.13, 1.18), 1.26 (95% CI: 1.05, 1.50) was observed for all-cause mortality, all-cause hospitalizations, respiratory disease, and chronic obstructive pulmonary disease hospitalizations, respectively, after cyclone exposures, whereas no statistically significant risks were identified for diabetes mortality, heart disease mortality, and preterm birth. High between-study heterogeneity was observed. CONCLUSIONS There is generally consistent evidence supporting the notion that high-amplitude cyclones could significantly increase risks of mental disorders, especially for PTSD, as well as mortality and hospitalizations, but the evidence for other health outcomes, such as chronic diseases (e.g., CVDs, cancer, diabetes), and adverse birth outcomes remains limited or inconsistent. More studies with rigorous exposure assessment, of larger spatial and temporal scales, and using advanced modeling strategy are warranted in the future, especially for those small cyclone-prone countries or regions with low and middle incomes. https://doi.org/10.1289/EHP12158.
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Affiliation(s)
- Wenzhong Huang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuan Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhengyu Yang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tingting Ye
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth A. Ritchie
- School of Earth Atmosphere and Environment, Monash University, Melbourne, Victoria, Australia
- Department of Civil Engineering, Monash University, Melbourne, Victoria, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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13
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Huang W, Li S, Vogt T, Xu R, Tong S, Molina T, Masselot P, Gasparrini A, Armstrong B, Pascal M, Royé D, Sheng Ng CF, Vicedo-Cabrera AM, Schwartz J, Lavigne E, Kan H, Goodman P, Zeka A, Hashizume M, Diaz MH, De la Cruz Valencia C, Seposo X, Nunes B, Madureira J, Kim H, Lee W, Tobias A, Íñiguez C, Guo YL, Pan SC, Zanobetti A, Dang TN, Van Dung D, Geiger T, Otto C, Johnson A, Hales S, Yu P, Yang Z, Ritchie EA, Guo Y. Global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019: a multi-country time-series study. Lancet Planet Health 2023; 7:e694-e705. [PMID: 37558350 DOI: 10.1016/s2542-5196(23)00143-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 05/25/2023] [Accepted: 06/25/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND The global spatiotemporal pattern of mortality risk and burden attributable to tropical cyclones is unclear. We aimed to evaluate the global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019. METHODS The wind speed associated with cyclones from 1980 to 2019 was estimated globally through a parametric wind field model at a grid resolution of 0·5° × 0·5°. A total of 341 locations with daily mortality and temperature data from 14 countries that experienced at least one tropical cyclone day (a day with maximum sustained wind speed associated with cyclones ≥17·5 m/s) during the study period were included. A conditional quasi-Poisson regression with distributed lag non-linear model was applied to assess the tropical cyclone-mortality association. A meta-regression model was fitted to evaluate potential contributing factors and estimate grid cell-specific tropical cyclone effects. FINDINGS Tropical cyclone exposure was associated with an overall 6% (95% CI 4-8) increase in mortality in the first 2 weeks following exposure. Globally, an estimate of 97 430 excess deaths (95% empirical CI [eCI] 71 651-126 438) per decade were observed over the 2 weeks following exposure to tropical cyclones, accounting for 20·7 (95% eCI 15·2-26·9) excess deaths per 100 000 residents (excess death rate) and 3·3 (95% eCI 2·4-4·3) excess deaths per 1000 deaths (excess death ratio) over 1980-2019. The mortality burden exhibited substantial temporal and spatial variation. East Asia and south Asia had the highest number of excess deaths during 1980-2019: 28 744 (95% eCI 16 863-42 188) and 27 267 (21 157-34 058) excess deaths per decade, respectively. In contrast, the regions with the highest excess death ratios and rates were southeast Asia and Latin America and the Caribbean. From 1980-99 to 2000-19, marked increases in tropical cyclone-related excess death numbers were observed globally, especially for Latin America and the Caribbean and south Asia. Grid cell-level and country-level results revealed further heterogeneous spatiotemporal patterns such as the high and increasing tropical cyclone-related mortality burden in Caribbean countries or regions. INTERPRETATION Globally, short-term exposure to tropical cyclones was associated with a significant mortality burden, with highly heterogeneous spatiotemporal patterns. In-depth exploration of tropical cyclone epidemiology for those countries and regions estimated to have the highest and increasing tropical cyclone-related mortality burdens is urgently needed to help inform the development of targeted actions against the increasing adverse health impacts of tropical cyclones under a changing climate. FUNDING Australian Research Council and Australian National Health and Medical Research Council.
