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Mehta MM, Johnson AE, Ratnakaran B, Seritan I, Seritan AL. Climate Change and Aging: Implications for Psychiatric Care. Curr Psychiatry Rep 2024; 26:499-513. [PMID: 39210192 PMCID: PMC11384634 DOI: 10.1007/s11920-024-01525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW We reviewed recent evidence regarding the impact of climate change (specifically, high ambient temperatures, heatwaves, weather-related disasters, and air pollution) on older adults' mental health. We also summarized evidence regarding other medical problems that can occur in aging adults in connection with climate change, resulting in psychiatric manifestations or influencing psychopharmacological management. RECENT FINDINGS Older adults can experience anxiety, depressive, and/or posttraumatic stress symptoms, as well as sleep disturbances in the aftermath of climate disasters. Cognitive deficits may occur with exposure to air pollutants, heatwaves, or post-disaster. Individuals with major neurocognitive disorders and/or preexisting psychiatric illness have a higher risk of psychiatric hospitalizations after exposure to high temperatures and air pollution. There is a growing body of research regarding psychiatric clinical presentations associated with climate change in older adults. However, there is a paucity of evidence on management strategies. Future research should investigate culturally appropriate, cost-effective psychosocial and pharmacological interventions.
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Affiliation(s)
- Michelle M Mehta
- White Earth Tribal Behavioral Health, P.O. Box 300, White Earth, MN, 56591, USA
| | - Anne E Johnson
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. #9070, Dallas, TX, 75930, USA
| | - Badr Ratnakaran
- Department of Psychiatry and Behavioral Medicine, Carilion Clinic-Virginia Tech Carilion School of Medicine, 2017 S. Jefferson St., Roanoke, VA, 24014, USA
| | - Ioana Seritan
- American Birding Association, Colorado Springs, CO, 80934, USA
| | - Andreea L Seritan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94107, USA.
- UCSF Weill Institute for the Neurosciences, San Francisco, 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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Ayalon L, Ulitsa N, AboJabel H, Engdau-Vanda S. "We Used to Have Four Seasons, but Now There Is Only One": Perceptions Concerning the Changing Climate and Environment in a Diverse Sample of Israeli Older Persons. J Appl Gerontol 2024; 43:527-535. [PMID: 38085273 PMCID: PMC10981184 DOI: 10.1177/07334648231212279] [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: 07/20/2023] [Revised: 09/21/2023] [Accepted: 10/18/2023] [Indexed: 04/01/2024] Open
Abstract
Solastalgia is the pain caused by the loss of solace and isolation from one's environment. Solastalgia is contrasted with nostalgia, which is defined as melancholy characterized by homesickness or the distance from one's home. The present study examines the two concepts of solastalgia and nostalgia in the context of climate change among diverse populations of older Israelis. In total, 50 older persons from four different population groups (e.g., veteran Israeli Jews, Israeli Arabs, immigrants from the former Soviet Union, and Ethiopian immigrants) were interviewed. All interviews were transcribed and analyzed thematically. Members of all four groups expressed emotional distress and grief associated with the changing climate, increased environmental pollution, and the disappearance of nature. Perceptions around the undesirability of these changes were quite unanimous, thus leading us to conclude that the outcomes associated with solastalgia and nostalgia are quite similar despite different etiological explanations.
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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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Yu M, Kang YS, Hong HY, Hong CU, Kwon TK. Evacuation safety effects of a lightweight elevator-type evacuation device using carbon material: Focus on plantar pressure and muscle strength. Technol Health Care 2024; 32:115-124. [PMID: 38759042 PMCID: PMC11191485 DOI: 10.3233/thc-248010] [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: 05/19/2024]
Abstract
BACKGROUND Elevator-type evacuation devices have proven to be feasible in high-rise buildings through studies on safety performance and evacuation time. However, there is a lack of research on safety using biosignal analysis in the elderly population. OBJECTIVE A carbon material is used in this study to reduce the weight of an evacuation elevator. The impact on the human body is evaluated by conducting a satisfaction survey involving elderly and youth groups and quantitatively analyzing biological signals, including electromyography (EMG) and plantar pressure, during five repeated uses of the proposed device. METHODS The study involves 12 healthy adults in their 20s and 20 elderly individuals with no experience in using an evacuation elevator. The EMG and left and right plantar pressures are analyzed to evaluate the physical factors affected by repeated use. RESULTS The experiment results showed that the normalization of EMG to maximum voluntary contraction showed a significant decrease with repeated use, especially in the right tibialis anterior muscle. Moreover, plantar pressure shows a significant difference, which decreased with repetition, and the left and right balance gradually tilted to the left. CONCLUSION This suggests that with more repeated use, muscle tension decreases owing to adaptation, resulting in lower muscle activity and plantar pressure. Particularly, the tibialis anterior muscle experiences significant muscle activity, indicating increased load, but without any apparent danger. In the future, it will be necessary to evaluate elevators for disabled individuals.
