Impact of Extreme Weather Events on Health Outcomes of Nursing Home Residents Receiving Post-Acute Care and Long-Term Care: A Scoping Review

Objectives: 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).

Design: 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.

Settings and participants: Studies published on short-stay PAC and long-stay residents in NHs.

Methods: 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.

Results: 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.

Conclusions and implications: 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.