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Vulnerability of Older Adults in Disasters: Emergency Department Utilization by Geriatric Patients After Hurricane Sandy

Published online by Cambridge University Press:  02 August 2017

Sidrah Malik ,
David C. Lee ,
Kelly M. Doran ,
Corita R. Grudzen ,
Justin Worthing ,
Ian Portelli ,
Lewis R. Goldfrank  and
Silas W. Smith
Sidrah Malik
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
David C. Lee
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York Department of Population Health, New York University School of Medicine, New York, New York
Kelly M. Doran
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York Department of Population Health, New York University School of Medicine, New York, New York
Corita R. Grudzen
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York Department of Population Health, New York University School of Medicine, New York, New York
Justin Worthing
Affiliation:
New York University School of Medicine, New York, New York
Ian Portelli
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
Lewis R. Goldfrank
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
Silas W. Smith*
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York Institute for Innovations in Medical Education, NYU Langone Medical Center, New York, New York
*
Correspondence and reprint requests to Silas W. Smith, MD, 462 First Avenue, Room A345A, New York, NY 10016 (e-mail: [email protected]).
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Abstract

Objective

Older adults are a potentially medically vulnerable population with increased mortality rates during and after disasters. To evaluate the impact of a natural disaster on this population, we performed a temporal and geospatial analysis of emergency department (ED) use by adults aged 65 years and older in New York City (NYC) following Hurricane Sandy’s landfall.

Methods

We used an all-payer claims database to analyze demographics, insurance status, geographic distribution, and health conditions for post-disaster ED visits among older adults. We compared ED patterns of use in the weeks before and after Hurricane Sandy throughout NYC and the most afflicted evacuation zones.

Results

We found significant increases in ED utilization by older adults (and disproportionately higher in those aged ≥85 years) in the 3 weeks after Hurricane Sandy, especially in NYC evacuation zone one. Primary diagnoses with notable increases included dialysis, electrolyte disorders, and prescription refills. Secondary diagnoses highlighted homelessness and care access issues.

Conclusions

Older adults display heightened risk for worse health outcomes with increased ED visits after a disaster. Our findings suggest the need for dedicated resources and planning for older adults following a natural disaster by ensuring access to medical facilities, prescriptions, dialysis, and safe housing and by optimizing health care delivery needs to reduce the burden of chronic disease. (Disaster Med Public Health Preparedness. 2018;12:184–193)

Keywords

older adultsdisaster managementemergency departmentgeographic information systemsvulnerable populations
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 12 , Issue 2 , April 2018 , pp. 184 - 193
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2017 

