A multistakeholder eDelphi consensus on geriatric rehabilitation care for Chinese older adults in contexts of flooding

A multistakeholder eDelphi consensus on geriatric rehabilitation care for Chinese older adults in contexts of flooding | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A multistakeholder eDelphi consensus on geriatric rehabilitation care for Chinese older adults in contexts of flooding Joseph Kimuli Balikuddembe, Yafang Zheng, Pengbo Fu, Jerico B Ogaya, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4021080/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Rehabilitation care is indispensable in promoting the healthy lives of people as they grow older, especially when they are experiencing an increasing burden of disabling conditions, like in the aftermath of floods and disaster emergencies. We engaged experts to seek their consensus on the interventions that were identified in a prior systematic review for enhancing geriatric rehabilitation care (GRC) for Chinese older adults to manage or live with disabling health conditions induced by floods. Methods: We conducted the eDelphi consensus study drawing a composition of international experts across diverse professional fields both within and outside China. Using a pilot-tested and Qualtrics-generated eDelphi survey that contained 31 statements on interventions identified earlier in a systematic review a priori, experts were invited by email to independently rate them based on a 5-point Likert scale in two rounds (R1 and R2). Results: Of the 200 eDelphi experts who were initially invited to participate in the study, 50 and 44 completed R1 and R2, respectively. A majority of them were male (R1 = 64% and R2 = 61.4%), Chinese (R1 = 68% and R2 = 70.5%), and work in disaster risk reduction field (R1 = 38% and R2 = 36.4%). Expert consensus at ≥=70% was only attained on 4 and 9 statements in R1 and R2, respectively. In R2, consensus dwelt on interventions for promoting timely psychosocial care, adequate resource allocation, as well as social support and participation. Conclusions: While this eDelphi study contributes knowledge on promoting GRC in China and other contexts that witness ageing population and extreme climate events like floods, it agitates for further research, especially on the interventions that did not attain ≥50% consensus in R2. Geriatric rehabilitation ageing flooding China eDelphi consensus Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Over the past decades, there has been an increase in life expectancy, whereby most people can expect to live into their sixties and beyond. While this is one of the remarkable gains of the 20th century [ 1 ], it has also led to what has been described as the ageing tsunami [ 2 ]. Ageing shifted from being a common challenge for industrialized economies to also being a challenge for developing countries like China, with their ageing population in recent years reported at 264.02 million (18.7% of the total population). This is comparable to other countries within the East Asia region that have witnessed exponentially ageing populations, such as Japan and South Korea, with 35.8% and 25.5% of their population, respectively, aged 60 years or older [ 3 – 5 ]. Aside from its previous one-child policy and the current universal two-child policy, which have plummeted birth rates to 6.39 births from 6.77 births per 1,000 people in 2022 [ 6 , 7 ], other factors have also accelerated the ageing population in China. They include low mortality and fertility rates and low immigration of foreigners, as well as socioeconomic transitions that have led many young adults and married couples or spouses to resort to childlessness [ 1 , 3 , 4 , 8 , 9 ]. Based on the World Bank reports, over 211 million people aged 65 or older who lived in East Asia and the Pacific in 2010, including 130 million in China alone, accounted for 36% of the global ageing population and were anticipated to rise between 12% and 26% by 2050 [ 10 , 11 ]. This projection tallies with the statistics in the most recent 2020 census in China, whereby the proportion of Chinese aged 65 years old and above increased by 13.26–18.70% between 2010 and 2020, respectively [ 2 , 12 ]. In the face of ageing population, extreme climate events and their associated impacts, in particular floods, continue to ravage China. This has been attributed, among other factors, to China’s close location to the Pacific Ocean, the South China Sea, and the Mediterranean-Himalayan belts [ 13 – 16 ], which subject it to climatic, geophysical, and hydrometeorological hazards. As such, China is one of the countries most exposed to frequent and severe floods in Asia, whereby two-thirds of its territory and over 68% of its population, especially in urban areas, are at high risk, given that they increasingly occurred between 1990 and 2021 [ 15 – 18 ]. The role of healthcare systems is indispensable in promoting healthy lives for people as they grow older, which may also coincide with their experiencing an increasing burden of diseases and disabling conditions [ 4 ]. This can become a critical challenge in the aftermath of floods, where there is a great need to care for older people who are disproportionately affected compared to younger adults [ 19 , 20 ]. Accordingly, extreme climate events, limited not only to floods, which are increasingly occurring, affect mostly high-risk groups like older adults, the disabled, and people with chronic health conditions, especially in developing settings [ 21 ]. After their occurrences, as reported in some previous studies, floods induce various injuries and wounds, bodily pain, post-traumatic stress disorder, depression, dementia, insomnia, hypertension, and cardiovascular and respiratory complications [ 20 , 22 – 25 ]. With this in mind, how can geriatric rehabilitation care (GRC) for older adults be enhanced to manage or live with the disabling health conditions induced by floods in settings like China that have not only witnessed the rapid ageing populations but also have become prone to floods over the recent past years? To address this, we identified and engaged experts from within and outside China to seek their consensus on prior interventions we identified in a prior systematic review for enhancing GRC for Chinese older adults to manage or live with disabling health conditions induced by floods. METHODS Study design This study used the Delphi method technique, which has become increasingly embraced in health science disciplines. The method was employed based on two modified rounds of online surveys (herein referred