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Hurricanes Increase Mortality Risk in Alzheimer Disease, Integrated Care Approach Recommended
Hurricane exposure was associated with a higher risk of mortality in people with Alzheimer disease and other related dementias (ADRD), according to a research letter based on a University of Michigan study published in JAMA Network Open.
“As climate change impacts advance, an integrated approach designed to anticipate and respond to the needs of older Americans living with ADRD during disasters is critical,” lead author Sue Anne Bell, PhD, Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, and co-authors noted. “Improved response processes informed by research, policy, funding, and operational considerations to support the ADRD population affected by disasters are needed.”
Related: Lifelong Marriage and Children Associated With Reduced Dementia Risk
People with ADRD are more vulnerable to hurricanes and other natural disasters in general than those without cognitive decline due to their dependence on others. Though mortality increases following hurricanes have been examined in previous studies, the increase in people with ADRD has never been properly investigated
The retrospective cohort study used Medicare data from fee-for-service beneficiaries 65 years or older affected by Hurricanes Harvey (2017), Irma (2017), and Florence (2018). Researchers used the date of death among decedents to determine all-cause mortality in older adults, both with and without ADRD. Comparing mortality rates before versus after the hurricane made landfall created the estimated risk differences. Analysis was repeated on beneficiaries in counties that did not experience a hurricane. Sociodemographic characteristics such as age, sex, race, and comorbidities were also analyzed. Federal Emergency Management Agency (FEMA) disaster declarations were used to select hurricanes.
The 346,171 beneficiaries living in 139 hurricane-affected counties were compared with 352,616 beneficiaries in 437 counties in the same states that did not have a FEMA disaster declaration. The year after hurricane exposure, 54,340 older adults with ADRD died (mean age, 85.4 years; 59.7% women and 40.3% men). In total, 1.32 deaths per 1000 people were attributed to hurricane exposure among the ADRD population. Risks were lower in hurricane-free counties (attributable risk, 0.63; 95% CI, 0.42-0.84; RR, 1.03; 95% CI, 1.02-1.05). Mortality spiked in the 3 to 6 months following Hurricanes Irma and Harvey—morality attributed to exposure in the ADRD population ranged from 10.9% for Harvey to 6.2% for Irma. Mortality risk was highest in those with ADRD who were 85 years or older.
Bell estimates that the increase is due in large part to the disruptions that happen with any natural disaster: decreased access to caregiving and medications, changes in living environment, and loss of daily routine.
"There is so much more that needs to be studied here that could help inform us about being ready for disasters," Bell said in a news release. "Studying how caregivers have prepared, whether people evacuated, what type of response capabilities their community had––would potentially influence the impact of the disaster on this group of older adults."