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References

1. Lee, DC, Smith, SW, Carr, BG, et al. Geographic distribution of disaster-specific emergency department use after Hurricane Sandy in New York City. Disaster Med Public Health Prep. 2016;10(03):351-361. https://doi.org/10.1017/dmp.2015.190.CrossRefGoogle ScholarPubMed
2. Ortman, JM, Velkoff, VA, Hogan, H. An Aging Nation: The Older Population in the United States. Population Estimates and Projections. Current Population Reports . Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau; 2014:25-1140.Google Scholar
3. Gray-Graves, A, Turner, KW, Swan, JH. The level of willingness to evacuate among older adults. Gerontol Geriatr Educ. 2011;32(2):107-121. https://doi.org/10.1080/02701960.2011.572034.CrossRefGoogle ScholarPubMed
4. Lach, HW, Langan, JC, James, DC. Disaster planning: are gerontological nurses prepared? J Gerontol Nurs. 2005;31(11):21-27. https://doi.org/10.3928/0098-9134-20051101-07.CrossRefGoogle ScholarPubMed
5. Cherniack, EP. The impact of natural disasters on the elderly. Am J Disaster Med. 2008;3:133-139.CrossRefGoogle ScholarPubMed
6. Cloyd, E, Dyer, CB. Catastrophic events and older adults. Crit Care Nurs Clin North Am. 2010;22(4):501-513. https://doi.org/10.1016/j.ccell.2010.10.003.CrossRefGoogle ScholarPubMed
7. Behr, JG, Diaz, R. Disparate health implications stemming from the propensity of elderly and medically fragile populations to shelter in place during severe storm events. J Public Health Manag Pract. 2013;19(suppl 2):S55-S62. https://doi.org/10.1097/PHH.0b013e318297226a.CrossRefGoogle ScholarPubMed
8. Johnson, HL, Ling, CG, McBee, EC. Multi-disciplinary care for the elderly in disasters: an integrative review. Prehosp Disaster Med. 2015;30(01):72-79. https://doi.org/10.1017/S1049023X14001241.CrossRefGoogle ScholarPubMed
9. Aldrich, N, Benson, WF. Disaster preparedness and the chronic disease needs of vulnerable older adults. Prev Chronic Dis. 2008;5:A27.Google ScholarPubMed
10. Al-Rousan, TM, Rubenstein, LM, Wallace, RB. Preparedness for natural disasters among older US adults: a nationwide survey. Am J Public Health. 2015;105(S4)(suppl 4):S621-S626. https://doi.org/10.2105/AJPH.2013.301559r.CrossRefGoogle Scholar
11. Adams, V, Kaufman, SR, van Hattum, T, et al. Aging disaster: mortality, vulnerability, and long-term recovery among Katrina survivors. Med Anthropol. 2011;30(3):247-270. https://doi.org/10.1080/01459740.2011.560777.CrossRefGoogle ScholarPubMed
12. Dosa, DM, Hyer, K, Brown, LM, et al. The controversy inherent in managing frail nursing home residents during complex hurricane emergencies. J Am Med Dir Assoc. 2008;9(8):599-604. https://doi.org/10.1016/j.jamda.2008.05.007.CrossRefGoogle ScholarPubMed
13. Klinenberg, E. Heat Wave: A Social Autopsy of Disaster in Chicago [book review]. N Engl J Med. 2002;347:1046. doi: 10.1056/NEJM200209263471322.Google Scholar
14. Lamb, KV, O’Brien, C, Fenza, PJ. Elders at risk during disasters. Home Healthc Nurse. 2008;26(1):30-38. https://doi.org/10.1097/01.NHH.0000305552.32597.4d.CrossRefGoogle ScholarPubMed
15. Tsukasaki, K, Kanzaki, H, Kyota, K, et al. Preparedness for protecting the health of community-dwelling vulnerable elderly people in Eastern and Western Japan in the event of natural disasters. J Community Health Nurs. 2016;33(2):107-116. https://doi.org/10.1080/07370016.2016.1159442.CrossRefGoogle ScholarPubMed
16. Dostal, PJ. Vulnerability of urban homebound older adults in disasters: a survey of evacuation preparedness. Disaster Med Public Health Prep. 2015;9(03):301-306. https://doi.org/10.1017/dmp.2015.50.CrossRefGoogle ScholarPubMed
