Storm Impact and Depression Among Older Adults Living in Hurricane Sandy–Affected Areas

Climate change effects in older people's health: A scoping review

BACKGROUND

Climate change has serious consequences for the morbidity and mortality of older adults.

OBJECTIVE

To identify the effects of climate change on older people's health.

METHODS

A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Quantitative research and reports from organizations describing the effects of climate change on older people were selected.

RESULTS

Sixty-three full-text documents were selected. Heat and air pollution were the two factors that had the most negative effects on cardiovascular and respiratory morbidity and mortality in older people. Mental health and cognitive function were also affected.

CONCLUSIONS

Climate change affects several health problems in older individuals, especially high temperatures and air pollution. Nursing professionals must have the necessary skills to respond to the climate risks in older adults. More instruments are required to determine nursing competencies on climate change and the health of this population group.

PATIENT OF PUBLIC CONTRIBUTION

No patient or public contribution.

Tailoring Household Disaster Preparedness Interventions to Reduce Health Disparities: Nursing Implications from Machine Learning Importance Features from the 2018-2020 FEMA National Household Survey

Tailored disaster preparedness interventions may be more effective and equitable, yet little is known about specific factors associated with disaster household preparedness for older adults and/or those with African American/Black identities. This study aims to ascertain differences in the importance features of machine learning models of household disaster preparedness for four groups to inform culturally tailored intervention recommendations for nursing practice. A machine learning model was developed and tested by combining data from the 2018, 2019, and 2020 Federal Emergency Management Agency National Household Survey. The primary outcome variable was a composite readiness score. A total of 252 variables from 15,048 participants were included. Over 10% of the sample self-identified as African American/Black and 30.3% reported being 65 years of age or older. Importance features varied regarding financial and insurance preparedness, information seeking and transportation between groups. These results reiterate the need for targeted interventions to support financial resilience and equitable resource access. Notably, older adults with Black racial identities were the only group where TV, TV news, and the Weather Channel was a priority feature for household disaster preparedness. Additionally, reliance on public transportation was most important among older adults with Black racial identities, highlighting priority needs for equity in disaster preparedness and policy.

Cognitive Interview Validation of a Novel Household Hazard Vulnerability Assessment Instrument

BACKGROUND

Weather and climate disasters are responsible for over 13 000 US deaths, worsened morbidity, and $1.7 trillion in additional costs over the last 40 years with profound racial disparities.

OBJECTIVES

This project empirically generated items for a novel survey instrument of household hazard vulnerability with initial construct validation while addressing racial bias in the data collection process.

METHODS

Cognitive interviews facilitated understanding regarding the performance of drafted survey questions with transdisciplinary expert panelists from diverse US regions on unique hazard/disaster/event items. To prevent representation bias in data collection, those with Black and/or African American racial, biracial, or multiracial identities were over-sampled. Interview video recordings were qualitatively analyzed using thematic and pattern coding.

RESULTS

A cognitive process mapped to themes of disaster characteristics, resources, individual life facets, and felt effects was revealed. We identified 379 unique instances of linked terms as synonyms, co-occurring, compounding, or cascading events. Potential for racial bias in data collection was elucidated. Analysis of radiation exposure, trauma, and criminal acts of intent items revealed participants may not interpret survey items with these terms as intended.

CONCLUSION

Potential for racial bias exists relative to water dam failure, evacuation, external flood, suspicious packages/substances, and transportation failure. Hazard terms that were not interpreted as intended require further revision in the validation process of individual or household disaster vulnerability assessments. Several commonalities in the cognitive process and mapping of disaster terms may be utilized in disaster and climate change research aimed at the individual and household unit of analysis.

Driving the determinants of older people's mental health in the context of urban resilience: a scoping review

BACKGROUND

Population aging is a pervasive phenomenon occurring rapidly worldwide, while sustainable development goals are considered the mental health among older adults.

METHODS

To investigate the factors affecting mental health, we conducted a scoping review of the 47 papers published between 2015 and 2022 to explore various dimensions affecting older adults' mental health.

