Risk Factor for Incident Functional Disability and the Effect of a Preventive Exercise Program: A 4-Year Prospective Cohort Study of Older Survivors from the Great East Japan Earthquake and Nuclear Disaster

Abstract

Objective: The aim of this study is to assess the risk factors for incident functional disability among long-term evacuees of Iitate village after Great East Japan Earthquake and nuclear disaster (GEJE). We also investigated the effectiveness of exercise classes as an intervention measure in this situation. Methods: 1159 subjects (75.2 ± 5.8 years, 57.5% female) were included at baseline, and followed-up for four years. Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of incident functional disability according to the presence of risk factors evaluated by the municipality’s self-assessment Basic Checklist (BCL). Evacuees from Iitate who participated in the exercise classes and those who did not were matched using the propensity scores, which were then used to obtain the HR of incident functional disability. Results: New functional disability occurred in 280 (24.2%) participants during the follow-up. Participants who scored negative for the “Physical function” domain in the BCL had a HR of 2.04 (95% CI: 1.54–2.69) for incident functional disability when compared to those who scored positive for this domain. Similarly, the HR for “Cognitive function” was 1.37 (CI: 1.06–1.77), and 1.60 (CI: 1.24–2.08) for “Depression”. Using a Cox proportional hazard regression model, both the group with low-participation in the exercise program and the group with high-participation in the exercise program had a significantly lower rate of incident functional disability compared to those who did not participate at all (HR = 0.27, CI: 0.16–0.46; HR = 0.30, CI: 0.12–0.74, respectively). Conclusions: Pre-disaster BCL domains were useful to identify individuals at risk of functional disability after a major socio-technical disaster. Therefore, this instrument can be used to identify at-risk older adults who would benefit from early exercise programs to prevent incident functional disability.

The role of radiological protection experts in stakeholder involvement in the recovery phase of post-nuclear accident situations: Some lessons from the Fukushima-Daïchi NPP accident

“…They have been at the forefront of dialogues with the residents since the very early stage of the accident. Their role is to provide community members health-related advice, but it has become difficult in the nuclear accident aftermath (Kuroda et al, 2018a(Kuroda et al, , 2018b. Together with a psychologist from Fukushima Medical University, they initiated various actions, especially, round-table dialogues in all 'Kasetsu' (temporary houses) and a nursery for young children from Iitate.…”

Relationship between Psychological Factors and Social Support after Lifting of Evacuation Order in Fukushima Prefecture, Japan

“…Previous research has indicated that long-term evacuees experienced multiple stressors, including uncertainty about the future, lifestyle changes, and psychological stress, which have resulted in deterioration of both physical and mental health [ 11 , 12 , 13 , 14 ]. Analysis of the relationship between the evacuees’ living environment and their levels of mental health and social support indicated that those residing in rental apartments had poorer mental health and more difficulty getting social support than those residing in temporary housing [ 8 ].…”

Musculoskeletal pain and new-onset poor physical function in elderly survivors of a natural disaster: a longitudinal study after the great East Japan earthquake

“…Functional disability is a significant problem after natural disasters, especially among elderly survivors [1]. The Great East Japan Earthquake (GEJE) and tsunami destroyed the northeast coastal region of Japan in 2011.…”

“…Preventing functional decline is an important issue after natural disasters and should be considered even during the disaster recovery period. The environmental habitat changed and many evacuees lost connections with their local communities after the GEJE [1, 5]. Because older survivors are more vulnerable to these changes, they have had fewer opportunities to go out into the community.…”