Many older adults still homebound after 2011 Great East Japan Earthquake

A team of researchers led by Naoki Kondo of the University of Tokyo's School of Public Health studied data from the city of Rikuzentakata, an area that was seriously damaged by the disaster. Of its total population of 23,302 before the events of 2011, 1,773 people died or are still missing. Of 7,730 houses, 3,368 (43.6%) were affected with 3,159 "completely destroyed." Much of the population had been concentrated in flat coastal areas, and since the community infrastructure was totally shattered, many people who lost their houses insisted on moving to areas in the mountains.

This study used home-visit interviews with 2,327 adults over 65 years old (1027 men; 1300 women), and was carried out between August 2012 and October 2013. Interviewers gathered information of current morbidity, socio-economic status, health behaviour (diet, smoking, and alcohol intake), frequency of going out, and social support. 19.6% of men and 23.2% of women were shown to be homebound, defined as only leaving the house every 4 or more days. Of those older adults who were classified as homebound, around 40% also had no contact with neighbours.

Information was also obtained on the locations of grocery stores, convenience stores, and shopping centres from the online community directory database in August 2012. Information on shopper bus stops and hawker sites was provided by a disaster support team, and the team also collated road network data. This geographical analysis indicated that distances to retail stores was associated with the risk of people being homebound.

Lead author Naoki Kondo says: "This study has important implications for public health, especially in the setting of post-disaster community reconstruction. First, community diagnoses in a post-disaster setting should cover the built environment, including access to shopping facilities. Second, to prevent older victims of a disaster such as the Great East Japan Earthquake being homebound, it is clearly essential to provide access to the facilities that fulfil their daily needs.

"Given the findings of this study, such access could be increased by the private sector, suggesting the importance of public-private partnerships for post-disaster reconstruction."

Key messages:

• The homebound status of older victims of the 2011 Great East Japan Earthquake is a matter of public health concern
• Geographical analysis indicated that distances to retail stores was associated with the risk of people being homebound
• Hawker and shopping bus services contributed to improved access, providing more opportunities for going out