RESULTS

Our finding mirrors four dimensions of creating healthy and sustainable environments for older adults: person, place, processes, and resilience-related health in the living environment. The person dimension includes individual characteristics, attitudes and behaviors, and health status. The place dimension is divided into five categories: land use, access, physical form, public open spaces, and housing, while the process consists of the social, cultural, and economic environments. Resilience-related health dimension emphasizes the impact of natural and man-made disasters on older people's mental health.

DISCUSSION

These findings can provide policymakers insights into developing community-based environmental intervention strategies to promote mental health among older adults and support healthy and active aging.

Mapping social vulnerability indicators to understand the health impacts of climate change: a scoping review

The need to assess and measure how social vulnerability influences the health impacts of climate change has resulted in a rapidly growing body of research literature. To date, there has been no overarching, systematic examination of where this evidence is concentrated and what inferences can be made. This scoping review provides an overview of studies published between 2012 and 2022 on social vulnerability to the negative health effects of climate change. Of the 2115 studies identified from four bibliographic databases (Scopus, Web of Science, PubMed, and CAB Direct), 230 that considered indicators of social vulnerability to climate change impacts on health outcomes were selected for review. Frequency and thematic analyses were conducted to establish the scope of the social vulnerability indicators, climate change impacts, and health conditions studied, and the substantive themes and findings of this research. 113 indicators of social vulnerability covering 15 themes were identified, with a small set of indicators receiving most of the research attention, including age, sex, ethnicity, education, income, poverty, unemployment, access to green and blue spaces, access to health services, social isolation, and population density. The results reveal an undertheorisation and few indicators that conceptualise and operationalise social vulnerability beyond individual sociodemographic characteristics by identifying structural and institutional dimensions of vulnerability, and a preponderance of social vulnerability research in high-income countries. This Review highlights the need for future research, data infrastructure, and policy attention to address structural, institutional, and sociopolitical conditions, which will better support climate resilience and adaptation planning.

Building Flood Resilience Among Older Adults Living in Miami-Dade County, Florida

OBJECTIVE

This paper explores compounding challenges for older coastal populations due to accelerated sea level rise at the nexus of physical hazard exposure and place-based socioeconomic and health considerations.

METHODS

This study applies geospatial analysis to assess the spatial distribution of older adults (age 65+) and their socioeconomic characteristics in Miami-Dade County in Florida. Next, it uses logistic regression to evaluate the socioeconomic determinants of block groups with 20% or more of residents age 65 and older at 3 feet of sea level rise compared to the other block groups in Miami-Dade.

RESULTS

The results show that this study area has an older population clustered in flood-prone locations along the shoreline. The block groups with more than 20% of older adults and sea level rise risk have higher homeownership and vacancy rates, a higher percentage of homes constructed before 1980, and more older individuals who live alone.

CONCLUSION

This study identifies place-based compounding factors undermining the ability of older residents to adequately cope with accelerated sea level rise flooding in coastal urban locations. Namely, owning an older home in a declining neighborhood and living alone can trap older individuals in place and increase their flood risk.

Mental health and associated risk factors of Puerto Rico Post-Hurricane María

BACKGROUND

Mental health disorders have an increased prevalence in communities that experienced devastating natural disasters. Maria, a category 5 hurricane, struck Puerto Rico on September 20, 2017, weakening the island's power grid, destroying buildings and homes, and limiting access to water, food, and health care services. This study characterized sociodemographic and behavioral variables and their association with mental health outcomes in the aftermath of Hurricane Maria.

METHODS

A sample of 998 Puerto Ricans affected by Hurricane Maria was surveyed between December 2017 and September 2018. Participants completed a 5-tool questionnaire: Post-Hurricane Distress Scale, Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder (GAD) 7, and Post-Traumatic Stress Disorder checklist for DSM-V. The associations of sociodemographic variables and risk factors with mental health disorder risk outcomes were analyzed using logistic regression analysis.

