Hu Huaqin, Li Buqun, Hikichi Hiroyuki, Kawachi Ichiro, Li Xiaoyu
Department of Sociology, Tsinghua University, Beijing, China.
Division of Public Health, Kitasato University School of Medicine, Kanagawa, Japan.
JAMA Netw Open. 2024 Dec 2;7(12):e2448277. doi: 10.1001/jamanetworkopen.2024.48277.
Older adults are at high risk for cognitive impairments following natural disasters, but the persistence of such effects is not well understood.
To track older adults' postdisaster cognitive disability trajectories over a decade and examine associations of cognitive disability with disaster damage exposure.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used predisaster baseline surveys conducted in August 2010 and 4 follow-ups approximately every 3 years until November 10, 2022. Invitations were mailed at baseline to all citizens 65 years or older in Iwanuma City, Japan, a coastal municipality significantly impacted by the 2011 Great East Japan Earthquake and Tsunami. A total of 1988 respondents who were cognitively independent (ie, without cognitive disability) before the disaster completed the 4 postdisaster cognitive assessments.
Experiences of residential damage, worsening financial conditions, loss of loved ones, and disruption in health care services. A composite score quantified these experiences, with higher scores indicating greater overall damage.
Cognitive disability level was assessed using a standardized in-home evaluation under a national long-term care insurance scheme. Trained investigators evaluated participants' activities of daily living, cognitive function, and presence of mental and/or behavioral disorders. Latent class growth analyses (LCGA) identified distinct cognitive disability trajectories. Primary outcomes consisted of inclusion in these trajectories.
The analytic sample consisted of 1988 participants who were cognitively independent at baseline, with a mean (SD) age of 72.4 (5.4) years, of whom 1159 (58.3%) were female. LCGA identified 3 cognitive disability trajectories: high and gradual deterioration (277 [13.9%]; high levels of cognitive disability with increasing impairment over time), low and progressive deterioration (541 [27.2%]; low levels of cognitive disability with accelerated decline in cognitive function over time), and low and stable (1170 [58.9%]; low levels of cognitive disability that remained stable). In multinomial regression analyses with the low and stable trajectory serving as the reference, housing damage (adjusted odds ratio [AOR], 2.52; 95% CI, 1.26-5.04), worsening financial conditions (AOR, 1.83; 95% CI, 1.15-2.90), and disruption in health care services (AOR, 1.76; 95% CI, 1.03-2.99) were associated with high and gradual deterioration. Worsening financial conditions (AOR, 1.38; 95% CI, 1.01-1.90) and higher composite damage scores (AOR, 1.16; 95% CI, 1.01-1.34) were associated with low and progressive deterioration. These associations no longer remained after adjusting for postdisaster depressive symptoms.
In this cohort study of older adults who survived the 2011 Great East Japan Earthquake and Tsunami, disaster-related exposures were associated with worse long-term cognitive disability trajectories. These findings could inform tailored interventions to preserve cognitive function in older disaster survivors.
老年人在自然灾害后有发生认知障碍的高风险，但此类影响的持续性尚不清楚。
追踪老年人灾后十年的认知残疾轨迹，并研究认知残疾与灾害破坏暴露之间的关联。
设计、设置和参与者：这项前瞻性队列研究使用了2010年8月进行的灾前基线调查以及大约每3年进行一次的4次随访，直至2022年11月10日。在基线时，向日本石卷市所有65岁及以上的公民邮寄了邀请函，石卷市是一个受2011年东日本大地震和海啸严重影响的沿海城市。共有1988名在灾难前认知功能正常（即无认知残疾）的受访者完成了4次灾后认知评估。
住房受损经历、经济状况恶化、亲人离世以及医疗服务中断。通过综合评分对这些经历进行量化，分数越高表明总体破坏越大。
使用国家长期护理保险计划下的标准化居家评估来评估认知残疾水平。经过培训的调查人员评估参与者的日常生活活动、认知功能以及精神和/或行为障碍的存在情况。潜在类别增长分析（LCGA）确定了不同的认知残疾轨迹。主要结局包括纳入这些轨迹。
分析样本包括1988名在基线时认知功能正常的参与者，平均（标准差）年龄为72.4（5.4）岁，其中1159名（58.3%）为女性。LCGA确定了3种认知残疾轨迹：高且逐渐恶化（277名[13.9%]；认知残疾水平高，且随着时间推移损害加剧）、低且进行性恶化（541名[27.2%]；认知残疾水平低，且随着时间推移认知功能加速下降）以及低且稳定（1170名[58.9%]；认知残疾水平低且保持稳定）。在以低且稳定轨迹为参照的多项回归分析中，住房受损（调整优势比[AOR]，2.52；95%置信区间，1.26 - 5.04）、经济状况恶化（AOR，1.83；95%置信区间，1.15 - 2.90）以及医疗服务中断（AOR，1.76；95%置信区间，1.03 - 2.99）与高且逐渐恶化相关。经济状况恶化（AOR，1.38；95%置信区间，1.01 - 1.90）以及更高的综合破坏评分（AOR，1.16；95%置信区间，1.01 - 1.34）与低且进行性恶化相关。在对灾后抑郁症状进行调整后，这些关联不再存在。
在这项针对在2011年东日本大地震和海啸中幸存的老年人的队列研究中，与灾害相关的暴露因素与更差的长期认知残疾轨迹相关。这些发现可为制定有针对性的干预措施以保护老年灾害幸存者的认知功能提供参考。