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Affiliation(s)
- Mi Yu
- Division of Biomedical Engineering, Jeonbuk National University, Jeonju, Korea
- Center for Healthcare Technology Development, Jeonbuk National University, Jeonju, Korea
| | - Young-Soek Kang
- Department of Healthcare Engineering, Jeonbuk National University, Jeonju, Korea
| | - Hwa-Young Hong
- Department of Convergence Management of Technology, Jeonbuk National University, Jeonju, Korea
| | - Chul-Un Hong
- Division of Biomedical Engineering, Jeonbuk National University, Jeonju, Korea
- Research Center of Healthcare and Welfare Instrument for the Aged, Jeonbuk National University, Jeonju, Korea
| | - Tae-Kyu Kwon
- Division of Biomedical Engineering, Jeonbuk National University, Jeonju, Korea
- Research Center of Healthcare and Welfare Instrument for the Aged, Jeonbuk National University, Jeonju, Korea
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McDonald VM, Archbold G, Beyene T, Brew BK, Franklin P, Gibson PG, Harrington J, Hansbro PM, Johnston FH, Robinson PD, Sutherland M, Yates D, Zosky GR, Abramson MJ. Asthma and landscape fire smoke: A Thoracic Society of Australia and New Zealand position statement. Respirology 2023; 28:1023-1035. [PMID: 37712340 PMCID: PMC10946536 DOI: 10.1111/resp.14593] [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: 01/12/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
Landscape fires are increasing in frequency and severity globally. In Australia, extreme bushfires cause a large and increasing health and socioeconomic burden for communities and governments. People with asthma are particularly vulnerable to the effects of landscape fire smoke (LFS) exposure. Here, we present a position statement from the Thoracic Society of Australia and New Zealand. Within this statement we provide a review of the impact of LFS on adults and children with asthma, highlighting the greater impact of LFS on vulnerable groups, particularly older people, pregnant women and Aboriginal and Torres Strait Islander peoples. We also highlight the development of asthma on the background of risk factors (smoking, occupation and atopy). Within this document we present advice for asthma management, smoke mitigation strategies and access to air quality information, that should be implemented during periods of LFS. We promote clinician awareness, and the implementation of public health messaging and preparation, especially for people with asthma.