RESULTS

Most respondents reported experiencing hurricane-related stressors. Urban respondents reported a higher incidence of exposure to stressors when compared to rural respondents. Low income (OR = 3.66; 95% CI = 1.34-11.400; p < 0.05) and level of education (OR = 4.38; 95% CI = 1.20-15.800; p < 0.05) were associated with increased risk for severe mental illness (SMI), while being employed was correlated with lower risk for GAD (OR = 0.48; 95% CI = 0.275-0.811; p < 0.01) and lower risk for SIM (OR = 0.68; 95% CI = 0.483-0.952; p < 0.05). Abuse of prescribed narcotics was associated with an increased risk for depression (OR = 2.94; 95% CI = 1.101-7.721; p < 0.05), while illicit drug use was associated with increased risk for GAD (OR = 6.56; 95% CI = 1.414-39.54; p < 0.05).

CONCLUSION

Findings underline the necessity for implementing a post-natural disaster response plan to address mental health with community-based social interventions.

The Epidemiology and Geographic Patterns of Natural Disaster and Extreme Weather Mortality by Race and Ethnicity, United States, 1999-2018

OBJECTIVES

The adverse effects that racial and ethnic minority groups experience before, during, and after disaster events are of public health concern. The objective of this study was to examine disparities in the epidemiologic and geographic patterns of natural disaster and extreme weather mortality by race and ethnicity.

METHODS

We used mortality data from the Centers for Disease Control and Prevention from January 1, 1999, through December 31, 2018. We defined natural disaster and extreme weather mortality based on International Classification of Diseases, 10th Revision codes X30-X39. We calculated age-adjusted mortality rates by race, ethnicity, and hazard type, and we calculated age-adjusted mortality rate ratios by race, ethnicity, and state. We used geographic mapping to examine age-adjusted mortality rate ratios by race, ethnicity, and state.

RESULTS

Natural disasters and extreme weather caused 27 335 deaths in the United States during 1999-2018. Although non-Hispanic White people represented 68% of total natural disaster and extreme weather mortality, the mortality rate per 100 000 population among non-Hispanic Black people was 1.87 times higher (0.71) and among non-Hispanic American Indian/Alaska Native people was 7.34 times higher (2.79) than among non-Hispanic White people (0.38). For all racial and ethnic groups, exposure to extreme heat and cold were the 2 greatest causes of natural disaster and extreme weather mortality. Racial and ethnic disparities in natural disaster and extreme weather mortality were highest in the South, Southwest, Mountain West, and Upper Midwest.

CONCLUSIONS

Racial and ethnic minority populations have a greater likelihood of mortality from natural disaster or extreme weather events than non-Hispanic White people. Our study strengthens the current knowledge base on these disparities and may inform and improve disaster preparedness and response efforts.

The Impact of Foehn Wind on Mental Distress among Patients in a Swiss Psychiatric Hospital

Psychiatric patients are particularly vulnerable to strong weather stimuli, such as foehn, a hot wind that occurs in the alps. However, there is a dearth of research regarding its impact on mental health. This study investigated the impact of foehn wind among patients of a psychiatric hospital located in a foehn area in the Swiss Alps. Analysis was based on anonymized datasets obtained from routine records on admission and discharge, including the Brief Symptom Checklist (BSCL) questionnaire, as well as sociodemographic parameters (age, sex, and diagnosis). Between 2013 and 2020, a total of 10,456 admission days and 10,575 discharge days were recorded. All meteorological data were extracted from the database of the Federal Office of Meteorology and Climatology of Switzerland. We estimated the effect of foehn on the BSCL items using a distributed lag model. Significant differences were found between foehn and non-foehn admissions in obsession-compulsion, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation, and general severity index (GSI) (p < 0.05). Our findings suggest that foehn wind events may negatively affect specific mental health parameters in patients. More research is needed to fully understand the impact of foehn's events on mental health.

The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications

Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people's mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.

