Impact of social cohesion on functional recovery after earthquake and tsunami

项目摘要 Iwanuma研究（R 01 AG 042463 -04）的目的是研究社会因素的作用 在2011年3月11日地震和海啸的老年幸存者中提高灾难恢复力的凝聚力 在日本东北部。我们的基线数据是作为日本全国性队列研究的一部分收集的- 日本老年学评估研究（JAGES）-灾难发生前7个月。其中一个现场的 JAGES的队列是宫城县的岩沼市，位于地震震中以西80公里处。我们 在灾难发生后大约3年，设法找到了99.7%的幸存参与者。迄今为止 岩沼研究已经确定：（a）11%的幸存者正在经历严重的PTSD症状 灾难发生后的几年，以及灾难发生前较高水平的社区社会凝聚力降低了 严重PTSD症状的几率（比值比0.7，95% CI：0.6 - 0.9）（美国流行病学杂志，2016年3月）;（B）住房 损害和住宅搬迁与幸存者中的认知损伤有关（Proc Natl Acad Sci， 2016年9月）;以及（c）与邻居的非正式社交缓冲了灾害经历的不利影响 关于认知能力下降（《柳叶刀行星健康》出版）。 在这一相互竞争的更新中，我们寻求扩大我们对灾害经验对健康影响的后续行动， 老年幸存者，特别关注三个与衰老相关的结果：认知能力下降，功能障碍， 超重我们的项目之所以创新，有几个原因。首先，我们的研究设计利用了一种独特的“自然 通过收集2011年东北灾难前的个人数据，“实验”成为可能。第二、 我们注重与受灾害影响的老年人的健康需求有关的成果，即： 认知功能、功能独立性和营养状况。老年人在精神上受到影响， 在灾害期间和之后，由于慢性疾病或状况， 作为衰老的一部分经历的认知变化。第三，我们的建议涉及知识方面的一个重要空白 通过记录灾后的长期健康轨迹，与以前的文献相比， 关注直接/短期健康影响。第四，我们的分析将利用四个调查波， 在灾害情况下很少可用：2010年（灾前），2013年，2016年，以及计划于2019年进行的第四波。 这些数据将使我们能够检查至少两次幸存者经历大规模死亡的情况。 改变居住环境。最后，我们的研究将利用客观的暴露措施（例如住房 建筑物检查员评估的损害;当地食品环境的地理信息系统数据）以及健康状况（例如， 根据日本的长期计划，从家庭评估中获得的痴呆症和残疾状况 护理保险登记处）。

PROJECT SUMMARY The Iwanuma Study (R01AG042463-04) was established with the objective to investigate the role of social cohesion in promoting disaster resilience among older survivors of the March 11, 2011 earthquake and tsunami in northeastern Japan. Our baseline data were gathered as part of a nationwide cohort study in Japan – the JApan Gerontological Evaluation Study (JAGES) -- seven months prior to the disaster. One of the field sites of the JAGES cohort was the city of Iwanuma in Miyagi Prefecture, 80 km west of the earthquake epicenter. We managed to locate 99.7% of the surviving participants approximately 3 years after the disaster. To date, the Iwanuma study has established that: (a) 11 percent of survivors are experiencing severe PTSD symptoms three years after the disaster, and that higher levels of community social cohesion pre-dating the disaster lowers the odds of severe PTSD symptoms (odds ratio 0.7, 95% CI: 0.6 – 0.9) (Am J Epidemiol, March 2016); (b) housing damage and residential relocation is associated with cognitive impairment among survivors (Proc Natl Acad Sci, September 2016); and (c) informal socializing with neighbors buffers the adverse impact of disaster experience on cognitive decline (Lancet Planetary Health in press). In this competing renewal, we seek to extend our follow-up of the impacts of disaster experience on the health of aging survivors, focusing specifically on three aging-related outcomes: cognitive decline, functional disability, and overweight. Our project is innovative for several reasons. First, our study design leverages a unique “natural experiment” made possible by the collection of individual data pre-dating the 2011 Tohoku disaster. Secondly, we focus on outcomes that are relevant to the health needs of older populations affected by disaster, viz. cognitive function, functional independence, and nutritional status. The elderly are disproportionally affected both during and after disasters, because of chronic diseases or conditions, impaired physiological, sensory, and cognitive changes experienced as part of aging. Thirdly, our proposal addresses an important gap in knowledge by documenting the long-term health trajectories after disaster, in contrast to previous literature which has mostly focused on the immediate/short-term health effects. Fourthly, our analyses will utilize four survey waves which is seldom available in disaster situations: 2010 (pre-disaster), 2013, 2016, and a 4th wave planned in 2019. These data will enable us to examine at least two occasions on which survivors experienced a large-scale change in residential environment. Lastly, our study will utilize objective measures of exposure (e.g. housing damage as assessed by building inspectors; GIS data on local food environment) as well as health status (e.g. dementia symptomatology and disability status obtained from in-home assessment under Japan’s Long Term Care Insurance registry).