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Affiliation(s)
- Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Thomas Vogt
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China; Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China
| | - Tomás Molina
- Department of Applied Physics, University of Barcelona, Barcelona, Spain
| | - Pierre Masselot
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - Dominic Royé
- CIBER of Epidemiology and Public Health, Madrid, Spain; Department of Geography, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ana Maria Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric Lavigne
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Air Health Science Division, Health Canada, Ottawa, ON, Canada
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Patrick Goodman
- School of Physics, Technological University Dublin, Dublin, Ireland
| | - Ariana Zeka
- Institute for Environment, Health and Societies, Brunel University London, London, UK
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Magali Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - César De la Cruz Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Joana Madureira
- Environmental Health Department, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Whanhee Lee
- School of the Environment, Yale University, New Haven, CT, USA; Department of Occupational and Environmental Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Aurelio Tobias
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
| | - Carmen Íñiguez
- CIBER of Epidemiology and Public Health, Madrid, Spain; Department of Statistics and Computational Research, Universitat de València, València, Spain
| | - Yue Leon Guo
- Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan; Graduate Institute of Environmental and Occupational Health Sciences, NTU College of Public Health, Taipei, Taiwan
| | - Shih-Chun Pan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tran Ngoc Dang
- Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam; Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Do Van Dung
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Tobias Geiger
- Potsdam Institute for Climate Impact Research, Potsdam, Germany; Deutscher Wetterdienst, Climate and Environment Consultancy, Stahnsdorf, Germany
| | - Christian Otto
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Amanda Johnson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Simon Hales
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Pei Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Zhengyu Yang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth A Ritchie
- School of Earth Atmosphere and Environment, Monash University, Melbourne, VIC, Australia; Department of Civil Engineering, Monash University, Melbourne, VIC, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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14
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Hsieh SL, Shultz JM, Briggs F, Espinel Z, Shapiro LT. Climate Change and the Urgent Need to Prepare Persons With Multiple Sclerosis for Extreme Hurricanes. Int J MS Care 2023; 25:152-156. [PMID: 37469332 PMCID: PMC10353692 DOI: 10.7224/1537-2073.2022-032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Climate change is contributing to increasingly hazardous tropical cyclones that endanger persons living in susceptible coastal and island communities. People living with chronic illness, including multiple sclerosis (MS), face unique challenges and vulnerabilities when exposed to hurricane hazards. Disaster and emergency preparedness requires a customized approach that considers the necessary adaptations to accommodate the mobility, self-care, sensory, cognitive, and communication impairments of persons living with MS. Related considerations include the potential for worsening neurologic signs and symptoms during and after a catastrophic storm. The impact of emotional and financial stresses, as well as disruptions in health care delivery, on this population are also key concerns. This paper addresses the challenges faced by individuals with MS in advance of, during, and in the aftermath of extreme storms. We propose new guidelines on how health care professionals can assist persons with MS when creating tailored disaster readiness and response plans.
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Affiliation(s)
- Sharon L. Hsieh
- From the MD/MPH Program (SLH), University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - James M. Shultz
- Department of Public Health Sciences (JMS), University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Farren Briggs
- The Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA (FB)
| | - Zelde Espinel
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center (ZE), University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Lauren T. Shapiro
- Department of Physical Medicine and Rehabilitation (LTS), University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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15
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Festa N, Throgmorton KF, Davis-Plourde K, Dosa DM, Chen K, Zang E, Kelly J, Gill TM. Assessment of Regional Nursing Home Preparedness for and Regulatory Responsiveness to Wildfire Risk in the Western US. JAMA Netw Open 2023; 6:e2320207. [PMID: 37358851 PMCID: PMC10293909 DOI: 10.1001/jamanetworkopen.2023.20207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/10/2023] [Indexed: 06/27/2023] Open
Abstract
Importance It is uncertain whether emergency preparedness and regulatory oversight for US nursing homes are aligned with local wildfire risk. Objective To evaluate the likelihood that nursing homes at elevated risk of wildfire exposure meet US Centers for Medicare & Medicaid Services (CMS) emergency preparedness standards and to compare the time to reinspection by exposure status. Design, Setting, and Participants This cross-sectional study of nursing homes in the continental western US from January 1, 2017, through December 31, 2019, was conducted using cross-sectional and survival analyses. The prevalence of high-risk facilities within 5 km of areas at or exceeding the 85th percentile of nationalized wildfire risk across areas overseen by 4 CMS regional offices (New Mexico, Mountain West, Pacific/Southwest, and Pacific Northwest) was determined. Critical emergency preparedness deficiencies cited during CMS Life Safety Code Inspections were identified. Data analysis was performed from October 10 to December 12, 2022. Main Outcomes and Measures The primary outcome classified whether facilities were cited for at least 1 critical emergency preparedness deficiency during the observation window. Regionally stratified generalized estimating equations were used to evaluate associations between risk status and the presence and number of deficiencies, adjusted for nursing home characteristics. For the subset of facilities with deficiencies, differences in restricted mean survival time to reinspection were evaluated. Results Of the 2218 nursing homes in this study, 1219 (55.0%) were exposed to elevated wildfire risk. The Pacific/Southwest had the highest percentage of both exposed (680 of 870 [78.2%]) and unexposed (359 of 486 [73.9%]) facilities with 1 or more deficiencies. The Mountain West had the largest difference in the percentage of exposed (87 of 215 [40.5%]) vs unexposed (47 of 193 [24.4%]) facilities with 1 or more deficiencies. Exposed facilities in the Pacific Northwest had the greatest mean (SD) number of deficiencies (4.3 [5.4]). Exposure was associated with the presence of deficiencies in the Mountain West (odds ratio [OR], 2.12 [95% CI, 1.50-3.01]) and the presence (OR, 1.84 [95% CI, 1.55-2.18]) and number (rate ratio, 1.39 [95% CI, 1.06-1.83]) of deficiencies in the Pacific Northwest. Exposed Mountain West facilities with deficiencies were reinspected later, on average, than unexposed facilities (adjusted restricted mean survival time difference, 91.2 days [95% CI, 30.6-151.8 days]). Conclusions and Relevance In this cross-sectional study, regional heterogeneity in nursing home emergency preparedness for and regulatory responsiveness to local wildfire risk was observed. These findings suggest that there may be opportunities to improve the responsiveness of nursing homes to and regulatory oversight of surrounding wildfire risk.
