Voices of the most vulnerable and forgotten: Health and Subjective Well-being of Older Adults after the 2011 Triple Disaster in Fukushima, Japan: Scenario Mapping Analysis Akiko Kitamura 1, Yukako Komasa 2, Maya Fujimura 1, Yukio Ohsawa 3, Masamine Jimba 1 1. Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Japan 2. Laboratory of International Epidemiology, Dokkyo Medical University, Japan 3. Department of Systems Innovation, School of Engineering, The University of Tokyo, Japan Research Objectives: The objectives of this study were 1) to preserve the dignity of the older adults by understanding the situation of the evacuation-instructed area of where the Fukushima Daiichi Nuclear Power Accident occurred and 2) to determine the key issues of disaster recovery for older adults and improving the elderly-oriented support. Iitate village - “The most beautiful village in Japan”, before the nuclear accident. 〜2010 2011 After the accident, people were not allowed to live in the village, due to the high level of radiation. Over 6,500 people were driven out of their home, to temporal housings. 2018 In March 2017, the evacuation order was partly lifted after decontamination. About 10% of the evacuees started to live in – but most of them are older adults. Radioactive wastes are left in residential areas and agricultural fields, unlikely to be removed. Background： Older adults are most often forgotten and susceptible to adverse health outcomes in post disaster situations. The 2011 Fukushima Daiichi Nuclear Power Plant accident has caused the spread of radioactive substances, which forced over 160,000 people to leave their hometown. Iitate village, where 6,500 people lived, is located 40 km northwest of the power plant. The village is mountainous, and most of the older adults engaged in traditional agriculture. The accident has drastically changed their lives. The study aims to give full attention to the voices of older adult evacuees, on “what they lost by the accident” and “how they would like to live the rest of their lives ”, to find the key elements for disaster recovery. Methods： In-depth semi-structured interviews were conducted with 31 older adult evacuees (over the age of 65) from Iitate Village, interviews at the participants temporary housing. Study period was within October to December 2014 to explore the subjective well-being. Participants were 74.4 years old on average. Overall, 38 hours and 14 minutes of interview was recorded. To explore the subjective well-being, interview text was analyzed using thematic analysis, as well as KeyGraph™ scenario mapping analysis, a text mining method. Analysis: KeyGraph-Step: 1) Obtain islands, i.e., co-occurring groups of frequent items in the data. C4 C3 The information from the qualitative interview was analyzed by KeyGraph™ algorithms, based on the frequency and term location, which reveals common phrases and key words of the interview. Nodes (black dots) are the keywords, and the links (red dots) between the cluster of nodes are formed when those terms co-occur throughout the interview. This method allows us to discover and visualize clusters of keywords . a5 a4 a10 a1 a2 C1 C2 KeyGraph-Step: 2) Obtain hubs, i.e., items co-occurring with (i.e., bridging) multiple islands. If the node is rarer than black nodes, it is a new node put as a red one. Otherwise it is a black node surrounded by green circles. Results: Health, Time period Agriculture and Decontamination Radiation and Local government Nuclear accident and National policy Community and Ralationship Life and living place Medicine, Mobility, Transportation By another 20 or 30 years, we will not be alive so we want to be able to live securely. We were able to see our children and grandchildren everyday before, but everyone has separated and left the town. Even if we are told to return since the decontamination is over, if the people we know are sparse then it does not necessarily mean it is good to go back. Due to the radiation pollution across the agricultural land and forests, keywords and phrases such as “loss of nature/mountain blessings”, “irreversibility of earth”, “give up on agriculture”, “decontamination work agitating soil” expressed the negative feelings towards their future livelihood on agriculture and nature. Access to health care services, transportation, farming and contamination, governmental policies around radioactive contamination were raised as perceived issues. More than half had been diagnosed with a condition and/or needed medical treatment post-disaster, both due to aging and changed in lifestyle from the evacuation. The main concern of the older adults was that while the younger generation are determined to stay out of the village even after the evacuation order is lifted, the village is re-population with mainly older people and the future will be devoid of children. In rebuilding the life for future, family members and community was considered as the key. Especially for the elderly the existence of children and grandchildren was the psychological and physical support. Many of the older adults answered that their needs and concerns have rarely been reflected in emergency planning and policy-making processes in both local governance and national policy. Fukushima Prefecture Areas with evacuation order on April 22, 2011 Discussion: Participants voiced pessimistic view about the future of the region, mostly due to the reasons such as a stolen peaceful agricultural life and feeling of regret toward the young generation who could not continue to live there. The village lacked functioning utilities and systems in the post-disaster days. Supply with basic health care, elderly care, and transportation is essential to re-start the lives of older adults after the evacuation order is lifted. The problem lies in how to reconnect the people who have lived with rich social capital in the mountainous areas now live apart from their families and friends due to the evacuation. Conclusion: Our study suggests the advantage of software-led text mining in reflecting rather latent content of the interviews, which is difficult to capture by traditional indexing methods used in qualitative studies. Factors such as long-term psychosocial impact and community restoration would promote better subjective well-being of older adults and should be further considered. Presented at Geneva Health Forum Geneva, Switzerland, April 10-12, 2018