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

自然灾害对美国老年人残疾和健康的长期影响

基本信息

批准号：
8741914
负责人：
Theodore J Iwashyna
金额：
$ 19.44万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-30 至 2015-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8741914
关键词：
Activities of Daily Living Acute Address Affect Aging American Area Behavioral Research Caring Case Study Characteristics Chronic Chronically Ill County Development Devices Disabled Persons Disasters Elderly Emergency Situation Environment Epidemiology Event Exposure to Family Family Caregiver Fire - disasters Floods Health Health Personnel Healthcare Heterogeneity Home environment Hospitalization Hurricane Individual Injury Insulin Intervention Knowledge Life Link Literature Long-Term Effects Maps Measures Medical Medicare Mental Health Morbidity - disease rate National Institute on Aging National Research Council Natural Disasters Neighborhoods Nursing Research Pathway interactions Patients Phase Physical Function Physical activity Physical environment Play Population Poverty Process Psychological Impact Public Health Publishing Qualifying Recovery Reporting Research Research Infrastructure Research Personnel Resources Respondent Retirement Role Services Shock Social Sciences Social Welfare Social support Societies Survivors Testing Time United States Vulnerable Populations chemotherapy cohort cost disability disaster survivor epidemiology study experience health inequalities improved innovation instrumental activity of daily living long term hospitalization member mortality neglect prevent primary outcome programs public health relevance repaired response social

项目摘要

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.

描述（由申请人提供）：随着社会老龄化和家庭重组，了解个人如何致残变得越来越重要。新的残疾与死亡率增加、医疗费用大幅增加（通常由公共支付者承担）以及家庭和护理人员的沉重负担有关。虽然按照 Verburgge & Jette 及其继任者的理论，残疾过程传统上被视为长期且渐进的，但人们越来越认识到急性事件在残疾中起着关键作用。医疗疾病并不是唯一可能导致残疾的事件。 NIA 和 NINR 最近发布了 PA-11-265，呼吁开展“灾害中老年人的社会和行为研究”，认识到自然灾害很常见，但我们对其对健康和残疾的影响知之甚少。国家研究委员会人口委员会于 2009 年发表了一份报告，不仅记录了我们在这一领域的无知，而且更重要的是，记录了研究灾害以了解残疾和健康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久发病的假设，而现有的健康和福利计划尚未完全解决这一问题；（b）发现产生这种持久发病的可补救机制。在这里，我们建议在全国范围内测试灾区生活与个人长期残疾和医疗保健使用的关系。为了执行此测试，我们将链接的健康和退休研究 (HRS)/医疗保险文件中超过 16,000 名受访者的独特纵向资源与新构建的 1998 年至 2012 年间所有 FEMA 灾难声明的映射相结合。我们将通过以下具体目标，以跨越时间和空间的普遍视角，解决现有详细单一灾害研究文献中的关键差距：目标 1：量化灾害测量特征之间的关联作为灾难的类型、公共基础设施的修复成本、灾后 5 年内恢复的持续时间以及幸存者残疾程度的增加。目标 2：量化灾难特征与幸存者住院可能性增加之间的关联。目标 3：检验残疾程度和住院可能性增加的假设对于生活在贫困程度较高县的人们来说，灾难发生后情况会更糟。该提案专门针对 PA-11-265。这项提议具有创新性，因为之前的研究系统地忽视了灾难的长期影响，特别是对脆弱的美国老年人的影响。它很重要，因为它将解决相对常见但尚未得到充分研究的暴露所造成的公共健康后果。此外，R21 的一个关键贡献将是评估国家研究委员会猜想的可行性，即自然灾害可以作为对环境的外源性冲击来研究，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。