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Affiliation(s)
- Natalia Festa
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program at Yale University, New Haven, Connecticut
| | - Kaitlin Fender Throgmorton
- Harvey Cushing/John Hay Whitney Medical Library, School of Medicine, Yale University, New Haven, Connecticut
| | - Kendra Davis-Plourde
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - David M. Dosa
- School of Public Health, Brown University, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Center of Innovation for Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Emma Zang
- Department of Sociology, Yale University, New Haven, Connecticut
| | - Jill Kelly
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Hua CL, Patel S, Thomas KS, Peterson LJ, Andel R, Gordon L, Jester DJ, Dosa DM. The relationship between exposure to Hurricane Harvey and mortality among nursing home residents. J Am Geriatr Soc 2023; 71:888-894. [PMID: 36541058 PMCID: PMC10023296 DOI: 10.1111/jgs.18143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nursing home (NH) residents are vulnerable to mortality after natural disasters. We examined NH residents' excess all-cause mortality associated with Hurricane Harvey, a unique disaster with long-lasting flooding effects. We also explored how mortality differed between short-stay and long-stay residents and by chronic conditions. METHODS We conducted a retrospective observational study of Texas NH residents, comparing 30- and 90-day mortality among residents exposed to Hurricane Harvey in August 2017 to residents not exposed in the same location and time period during the previous 2 years. Data came from the Minimum Data Set Assessments and the Medicare Beneficiary Summary File. We used linear probability models to examine the association between hurricane exposure and mortality, adjusting for resident demographics, clinical acuity, and NH fixed effects. Models were stratified by short-stay and long-stay status. We also described differences in mortality by residents' chronic conditions. RESULTS In 2017, 18,479 Texas NH residents were exposed to Hurricane Harvey. Exposure to Hurricane Harvey was not significantly associated with 30-day mortality. However, 7.6% (95% CI: 7.2, 7.9) of long-stay residents died 90 days after exposure to Harvey, compared to 6.3% (95% CI: 6.0, 6.7) during 2015. Apparently, this effect was driven by chronic obstructive pulmonary disease (COPD) as approximately 9.2% of these residents died within 90 days after Harvey landing compared to 7.2% in 2015 (p < 0.01). CONCLUSIONS Hurricane exposure appears to have significant consequences for mortality among long-stay NH residents, which appear to materialize over the long-term (90 days post-hurricane in our study) and may not be apparent immediately (30 days post-hurricane in our study). NH residents with COPD may be particularly vulnerable to increased mortality risk following hurricane exposure. The results highlight the need to pay special attention to mortality risk in NH residents, particularly those with COPD, following hurricane exposure.
