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

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.

Grant Number: 1RF1AG083768-01
NIH Institute/Center: NIH
Principal Investigator: Susan Bell