Assessing short-term and long-term mental health effects among older adults after Hurricane Sandy

BACKGROUND

Few studies have evaluated the long-term effects of disasters on older adults. We examined if older individuals experienced increased mental health (MH) effects immediately and long-term after Hurricane Sandy and if these effects varied by socioeconomic status (SES), disease subtypes, number of comorbidities, and length of stay.

METHODS

We identified older patients (≥64 years) with hospital admissions and Emergency Department (ED) visits (2001-2015) with primary diagnosis of MH diseases using the New York State discharged data. We quantified both short-term (immediately post-Sandy) and long-term effects (3-month, 1-year, 2-year, and 3-year) following Hurricane Sandy, and used the pre-Sandy period in the affected counties as the control period. Poisson regression was used to compare daily counts of MH cases overall and by multiple strata pre-/post Sandy.

FINDINGS

Older individuals had significantly increased risk of MH ED visits immediately (32%), and 3-months, 1, 2, and 3-years after Sandy (2%, 9%, 15%, and 10%, respectively). MH hospital admissions did not increase immediately, but significantly increased by 8% a year later. Males and those with low SES had delayed, but increased risks of MH 1-3 years after Sandy (RRs range: 1.14-1.71). The top MH subtypes after Sandy were psychosis, mood disorders, substance abuse, suicide, and anxiety (RRs range: 1.12-2.62). After Sandy, patients with ≥8 comorbidities increased from 15% to >25%, along with their length of hospital stay.

CONCLUSION

We found long-term adverse effects of MH after Sandy, especially among vulnerable populations, which may help plan future disaster preparedness and recovery efforts.

"Do More, Feel Better": Pilot RCT of Lay-Delivered Behavioral Activation for Depressed Senior Center Clients

This pilot randomized control trial (RCT) tested "Do More, Feel Better" (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: (1) the feasibility of training older lay volunteers to fidelity; and (2) the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB. Fifty-six depressed clients were randomized to receive 9 sessions of DMFB or Behavioral Activation delivered by social workers (MSW BA). Research assessments of overall client activity level (BADS) and depression severity (HAM-D) were conducted at baseline and Weeks 3, 6, and 9. Eighty-one percent of lay volunteers who underwent training were formally certified in DMFB. Depressed clients receiving each intervention reported high levels of satisfaction and showed large and clinically significant changes in 9-week activity level (d ≥ 1.35) and depression severity (d ≥ 3.34). Differences between treatment groups were very small for both activity level (d_MSW = 0.16; 95% CI, -0.70 to 1.02) and depression (d_MSW = 0.14; 95% CI, -0.63 to 0.91). Increases in activity level were associated with decreases in depression (β = -0.42; 95% CI, -0.55 to -0.30). Both interventions appeared to work as intended by increasing activity level and reducing depression severity. "Do More, Feel Better" shows the potential of evidence-based behavioral interventions delivered by supervised lay volunteers, and can help address the insufficient workforce available to meet the mental health needs of community-dwelling older adults.

Mental Health Effects of Hurricane Sandy on Older Adults

OBJECTIVES

To examine whether hurricane exposure, lack of access to medical care (LAMC), and displacement during Hurricane Sandy were associated with PTSD and other mental health (MH) symptoms among older adult New York residents.

METHODS

Participants (N = 411) were ≥60 years old at the time of survey data collection (1-4 years post-Sandy). Outcomes included PTSD, depression, and anxiety symptoms and stress. Hurricane exposure, displacement, and LAMC were primary predictors.

RESULTS

Older adults with greater hurricane exposure had increased PTSD, anxiety, and stress symptoms. LAMC had a strong association (ORadj = 4.11) with PTSD symptoms but was not associated with other MH symptoms. Displacement was not associated with MH outcomes.

DISCUSSION

This is the first study to examine exposure, displacement, and LAMC together and to examine their varying impacts on different MH outcomes among older adults post-hurricane. Findings support the importance of disaster preparedness interventions tailored to the MH needs of community-dwelling older adults.