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Affiliation(s)
- Cassandra L. Hua
- Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
| | - Sweta Patel
- School of Public Health, Brown University, Providence, Rhode Island
| | - Kali S. Thomas
- Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
| | | | - Ross Andel
- Center for Innovation in Healthy and Resilient Aging, Arizona State University
| | - Lily Gordon
- School of Public Health, Brown University, Providence, Rhode Island
| | - Dylan J. Jester
- School of Aging Studies, University of South Florida, Tampa, Florida
- Department of Psychiatry, University of California San Diego, La Jolla, CA. Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - David M. Dosa
- Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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17
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Festa N, Heaphy NM, Throgmorton KF, Canavan M, Gill TM. Evaluating California nursing homes' emergency preparedness for wildfire exposure. J Am Geriatr Soc 2023; 71:895-902. [PMID: 36541045 PMCID: PMC10023274 DOI: 10.1111/jgs.18142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The relationship between the risk of exposure to environmental hazards and the emergency preparedness of nursing homes is not well-understood. This study evaluates the association between wildfire exposure risk and nursing home emergency preparedness. METHODS From a sample of Centers for Medicare & Medicaid Services (CMS) certified nursing homes in California, we determined the prevalence of "exposed" facilities that were located within 5 km of a wildfire risk area, as informed by a field-tested model. Among the 1182 nursing homes, we identified emergency preparedness deficiencies from January 2017 to December 2019. We estimated associations between exposure and emergency preparedness deficiencies using unadjusted and adjusted generalized estimating equations with logistic and negative binomial distributions. RESULTS A greater percentage of the 495 exposed facilities had at least one emergency preparedness deficiency than the 687 unexposed facilities (83.9% vs 76.9%). The mean (3.6 vs 3.2) and median (3 vs 2) numbers of emergency preparedness deficiencies were also greater for exposed facilities. In both the unadjusted and adjusted analyses, exposure to wildfire risk was significantly associated with the likelihood of at least one emergency preparedness deficiency (adjusted odds ratio 1.52, p-value 0.007). There was a positive but not statistically significant association between exposure and the number of emergency preparedness deficiencies assigned to a nursing home (adjusted rate ratio 1.12, p-value 0.062). These results were consistent in analyses that used more stringent distance- and severity-thresholds to define exposure status. CONCLUSION California nursing homes at heightened risk of exposure to wildfires have poorer emergency preparedness than unexposed facilities. These findings suggest that nursing home management and staff may be unaware of important environmental risks to which their facilities are exposed. Improved integration of nursing homes into community disaster planning may better align facility preparedness with surrounding wildfire risk.
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Affiliation(s)
- Natalia Festa
- VA Office of Academic Affiliations through the VA/National Clinician Scholars Program and Yale University, New Haven, Connecticut, USA
- Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research (COPPER), Yale School of Medicine, New Haven, Connecticut, USA
| | - Nora M. Heaphy
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, USA
| | - Kaitlin Fender Throgmorton
- Harvey Cushing/John Hay Whitney Medical Library, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Maureen Canavan
- Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research (COPPER), Yale School of Medicine, New Haven, Connecticut, USA
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Dosa D, Jester D, Peterson L, Dobbs D, Black K, Brown L. Applying the age-friendly-health system 4M paradigm to reframe climate-related disaster preparedness for nursing home populations. Health Serv Res 2023; 58 Suppl 1:36-43. [PMID: 35908191 PMCID: PMC9843084 DOI: 10.1111/1475-6773.14043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- David Dosa
- Providence VA Medical CenterProvidenceRhode IslandUSA
- Warren Alpert School of MedicineBrown UniversityProvidenceRhode IslandUSA
- School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Dylan Jester
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Sam and Rose Stein Institute for Research on AgingUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Lindsay Peterson
- Florida Policy Exchange Center of AgingSchool of Aging Studies, University of South FloridaTampaFloridaUSA
| | - Debra Dobbs
- Florida Policy Exchange Center of AgingSchool of Aging Studies, University of South FloridaTampaFloridaUSA
| | - Kathy Black
- School of Aging StudiesUniversity of South Florida Sarasota‐Manatee CampusSarasotaFloridaUSA
| | - Lisa Brown
- Risk and Resilience LabPalo Alto UniversityPalo AltoCaliforniaUSA
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Festa N, Throgmorton KF, Heaphy N, Canavan M, Gill TM. Association of Nursing Home Exposure to Hurricane-Related Inundation With Emergency Preparedness. JAMA Netw Open 2023; 6:e2249937. [PMID: 36607635 PMCID: PMC9856665 DOI: 10.1001/jamanetworkopen.2022.49937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/16/2022] [Indexed: 01/07/2023] Open
Abstract
Importance Whether US nursing homes are well prepared for exposure to hurricane-related inundation is uncertain. Objectives To estimate the prevalence of nursing homes exposed to hurricane-related inundation and evaluate whether exposed facilities are more likely to meet Centers for Medicare & Medicaid Services (CMS) emergency preparedness standards. Design, Setting, and Participants This cross-sectional study included CMS-certified nursing homes in Coastal Atlantic and Gulf Coast states from January 1, 2017, to December 31, 2019. The prevalence of facilities exposed to at least 2 feet of hurricane-related inundation used models from the National Hurricane Center across coastal areas overseen by 5 CMS regional offices: New England, New York metropolitan area, Mid-Atlantic region, Southeast and Eastern Gulf Coast, and Western Gulf Coast. Critical emergency preparedness deficiencies cited during CMS life safety code inspections were identified. Main Outcomes and Measures The analysis used generalized estimating equations with binomial and negative binomial distributions to evaluate associations between exposure status and the presence and number of critical emergency preparedness deficiencies. Regionally stratified associations (odds ratios [ORs]) and rate ratios [RRs]) with 95% CIs, adjusted for state-level fixed effects and nursing home characteristics, were reported. Results Of 5914 nursing homes, 617 (10.4%) were at risk of inundation exposure, and 1763 (29.8%) had a critical emergency preparedness deficiency. Exposed facilities were less likely to be rural, were larger, and had similar CMS health inspection, quality, and staffing ratings compared with unexposed facilities. Exposure was positively associated with the presence and number of emergency preparedness deficiencies for the nursing homes within the Mid-Atlantic region (adjusted OR, 1.91 [95% CI, 1.15-3.20]; adjusted RR, 2.51 [95% CI, 1.41-4.47]). Conversely, exposure was negatively associated with the number of emergency preparedness deficiencies among facilities within the Western Gulf Coast (aRR, 0.55 [95% CI, 0.36-0.86]). The associations for the number of emergency preparedness deficiencies remained after correction for multiple comparisons. Conclusions and Relevance The findings of this cross-sectional study suggest that the association between exposure to hurricane-related inundation and nursing home emergency preparedness differs considerably across the Coastal Atlantic and Gulf regulatory regions. These findings further suggest that there may be opportunities to reduce regional heterogeneity and improve the alignment of nursing home emergency preparedness with surrounding environmental risks.