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Affiliation(s)
- Vanessa M. McDonald
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
- Department of Sleep and Respiratory MedicineHunter New England Local Health DistrictNewcastleNew South WalesAustralia
| | - Gregory Archbold
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
| | - Tesfalidet Beyene
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
| | - Bronwyn K. Brew
- National Perinatal Epidemiology and Biostatistics Unit, Centre for Big Data Research in Health, Discipline of Women's Health, Faculty of MedicineUNSWSydneyNew South WalesAustralia
| | - Peter Franklin
- School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Peter G. Gibson
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
- Department of Sleep and Respiratory MedicineHunter New England Local Health DistrictNewcastleNew South WalesAustralia
| | - John Harrington
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
- Department of Sleep and Respiratory MedicineHunter New England Local Health DistrictNewcastleNew South WalesAustralia
| | - Philip M. Hansbro
- Centre for InflammationCentenary Institute and University of Technology Sydney, School of Life Sciences, Faculty of ScienceSydneyNew South WalesAustralia
- Immune HealthHunter Medical Research Institute and The University of NewcastleCallaghanNew South WalesAustralia
| | - Fay H. Johnston
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Paul D. Robinson
- Department of Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
- Children's Health and Environment Program, Child Health Research CentreUniversity of QueenslandBrisbaneQueenslandAustralia
| | | | - Deborah Yates
- Department of Thoracic MedicineSt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Graeme R. Zosky
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
- Tasmanian School of MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Abstract
OBJECTIVES To determine death occurrences of Puerto Ricans on the mainland USA following the arrival of Hurricane Maria in Puerto Rico in September 2017. DESIGN Cross-sectional study. PARTICIPANTS Persons of Puerto Rican origin on the mainland USA. EXPOSURES Hurricane Maria. MAIN OUTCOME We use an interrupted time series design to analyse all-cause mortality of Puerto Ricans in the USA following the hurricane. Hispanic origin data from the National Vital Statistics System and from the Public Use Microdata Sample of the American Community Survey are used to estimate monthly origin-specific mortality rates for the period 2012-2018. We estimated log-linear regressions of monthly deaths of persons of Puerto Rican origin by age group, gender, and educational attainment. RESULTS We found an increase in mortality for persons of Puerto Rican origin during the 6-month period following the hurricane (October 2017 through March 2018), suggesting that deaths among these persons were 3.7% (95% CI 0.025 to 0.049) higher than would have otherwise been expected. In absolute terms, we estimated 514 excess deaths (95% CI 346 to 681) of persons of Puerto Rican origin that occurred on the mainland USA, concentrated in those aged 65 years or older. CONCLUSIONS Our findings suggest an undercounting of previous deaths as a result of the hurricane due to the systematic effects on the displaced and resident populations in the mainland USA. Displaced populations are frequently overlooked in disaster relief and subsequent research. Ignoring these populations provides an incomplete understanding of the damages and loss of life.
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Affiliation(s)
| | - Boriana Miloucheva
- Department of Economics, University of Toronto, Toronto, Ontario, Canada
| | - Gustavo J Bobonis
- Department of Economics, University of Toronto, Toronto, Ontario, Canada
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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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Ayalon L, Keating N, Pillemer K, Rabheru K. Climate Change and Mental Health of Older Persons: A Human Rights Imperative. Am J Geriatr Psychiatry 2021; 29:1038-1040. [PMID: 34294541 DOI: 10.1016/j.jagp.2021.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
Climate change threatens the basic prerequisites for wellbeing, including clean air and water, food supply and the adequacy and security of shelter. Climate change is a powerful and ongoing presence in the lives of older persons, both creating and exacerbating vulnerabilities. The absence of a legally binding international instrument specifically protecting the human rights of older persons and minimal references to older persons in key international climate instruments attest to the lack of attention to and visibility of older persons in national and international law. There is a need to integrate the areas of older people and environmental sustainability to ensure that the rights of older people are preserved especially now, as the effects of the climate change crisis become more pronounced.
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Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University (LA), Ramat Gan, Israel.
| | - Norah Keating
- Swansea University (NK), Swansea, Wales, UK; North-West University (NK), Vanderbijlpark, South Africa; University of Alberta (NK), Edmonton, Alberta, Canada
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, NY
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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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Ibrahim JE, Aitken G. A Proactive Nursing Home Risk Stratification Model for Disaster Response: Lessons Learned from COVID-19 to Optimize Resource Allocation. J Am Med Dir Assoc 2021; 22:1831-1839.e1. [PMID: 34390677 PMCID: PMC8292024 DOI: 10.1016/j.jamda.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/25/2021] [Accepted: 07/14/2021] [Indexed: 11/02/2022]
Abstract
A coordinated emergency management response to disaster management in nursing homes is desperately needed globally. During the most recent COVID-19 pandemic, aside from a few exemplary countries, most countries have struggled to protect their nursing home populations. Timely and appropriate allocation of resources to nursing homes during disaster response is a challenging yet crucial task to prevent morbidity and mortality of residents. The responsibility for the management of nursing homes during the pandemic was multifaceted, and responsibilities lay at the national, jurisdictional, and regional levels. Success in managing COVID-19 in nursing homes required all these levels to be aligned and supportive, ideally through management by an emergency response leadership team. However, globally there is a paucity of effective management strategies. This article uses the example of the COVID-19 pandemic to propose a risk stratification system to ensure timely and appropriate allocation of resources to nursing homes during disaster preparation and management. Nursing homes should be risk-stratified according to 4 domains: risk of intrusion, capability for outbreak containment, failure in organizational capability, and failure in the availability of community and health care supports. Risk stratification should also consider factors such as current levels of community transmission, if applicable, and geographic location of nursing homes and services. Early identification of nursing homes at risk for infectious disease, or disasters, and targeted allocation of resources might help reduce the number of outbreaks, lower the mortality, and preserve community supports such as acute hospital services. The next step is to debate this concept to validate the selected variables and then develop and pilot test a risk stratification tool for use.