17. Redfoot, D, Feinberg, L, Houser, A. The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Decline in the Availability of Family Caregivers. AARP Public Policy Institute. http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2013/baby-boom-and-the-growing-care-gap-insight-AARP-ppi-ltc.pdf. Published August 2013. Accessed December 20, 2016.Google Scholar
18. Center for Disease Control and Prevention. Deaths associated with Hurricane Sandy - October - November 2012. MMWR Morb Mortal Wkly Rep. 2013;62:393-397.Google Scholar
19. Diakakis, M, Deligiannakis, G, Katsetsiadou, K, Lekkas, E. Hurricane Sandy mortality in the Caribbean and continental North America. Disaster Prevention and Management: An International Journal. 2015;24(1):132-148. https://doi.org/10.1108/DPM-05-2014-0082.CrossRefGoogle Scholar
20. Seil, K, Spira-Cohen, A, Marcum, J. Injury deaths related to Hurricane Sandy, New York City, 2012. Disaster Med Public Health Prep. 2016;10(03):378-385. https://doi.org/10.1017/dmp.2016.36.CrossRefGoogle ScholarPubMed
21. The City of New York: Office of the Mayor. Hurricane Sandy After Action Report. http://www.nyc.gov/html/recovery/downloads/pdf/sandy_aar_5.2.13.pdf. Published May 2, 2013. Accessed January 5, 2016.Google Scholar
22. Teperman, S. Hurricane Sandy and the greater New York health care system. J Trauma Acute Care Surg. 2013;74(6):1401-1410. https://doi.org/10.1097/TA.0b013e318296fa9f.CrossRefGoogle ScholarPubMed
23. Gotanda, H, Fogel, J, Husk, G, et al. Hurricane Sandy: impact on emergency department and hospital utilization by older adults in Lower Manhattan, New York (USA). Prehosp Disaster Med. 2015;30(05):496-502. https://doi.org/10.1017/S1049023X15005087.CrossRefGoogle ScholarPubMed
24. Lee, DC, Long, JA, Wall, SP, et al. Determining chronic disease prevalence in local populations using emergency department surveillance. Am J Public Health. 2015;105(9):e67-e74. https://doi.org/10.2105/AJPH.2015.302679.CrossRefGoogle ScholarPubMed
25. Quan, JM. SPARCS: the New York State health care data system. J Clin Comput. 1980;8:255-263.Google ScholarPubMed
26. Jacobsen, LA, Kent, M, Lee, M, et al. America’s Aging Population. Washington, DC: Population Reference Bureau, Population Bulletin; 2011:66.Google Scholar
27. Fukuda, T, Ohashi-Fukuda, N, Matsubara, T, et al. Trends in outcomes for out-of-hospital cardiac arrest by age in Japan: an observational study. Medicine. 2015;94(49):e2049. https://doi.org/10.1097/MD.0000000000002049.CrossRefGoogle ScholarPubMed
28. Ishiguro, A, Yano, E. Tsunami inundation after the Great East Japan Earthquake and mortality of affected communities. Public Health. 2015;129(10):1390-1397. https://doi.org/10.1016/j.puhe.2015.06.016.CrossRefGoogle ScholarPubMed
29. Sung, KC, Liang, FW, Cheng, TJ, Lu, T-H, Kawachi, I. Trends in unintentional fall-related traumatic brain injury death rates in older adults in the United States, 1980-2010: A Joinpoint Analysis. J Neurotrauma. 2015;32(14):1078-1082. https://doi.org/10.1089/neu.2014.3509.CrossRefGoogle ScholarPubMed
30. Vierck, EHK. Aging: Demographics, Health, and Health Services. Westport, CT: Greenwood Press; 2003.Google Scholar
31. Department of City Planning City of New York. Atomic Polygons Shapefile Version 15B. http://www.nyc.gov/html/dcp/html/bytes/applbyte.shtml. Published April 2015. Accessed June 5, 2015.Google Scholar
32. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/icd/icd9cm.htm. Published September 1, 2009. Accessed March 30, 2016.Google Scholar
33. Bhalla, MC, Burgess, A, Frey, J, Hardy, W. Geriatric disaster preparedness. Prehosp Disaster Med. 2015;30(05):443-446. https://doi.org/10.1017/S1049023X15005075.CrossRefGoogle ScholarPubMed
34. Zgibor, JC, Orchard, TJ, Saul, M, et al. Developing and validating a diabetes database in a large health system. Diabetes Res Clin Pract. 2007;75(3):313-319. https://doi.org/10.1016/j.diabres.2006.07.007.CrossRefGoogle Scholar
