Impact of social cohesion on functional recovery after earthquake and tsunami

描述（由申请人提供）：我们建议调查 2011 年 3 月 11 日日本东北部地震和海啸幸存者的功能状态轨迹（活动能力、日常生活活动、残疾发生）。我们的研究是为了响应 PA-11-263，该文件呼吁“研究灾难对老年人健康的影响，最终目标是预防和减轻有害后果”。我们提出的研究将利用作为国家队列研究（J-AGES - 日本老年学评估研究）的一部分从 3 月 11 日事件发生前 7 个月从位于灾区的一个城镇收集的基线数据。宫城县岩沼町靠近海岸的部分地区被海啸淹没，而内陆部分地区则幸免于难。 44,184 名居民中，约有 180 名居民据报死亡或失踪，6,600 人被疏散到临时避难所。海啸前的基线数据来自岩沼市 5,060 名 65 岁及以上的居民。研究小组获准在 2014 年重复这项调查。这一设计将使我们能够实现两个具体目标：1）研究遭受灾害（失去亲人、财产损失/损坏、获得医疗服务中断）对老年人功能状态和残疾发生轨迹的影响； 2) 研究灾前社区社会凝聚力的变化对受灾居民三年内功能衰退轨迹的影响。我们的建议在三个方面具有创新性：1）强大的因果设计。我们解决了灾害研究的两个主要局限性：灾前研究的可用性 有关健康状况和预测因素的信息；以及使用适当的比较组，即居住在同一城镇但恰好位于海啸未到达地区的居民； 2）除了收集有关心理健康的信息外，还关注老年人因灾难而造成的长期身体健康后遗症； 3) 除了研究个人层面的预测因素外，还应关注社区层面的康复社会决定因素。我们汇集了来自美国和日本的经验丰富的研究团队，他们在社会流行病学、多层次分析、老年学和老龄化方面拥有丰富的专业知识。

DESCRIPTION (provided by applicant): We propose to investigate the trajectories of functional status (mobility, activities of daily living, onset of disability) among survivors of th March 11, 2011 earthquake and tsunami in northeast Japan. Our study is in response to PA-11-263 which calls for "research on the consequences of disaster for the health of the elderly with the ultimate goal of preventing and mitigating harmful consequences". Our proposed study will leverage baseline data that were collected as part of a national cohort study (the J-AGES - the JApan Gerontological Evaluation Study) from a town located in the disaster zone seven months prior to the March 11 event. Some areas of the town of Iwanuma, Miyagi Prefecture, which were close to the shore were inundated by the tsunami, while parts that were further inland were spared. Of the population of 44,184, about 180 residents have been reported dead or missing, while 6,600 were evacuated to temporary shelters. Baseline data prior to the tsunami were obtained from 5,060 residents of Iwanuma who were 65 years and older. The research team has permission to repeat the survey in 2014. This design will allow us to address two specific aims: 1) to examine the impact of exposure to disaster (loss of loved ones, loss/damage to property, disruptions in access to health services) on the trajectory of functional status and disability onset among elders; and 2) to examine the impact of pre- disaster variations in community social cohesion on the trajectory of functional decline among disaster-exposed residents over a period of 3 years. Our proposal is innovative in three ways: 1) Strong causal design. We address the two major limitations of disaster research: the availability of pre-disaster information on health status as well as predictors; and the use of appropriate comparison groups, i.e. residents living in the same town who happened to be in locations that the tsunami did not reach; 2) Focus on the long-term physical health sequelae of disaster in the elderly - in addition to gathering information about mental health; 3) Focus on community-level social determinants of recovery in addition to studying individual-level predictors. We bring together an experienced team of investigators from the United States and Japan noted for their expertise in social epidemiology, multilevel analysis, gerontology and aging.