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Affiliation(s)
- Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.
| | - Georgia Aitken
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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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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15
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Marfori MT, Campbell SL, Garvey K, McKeown S, Veitch M, Wheeler AJ, Borchers-Arriagada N, Johnston FH. Public Health Messaging During Extreme Smoke Events: Are We Hitting the Mark? Front Public Health 2020; 8:465. [PMID: 32984250 PMCID: PMC7492534 DOI: 10.3389/fpubh.2020.00465] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Emergency services working to protect communities from harm during wildfires aim to provide regular public advisories on the hazards from fire and smoke. However, there are few studies evaluating the success of public health communications regarding the management of smoke exposure. We explored the responses to smoke-related health advisories of people living in a severely smoke-affected region during extensive wildfires in Tasmania, Australia early in 2019. We also evaluated the acceptability of portable high efficiency particle air (HEPA) cleaners used in study participant's homes during the smoky period. Methods: We conducted semi-structured interviews with 24 households in the Huon Valley region of Tasmania following a severe smoke episode. These households were initially recruited into a HEPA cleaner study. Interviews were recorded, transcribed, and analyzed for common themes using an inductive framework approach. Results: Public health messaging during the 2019 wildfire event in Tasmania was widely shared and understood, with social media playing a central role. However, some participants expressed concerns about the timeliness and effectiveness of the recommended interventions, and some would have appreciated more detailed information about the health risks from smoke. Public messages and actions to protect households from wildfire threat were, at times, contradictory or dominated in coverage over the smoke messaging, and many participants were conflicted with the multiple public messages and action relating to the more serious perceived threat from the fire. Conclusions: Public messaging about smoke and health should continue to use multiple avenues of communication, with a focus on simple messages provided through social media. Messaging about the smoke hazard should be available from a trusted central source regarding all aspects of the wildfire emergency, with links to more detailed information including local air quality data alongside interpretation of the associated health risks.
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Affiliation(s)
- M Therese Marfori
- Environmental Health Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Public Health Services, Department of Health, Tasmanian Government, Hobart, TAS, Australia
| | - Sharon L Campbell
- Environmental Health Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Public Health Services, Department of Health, Tasmanian Government, Hobart, TAS, Australia
| | - Kate Garvey
- Public Health Services, Department of Health, Tasmanian Government, Hobart, TAS, Australia
| | - Scott McKeown
- Public Health Services, Department of Health, Tasmanian Government, Hobart, TAS, Australia
| | - Mark Veitch
- Public Health Services, Department of Health, Tasmanian Government, Hobart, TAS, Australia
| | - Amanda J Wheeler
- Environmental Health Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Nicolas Borchers-Arriagada
- Environmental Health Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Fay H Johnston
- Environmental Health Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Public Health Services, Department of Health, Tasmanian Government, Hobart, TAS, Australia
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16
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Peterson LJ, June J, Sakib N, Dobbs D, Dosa DM, Thomas KS, Jester DJ, Hyer K. Assisted Living Communities During Hurricane Irma: The Decision to Evacuate or Shelter in Place and Resident Acuity. J Am Med Dir Assoc 2020; 21:1148-1152.e3. [PMID: 32151551 PMCID: PMC7396303 DOI: 10.1016/j.jamda.2020.01.