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Affiliation(s)
- Natalia Festa
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program at Yale University, New Haven, Connecticut
| | - Kaitlin F. Throgmorton
- Harvey Cushing/John Hay Whitney Medical Library, School of Medicine, Yale University, New Haven, Connecticut
| | - Nora Heaphy
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut
| | - Maureen Canavan
- Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research, Yale School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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20
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Peterson LJ. Three Decades of Research Guiding Policy and Policy Guiding Research: Academic Efforts Concerning Aging and Public Policy. THE PUBLIC POLICY AND AGING REPORT 2022; 33:13-16. [PMID: 36873957 PMCID: PMC9976700 DOI: 10.1093/ppar/prac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Lindsay J Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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21
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Anderson FW, Walters CR. Medical-legal partnerships can mitigate climate health impacts on the underserved. Fam Pract 2022; 40:502-504. [PMID: 36444897 DOI: 10.1093/fampra/cmac127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Frederick W Anderson
- Department of Humanities, Health, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Christina R Walters
- Department of Public Interest and Medical-Legal Partnerships, Community Legal Services of Mid-Florida, Inc. Orlando, Orlando, FL, United States
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22
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Crowley R, Mathew S, Hilden D. Environmental Health: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1591-1593. [PMID: 36279541 DOI: 10.7326/m22-1864] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Environmental health refers to the health effects associated with environmental factors, such as air pollution, water contamination, and climate change. Environmental hazards are associated with poor outcomes in common diseases, including diabetes and heart disease. In this position paper, the American College of Physicians (ACP) seeks to inform physicians about environmental health and offers policymakers recommendations to reduce the adverse health consequences of climate change, improve air and water quality, reduce exposure to toxic substances, and address environmental injustice. ACP affirms that all communities, including people of color, people with low income, and marginalized populations, deserve to live in a healthy environment.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C.)
| | - Suja Mathew
- Atlantic Health System, Morristown, New Jersey (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
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Dobbs D, Skarha J, Gordon L, Jester DJ, Peterson LJ, Dosa DM. Mortality among Nursing Home Residents Enrolled in Hospice and Hospice Utilization Post-Hurricane Irma. J Palliat Med 2022; 25:1355-1360. [PMID: 35325566 PMCID: PMC9492905 DOI: 10.1089/jpm.2021.0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Nursing home (NH) residents are vulnerable to increased mortality after a natural disaster such as hurricanes but the specific vulnerability of NH residents on hospice and the impact on admission to hospice are unknown. Objectives: Exposure to Hurricane Irma (2017) was used to evaluate increased mortality among Florida NH residents by hospice status compared with the same time period in a nonhurricane year. Difference in hospice utilization rates poststorm for short- and long-stay NH residents was also examined. Setting/Subjects: Subject were all Florida NH residents of age 65 years and older utilizing fee-for-service Medicare claims data exposed to Hurricane Irma in 2017 compared with a control group of residents residing at the same NHs in 2015. Analysis: Mortality rates were calculated by hospice status, rates of hospice enrollment, and the corresponding odds ratios (ORs). Results: Hurricane exposure was associated with an increase in mortality 30 days poststorm (OR = 1.12, 95% confidence interval [CI]: 1.00-1.26) but not 90 days poststorm (OR = 1.02, 95% CI: 0.95-1.10) for residents on hospice. For the rate of hospice enrollment poststorm among residents previously not on hospice, there was an increase in odds of enrollment among long-stay residents in 30 days (OR = 1.15, 95% CI: 1.02-1.23) and 90 days (OR = 1.12, 95% CI: 1.05-1.20) but not short-stay residents within 30 (OR = 1.02, 95% CI: 0.91-1.15) and 90 days (OR = 1.07, 95% CI: 0.99-1.15). Conclusion: Mortality in NH residents on hospice care increased in the aftermath of Hurricane Irma. In addition, NH residents not on hospice were more likely to be referred to hospice in the 30 days after the storm.
