Mortality in Nursing Homes Following Emergency Evacuation: A Systematic Review

Objectives: To determine the risk associated with mortality among nursing home residents within 6 months following an evacuation because of man-made or natural disasters. Design: A systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. Setting: All peer-reviewed studies published in English, French, German, or Spanish between January 1, 2000 and December 31, 2015, examining mortality within 6 months of disaster evacuation from a nursing home. Measurements: Extracted information included study and population characteristics, mortality measures, and risk factors. Studies were examined using the disaster management cycle that considers preparedness, response, recovery, and mitigation. Results: The 10 included studies were published between 2010 and 2015 with one-half conducted in the United States. Only 3 studies detailed the preparedness stage, and 4 detailed the response stage of the disaster management cycle. Mortality was measured as an indicator of recovery and was found to be elevated at 1 month [from 0.03% (n = 1088) to 10.5% (n = 75)] 3 months [from 0.08% (n = 3091) to 15.2% (n = 197)], and 6 months [from 14.9% (n = 263) and 16.8% (n = 22)] postevacuation compared with pre-evacuation and sheltering-in-place. Studies identified vulnerable residents as being over 80 years of age, frail, dependent, male residents with multiple comorbidities and, made recommendations on disaster preparedness. Conclusions: There is little research on the effects of evacuation on nursing home residents, which is surprising considering the elevated risk of mortality postevacuation. Evacuation seems to have a negative effect on the survival of nursing home residents independent of the effect of the disaster. Standard evacuation procedures may be less applicable to this vulnerable population because of extra challenges they face in disasters.