Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
J Am Med Dir Assoc. 2024 Nov;25(11):105230. doi: 10.1016/j.jamda.2024.105230. Epub 2024 Aug 26.
To systematically examine the evidence of the association between extreme weather events (EWEs) and adverse health outcomes among short-stay patients undergoing post-acute care (PAC) and long-stay residents in nursing homes (NHs).
This is a scoping review. The findings were reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews checklist.
Studies published on short-stay PAC and long-stay residents in NHs.
A literature search was performed in 6 databases. Studies retrieved were screened for eligibility against predefined inclusion and exclusion criteria. Studies were qualitatively synthesized based on the EWE, health outcomes, and special populations studied.
Of the 5044 studies reviewed, 10 met our inclusion criteria. All were retrospective cohort studies. Nine studies examined the association between hurricane exposure, defined inconsistently across studies, and PAC patients and long-stay residents in the NH setting in the Southern United States; the other study focused on post-flood risk among North Dakota NH residents. Nine studies focused on long-stay NH residents receiving custodial care, and 1 focused on patients receiving PAC. Outcomes examined were unplanned hospitalization rates and mortality rates within 30 and 90 days and changes in cognitive impairment. Nine studies consistently found an association between hurricane exposure and increased risk of 30- and 90-day mortality compared to unexposed residents.
Of the EWEs examined, hurricanes are associated with an increased risk of mortality among long-stay NH residents and those admitted to hospice, and with increased risk of hospitalization for short-stay PAC patients. As the threat of climate-amplified EWEs increases, future studies of NH residents should evaluate the impact of all types of EWEs, and not solely hurricanes, across wider geographic regions, and include longer-term health outcomes, associated costs, and analyses of potential disparities associated with vulnerable populations in NHs.
系统研究极端天气事件（EWE）与接受急性后护理（PAC）的短期住院患者和疗养院（NH）长期居民不良健康结果之间关联的证据。
这是一个范围审查。研究结果使用系统评价和荟萃分析扩展范围审查报告首选项目清单报告。
研究对象为 NH 中短期 PAC 和长期居民。
在 6 个数据库中进行了文献检索。根据预先确定的纳入和排除标准，对检索到的研究进行了筛选，以确定其是否符合条件。根据 EWE、健康结果和研究的特殊人群对研究进行定性综合。
在审查的 5044 项研究中，有 10 项符合我们的纳入标准。所有这些都是回顾性队列研究。9 项研究调查了在美国南部 NH 环境中，定义不一致的飓风暴露与 PAC 患者和长期居民之间的关联；另一项研究侧重于北达科他州 NH 居民的洪水后风险。9 项研究侧重于接受长期护理的 NH 居民，1 项研究侧重于接受 PAC 的患者。研究中检查的结果是 30 天和 90 天内非计划性住院率和死亡率以及认知障碍变化。9 项研究一致发现，与未暴露的居民相比，暴露于飓风与 30 天和 90 天死亡率增加之间存在关联。
在所研究的 EWE 中，飓风与长期 NH 居民和临终关怀患者的死亡率增加有关，与短期 PAC 患者的住院率增加有关。随着气候放大 EWE 的威胁增加，未来对 NH 居民的研究应评估所有类型 EWE 的影响，而不仅仅是飓风，在更广泛的地理区域内，并包括更长期的健康结果、相关成本以及与 NH 中弱势人群相关的潜在差异分析。
