Longterm Impact of Natural Disasters on Disability and Health in Older Americans

描述（由申请人提供）：随着社会的老龄化和家庭的重组，了解个人如何成为残疾变得越来越重要。新的残疾与死亡率增加、医疗费用大幅增加（通常由公共付款人承担）以及家庭和照顾者的沉重负担有关。虽然残疾的过程——正如Verburgge和Jette及其后继者的理论——传统上被认为是慢性和渐进的，但越来越多的人认识到急性事件在残疾中起着至关重要的作用。医学疾病并不是唯一可能致残的事件。NIA和NINR最近发布了PA-11-265，呼吁进行“灾害中老年人的社会和行为研究”，认识到自然灾害是常见的，但我们对其对健康和残疾的影响知之甚少。国家研究委员会的人口委员会在2009年发表了一份报告，不仅记录了我们在这一领域的无知，而且重要的是，研究灾害以了解残疾和健康的基本过程的潜在价值。我们的长期研究议程是：(a)检验自然灾害导致幸存者长期患病的假设，而现有的健康和福利计划并没有完全解决这一问题；(b)发现产生这种长期患病的可补救机制。在这里，我们提出了一个全国性的测试的关系，生活在灾区与个人的长期残疾和医疗保健使用。为了进行这项测试，我们将结合健康与退休研究(HRS) /医疗保险档案中16,000多名受访者的独特纵向资源，以及1998年至2012年FEMA所有灾难声明的新构建地图。我们将通过以下具体目标，以跨越时间和空间的可概括视角，解决现有详细单一灾害研究文献中的关键空白：目标1：量化灾害特征（以灾害类型、公共基础设施的修复成本和恢复时间为衡量标准）与灾后5年内幸存者残疾水平增加之间的关系。目标2：量化灾害特征与幸存者住院可能性增加之间的关系。目标3：检验残疾水平和住院可能性增加的假设

DESCRIPTION (provided by applicant): With the aging of society and restructuring of families, it is increasingly important to understand how individuals become disabled. New disability is associated with increased mortality, substantial increases in medical costs (often borne by public payers), and a heavy burden on families and caregivers. While the disablement process-as theorized by Verburgge & Jette and their successors-has traditionally been seen as chronic and gradual, there is increasing recognition that acute events play a critical role in disability. Medical illnesses are not the only potentially disabling events. NIA & NINR recently posted PA-11-265, calling for "Social and Behavioral Research on the Elderly in Disasters" in recognition that natural disasters are common, but we know little about their impact on health and disability. The National Research Council's Committee on Population published a report in 2009 documenting not only our ignorance in this area, but, importantly, the potential value of studying disasters to understand fundamental processes in disability and health. Our long-term research agenda is (a) to test the hypothesis that natural disasters cause enduring morbidity for survivors that is not fully addressed by existing health and welfare programs, and (b) to discover remediable mechanisms that generate that enduring morbidity. Here we propose a nationwide test of the association of living in a disaster area with individuals' long-term disability and heath care use. To perform this test, we will combine the unique longitudinal resources of over 16,000 respondents in the linked Health and Retirement Study (HRS) / Medicare files with a newly constructed mapping of all FEMA disaster declarations between 1998 and 2012. We will address key gaps in the existing literature of detailed single- disaster studies with a generalizable perspective across time and space via these Specific Aims: AIM 1: Quantify the association between the characteristics of a disaster-measured as the type of disaster, the repair cost to public infrastructure, and duration of recovery-and increases in level of disabilit among survivors, for 5 years post- disaster. AIM 2: Quantify the association between the characteristics of a disaster and increases in the likelihood of hospitalization among survivors. AIM 3: Test the hypothesis that increases in level of disability and likelihood of hospitalization after disasters are worse for those living in counties with higher levels of poverty. This proposa is specifically responsive to PA-11-265. This proposal is innovative because long-term effects of disasters, particularly for vulnerable older Americans, have been systematically neglected in previous research. It is significant because it will address the public health consequences of a relatively common but understudied exposure. Further, a key contribution of this R21 will be to evaluate the feasibility of the National Research Council conjecture that natural disasters can be studied as exogenous shocks to the environment, and that we can thereby test and elaborate usually endogenous mechanisms in the development of disability.