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/01/2019] [Accepted: 01/20/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the factors associated with whether assisted living communities (ALCs) in Florida evacuated or sheltered in place for Hurricane Irma in 2017, focusing on license type as a proxy for acuity of care. DESIGN Cross-sectional study using data collected by the state through its emergency reporting system and a post-hurricane survey. SETTING AND PARTICIPANTS Analyses included all 3112 ALCs in the emergency reporting system. A subset of 1880 that completed the survey provided supplementary data. METHODS χ2 tests were used to examine differences between ALC characteristics (license type, size, payment, profit status, rural location, geographical region, and being under an evacuation order) and whether they evacuated. Logistic regression was used to test associations between characteristics and evacuation status. RESULTS Of 3112 ALCs, 560 evacuated and 2552 sheltered in place. Bivariate analysis found significant associations between evacuation status and evacuation order, license type (mental health care), payment, and region. In the adjusted analysis, medium and larger ALCs were 43% (P < .001) and 53% (P < .001) less likely to evacuate than ALCs with fewer than 25 beds. Compared with ALCs in the Southeast, nearly every region was more likely to evacuate, with the highest likelihood in the Central West (odds ratio 1.76, 95% confidence interval 1.35‒2.30). ALCs under an evacuation order were 8 times more likely to evacuate (P < .001). We found no relationship between evacuation status and having a license to provide higher care. CONCLUSIONS AND IMPLICATIONS Prior research highlighting harm associated with evacuation has led to recommendations that long-term care facilities carefully consider resident impairment in evacuation decision-making. Evidence that small ALCs are more likely to evacuate and that having a higher-care license is not associated with evacuation likelihood shows research is needed to understand how ALCs weigh resident risks in decisions to evacuate or shelter in place.
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Affiliation(s)
- Lindsay J Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL.
| | - Joseph June
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL
| | - Nazmus Sakib
- College of Engineering, University of South Florida, Tampa, FL
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL
| | - David M Dosa
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; School of Public Health, Brown University, Providence, RI; Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Kali S Thomas
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI; School of Public Health, Brown University, Providence, RI
| | - Dylan J Jester
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL
| | - Kathryn Hyer
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL
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17
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Gurwitz JH. COVID-19, Post-acute Care Preparedness and Nursing Homes: Flawed Policy in the Fog of War. J Am Geriatr Soc 2020; 68:1124-1125. [PMID: 32315075 PMCID: PMC7264796 DOI: 10.1111/jgs.16499] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Jerry H. Gurwitz
- Division of Geriatric MedicineMeyers Primary Care Institute, University of Massachusetts Medical SchoolWorcesterMassachusettsUSA
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18
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Omissions of Care in Nursing Home Settings: A Narrative Review. J Am Med Dir Assoc 2020; 21:604-614.e6. [DOI: 10.1016/j.jamda.2020.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
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19
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Vardoulakis S, Jalaludin BB, Morgan GG, Hanigan IC, Johnston FH. Bushfire smoke: urgent need for a national health protection strategy. Med J Aust 2020; 212:349-353.e1. [PMID: 32088929 PMCID: PMC7318141 DOI: 10.5694/mja2.50511] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT
| | - Bin B Jalaludin
- Ingham Institute for Applied Medical Research, University of New South Wales
| | - Geoffrey G Morgan
- School of Public Health and University Centre for Rural Health, University of Sydney, Sydney, NSW
| | - Ivan C Hanigan
- School of Public Health and University Centre for Rural Health, University of Sydney, Sydney, NSW.,Health Research Institute, University of Canberra, ACT
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
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20
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Dempsey TM, Lapinsky SC, Melnychuk E, Lapinsky SE, Reed MJ, Niven AS. Special Populations: Disaster Care Considerations in Chronically Ill, Pregnant, and Morbidly Obese Patients. Crit Care Clin 2019; 35:677-695. [PMID: 31445613 DOI: 10.1016/j.ccc.2019.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Special populations, which include the morbidly obese and patients with chronic, complex medical conditions that require long-term health care services and infrastructure, are at increased risk for morbidity and mortality when these services are disrupted during a disaster. Past experiences have identified significant challenges in restoring necessary care services to these patients following major environmental events. This article describes the impact of disasters on special populations, provides a framework for future disaster preparation and planning, and identifies areas in need of further research. Gravid patients, who are often overlooked in disaster planning and preparation, are also discussed.