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Affiliation(s)
- Debra Dobbs
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - Julianne Skarha
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Lily Gordon
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Dylan J. Jester
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - Lindsay J Peterson
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA
| | - David M. Dosa
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Providence VAMC, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island, USA
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24
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Crowley R, Atiq O, Hilden D. Long-Term Services and Supports for Older Adults: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1172-1174. [PMID: 35816710 DOI: 10.7326/m22-0864] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The number of Americans aged 65 years or older is expected to increase in the coming decades. Because the risk for disability increases with age, more persons will need long-term services and supports (LTSS) to help with bathing, eating, dressing, and other everyday tasks. Long-term services and supports are delivered in nursing homes, assisted living facilities, the person's home, and other settings. However, the LTSS sector faces several challenges, including keeping patients and staff safe during the COVID-19 pandemic, workforce shortages, quality problems, and fragmented coverage options. In this position paper, the American College of Physicians offers policy recommendations on LTSS coverage, financing, workforce, safety and quality, and emergency preparedness and calls on policymakers and other stakeholders to reform and improve the LTSS sector so that care is high quality, accessible, equitable, and affordable.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
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25
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Wasserman M, Konetzka RT. Beyond Compliance: A More Integrated Public Health Approach To Outbreaks In Nursing Homes And Other Disasters. Health Aff (Millwood) 2022; 41:831-837. [PMID: 35666972 DOI: 10.1377/hlthaff.2021.01839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nursing home residents are vulnerable to disproportionate harm during disasters and health emergencies, as evidenced by the recent impact of COVID-19 and extreme weather events. Evaluation of these disasters shows that the nursing homes in question were often in compliance with relevant regulations around emergency planning. However, advance planning for disasters cannot anticipate every contingency, leading to the need for flexibility and quick adaptation on the part of nursing home leaders. In addition, disasters often involve larger, regional problems and situations that individual providers cannot solve. We suggest that policy makers need to prioritize development and expectations around leadership skills in nursing home management and better integrate the long-term care sector into local, state, and federal public health planning for future pandemics and other disasters.
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26
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Jester DJ, Peterson LJ, Thomas KS, Dosa DM, Andel R. Nursing Home Compare Star Rating and Daily Direct-Care Nurse Staffing During Hurricane Irma. J Am Med Dir Assoc 2021; 23:1409-1412.e1. [PMID: 34740564 DOI: 10.1016/j.jamda.2021.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nursing homes (NHs) are affected by major hurricanes and other natural disasters. To mitigate adverse effects of a major hurricane, NHs often increase their direct-care nurse staffing levels to meet the needs of their residents. However, the quality rating of the NH may affect the resources available to obtain and retain staff. This data brief provides estimates of direct-care nurse staffing levels by quality star rating during Hurricane Irma. DESIGN Retrospective cohort study from September 3, 2017, to September 10, 2017. SETTING AND PARTICIPANTS 570 Florida NHs that sheltered in place during Hurricane Irma. METHODS We stratified NHs by their NH Compare overall quality star rating and then measured change in direct-care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. RESULTS We found that the NH Compare overall star rating was positively associated with a greater staffing level response during Hurricane Irma among registered nurses, licensed practical nurses, and certified nursing assistants. This change was largest for 5-star facilities and smallest for 1-star facilities. CONCLUSIONS AND IMPLICATIONS Higher-quality NHs may be more responsive and have the resources to be more responsive, to increased needs during a natural disaster. Our findings may serve as a platform for ongoing discussion on the role of the federal, state, and local governments in ensuring minimum staffing standards during natural disasters.
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Affiliation(s)
- Dylan J Jester
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA; Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA.
