Sep 15, 2017

Why Florida Nursing Home Death Counts Were So High After Hurricane Irma

Hollywood Hills, Hollywood, FL
USA
by
Jamie Wells, M.D.
,
American Council on Science Education and Health

Why is the geriatric set so vulnerable?

The biggest threat to their survival is the frequent existence of underlying medical problems, in particular cardiovascular and respiratory ones. The Environmental Protection Agency (EPA) reports of the heat-related deaths recorded since 1999, one-fourth were due to underlying cardiovascular disease as a contributing cause and of those people age 65+ were several times more likely to die than the general population. (1)

Additionally, there is great variability in what someone is used to in terms of temperature. The more extreme the leap from their normal, the more challenging it will be for that person to equilibrate. 

Medications are a huge factor. For example, an individual on a diuretic might be more at risk for fluid and electrolyte disturbances. Other drugs can speed up, slow down or impede metabolism and thermoregulation.

As we age, our immunity weakens. Mounting a vigorous response to stress in itself or rebounding from substantial insults can cause health issues like heart attacks or indirectly worsen existing co-morbidities. Diabetics are at great risk. As are those with heart failure. Those with advanced kidney disease, in general, require fluid restricting but in extreme heat their maintenance must be delicately handled by a knowledgeable medical professional. Injuries can occur amidst the chaos of these emergencies complicating the problems. 

A nursing home ups the stakes given many could be disabled and immobile. The more isolated, the more at risk. If a person cannot feed or drink by himself let alone ambulate to acquire these items, then that individual requires greater attention. Those with dementia can regress under extreme stress and be especially vulnerable to changes in routine. These situations can make them defiant in complying, increasingly confused or unable to articulate needs—all can delay proper care. Sterile wound care and pressure sores can be tough to manage in such post-hurricane states. Many residents in this type of facility can need complex care on a good day, so imagine what a colossal storm with its collateral damage can do to challenge the most defenseless.