Effects of Hurricane Sandy on Functional Limitation Trajectories of Older People

项目摘要： 虽然自然灾害给受灾社区的居民带来了严重挑战， 它们对老年人身体健康的影响仍然存在。长期目标是为干预提供信息， 旨在减轻灾害对老年人影响的资源规划工作， 提高老年人的生活质量。本申请的目的是 以确定功能限制的轨迹如何受到灾害的影响。我们的中心假设是， 大多数面临灾难的老年人都具有弹性，医疗保健利用率和相关支出 在灾难发生后的一些功能限制的轨迹是重要的，和灾前 个人和社区的特点可以区分复原力和脆弱性的轨迹。我们 假设是根据我们以前的经验和概念工作以及其他人的工作制定的。的 提出这项研究的理由是，一旦知道灾害如何影响功能限制， 轨迹，可以制定干预措施，将减少老年人的脆弱性，并增加他们的 提高灾害面前的抗灾能力，从而为改善 老年人该假设将通过追求三个具体目标来检验：（1）确定a的效果 自然灾害对老年人功能受限轨迹的影响;（2）对比老年人的医疗保健利用 以及与经历灾难的老年人的功能限制轨迹相关的支出， 未遭受灾害的老年人;以及（3）确定风险因素和 弹性资源影响功能限制的轨迹。这些目标将通过建立一个 当飓风桑迪袭击新泽西时，1,977名年龄在65-80岁之间的人组成了纵向小组。飓风后的三个月 自我报告的评估将补充先前两次数据收集工作的数据。业务数据集中 与Medicare/Medicaid索赔数据相关联。这项工作是重要的，因为它是一个连续的第一步， 研究预计将导致干预措施的发展，将加强老年人的能力， 自然灾害而不增加功能限制。本研究具有创新性，因为：（1） 侧重于功能限制，在残疾周期的关键，（2）审查灾害对一个大的影响， 生活在最近飓风袭击最严重的州之一的代表性样本，以及（3）建立在数据基础上 在风暴袭击前收集的数据，包括直接暴露在风暴中和没有直接暴露在风暴中的人， 灾害评估，产生了为数不多的研究，能够解开因果关系归因于 灾难该项目的知识将促进人们对灾害对老年人影响的了解， 在灾害发生之前和之后采取有可能改善其生活质量的知情干预措施。

Project Summary: Although natural disasters present serious challenges for residents of affected communities, many questions about their effects on the physical health of older adults remain. The long-term goal is to inform intervention and resource planning efforts designed to mitigate the effects of disasters on older people, reduce health care utilization and expenditures and improve the quality of life of older people. The objective of this application is to identify how trajectories of functional limitations are affected by disaster. Our central hypothesis is that the majority of older adults exposed to disaster are resilient, healthcare utilization and expenditures associated with some functional limitation trajectories in the wake of disaster are significant, and pre-disaster characteristics of individuals and communities can distinguish trajectories of resilience and vulnerability. Our hypothesis was formulated based on our previous empirical and conceptual work and on work by others. The rationale for the proposed research is that, once it is known how disasters affect functional limitation trajectories, interventions can be developed that will reduce the vulnerability of older adults and increase their resilience in the face of disaster, resulting in new and innovative approaches to improving the quality of life for older people. The hypothesis will be tested by pursing three specific aims: (1) To ascertain the effects of a natural disaster on the functional limitation trajectories of older adults; (2) To contrast the healthcare utilization and expenditures associated with functional limitation trajectories for older people experiencing disaster with those of older people not exposed to disaster; and (3) To identify the pathways by which risk factors and resilience resources influence trajectories of functional limitation. The aims will be addressed by building on a longitudinal panel of 1,977 people aged 65-80 when Hurricane Sandy hit New Jersey. Three post-hurricane self-reported assessments would complement data from two prior data collection efforts. These data would be linked with Medicare/Medicaid claims data. This work is significant because it is the first step in a continuum of research expected to lead to the development of interventions that will bolster the capabilities of older people to face natural disasters without increasing functional limitations. The proposed research is innovative, because it: (1) focuses on functional limitations, a linchpin in the disability cycle, (2) examines the effects of disaster on a large representative sample of people living in one of the states hardest hit by a recent hurricane, and (3) builds on data collected before the storm struck, includes people with and without direct exposure to the storm, and has 3 post- disaster assessments, yielding one of the few studies able to disentangle causal relationships attributable to disaster. Knowledge from this project will advance understanding of disaster's effects on older people, and inform interventions likely to improve their quality of life, both before and after disasters strike.