Evacuations During Emergencies Put Older Adults at Greater Risk of Death Up to Six Months Later: Study
Older adults in nursing homes and other post-acute and long-term care (PALTC) settings are at increased risk for harm from disasters such as hurricanes or floods because they are frailer, generally have more illnesses and disabilities, and rely on medications and supports such as oxygen. During Hurricane Katrina, for example, elders accounted for approximately one-half of all deaths directly related to the storm. A new study in the August issue of JAMDA suggests that, if nursing home residents are evacuated during an emergency, they have a higher risk of death up to 6 months afterwards.
In “Mortality in Nursing Homes Following Emergency Evacuation: A Systematic Review,” authors reviewed articles published between 2000 and 2015 about mortality within 6 months of a disaster-related nursing home evacuation. They found that mortality was higher at 1 month, 3 months, and 6 months after evacuation compared to those who sheltered-in-place during the emergency. However, the authors noted that in most studies, it wasn’t possible to determine what specific aspect of evacuation—the action of leaving the facility, transfer to a shelter or other temporary housing, or relocation to another health setting—is associated with mortality and what might be done to prevent or mitigate harm.
To date, the authors noted, there is limited research on the effects of evacuation on nursing home residents. However, their study suggests a call for customized disaster planning and evacuation procedures to address the unique needs of this vulnerable population. The researchers propose that effective interventions should include identifying which residents are more likely to benefit from evacuation versus those who should shelter-in-place. They also indicate that lessons from disasters such as Katrina stress the need for nursing homes to be included in community disaster plans.
The authors concluded, “Rather than being the default option, the decision to evacuate should arise from a judicious, transparent, and evidence-guided process. Standard evacuation procedures may be less applicable to this vulnerable population because of extra challenges that are exacerbated in disasters.”
In an accompanying editorial in JAMDA, David Smith, MD, CMD, President of Geriatric Consultants in Brownwood, TX, noted that most geriatricians would “intuitively predict” the increased risk of mortality for frail elders due to evacuations. However, he also noted the conundrum that facility leaders face. He said, “Disaster management authorities often mandate evacuation or officially and publicly proclaim evacuation as strongly recommended.” These decisions, he added, are then “applied ‘across the board’ without special consideration for the long-term care population we treat.” In cases of mandatory evacuation, clinical decision-making is thereby disallowed.
Dr. Smith suggests the value of initiating a discussion with emergency management authorities for a facility’s various jurisdictions and advocacy for some process of shared decision making that includes clinical decision makers, staff, residents, and families. At the same time, he suggests that decisions to evacuate or shelter in place should depend on the nature of the disaster at hand, resource availability, and the degree and nature of each resident’s vulnerabilities. He concluded, “Perhaps some preplanning could be designed to streamline that decision and give it a recognized framework that would resist later ‘Monday-morning quarterbacking.’” The study was conducted by researchers at the Health Law and Aging Research Unit in the Department of Forensic Medicine, Monash University, and the Victorian Institute of Forensic Medicine, both in Southbank, Victoria, Australia.