Elderly long-term care residents suffer cognitively during disasters

AppId is over the quota
AppId is over the quota
ScienceDaily (Oct. 21, 2011) — In a summer with unprecedented weather events, from tornados, floods, fires and hurricanes, researchers at the University of Pennsylvania School of Nursing found that physiological changes associated with aging and the presence of chronic illness make older adults more susceptible to illness or injury, even death, during a disaster.

Investigators followed 17 long-term care residents, with a mean age of 86, who were evacuated for five days due to a severe summer storm and were relocated to different facilities with different care providers and physical surroundings. The displaced participants experienced delirium, cognitive changes, hospitalizations, and death, according to research published in the Journal of Gerontological Nursing.

"Older adults often have visual and hearing deficits, making it more difficult to interpret their environments and precipitating increased stress," said lead author Pamela Cacchione, PhD, APRN, GNP, BC. "This stress can also exacerbate chronic illnesses, further precipitating delirium."

The 17 participants were part of a broader intervention study testing the effectiveness of a nursing intervention to improve vision and hearing impairment and decrease incident delirium and other outcomes.

As part of the parent study residents were measured with four different tests. The MMSE is a 30-item mental status test that includes questions on orientation, language, attention and recall. The GDS is a 30-item interview based depression rating scale requiring yes or no responses, the NEECHAM is a 9-item nurse rated scale that includes the participant's vital signs and pulse, which is designed to assess for acute confusion/delirium and the mCAM, another delirium assessment tool which includes tasks to assess attention.

The participants were all screened with the NEECHAM and the mCAM on the day of the severe storm and three times a week for two weeks upon their return to their home facility. The scores were compared with their Week 1 scores.

"This study provided documentation of what clinicians have known for some time, but such anecdotal accounts are seldom described with the clinical instrumentation described here," said Dr. Cacchione. "Unexpected relocation often leads to poor outcomes for nursing home residents."

The study, published in September 2011 issue, found that more than half the residents were negatively affected by evacuation and showed signs of delirium within the two weeks immediately following -- two participants were hospitalized and one died.

"Nurses in all care settings, not just LTC sites, should be aware of the potential difficulties older adults may experience as a result of a natural disaster, especially when evacuations and relocations occur," said Dr. Cacchione. "Basic physical care, ongoing assessment of chronic conditions, medication management, the return to familiar surroundings, and the return of valued objects should be facilitated as soon as possible."

Recommend this story on Facebook, Twitter,
and Google +1:

Other bookmarking and sharing tools:

Story Source:

The above story is reprinted from materials provided by University of Pennsylvania School of Nursing.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

Pamela Z. Cacchione, Lisa M. Willoughby, Joanne C. Langan, Kennith Culp. Disaster Strikes! Long-Term Care Resident Outcomes Following a Natural Disaster. Journal of Gerontological Nursing, 2011; 37 (9): 16 DOI: 10.3928/00989134-20110512-01

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

US residents say Hawaii's coral reef ecosystems worth $33.57 billion per year

AppId is over the quota
AppId is over the quota
ScienceDaily (Oct. 21, 2011) — A peer-reviewed study commissioned by NOAA shows the American people assign an estimated total economic value of $33.57 billion for the coral reefs of the main Hawaiian Islands.

"The study shows that people from across the United States treasure Hawaii's coral reefs, even though many never get to visit them," said Jane Lubchenco, Ph.D., under secretary of commerce for oceans and atmosphere and NOAA administrator. "It illustrates the economic value of coral reefs to all Americans, and how important it is to conserve these ecosystems for future generations."

"We are pleased that research is being done to look at the value of Hawaii's coral reefs, but before we consider any potential applications of the study we will consult closely with local communities," said William J. Aila, Jr., chairperson of the Hawaii Department of Land and Natural Resources.

The study employed a scientifically developed national Internet survey of more than 3,200 households -- a representative sample of all U.S. residents, not just Hawaii or coastal residents. From June through October 2009, the survey allowed the public to express its preferences and values for protection and restoration of the coral reef ecosystems around the main Hawaiian Islands. In this study, total economic value includes so-called passive use values, such as the willingness to pay to protect the coral reef ecosystem for future generations, as well as direct use values, such as snorkeling over a coral reef or consuming fish supported by coral reef ecosystems.

A panel of independent university and private scientists, from both Hawaii and the continental U.S., provided facts to the survey design team about the Hawaiian coral reef ecosystems and provided estimates of how the coral reef ecosystems would change in response to the two possible management options. The descriptions, including illustrations, of improvement to coral ecosystems gave survey respondents a clear understanding of what they were being asked to value and how the ecosystems would change as a result of the protection measures.

To estimate underlying values the public places on coral reef ecosystems, the study team presented survey participants with two specific measures to protect and restore coral reef ecosystems. One measure aimed at reducing effects to coral ecosystems from fishing, and another to repair reefs damaged by ships.

The main Hawaiian Islands consist of eight volcanic islands that range in age from active lava flows on the east side of the Big Island to seven million-year-old Kauai. Despite their economic significance, reefs near urbanized areas, such as Honolulu, Wailuku, and Kahului, have experienced increasing stress from ever-increasing population and other pressures.

The national survey was funded by NOAA and the National Science Foundation, and was designed to address the issue of Internet bias. The survey was conducted through two Internet panels; one recruited participants using controlled random digit dialing telephone surveys and the other using standard U.S. Bureau of the Census methods of randomly selecting households and going to each household to recruit participants via face-to-face interviewing.

Recommend this story on Facebook, Twitter,
and Google +1:

Other bookmarking and sharing tools:

Story Source:

The above story is reprinted from materials provided by National Oceanic and Atmospheric Administration.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Note: If no author is given, the source is cited instead.

Disclaimer: Views expressed in this article do not necessarily reflect those of ScienceDaily or its staff.

View the original article here