Malik Sidrah, Lee David C, Doran Kelly M, Grudzen Corita R, Worthing Justin, Portelli Ian, Goldfrank Lewis R, Smith Silas W
1Ronald O. Perelman Department of Emergency Medicine,New York University School of Medicine,New York,New York.
3New York University School of Medicine,New York,New York.
Disaster Med Public Health Prep. 2018 Apr;12(2):184-193. doi: 10.1017/dmp.2017.44. Epub 2017 Aug 2.
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.
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.
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.
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).
老年人是一个在医学上可能较为脆弱的群体，在灾难期间及灾后死亡率会升高。为评估自然灾害对该群体的影响，我们对桑迪飓风登陆后纽约市65岁及以上成年人的急诊科就诊情况进行了时间和地理空间分析。
我们使用了一个全支付方索赔数据库，来分析老年人灾后急诊科就诊的人口统计学特征、保险状况、地理分布和健康状况。我们比较了整个纽约市以及受灾最严重的疏散区在桑迪飓风前后数周的急诊科使用模式。
我们发现，桑迪飓风过后3周内，老年人的急诊科利用率显著增加（85岁及以上人群的增幅尤其大），尤其是在纽约市第一疏散区。显著增加的主要诊断包括透析、电解质紊乱和处方续签。次要诊断突出了无家可归和就医问题。
灾难后急诊科就诊增加，老年人出现更差健康结局的风险升高。我们的研究结果表明，自然灾害后需要为老年人提供专门资源并进行规划，确保他们能够获得医疗设施、处方、透析服务和安全住房，并优化医疗服务需求，以减轻慢性病负担。（《灾难医学与公共卫生防范》。2018年；12:184 - 193）