35. Doran, KM, McCormack, RP, Johns, EL, et al. Emergency department visits for homelessness or inadequate housing in New York City before and after Hurricane Sandy. J Urban Health. 2016;93(2):331-344. https://doi.org/10.1007/s11524-016-0035-z.CrossRefGoogle ScholarPubMed
36. Dyer, CB, Regev, M, Burnett, J, Festa, N, Cloyd, B. SWiFT: a rapid triage tool for vulnerable older adults in disaster situations. Disaster Med Public Health Prep. 2008;2(S1)(suppl 1):S45-S50. https://doi.org/10.1097/DMP.0b013e3181647b81.Google Scholar
37. Roush, RE, Tyson, SK. Geriatric emergency preparedness and response workshops: an evaluation of knowledge, attitudes, intentions, and self-efficacy of participants. Disaster Med Public Health Prep. 2012;6(04):385-392. https://doi.org/10.1001/dmp.2012.63.CrossRefGoogle ScholarPubMed
38. Baylor College of Medicine and American Medical Association. Recommendations for Best Practices in the Management of Elderly Disaster Victims. https://www.bcm.edu/pdf/bestpractices.pdf. Published March 2015. Accessed January 6, 2016.Google Scholar
39. The ADA and Emergency Shelters: Access for All in Emergencies and Disasters. Americans with Disabilities Act. https://www.ada.gov/pcatoolkit/chap7shelterprog.pdf. Published July 26, 2007. Accessed December 20, 2016.Google Scholar
40. Hamama-Raz, Y, Palgi, Y, Shrira, A, et al. Gender differences in psychological reactions to Hurricane Sandy among New York Metropolitan Area residents. Psychiatr Q. 2015;86(2):285-296. https://doi.org/10.1007/s11126-014-9333-3.CrossRefGoogle ScholarPubMed
41. Brown, JS, Cherry, KE, Marks, LD, et al. After Hurricanes Katrina and Rita: gender differences in health and religiosity in middle-aged and older adults. Health Care Women Int. 2010;31(11):997-1012. https://doi.org/10.1080/07399332.2010.514085.CrossRefGoogle ScholarPubMed
42. Wu, J, Xiao, J, Li, T, et al. A cross-sectional survey on the health status and the health-related quality of life of the elderly after flood disaster in Bazhong city, Sichuan, China. BMC Public Health. 2015;15(1):163. https://doi.org/10.1186/s12889-015-1402-5.CrossRefGoogle ScholarPubMed
43. Davidson, TM, Price, M, McCauley, JL, et al. Disaster impact across cultural groups: comparison of Whites, African Americans, and Latinos. Am J Community Psychol. 2013;52(1-2):97-105. https://doi.org/10.1007/s10464-013-9579-1.CrossRefGoogle ScholarPubMed
44. Sastry, N, Gregory, J. The effect of Hurricane Katrina on the prevalence of health impairments and disability among adults in New Orleans: differences by age, race, and sex. Soc Sci Med. 2013;80:121-129. https://doi.org/10.1016/j.socscimed.2012.12.009.CrossRefGoogle ScholarPubMed
45. Lee, DC, Smith, SW, Carr, BG, Goldfrank, LR, Polsky, D. Redistribution of emergency department patients after disaster-related closures of a public versus private hospital in New York City. Disaster Med Public Health Prep. 2015;9(03):256-264. https://doi.org/10.1017/dmp.2015.11.CrossRefGoogle ScholarPubMed
46. Smith, SW, Braun, J, Portelli, I, et al. Prehospital indicators for disaster preparedness and response: New York City emergency medical services in Hurricane Sandy. Disaster Med Public Health Prep. 2016;10(03):333-343. https://doi.org/10.1017/dmp.2015.175.CrossRefGoogle ScholarPubMed
47. Runkle, JD, Zhang, H, Karmaus, W, et al. Prediction of unmet primary care needs for the medically vulnerable post-disaster: an interrupted time-series analysis of health system responses. Int J Environ Res Public Health. 2012;9(12):3384-3397. https://doi.org/10.3390/ijerph9103384.CrossRefGoogle ScholarPubMed
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