| | - Lindsay J Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Kali S Thomas
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; School of Public Health, Brown University, Providence, RI, USA
| | - David M Dosa
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; School of Public Health, Brown University, Providence, RI, USA; Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Ross Andel
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
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Skarha J, Gordon L, Sakib N, June J, Jester DJ, Peterson LJ, Andel R, Dosa DM. Association of Power Outage With Mortality and Hospitalizations Among Florida Nursing Home Residents After Hurricane Irma. JAMA HEALTH FORUM 2021; 2:e213900. [PMID: 35977265 PMCID: PMC8796882 DOI: 10.1001/jamahealthforum.2021.3900] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/06/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Exposure to hurricanes is associated with increased mortality and morbidity in nursing home (NH) residents, but the factors contributing to these outcomes are less understood. One hypothesized pathway could be power outages from hurricanes that expose NH residents to excess ambient heat. Objective To determine the association of power loss from Hurricane Irma with hospitalization and mortality in NH residents in Florida. Design Setting and Participants This retrospective cohort study of NH residents residing in Florida when Hurricane Irma landed on September 10, 2017, assessed mortality at 7 and 30 days after the storm and hospitalization at 30 days after the storm. The analysis was conducted from May 2, 2021, to June 28, 2021. All NH residents residing in Florida at landfall were eligible (N = 67 273). We excluded those younger than 65 years, missing power status information, or who were evacuated (13 178 [19.6%]). Exposure We used state-administered surveys to determine NH power outage status. Exposed residents experienced a power outage poststorm, whereas unexposed residents did not experience a power outage poststorm. Main Outcomes and Measures We used Medicare claims to assess mortality and hospitalization after Hurricane Irma landfall using generalized linear models with robust standard errors. Results In the aftermath of Hurricane Irma, 27 892 residents (18 510 women [66.4%]; 3906 [14.0%] Black, 1651 [5.9%] Hispanic, and 21 756 [78.0%] White individuals) in 299 NHs were exposed to power loss and 26 203 residents (17 620 women [67.2%]; 4175 [15.9%] Black, 1030 [3.9%] Hispanic, and 20 477 [78.1%] White individuals) in 292 NHs were unexposed. Nursing homes that lost power were similar in size, quality star rating, and type of ownership compared with NHs that did not lose power. Power loss was associated with an increased adjusted odds of mortality among all residents within 7 days (odds ratio [OR],1.25; 95% CI,1.05-1.48) and 30 days (OR, 1.12; 95% CI,1.02-1.23) poststorm and hospitalization within 30 days, although only among residents aged 65 to 74 years (OR, 1.16; 95% CI, 1.03-1.33). Conclusions and Relevance In this cohort study, power loss was associated with higher odds of mortality in all affected NH residents and hospitalization in some residents. The benefits and costs of policies that require NHs to have emergency alternate power sources should be assessed.
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Affiliation(s)
- Julianne Skarha
- School of Public Health, Brown University, Providence, Rhode Island
| | - Lily Gordon
- School of Public Health, Brown University, Providence, Rhode Island
| | - Nazmus Sakib
- Department of Industrial and Management Systems Engineering, University of South Florida, Tampa
| | - Joseph June
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - Dylan J. Jester
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
- Department of Psychiatry, University of California San Diego, La Jolla
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla
| | - Lindsay J. Peterson
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - Ross Andel
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa
| | - David M. Dosa
- School of Public Health, Brown University, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Primary Care, Providence VAMC, Providence, Rhode Island
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Emergency preparedness: What is the future? ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e29. [PMID: 36168490 PMCID: PMC9495548 DOI: 10.1017/ash.2021.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
Emergency preparedness programs have evolved over the last several decades as communities have responded to natural, intentional, and accidental disasters. This evolution has resulted in a comprehensive all-hazards approach centered around 4 fundamental phases spanning the entire disaster life cycle: mitigation, preparedness, response, and recovery. Increasing frequency of outbreaks and epidemics of emerging and reemerging infectious diseases in the last decade has emphasized the significance of healthcare emergency preparedness programs, but the coronavirus disease 2019 (COVID-19) pandemic has tested healthcare facilities’ emergency plans and exposed vulnerabilities in healthcare emergency preparedness on a scale unexperienced in recent history. We review the 4 phases of emergency management and explore the lessons to be learned from recent events in enhancing health systems capabilities and capacities to mitigate, prepare for, respond to, and recover from biological threats or events, whether it be a pandemic or a single case of an unknown infectious disease. A recurring cycle of assessing, planning, training, exercising, and revising is vital to maintaining healthcare system preparedness, even in absence of an immediate, high probability threat. Healthcare epidemiologists and infection preventionists must play a pivotal role in incorporating lessons learned from the pandemic into emergency preparedness programs and building more robust preparedness plans.
