Preventing Deaths Among Older Americans with Alzheimer’s Disease and Other Related Dementias Exposed to Hurricanes

项目摘要 背景：迫切需要了解飓风等灾害如何影响老年人的生活 患有阿尔茨海默病和相关痴呆症(ADRD)。对于患有ADRD的老年人来说， 灾难造成的关键支持服务和日常生活的总体正常模式可能会很高 迷失方向，并立即导致健康和福祉的变化，导致功能衰退，甚至 死亡。我们现有的研究计划致力于研究灾害对健康结果的影响 在老年人中，以改进备灾和规划政策为目标。我们之前的工作 研究表明，在飓风暴露后的几个月里，患有ADRD的老年人的死亡人数增加了。 我们的目标：这一拟议项目的中心目标是确定暴露在何种程度上 飓风影响患有ADRD的老年人的死亡率--专注于寻找降低死亡率的方法 死亡。我们假设，飓风暴露后全因死亡率的增加将归因于 具体的死亡原因(即感染、跌倒、无法茁壮成长)、超额死亡率将因生活环境而异， 社会脆弱性将影响人口水平的死亡率。 我们的方法：使用管理医疗保健、死亡和天气数据的独特组合来研究 2001-2018年间的飓风样本，我们将追求以下目标：目标1将审查所有原因 暴露于飓风后的死亡率，并确定与老年人共同生活的相关死亡原因 ADRD；AIM 2将确定与老年人死亡人数最多相关的生活环境 与暴露在飓风中的ADRD有关；目标3将确定暴露在多个飓风中的影响 (相继)在社会和经济发展背景下，关于ADRD人口死亡率过高的灾难 脆弱性。 独特的特点和创新：这个项目具有创新性有几个原因；它将：(1)产生/使用小 多维(即，天气类型)和两者高度相关的恶劣天气暴露区域估计 空间和时间分辨率；(2)是最早使用全国死亡数据确定死因之一 指数，以及飓风暴露后ADRD人口的死亡时间；和(3)审查 在社区脆弱性的背景下，灾害对超额死亡率的累积影响。 预期影响：该项目的总体目标是发展有关以下ADRD死亡的知识 飓风暴露期，意在为ADRD人口提供备灾政策信息。 这项工作产生的建议将支持政策制定者、医疗保健提供者和紧急情况 规划人员正在完善针对患有ADRD的老年人的灾害管理政策。

PROJECT ABSTRACT Background: There is a critical need to understand how disasters such as hurricanes affect older adults living with Alzheimer’s disease and related dementias (ADRD). For older adults living with ADRD, the disruption in critical supportive services and overall normal patterns of daily living caused by a disaster can be highly disorienting and result in immediate changes in health and well-being, leading to functional decline and even death. Our existing program of research is dedicated to examining the effects of disasters on health outcomes among older adults, with the goal of improving disaster preparedness and planning policy. Our previous work has shown that deaths increase among older adults living with ADRD in the months after hurricane exposure. Our Goal: The central objective of this proposed project is to determine the extent to which exposure to hurricanes affects mortality among older adults living with ADRD – focused on identifying ways to reduce deaths. We hypothesize that an increase in all-cause mortality following hurricane exposure will be due to specific causes of death (i.e., infection, falls, failure to thrive), excess mortality will differ by living environment, and social vulnerability will influence population-level mortality. Our Approach: Using a unique combination of administrative healthcare, death, and weather data to study a sample of hurricanes between 2001-2018, we will pursue the following aims: Aim 1 will examine all-cause mortality following hurricane exposure and identify associated causes of death among older adults living with ADRD; Aim 2 will determine the living environment associated with the most deaths among older adults living with ADRD who are exposed to a hurricane; and Aim 3 will determine the effects of exposure to multiple (sequential) disasters on excess mortality among the ADRD population, within the context of social vulnerability. Unique Features and Innovation: This project is innovative for several reasons; it will: (1) generate/use small area estimates of severe weather exposure that are multi-dimensional (i.e., type of weather) and both highly spatially and temporally resolved; (2) be among the first to identify cause of death using the National Death Index, as well as timing of death among the ADRD population following hurricane exposure; and (3) examine the cumulating effects of disasters on excess mortality within the context of community vulnerability. Anticipated Impact: The overall goal of this project is to develop knowledge around ADRD deaths following hurricane exposure with the intention of informing disaster preparedness policy for the ADRD population. Recommendations generated from this work will support policymakers, healthcare providers, and emergency planners as they refine policies regarding disaster management for older adults living with ADRD.