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Affiliation(s)
- Timothy M Dempsey
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. https://twitter.com/tdemps3
| | - Stephanie C Lapinsky
- Division of Critical Care Medicine, University of Toronto, 600 University Avenue, #18-214, Toronto, Ontario M5G1X5, Canada
| | - Eric Melnychuk
- Department of Critical Care Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17821-2037, USA
| | - Stephen E Lapinsky
- Division of Critical Care Medicine, University of Toronto, 600 University Avenue, #18-214, Toronto, Ontario M5G1X5, Canada
| | - Mary Jane Reed
- Department of Critical Care Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17821-2037, USA. https://twitter.com/mj17820
| | - Alexander S Niven
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. https://twitter.com/niven_alex
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21
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Laumbach RJ. Clearing the Air on Personal Interventions to Reduce Exposure to Wildfire Smoke. Ann Am Thorac Soc 2019; 16:815-818. [PMID: 31145636 PMCID: PMC6600837 DOI: 10.1513/annalsats.201812-894ps] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/14/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- Robert J Laumbach
- Department of Environmental and Occupational Medicine, Rutgers School of Public Health, Piscataway, New Jersey
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22
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A Comparative Survival Analysis Between Evacuees and Nonevacuees Among Dialysis Patients in Fukushima Prefecture After Japan's 2011 Fukushima Nuclear Incident. Disaster Med Public Health Prep 2019; 13:898-904. [PMID: 31130148 DOI: 10.1017/dmp.2019.4] [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: 11/06/2022]
Abstract
OBJECTIVE There has been little research on the health consequences of evacuation in the disaster context. A comparative analysis of survival between evacuated and nonevacuated hospital dialysis patients was conducted following Japan's Fukushima Dai-ichi nuclear power plant incident, which occurred on March 11, 2011. METHODS The study included 554 patients (mean age: 70.9) receiving dialysis therapy at one of the Tokiwakai Group hospitals-all of which are located in and around Iwaki City, approximately 50 km from the Fukushima nuclear plant-as of the incident date. The patients' survival after the incident was tracked until March 3, 2017. Significant differences in mortality rates between postincident evacuees and nonevacuees were tested using the Bayesian survival analysis with Weibull multivariate regression. RESULTS Out of 554 dialysis patients, 418 (75.5%) were evacuated after the incident. The postincident mortality rate (adjusted for covariates) of evacuees was not statistically significantly different from that of nonevacuees. The hazard ratio was 1.17 (95% credible intervals: 0.77-1.74). CONCLUSIONS If performed in a well-planned manner with satisfactory arrangements for appropriate selection of evacuees and their transportation, evacuation could be a reasonable option, which might save more lives of vulnerable people.
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23
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Schnitker L, Fielding E, MacAndrew M, Beattie E, Lie D, FitzGerald G. A national survey of aged care facility managers' views of preparedness for natural disasters relevant to residents with dementia. Australas J Ageing 2019; 38:182-189. [PMID: 30791179 DOI: 10.1111/ajag.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 06/10/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim was to explore the natural disaster preparedness strategies of Australian residential aged care facilities (RACFs), focussing on aspects relevant to people with dementia. METHODS An online survey was sent to 2617 RACF managers, with 416 responding. Questions included the following: (a) demographics; (b) presence and detail level of disaster/evacuation plans; and (c) references to people with dementia. RESULTS One in four facilities had experienced a natural disaster in the previous five years. The majority had plans for natural disaster and evacuation. Two-thirds recognised the unique needs of people with dementia. Managers anticipated that residents with dementia would require more staff time and resources and might become disoriented. CONCLUSIONS Gaps identified in existing RACF evacuation plans highlighted challenges in ensuring the ongoing safety and care of residents, especially those with dementia. Facilities need to have adequate plans and processes that minimise the potential risks of natural disasters.
