Effects of Hurricane Sandy on Functional Limitation Trajectories of Older Adults

描述（由申请人提供）：虽然自然灾害对受影响社区的居民提出了严重的挑战，但有关其对老年人身体健康影响的许多问题仍然存在。长期目标是为旨在减轻灾害对老年人的影响、减少保健利用和支出以及提高老年人生活质量的干预和资源规划工作提供信息。这个应用程序的目的是o确定的轨迹功能限制是如何受到灾害的影响。我们的中心假设是，大多数老年人暴露于灾害是弹性的，医疗保健利用和支出与一些功能限制的轨迹在灾难发生后是显着的，和灾前的个人和社区的特征可以区分弹性和脆弱性的轨迹。我们的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。拟议研究的理由是，一旦知道灾害如何影响功能限制轨迹，可以制定干预措施，减少老年人的脆弱性，提高他们在灾害面前的复原力，从而产生新的和创新的方法来提高老年人的生活质量。该假设将通过追求三个具体目标进行检验：（1）确定自然灾害对老年人功能限制轨迹的影响;（2）对比经历灾害的老年人与未遭受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;以及（3）确定风险因素和复原力资源影响功能限制轨迹的途径。当飓风桑迪袭击新泽西时，这些目标将通过建立一个由1,977名65至80岁的人组成的纵向小组来实现。三次飓风后自我报告的评估将补充先前两次数据收集工作的数据。这些数据将与Medicare/Medicaid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，预期这些研究将导致制定干预措施，加强老年人应对自然灾害的能力，而不增加功能限制。这项研究具有创新性，因为它：（1）关注功能限制，这是残疾周期中的关键，（2）研究灾难对生活在最近飓风袭击最严重的州之一的大量代表性样本的影响，（3）建立在风暴袭击前收集的数据基础上，包括直接暴露于风暴和没有直接暴露于风暴的人，并进行了3次灾后评估，产生了为数不多的能够解开灾害因果关系的研究之一。该项目的知识将促进人们对灾害对老年人的影响的了解，并为可能改善老年人生活质量的干预措施提供信息，无论是在灾害发生之前还是之后。

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.