Disaster-Related Injuries in the Period of Recovery: The Effect of Prolonged Displacement on Risk of Injury in Older Adults

Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
The Journal of trauma (Impact Factor: 2.96). 10/2009; 67(4):834-40. DOI: 10.1097/TA.0b013e31817f2853
Source: PubMed

ABSTRACT Hurricane Katrina, which struck the Gulf Coast of the United States in August 2005, initially displaced over a million people from their primary place of residence. Displaced older adults subsequently faced challenges, such as new or inferior living conditions, which could increase vulnerability to serious or life-threatening injuries such as hip fracture. The aim of this study was to determine whether Katrina victims who were displaced for a prolonged period of time were more likely to experience injuries than nondisplaced victims.
We tracked injury outcomes including fractures, sprains or strains, and lacerations in a cohort of 25,019 older adults (age >or= 65 years) enrolled in a Medicare-Advantage Plan, for 1 year after Katrina. We used medical claims to obtain injury outcomes and analyzed propensity-score adjusted predictors of injury, including displacement status at 12 months.
In our sample, 7,030 (28%) older adults were displaced at 12-month post-Katrina. Displaced victims had 1.53 (95% CI: 1.10-2.13) greater odds of sustaining a hip fracture in the year after the storm and 1.24 (95% CI: 1.07-1.44) greater odds of sustaining other fractures after adjusting for other risk factors. There was no significant association between displacement status at 12 months and sprains or strains or lacerations.
Prolonged displacement is associated with increased risk of fracture in older adults. Emergency planners should screen temporary housing for injury hazards, and clinicians should regard displaced older adults as a vulnerable population in need of interventions such as risk communication messaging.

11 Reads
  • Source
    • "Displacement can also result in other physical health effects. Displacement at 12 months following Katrina was associated with increased risk of hip fracture among seniors, particularly among women, those with co-morbidities and a history of hip fracture [69]. Among nursing home residents in the Gulf Coast evacuated before a recent hurricane, 30- and 90-day mortality and hospitalization rates were higher compared with rates during non-hurricane control years [10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Coastal storms can take a devastating toll on the public's health. Urban areas like New York City (NYC) may be particularly at risk, given their dense population, reliance on transportation, energy infrastructure that is vulnerable to flood damage, and high-rise residential housing, which may be hard-hit by power and utility outages. Climate change will exacerbate these risks in the coming decades. Sea levels are rising due to global warming, which will intensify storm surge. These projections make preparing for the health impacts of storms even more important. We conducted a broad review of the health impacts of US coastal storms to inform climate adaptation planning efforts, with a focus on outcomes relevant to NYC and urban coastal areas, and incorporated some lessons learned from recent experience with Superstorm Sandy. Based on the literature, indicators of health vulnerability were selected and mapped within NYC neighborhoods. Preparing for the broad range of anticipated effects of coastal storms and floods may help reduce the public health burden from these events.
    Journal of Environmental and Public Health 05/2013; 2013(1):913064. DOI:10.1155/2013/913064
  • Source
    • "While minimal data on cyclone-related injuries and mortality is available from less developed settings, it can be presumed that developing nations also bear the burden of cyclone-attributable injury where the frequency and severity of injuries are inversely related to degree of physical protection 69. Minor trauma is common among the injured, including lacerations, abrasions and contusions, puncture wounds, and sprains and fractures 11,13,24,25,29,32,40,41,51,53,62,63. The majority of those injured in cyclones can be treated on an outpatient basis and do not require sophisticated surgical or inpatient care 5,77. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Cyclones have significantly affected populations in Southeast Asia, the Western Pacific, and the Americas over the past quarter of a century. Future vulnerability to cyclones will increase due to factors including population growth, urbanization, increasing coastal settlement, and global warming. The objectives of this review were to describe the impact of cyclones on human populations in terms of mortality, injury, and displacement and, to the extent possible, identify risk factors associated with these outcomes. This is one of five reviews on the human impact of natural disasters. Methods. Data on the impact of cyclones were compiled using two methods, a historical review from 1980 to 2009 of cyclone events from multiple databases and a systematic literature review of publications ending in October 2012. Analysis included descriptive statistics and bivariate tests for associations between cyclone characteristics and mortality using Stata 11.0. Findings. There were 412,644 deaths, 290,654 injured, and 466.1 million people affected by cyclones between 1980 and 2009, and the mortality and injury burden was concentrated in less developed nations of Southeast Asia and the Western Pacific. Inconsistent reporting suggests this is an underestimate, particularly in terms of the injured and affected populations. The primary cause of cyclone-related mortality is drowning; in developed countries male gender was associated with increased mortality risk, whereas females experienced higher mortality in less developed countries. Conclusions. Additional attention to preparedness and early warning, particularly in Asia, can lessen the impact of future cyclones.
    PLoS Currents 04/2013; 5. DOI:10.1371/currents.dis.2664354a5571512063ed29d25ffbce74
  • Source
    • "In an extreme weather event, wildfire, or flood, it may be more difficult for victims with mobility impairments to respond, to evacuate (if necessary), and to recover (Fernandez et al. 2002). The risk of injury or death during or after evacuation is highest among older adults (Uscher-Pines et al. 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Older adults make up 13% of the U.S. population, but are projected to account for 20% by 2040. Coinciding with this demographic shift, the rate of climate change is accelerating, bringing rising temperatures; increased risk of floods, droughts, and wildfires; stronger tropical storms and hurricanes; rising sea levels; and other climate-related hazards. Older Americans are expected to be located in places that may be relatively more affected by climate change, including coastal zones and large metropolitan areas. Objective: The objective of this review is to assess the vulnerability of older Americans to climate change and to identify opportunities for adaptation. Methods: We performed an extensive literature survey and summarized key findings related to demographics; climate stressors relevant to older adults; factors contributing to exposure, sensitivity, and adaptive capacity; and adaptation strategies. Discussion: A range of physiological and socioeconomic factors make older adults especially sensitive to and/or at risk for exposure to heat waves and other extreme weather events (e.g., hurricanes, floods, droughts), poor air quality, and infectious diseases. Climate change may increase the frequency or severity of these events. Conclusions: Older Americans are likely to be especially vulnerable to stressors associated with climate change. Although a growing body of evidence reports the adverse effects of heat on the health of older adults, research gaps remain for other climate-related risks. We need additional study of the vulnerability of older adults and the interplay of vulnerability, resilience, and adaptive responses to projected climate stressors.
    Environmental Health Perspectives 10/2012; 121(1). DOI:10.1289/ehp.1205223 · 7.98 Impact Factor
Show more