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To evacuate or shelter in place: implications of universal hurricane evacuation policies on nursing home residents.

Abstract：

OBJECTIVE:To examine the differential morbidity/mortality associated with evacuation versus sheltering in place for nursing home (NH) residents exposed to the 4 most recent Gulf hurricanes. METHODS:Observational study using Medicare claims and NH data sources. We compared the differential mortality/morbidity for long-stay residents exposed to 4 recent hurricanes (Katrina, Rita, Gustav, and Ike) relative to those residing at the same NHs over the same time periods during the prior 2 nonhurricane years as a control. Using an instrumental variable analysis, we then evaluated the independent effect of evacuation on outcomes at 90 days. RESULTS:Among 36,389 NH residents exposed to a storm, the 30- and 90-day mortality/hospitalization rates increased compared with nonhurricane control years. There were a cumulative total of 277 extra deaths and 872 extra hospitalizations at 30 days. At 90 days, 579 extra deaths and 544 extra hospitalizations were observed. Using the instrumental variable analysis, evacuation increased the probability of death at 90 days from 2.7% to 5.3% and hospitalization by 1.8% to 8.3%, independent of other factors. CONCLUSION:Among residents exposed to hurricanes, evacuation significantly exacerbated subsequent morbidity/mortality.

journal_name

J Am Med Dir Assoc

journal_title

Journal of the American Medical Directors Association

authors

Dosa D,Hyer K,Thomas K,Swaminathan S,Feng Z,Brown L,Mor V

doi

10.1016/j.jamda.2011.07.011

subject

Has Abstract

pub_date

2012-02-01 00:00:00

pages

190.e1-7

issue

2

eissn

1525-8610

issn

1538-9375

pii

S1525-8610(11)00268-4

journal_volume

13

pub_type

杂志文章

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