02/02/12

Evacuations and Mortality Risk

An evacuation of nursing home residents during a hurricane increased their likelihood of subsequent death and hospitalization, according to an observational study of 36,389 residents exposed to any of four hurricanes.

Using clinical data from the nursing homes as well as Medicare claims and enrollment information, the researchers compared out- comes between 20,577 residents exposed to hurricanes Katrina and Rita in 2005 and residents living in the same homes during 2003 (38,767 residents) and 2004 (21,420 residents), which saw no hurricane. The scientists also compared outcomes of 15,812 residents exposed to hurricanes Gustav and Ike in 2008 with those of 34,196 residents living in the facilities during non-hurricane years.

When comparing those residents who evacuated with those who did not experience a hurricane, the researchers found that an extra 277 deaths (7.6 additional deaths per 1,000 residents) occurred within 30 days after an evacuation, and 579 (15.9 per 1,000) occurred within 90 days. Also, there were an extra 872 hospitalizations (23.9 per 1,000) by 30 days and 544 (14.9 per 1,000) by 90 days after an evacuation.

The impetus for the study came from interviews with 20 medical directors after the 2005 hurricanes, lead author Dr. David Dosa of the Center for Gerontology and Health Care Research at Brown University, Providence, R.I., said in an interview. “They all echoed the sentiment that they didn’t want to go.”

Since negative publicity about 78 nursing home deaths in Louisiana during Katrina, nursing home administrators have been more likely to order evacuations, Dr. Dosa’s team reported. They cited data showing that 30 Louisiana nursing homes were evacuated for hurricane Katrina in 2005, while 119 were evacuated for hurricane Gustav in 2008.

Previous research has shown that relocation of frail and impaired nursing home residents carries its own risks, Dr. Dosa and his colleagues reported.

Rather than evacuate everyone, a targeted approach may be more effective, Dr. Dosa said. Patients who have congestive heart failure, renal disease, or require wound management probably should be prime evacuation candidates, he said, as they would be at greatest risk from a storm-related loss of electricity.

Evacuating a nursing home “is not a straightforward decision, but one that needs to be very carefully thought out and made on a storm-by-storm and case- by-case basis,” Dr. Dosa said.

► Source: To Evacuate or Shelter in Place: Implications of Universal Hurricane Evacuation Policies on Nursing Home Residents Dosa et al.

Robots Improve Socialization

Use of robots for social interaction has had positive psychosocial and physiological effects in nursing home patients, according to limited evidence gleaned from a review of 17 studies.

For decades, robots have been used for physical rehabilitation. Recently, robots have been increasingly used to promote social interaction. In generally small, uncontrolled studies, positive effects included improved mood, more social interaction among residents, and decreased loneliness.

The potential for improved quality of life warrants additional research into the role that such so-called socially assistive robots might play in providing social interaction among nursing home residents, the researchers concluded.

► Source: Socially Assistive Robots in Elderly Care: A Systematic Review into Effects and Effectiveness Bemelmans et al.


Jeffrey S. Eisenberg, a freelance medical writer based in Philadelphia, compiled this report.

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