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Vulnerability of Older Adults in Disasters: Emergency Department Utilization by Geriatric Patients After Hurricane Sandy

Published online by Cambridge University Press:  02 August 2017

Sidrah Malik ,
David C. Lee ,
Kelly M. Doran ,
Corita R. Grudzen ,
Justin Worthing ,
Ian Portelli ,
Lewis R. Goldfrank  and
Silas W. Smith
Sidrah Malik
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
David C. Lee
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York Department of Population Health, New York University School of Medicine, New York, New York
Kelly M. Doran
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York Department of Population Health, New York University School of Medicine, New York, New York
Corita R. Grudzen
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York Department of Population Health, New York University School of Medicine, New York, New York
Justin Worthing
Affiliation:
New York University School of Medicine, New York, New York
Ian Portelli
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
Lewis R. Goldfrank
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York
Silas W. Smith*
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York Institute for Innovations in Medical Education, NYU Langone Medical Center, New York, New York
*
Correspondence and reprint requests to Silas W. Smith, MD, 462 First Avenue, Room A345A, New York, NY 10016 (e-mail: Silas.Smith@nyumc.org).
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Abstract

Objective

Older adults are a potentially medically vulnerable population with increased mortality rates during and after disasters. To evaluate the impact of a natural disaster on this population, we performed a temporal and geospatial analysis of emergency department (ED) use by adults aged 65 years and older in New York City (NYC) following Hurricane Sandy’s landfall.

Methods

We used an all-payer claims database to analyze demographics, insurance status, geographic distribution, and health conditions for post-disaster ED visits among older adults. We compared ED patterns of use in the weeks before and after Hurricane Sandy throughout NYC and the most afflicted evacuation zones.

Results

We found significant increases in ED utilization by older adults (and disproportionately higher in those aged ≥85 years) in the 3 weeks after Hurricane Sandy, especially in NYC evacuation zone one. Primary diagnoses with notable increases included dialysis, electrolyte disorders, and prescription refills. Secondary diagnoses highlighted homelessness and care access issues.

Conclusions

Older adults display heightened risk for worse health outcomes with increased ED visits after a disaster. Our findings suggest the need for dedicated resources and planning for older adults following a natural disaster by ensuring access to medical facilities, prescriptions, dialysis, and safe housing and by optimizing health care delivery needs to reduce the burden of chronic disease. (Disaster Med Public Health Preparedness. 2018;12:184–193)

Keywords

older adultsdisaster managementemergency departmentgeographic information systemsvulnerable populations
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 12 , Issue 2 , April 2018 , pp. 184 - 193
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2017 

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