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Affiliation(s)
- Linda Schnitker
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elaine Fielding
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Margaret MacAndrew
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Lie
- Queensland Department of Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gerard FitzGerald
- Centre for Emergency and Disaster Management, School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
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24
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Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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25
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Shimada Y, Nomura S, Ozaki A, Higuchi A, Hori A, Sonoda Y, Yamamoto K, Yoshida I, Tsubokura M. Balancing the risk of the evacuation and sheltering-in-place options: a survival study following Japan's 2011 Fukushima nuclear incident. BMJ Open 2018; 8:e021482. [PMID: 30056383 PMCID: PMC6067355 DOI: 10.1136/bmjopen-2018-021482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The decision to evacuate or shelter-in-place is fundamental to emergency response, especially for a vulnerable population. While an elevated risk of mortality due to a hasty, unplanned evacuation has been well documented, there is little research on and knowledge about the health consequences of sheltering-in-place in disaster contexts. We compared hospital mortality in patients who sheltered-in-place (non-evacuees) after the incident with the baseline preincident mortality and articulated postincident circumstances of the hospital while sheltering-in-place. PARTICIPANTS We considered all 484 patients admitted to Takano Hospital (located 22 km South of the Fukushima Daiichi nuclear power plant) from 1 January 2008 to 31 December 2016. METHODS Significant differences in mortality rates between preincident baseline and three postincident groups (evacuees, non-evacuees (our major interest) and new admittees) were tested using the Bayesian survival analysis with Weibull multivariate regression and survival probability using the Kaplan-Meier product limit method. All the analyses were separately performed by the internal and psychiatry department. RESULTS After adjusting for covariates, non-evacuees in the internal department had a significantly higher mortality risk with an HR of 1.57 (95% credible intervals 1.11 to 2.18) than the baseline preincident. Of them, most deaths occurred within the first 100 days of the incident. No significant increase in mortality risk was identified in evacuees and new admittees postincident in the department, which were adjusted for covariates. In contrast, for the psychiatry department, statistical difference in mortality risk was not identified in any groups. CONCLUSIONS The mortality risk of sheltering-in-place in a harsh environment might be comparable to those in an unplanned evacuation. If sheltering-in-place with sufficient resources is not guaranteed, evacuation could be a reasonable option, which might save more lives of vulnerable people if performed in a well-planned manner with satisfactory arrangements for appropriate transportation and places to safely evacuate.
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Affiliation(s)
- Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Japan
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital, Fukushima, Japan
- Department of Biostatistics and Epidemiology, Teikyo University Graduate School of Public Health, Tokyo, Japan
| | | | - Arinobu Hori
- Hori Mental Clinic, Fukushima, Japan
- Department of Disaster and Comprehensive Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuki Sonoda
- Department of nursing, Jyoban Hospital, Tokiwakai Group, Fukushima, Japan
| | - Kana Yamamoto
- Department of Internal Medicine, Ohmachi Hospital, Fukushima, Japan
| | | | - Masaharu Tsubokura
- Department of Internal Medicine, Minamisoma Municipal General Hospital, Fukushima, Japan
- Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan
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Murakami M. Importance of risk comparison for individual and societal decision-making after the Fukushima disaster. JOURNAL OF RADIATION RESEARCH 2018; 59:ii23-ii30. [PMID: 29420739 PMCID: PMC5941137 DOI: 10.1093/jrr/rrx094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/07/2017] [Indexed: 05/14/2023]
Abstract
Risk comparison is essential for effective societal and individual decision-making. After the Fukushima disaster, studies compared radiation and other disaster-related risks to determine the effective prioritizing of measures for response. Evaluating the value of risk comparison information can enable effective risk communication. In this review, the value of risk comparison after the Fukushima disaster for societal and individual decision-making is discussed while clarifying the concept of radiation risk assessment at low doses. The objectives of radiation risk assessment are explained within a regulatory science framework, including the historical adoption of the linear non-threshold theory. An example of risk comparison (i.e. radiation risk versus evacuation-related risk in nursing homes) is used to discuss the prioritization of pre-disaster measures. The effective communication of risk information by authorities is discussed with respect to group-based and face-to-face approaches. Furthermore, future perspectives regarding radiation risk comparisons are discussed.
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Affiliation(s)
- Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, 960-1295, Japan
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27
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Pierce JR, West TA. Mortality in Evacuating Nursing Home Residents. J Am Med Dir Assoc 2017; 18:803. [DOI: 10.1016/j.jamda.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 11/16/2022]
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28
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Smith DA, Swacina PJ. The Disaster Evacuation or Shelter-in-Place Decision: Who Will Decide? J Am Med Dir Assoc 2017. [PMID: 28623158 DOI: 10.1016/j.jamda.2017.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David A Smith
- Geriatric Consultants of Central Texas, Brownwood, Texas.
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