Unequal social vulnerability to Hurricane Sandy flood exposure

Disparities exist in post-disaster flooding exposure and vulnerable populations bear a disproportionate impact of this exposure. We describe the unequal burden of flooding in a cohort of New York residents following Hurricane Sandy and assess whether the likelihood of flooding was distributed equally according to socioeconomic demographics, and whether this likelihood differed when analyzing self-reported or FEMA flood exposure measures. Residents of New York City and Long Island completed a self-administered survey 1.5-4.0 years after the storm. Multivariable logistic regressions were performed to determine the relationship between sociodemographic characteristics and flood exposure. Participants (n = 1231) residing in areas of the lowest two quartiles of median household income experienced flooding the most often (FEMA/self-reported: <$40,298: 65.3%/42.0%, $40,298-$67,188: 43.3%/32.1%), and these areas contained the highest proportions of non-White participants (<$40,298: 39.1%, $40,298-$67,188: 36.6%) and those with ≤high school education (<$40,298: 35.5%, $40,298-$67,188: 33.6%). Both self-report (p < 0.05) and FEMA (p < 0.05) flood measures indicated that older participants were more likely to live in a household exposed to flooding, while those living in higher-income areas had decreased likelihood of flooding (p < 0.0001). Socioeconomic and age disparities were present in exposure to flooding during Hurricane Sandy. Future disaster preparedness responses must understand flooding from an environmental justice perspective to create effective strategies that minimize disproportionate exposure and its adverse outcomes.

Community delivery of brief therapy for depressed older adults impacted by Hurricane Sandy

Older adults frequently under-report depressive symptoms and often fail to access services after a disaster. To address unmet mental health needs, we developed a service delivery program (SMART-MH) that combines outreach, assessment, and therapy and implemented it in New York City after Hurricane Sandy. This study aimed to examine the feasibility, effectiveness, and patients' engagement of our brief psychotherapy ("Engage"). We predicted that Engage would result in reductions of depression, and that the benefits would be comparable to those of a historical comparison group who received Engage in a controlled experimental setting. A total of 2,831 adults (age ≥ 60) impacted by Hurricane Sandy were screened for depression. Assessments and therapy were conducted in English, Spanish, Cantonese, and Russian. Depressed individuals (PHQ-9 ≥ 10) who were not in treatment were offered Engage therapy in their native language at local senior center/nutrition sites. Twelve percent of the participants reported depression (N = 333). Of these 333 participants, 201 (60%) were not receiving treatment and 143 agreed to receive Engage therapy. Linear mixed-effects model showed that depression severity decreased significantly over time. More than two thirds had a five-point reduction in PHQ-9 scores and post-treatment scores ≤9. Post-hoc comparison of standardized slopes of change found patterns of depression reductions equivalent to Engage provided in a controlled setting. Partnerships to integrate mental health care into community settings can increase detection of mental-health needs and access to services in patients' native language. Brief reward exposure-based psychotherapy delivered in the community can provide comparable benefits to those achieved in research settings.

Effects of social support on mental health outcomes in disasters: A cross-sectional study

This study examined the mediating effects of social support on the association between disaster distress and mental health outcomes. We analyzed the data of 1006 participants with either direct or indirect exposure to one or more disasters. Disaster distress, social support, depression, and anxiety were significantly correlated. Multiple regression and mediation analyses with bootstrapping showed that social support was a partial mediator between disaster distress and depression, and between disaster distress and trait anxiety. It was a complete mediator between disaster distress and state anxiety. The results suggest that enhancing social support may reduce the negative effects of disaster distress on depression and anxiety. Therefore, comprehensive interventions incorporating disaster distress management and enhanced social support are essential in national disaster management policies and psychiatric and mental health nursing services for individuals who have experienced disasters.

