Hurricane Evacuation: Its Impact on Nursing Home Residents with Dementia

Natural disasters challenge any organization that must put evacuation plans in place to move those who are vulnerable. Recent research suggests that those with dementia may be particularly susceptible to the impact of evacuation. Researchers fromUniversityofSouth Florida’sSchoolofAging Studiesfound that evacuation contributed significantly to increased rates of hospitalization, morbidity, and mortality of nursing home residents.

The event studied for this research was the response to Hurricane Gustav, a 2008 storm that occurred after Hurricane Katrina (2005).Because the Gulf region was especially sensitive to the importance of evacuation at this time, a much greater number of nursing homes complied with  warnings to flee the storm. The storm’s impact was far less serious than anticipated. As a result, Gustav provided an opportunity to study a storm that prompted significant evacuation but caused little disruption to residents’ lives once the storm passed. Most nursing home evacuees were never directly exposed to the hurricane and were able to return to their prior nursing home residences, i.e., avoiding relocation to a new facility after the storm.

The residents studied were Medicare-eligible nursing home residents who had resided in the nursing home for at least three months prior to Hurricane Gustav’s landfall. The nursing homes studied were those within the National Weather Service’s initial hurricane watch at 48 hours and the subsequent warning zone at 24 hours, or those in a parish or county beyond these zones where at least one nursing home was known to have evacuated..

The study’s data set included 21,255 residents at 119 nursing homes over 3 years of observation. Of these, 18 percent were severely cognitively impaired (based on a scale designed to measure cognitive status in long-term care residents). A total of 5,036 residents resided in facilities that completely evacuated prior to Hurricane Gustav’s landfall.

The percentage of residents with high CPS scores who died over the study period (at 30 days and 90 days) varied significantly between the nursing homes where residents were evacuated and those where residents weathered the storm in place. The study shows those who sheltered in place with high CPS scores had a death (within 30 days) rate of less than half of those who were evacuated (3.04 percent versus 6.72 percent); the 90-day mortality rate was also lower for those who sheltered in place (11.03 percent versus 15.01 percent).

The study shows that current disaster preparedness emphasizes maintaining the physical safety of residents, but that evacuation puts other stresses on residents with dementia beyond the immediate physical safety risk. Residents’ needs may best be met by, for example, training staff to address their mental health needs by limiting exposure to disturbing TV programming or arranging relocation to family members’ homes. Specifically, the authors urged the development and testing of interventions that will best protect residents with dementia when there is no choice but to evacuate.


Brown, L. M., D. M. Dosa, K. Thomas et al. The Effects of Evacuation on Nursing Home Residents with Dementia. American Journal of Alzheimer’s Disease & Other Dementias (2012). 27(6) 406-412.



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