Effects of Hurricane Sandy on Functional Limitation Trajectories of Older Adults

描述（由申请人提供）：虽然自然灾害给受灾社区的居民带来了严重的挑战，但它们对老年人身体健康的影响仍然存在许多问题。长期目标是为干预和资源规划工作提供信息，以减轻灾害对老年人的影响，减少保健服务的利用和支出，并改善老年人的生活质量。本应用程序的目的是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，大多数遭受灾害的老年人具有复原力，灾后与某些功能限制轨迹相关的医疗保健利用和支出显著，个人和社区的灾前特征可以区分复原力和脆弱性的轨迹。我们的假设是基于我们之前的经验和概念工作以及其他人的工作而制定的。这项拟议研究的基本原理是，一旦了解了灾害如何影响功能限制轨迹，就可以开发干预措施，减少老年人的脆弱性，提高他们面对灾害的复原力，从而产生改善老年人生活质量的新方法和创新方法。该假设将通过三个具体目标进行验证：(1)确定自然灾害对老年人功能限制轨迹的影响；(2)对比经历过灾害的老年人与未经历过灾害的老年人的功能限制轨迹相关的医疗保健利用和支出；(3)确定风险因素和恢复力资源影响功能限制轨迹的途径。飓风桑迪袭击新泽西时，纵向调查了1977名年龄在65岁至80岁之间的老人。三次飓风后自我报告的评估将补充之前两次数据收集工作的数据。这些数据将与医疗保险/医疗补助索赔数据相关联。这项工作意义重大，因为它是一系列研究的第一步，预计将导致开发干预措施，增强老年人面对自然灾害的能力，而不会增加功能限制。拟议的研究具有创新性，因为它：(1)侧重于功能限制，这是残疾周期的关键；(2)在最近遭受飓风袭击最严重的一个州，对生活在其中一个州的大量有代表性的人群样本进行了灾难影响的检验；(3)以风暴来袭前收集的数据为基础，包括有和没有直接接触风暴的人群，并进行了3次灾后评估，产生了为数不多的能够分解灾害因果关系的研究之一。该项目的知识将促进对灾害对老年人影响的认识，并为可能改善他们在灾害发生前后的生活质量的干预措施提供信息。

DESCRIPTION (provided by applicant): 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 o identify how trajectories of functional limitations are affected by disaster. Our central hypothesi 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 ca be developed that will reduce the vulnerability of older adults and increase their resilience in th 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 to 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 ona 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.