Effects of Hurricane Sandy on Functional Limitation Trajectories of Older Adults

描述(申请人提供)：尽管自然灾害给受影响社区的居民带来了严重的挑战，但关于其对老年人身体健康的影响仍有许多问题。其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改善老年人生活质量的干预和资源规划工作提供信息。这个应用程序的目标是确定灾难如何影响功能限制的轨迹。我们的中心假设是，大多数面临灾难的老年人具有弹性，灾难发生后与某些功能限制轨迹相关的医疗利用和支出是显著的，个人和社区的灾前特征可以区分弹性轨迹和脆弱性轨迹。我们的假设是基于我们之前的经验和概念性工作以及其他人的工作提出的。拟议研究的理由是，一旦知道灾难如何影响功能限制轨迹，就可以开发干预措施，降低老年人的脆弱性，增加他们在灾难面前的韧性，从而产生改善老年人生活质量的新的创新方法。该假说将通过追求三个具体目标来检验：(1)确定自然灾害对老年人功能限制轨迹的影响；(2)比较与遭受灾难的老年人和未遭受灾难的老年人的功能限制轨迹相关的医疗利用和支出；以及(3)确定风险因素和韧性资源影响功能限制轨迹的路径。飓风桑迪袭击新泽西州时，将通过一个由1,977名年龄在65岁至80岁之间的人组成的纵向小组来实现这些目标。三次飓风后自我报告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索赔数据相链接。这项工作意义重大，因为它是一系列研究的第一步，预计这些研究将导致制定干预措施，在不增加功能限制的情况下增强老年人面对自然灾害的能力。拟议的研究是创新的，因为它：(1)侧重于功能限制，这是残疾周期的关键；(2)检查灾难对生活在最近受飓风袭击最严重的州之一的具有代表性的大样本人群的影响；(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，并有3项灾后评估，产生了能够理清灾害因果关系的为数不多的研究之一。来自该项目的知识将促进对灾难对老年人影响的了解，并为可能改善他们生活质量的干预措施提供信息，无论是在灾难发生之前还是之后。

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.