Wind disasters adaptation in cities in a changing climate: A systematic review

Wind-related disasters will bring more devastating consequences to cities in the future with a changing climate, but relevant studies have so far provided insufficient information to guide adaptation actions. This study aims to provide an in-depth elaboration of the contents discussed in open access literature regarding wind disaster adaptation in cities. We used the Latent Dirichlet Allocation (LDA) to refine topics and main contents based on 232 publications (1900 to 2019) extracted from Web of Science and Scopus. We conducted a full-text analysis to filter out focal cities along with their adaptation measures. The results show that wind disaster adaptation research in cities has formed a systematic framework in four aspects: 1) vulnerability and resilience of cities, 2) damage evaluation, 3) response and recovery, and 4) health impacts of wind disaster. Climate change is the background for many articles discussing vulnerability and adaptation in coastal areas. It is also embedded in damage evaluation since it has the potential to exacerbate disaster consequences. The literature is strongly inclined towards more developed cities such as New York City and New Orleans, among which New York City associated with Hurricane Sandy ranks first (38/232). Studies on New York City cover all the aspects, including the health impacts of wind disasters which are significantly less studied now. Distinct differences do exist in the number of measures regarding the adaptation categories and their subcategories. We also find that hard adaptation measures (i.e., structural and physical measures) are far more popular than soft adaptation measures (i.e., social and institutional measures). Our findings suggest that policymakers should pay more attention to cities that have experienced major wind disasters other than New York. They should embrace the up-to-date climate change study to defend short-term disasters and take precautions against long-term changes. They should also develop hard-soft hybrid adaptation measures, with special attention on the soft side, and enhance the health impact study of wind-related disasters.

Acceptability of a lay-delivered intervention for depression in senior centers

OBJECTIVE

We examined: 1. depression rates among senior center clients; and 2. the acceptability of a lay-delivered intervention for depression ("Do More, Feel Better") from the perspective of key stakeholders prior to its implementation.

METHOD

We conducted cross-sectional surveys at four Seattle-area senior centers of 140 clients, 124 volunteers, and 12 administrators and staff. Client measures included the Patient Health Questionnaire-9 (PHQ-9) to determine depression severity, and items assessing depression treatment preferences. Following description of "Do More, Feel Better" as a lay-delivered intervention focused on increasing participation in rewarding activities, we used quantitative and qualitative items to assess acceptability to: 1. clients participating in; 2. volunteers administering; and 3. administrators and staff supporting the intervention.

RESULTS

25% of senior center clients (35/140) endorsed elevated depressive symptoms (PHQ-9 ≥ 10). 81% of clients (114/140) reported that they would consider participating in "Do More, Feel Better," and 59% percent of volunteers (73/123) expressed interest in learning how to assist others using the intervention. Administrators and staff reported high comfort levels with proposed volunteer training procedures, and they identified funding and staffing considerations as challenges to sustaining the intervention.

CONCLUSION

Findings indicate high depression rates among senior center clients and support the acceptability of lay-delivered behavioral interventions for depression from a variety of stakeholders. Further investigation of the feasibility, effectiveness, and implementation of "Do More, Feel Better" is warranted, particularly in the context of a lack of health care professionals available to meet the mental health needs of older adults.

Anxiety and resilience in the face of natural disasters associated with climate change: A review and methodological critique

In the past two decades, climate change-related natural disasters, such as hurricanes, floods, and droughts have become increasingly frequent and severe, impacting the emotional and psychological well-being of those who are directly or indirectly exposed to them. Despite great interest in understanding differences in anxiety and resilience in response to natural disasters, enthusiasm appears to outstrip empirical clarity, as there remains considerable ambiguity as to determinants of resilient or pathological outcomes following exposure to natural disasters. In addition, there are several major methodological limitations in climate change and related natural disaster research, including the use of univariate analyses, cross-sectional design, and retrospective measures. Keeping these limitations in mind, we first review literature examining the mental health outcomes of natural disasters. Findings suggest that, overall, resilience is more common than pathological outcomes. Second, we use a multi-dimensional framework of resilience to selectively review factors at the event, individual, as well as family and community levels that could help inform resilient or pathological outcomes. Finally, we consider key limitations and future directions for research and practice in the field of anxiety and resilience in response to climate disasters.

