Disaster-Related Injuries in the Period of Recovery: The Effect of Prolonged Displacement on Risk of Injury in Older Adults
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.
SourceAvailable from: Gloria Giarratano[Show abstract] [Hide abstract]
ABSTRACT: Nurses working or living near a community disaster have the opportunity to study health-related consequences to disaster or disaster recovery. In such a situation, the researchers need to deal with the conceptual and methodological issues unique to postdisaster research and know what resources are available to guide them, even if they have no specialized training or previous experience in disaster research. The purpose of this article is to review issues and challenges associated with conducting postdisaster research and encourage nurses to seek resources and seize opportunities to conduct research should the situation arise. Current disaster studies and the authors' personal experiences conducting maternal-child research in post-Katrina New Orleans (2005-2013) provide real-life examples of how health professionals and nurses faced the challenges of doing postdisaster research. After catastrophic events, nurses need to step forward to conduct disaster research that informs and improves future disaster planning and healthcare responses.Nursing Inquiry 07/2013; 21(3). DOI:10.1111/nin.12049 · 1.05 Impact Factor
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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.04/2013; 5. DOI:10.1371/currents.dis.2664354a5571512063ed29d25ffbce74
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ABSTRACT: With an increase in the number of severe weather events making nationwide headlines lately, including heat waves, tornados, and hurricanes, healthcare providers need to be more knowledgeable about emergency preparedness in their communities and be able to advise patients, particularly those who are bedridden and receiving home care, on resources to use in the event of prolonged power outages. In this article, the authors describe two cases in which patients developed progressive pressure sores because their usual level of care had been disrupted by a power outage following a severe storm. Because no power company can guarantee timely restoration of service after such an event, the authors present two available but relatively unknown options for families and caregivers requiring assistance in emergency medical situations. It seems that we are experiencing increasingly severe weather events every year, and this trend is projected to continue. 1 Subsequently, these events give rise to an increase in resulting medical problems, such as direct trauma, dehydration/malnutrition, and infections from exposure to the elements and less-than-ideal living conditions; however, serious medical complications can arise even from the loss of home electricity for prolonged periods of time. Such problems may include pulmonary complications from loss of oxygen and respiratory equipment, problems caused by an inability to refrigerate food and medications, and exposure to extreme environmental temperatures due to loss of heating or cooling. We describe two cases of an underreported complication arising from a prolonged power outage that occurred following a severe derecho (intense, widespread, and fast-moving windstorm). Both patients had late-stage dementia and were bedridden, and both developed complicated pressure sores after being without power for several days. After these case presentations, we share some of the lessons we learned from these experiences. We also describe two available programs for persons seeking assistance after such an event, both of which seem to be virtually unknown in the medical community. Finally, we provide a tip sheet that healthcare providers can share with community-dwelling older adults and their caregivers to alert them to these resources and help them prepare for disasters.Clinical Geriatrics 11/2013; 21(11).