Impact of social cohesion on functional recovery after earthquake and tsunami

描述（由申请人提供）：我们计划调查2011年3月11日日本东北部地震和海啸幸存者的功能状态（活动能力、日常生活活动能力、残疾发生）轨迹。我们的研究是响应PA-11-263的呼吁，该呼吁要求“研究灾害对老年人健康的影响，最终目标是预防和减轻有害后果”。我们拟议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）的一部分收集的基线数据，这些数据来自3月11日事件发生前7个月位于灾区的一个城镇。宫城县岩沼镇靠近海岸的部分地区被海啸淹没，而更远的内陆地区则幸免于难。据报道，在44，184名居民中，约有180名居民死亡或失踪，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。这种设计将使我们能够解决两个具体目标：1）检查暴露于灾害的影响（失去亲人、财产损失/损坏、无法获得保健服务）对老年人功能状况和残疾发生的影响; 2）考察灾前社区社会凝聚力的变化对灾后社区功能衰退轨迹的影响-暴露的居民在3年内。我们的建议在三个方面是创新的：1）强因果设计。我们讨论了灾害研究的两个主要局限性：灾前信息的可用性 关于健康状况和预测因素的信息;以及使用适当的比较群体，即生活在同一城镇但恰好在海啸没有到达的地点的居民;（2）除了收集关于心理健康的信息外，还注重老年人灾害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，还关注社区层面的社会康复决定因素。我们汇集了来自美国和日本的经验丰富的调查人员团队，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.