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

描述（由申请人提供）：随着社会老龄化和家庭重组，了解个人如何成为残疾人越来越重要。新的残疾与死亡率增加、医疗费用大幅增加（通常由公共支付者承担）以及家庭和照顾者的沉重负担有关。虽然残疾的过程-理论上由Verburgge和Jette和他们的继任者-传统上被视为慢性和渐进的，有越来越多的认识，急性事件在残疾中发挥着关键作用。医学疾病并不是唯一的潜在致残事件。NIA & NINR最近发布了PA-11-265，呼吁“对灾害中的老年人进行社会和行为研究”，认识到自然灾害很常见，但我们对它们对健康和残疾的影响知之甚少。国家研究理事会人口委员会在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，记录了研究灾害对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持续发病的假设，而现有的健康和福利计划没有完全解决这一问题;（B）发现产生这种持续发病的补救机制。在这里，我们提出了一个全国性的测试，在灾区生活与个人的长期残疾和医疗保健使用的关联。为了进行这项测试，我们将结合联合收割机的独特的纵向资源，超过16,000名受访者在链接的健康和退休研究（HRS）/医疗保险文件与新构建的映射所有联邦应急管理局的灾难声明在1998年和2012年之间。我们将通过以下具体目标，以跨时间和空间的可推广视角，解决详细的单一灾害研究的现有文献中的关键空白：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持续时间衡量）与灾后5年幸存者残疾程度增加之间的关联。目标2：量化灾害特征与幸存者住院可能性增加之间的关联。目的3：检验残疾程度和住院可能性增加的假设 对于那些生活在贫困程度较高的县的人来说，灾害后的情况更糟。 本提案专门响应PA-11-265。这一建议是创新的，因为灾害的长期影响，特别是对脆弱的老年美国人，在以前的研究中被系统地忽视了。这是重要的，因为它将解决一个相对常见但研究不足的暴露的公共卫生后果。此外，这一R21的一个关键贡献将是评估国家研究理事会推测的可行性，即自然灾害可以作为对环境的外源性冲击进行研究，从而我们可以测试和阐述残疾发展中通常是内源性的机制。

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.