Mortality From Forces of Nature Among Older Adults by Race/Ethnicity and Gender

Older adults are especially vulnerable to disasters due to high rates of chronic illness, disability, and social isolation. Limited research examines how gender, race/ethnicity, and forces of nature-defined here as different types of natural hazards, such as storms and earthquakes-intersect to shape older adults' disaster-related mortality risk. We compare mortality rates among older adults (60+ years) in the United States across gender, race/ethnicity, and hazard type using the Centers for Disease Control and Prevention's Wonder database. Our results demonstrate that older adult males have higher mortality rates than females. American Indian/Alaska Native (AI/AN) males have the highest mortality and are particularly impacted by excessive cold. Mortality is also high among Black males, especially due to cataclysmic storms. To address disparities, messaging and programs targeting the dangers of excessive cold should be emphasized for AI/AN older adult males, whereas efforts to reduce harm from cataclysmic storms should target Black older adult males.

Identifying Palliative Care Needs Among Older Adults in Nonclinical Settings

Though palliative care is appropriate for patients with serious illness at any stage of the illness and treatment process, the vast majority of palliative care is currently delivered in inpatient medical settings in the past month of life during an acute hospitalization. Palliative care can have maximal benefit to patients when it is integrated earlier in the illness trajectory. One possible way to increase earlier palliative care use is to screen for unmet palliative care needs in community settings. The goal of this study was to assess the rates of unmet palliative care needs in older adults who attend New York City-based senior centers. The results of this study revealed that 28.8% of participants screened positive for unmet palliative care needs. Lower education and living alone were predictors of positive palliative care screens, but age, gender, marital status, and race were not. This study determined that the rate of unmet palliative care needs in community-based older adults who attend senior center events was high and that living arrangement and education level are both correlates of unmet palliative care needs. Screening for unmet palliative care needs in community settings is a promising approach for moving palliative care upstream to patients who could benefit from the additional supportive services prior to an acute hospitalization.

All-Cause Hospital Admissions Among Older Adults After a Natural Disaster

STUDY OBJECTIVE

We characterize hospital admissions among older adults for any cause in the 30 days after a significant natural disaster in the United States. The main outcome was all-cause hospital admissions in the 30 days after natural disaster. Separate analyses were conducted to examine all-cause hospital admissions excluding the 72 hours after the disaster, ICU admissions, all-cause inhospital mortality, and admissions by state.

METHODS

A self-controlled case series analysis using the 2011 Medicare Provider and Analysis Review was conducted to examine exposure to natural disaster by elderly adults located in zip codes affected by tornadoes during the 2011 southeastern superstorm. Spatial data of tornado events were obtained from the National Oceanic and Atmospheric Administration's Severe Report database, and zip code data were obtained from the US Census Bureau.

RESULTS

All-cause hospital admissions increased by 4% for older adults in the 30 days after the April 27, 2011, tornadoes (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). When the first 3 days after the disaster that may have been attributed to immediate injuries were excluded, hospitalizations for any cause also remained higher than when compared with the other 11 months of the year (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). There was no increase in ICU admissions or inhospital mortality associated with the natural disaster. When data were examined by individual states, Alabama, which had the highest number of persons affected, had a 9% increase in both hospitalizations and ICU admissions.

CONCLUSION

When all time-invariant characteristics were controlled for, this natural disaster was associated with a significant increase in all-cause hospitalizations. This analysis quantifies acute care use after disasters through examining all-cause hospitalizations and represents an important contribution to building models of resilience-the ability to recover from a disaster-and hospital surge capacity.