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Dobbs D, June JW, Dosa DM, Peterson LJ, Hyer K. Protecting Frail Older Adults: Long-Term Care Administrators' Satisfaction With Public Emergency Management Organizations During Hurricane Irma and COVID-19. THE PUBLIC POLICY AND AGING REPORT 2021; 31:145-150. [PMID: 34691480 PMCID: PMC8500148 DOI: 10.1093/ppar/prab019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Debra Dobbs
- Florida Policy Exchange Center on Aging, Tampa, Florida, USA
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Joseph W June
- Florida Policy Exchange Center on Aging, Tampa, Florida, USA
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - David M Dosa
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Providence VA Medical Center, Providence, Rhode Island, USA
| | - Lindsay J Peterson
- Florida Policy Exchange Center on Aging, Tampa, Florida, USA
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, Tampa, Florida, USA
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
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Peterson LJ, Dobbs D, June J, Dosa DM, Hyer K. "You Just Forge Ahead": The Continuing Challenges of Disaster Preparedness and Response in Long-Term Care. Innov Aging 2021; 5:igab038. [PMID: 34805555 PMCID: PMC8600546 DOI: 10.1093/geroni/igab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Protecting nursing home and assisted living community residents during disasters continues to be a challenge. The present study explores the experiences of long-term care facilities in Florida that were exposed to Hurricane Irma in 2017. RESEARCH DESIGN AND METHODS We used an abductive approach, combining induction and deduction. Interviews and focus groups beginning in May 2018 were conducted by telephone and in person with 89 administrative staff members representing 100 facilities (30 nursing homes and 70 assisted living communities). Analyses identified themes and subthemes. Findings were further analyzed using the social ecological model to better understand the preparedness and response of nursing homes and assisted living communities to Hurricane Irma. RESULTS 3 main themes were identified including: (1) importance of collaborative relationships in anticipating needs and planning to shelter in place or evacuate; (2) efforts required to maintain safety and stability during an unprecedented event; and (3) effects, repercussions, and recommendations for change following the disaster. DISCUSSION AND IMPLICATIONS Preparing for and managing disasters in nursing homes and assisted living communities involves actions within multiple environments beyond the residents and facilities where they live. Among these, community-level relationships are critical.
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Affiliation(s)
- Lindsay J Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Joseph June
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - David M Dosa
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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Gray‐Miceli D, Rogowski J, de Cordova PB, Boltz M. A framework for delivering nursing care to older adults with COVID-19 in nursing homes. Public Health Nurs 2021; 38:610-626. [PMID: 33715193 PMCID: PMC8251143 DOI: 10.1111/phn.12885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
Public health emergencies threaten the lives of U.S. citizens, often in disproportionate ways. Hardest hit are vulnerable populations of older adults (OAs) residing in nursing homes (NHs), who comprised nearly 43% of all deaths from COVID-19 in NHs in 2020. New Jersey (NJ) ranks #2 nationally behind New York with the highest numbers of resident deaths; more than 50% of all COVID-19-related deaths in NJ have occurred in NHs. This public health emergency has prompted investigators to evaluate existing structural, resident, process of care, regulatory, and policy characteristics that have impacted the delivery of nursing care within NJ NHs. In this manuscript, we discuss data from NJ NHs during COVID-19, drawing from publicly available data, state reports, and the geriatric literature to offer recommendations. Based on evidence-based practices (EBPs), we present a series of recommendations to modify existing contextual factors in NHs to best prepare for the next health disaster.
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Affiliation(s)
- Deanna Gray‐Miceli
- Jefferson College of Nursing, Thomas Jefferson UniversityPhiladelphiaPAUSA
| | - Jeannette Rogowski
- Department of Health Policy and AdministrationThe Pennsylvania State UniversityUniversity ParkPAUSA
| | | | - Marie Boltz
- Penn State College of NursingUniversity ParkPAUSA
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Jester DJ, Thomas KS, Peterson LJ, Dosa DM, Andel R, Hyer K. Effect of Hurricane Irma on daily direct-care nurse staffing in nursing homes. J Am Geriatr Soc 2021; 69:2298-2305. [PMID: 33979461 DOI: 10.1111/jgs.17220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the effect of Hurricane Irma on staff-related financial expenditures and daily direct-care nurse staffing levels. DESIGN Retrospective cohort study. SETTING September 3-24, 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10, 2017. PARTICIPANTS Six hundred and fifty-three nursing homes (NHs), 81 evacuated facilities, and 572 facilities that sheltered-in-place. MEASUREMENTS This study used data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida's health providers' emergency reporting system. PBJ provided estimates of daily direct-care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility-level characteristics such as profit status, chain membership, and special care unit availability. Florida's emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed-effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3 to 10. RESULTS Among all facilities, we found significant increases in staffing for licensed practical nurses (p = 0.02) and certified nursing assistants (p < 0.001), but not for registered nurses (p = 0.10) before Hurricane Irma made landfall. From 1 week before landfall to 2 weeks after landfall (September 3-24), an additional estimated $2.41 million was spent on direct-care nurse staffing. In comparison to facilities that sheltered-in-place, evacuated facilities increased staffing levels of all nurse types (all p < 0.001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident whereas facilities that sheltered-in-place spent $76.10 on nurse staffing per resident. CONCLUSION NHs face unprecedented challenges during hurricanes, including maintaining adequate direct-care nurse staffing levels to meet the needs of their residents. NHs that evacuated residents had an increase in direct-care nurse staffing that was greater than that seen in NHs that sheltered-in-place.
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Affiliation(s)
- Dylan J Jester
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kali S Thomas
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Lindsay J Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - David M Dosa
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,School of Public Health, Brown University, Providence, Rhode Island, USA.,Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Ross Andel
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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