Medium-Term Health of Seniors Following Exposure to a Natural Disaster

The article aims to describe the medium-term impacts of a major earthquake event (Chile, February 27, 2010) on 26 seniors. The authors adopted a qualitative study approach. Data obtained using the Impact of Event Scale-Revised (IES-R) show the presence of manifestations of posttraumatic stress in the majority of respondents. In addition, data collected in interviews demonstrated a progressive deterioration of the health of respondents over a period of 4 years following the disaster. Seniors are particularly vulnerable to the effects of material loss, emotional stress, and postdisaster health complications. These impacts are exacerbated by low economic status. Furthermore, broader research is necessary involving elderly living in poverty who have survived natural disasters and others without such experiences, in order to better identify and differentiate between health complications associated with exposure to disaster events and those linked more strictly with natural aging processes.

Lack of access to medical care during Hurricane Sandy and mental health symptoms

Destruction caused by natural disasters compromises medical providers' and hospitals' abilities to administer care. Hurricane Sandy was particularly devastating, resulting in massive disruptions of medical care in the region. This study aimed to determine whether a lack of access to medical care during Hurricane Sandy was associated with posttraumatic stress disorder (PTSD) symptoms and other mental health/substance abuse outcomes. A secondary aim was to examine whether having a chronic illness moderates those associations. Self-reported medical access and mental health symptomatology were obtained from New York City and Long Island residents (n = 1669) following Hurricane Sandy under the Leaders in Gathering Hope Together project (10/23/2013–2/25/2015) and Project Restoration (6/5/2014–8/9/2016). Multivariable logistic regressions were utilized to determine the relationship between lack of access to medical care and mental health outcomes. Of the 1669 participants, 994 (59.57%) were female, 866 (51.89%) were white, and the mean age was 46.22 (SD = 19.2) years old. Those without access to medical care had significantly higher odds of showing symptoms of PTSD (AOR = 2.71, CI = [1.77–4.16]), as well as depression (AOR = 1.94, CI = [1.29–2.92]) and anxiety (AOR = 1.61, CI = [1.08–2.39]) compared to those with access. Lack of access to care was associated with a 2.12 point increase in perceived stress scale score (SE = 0.63). The interaction between having a chronic illness and lack of access to medical care was not significantly associated with any outcomes. The findings emphasize the importance of making medical care more accessible to patients, both chronically and acutely ill, during natural disasters to benefit their physical as well as their mental health.

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Individuals without access to medical care had asignificantly higher odds of showing symptoms of mental health difficulties.

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Chronic illness did not moderate the relationship between a lack of access to care and mental health outcomes.

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Access to medical care during natural disasters may benefit the mental health of survivors with and without chronic illness.</span>

Development of a Community-Based Palliative Care Screening Tool for Underserved Older Adults With Chronic Illnesses

Although they experience high rates of chronic illness, low-income minority communities have traditionally underutilized palliative care services compared to whites and those with higher incomes. One reason for this trend is lack of screening by community providers. We utilized a community-based participatory research approach to develop and implement an innovative multidomain palliative care screening tool in aging service agencies. Participants were aging service providers and clients in the East and Central Harlem neighborhoods of New York City, which are characterized by high poverty, largely African American and Latino populations, disproportionally high rates of chronic conditions, and limited health-care access. Screening tool development included reviewing existing measures and obtaining feedback from an expert panel, aging service providers, and older adults. We developed a 22-item tool covering 3 domains of palliative care need (physical symptoms, emotional concerns, and goals of care), which can be administered in 10 to 15 minutes. Sixteen providers at 2 aging service agencies were trained to use the tool over a 3-month pilot period. The tool showed evidence of feasibility of implementation, with 44 older adult clients screened. Providers reported high acceptability, 36% of clients screened positive, and the majority accepted referrals to outpatient palliative care clinics. The screening tool has the potential to increase palliative care utilization among underserved community-dwelling older adults and may improve their quality of life, potentially in communities worldwide. Future work should examine the psychometric proprieties of the tool, examine predictors of positive screens, explore its impact on clinical outcomes, and expand its reach.

Advances in Psychotherapy for Depressed Older Adults

PURPOSE OF REVIEW

We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings.

RECENT FINDINGS

Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.