to as the eDelphi survey) to achieve the study objective. The Delphi technique involves iterative or structured processes designed to collect the opinions, views, or feedback of experts on a particular research question where uncertain, complex, or incomplete knowledge and information exist [ 26 , 27 ]. The aggregated group answers in each round are sent back to participants so that they can reconsider their opinions or judgments on the basis of the feedback received and revise them if necessary to resolve any disagreements before arriving at group consensus or salient recommendations [ 26 ]. As such, we considered the Delphi method appropriate to ultimately attain the consensus of multi-stakeholder experts from within and outside China and across diverse professional fields on interventions for enhancing GRC for older adult Chinese in managing or living with disabling health conditions induced by floods. While some studies have proposed some guidelines for conducting Delphi studies, there are still no specified criteria or guidelines about the number of Delphi rounds, sample size, or how to organize them. In this case, we only conducted two rounds of eDelphi expert consultations, whereby the first one was informed by the findings of a systematic review conducted a priori. Development of the eDelphi survey The survey was designed and distributed online using the Qualtrics XM platform (Provo, USA) in both Chinese and English by the research team, drawing on their prior experience and knowledge in conducting mixed-method research, including Delphi methods and systematic reviews in fields like disaster risk reduction (DRR), health-related rehabilitation, disability, and emergency medicine [ 28 – 30 ]. Aside from the participants’ demographic and informed consent sections, the survey consisted of 4 domains of statements about the proposed interventions in prior systematic review to address a) cognitive and intellectual; b) physical; c) mental and psychosocial; and d) chronic and terminal conditions among Chinese older adults in contexts of flooding. The demographic part aimed at capturing the information of eDelphi participants, for example, about their age, gender, nationality, province or location, educational level and background, current work position, and years of experience. The study team jointly constructed and refined the statements on GRC interventions in the first draft of the eDelphi survey, which contained 44 statements based on four categories of disabling conditions that were identified in an earlier systematic review. Afterwards, the 2nd version of the multilingual eDelphi survey (both Chinese and English) was pilot-tested with 4 international academics (excluded from participating in R1 and R2) who are actively involved in research related to the study theme. This helped to modify and improve the structure and readability of some statements, as well as determine whether some were to be either added or removed. As a result, 13 statements were removed, and the final version of the eDelphi survey that was disseminated to the experts in R1 consisted of a list of 31 statements (S). On top of that, following the pilot-testing of the eDelphi survey, these statements were listed in general, unlike their previous grouping under the four domains as aforementioned. The survey was designed in such a way that, after consenting, participants were also required to provide their email(s) so that the eDelphi survey in the two rounds (R1 and R2) could be emailed to them and contacted in case of any further clarifications. A provision for a free-text response was included in the eDelphi survey for participants to elaborate on and explain their rating or make any comments they felt were necessary on any statements. It is worth noting that although three rounds were originally planned to be conducted, the third was foregone because a majority consensus on statements was achieved in the first two rounds. Additionally, since the statements were constructed from the findings of a systematic review conducted a priori, two survey rounds were also deemed enough for eDelphi participants to reflect on their rating before reaching optimal consensus. The eDelphi participants were required to independently rank the statements based on a 5-point Likert scale (agree, somewhat agree, disagree, somewhat disagree, and neither agree nor disagree). The Likert scale has been disclosed to be favorable and reliable for Delphi studies because it measures the extent to which participants agree with a statement and determines the degree to which they agree with each other [ 31 ]. The entire process of drafting, pilot testing, reviewing, revising, and coming up with the last version of the eDelphi survey happened between September and October 2023. All authors actively participated in these processes, and disagreements about the statement formulation were resolved through consensus. Each eDelphi round was estimated to take between 10 and 15 minutes and be completed within a month. Two email reminders were to be sent to respondents during either round to complete the eDelphi survey if no responses had not been received from them two weeks after launching the round, and the second reminder one week before the round closure. Recruitment of the eDelphi experts: The distinguished experts the research team identified through their online publications and biographies, and also through a snowballing approach, were invited by email to participate in the study with a short explanation about the study background. As the criteria for their selection, we explicitly recruited those who are knowledgeable and whose scholarship, research, or policymaking undertakings, particularly in China, revolved around the fields of ageing, gerontology, rehabilitation, disability, DRR, climate change, public health, and others, as shown in Table 1 . They also had to be aged 18 years and older, widely published in renown journals, possess the requisite work experience spanning at least 3 years, be fluent in Chinese or English, be affiliated with notable policy, academic, research, or organizational institutions within and outside China, and agree to participate in all two rounds of the eDelphi survey. Table 1 Characteristics of eDelphi experts who participated in R1 and R2 Round 1 (n = 50) Round 2 (n = 44) Age Min 25 25 Max 74 74 Mean 42.46 42.6 Gender Male 32 (64%) 27 (61.4%) Female 18 (36%) 17 (38.6%) Nationality Chinese 33 (66%) 31 (70.5%) Others 13 (26%) 10 (22.7%) American 2 (4%) 1 (2.3%) British 1 (2%) 1 (2.3%) Korean 1 (2%) 1 (2.3%) Province Shanxi 1 (2%) 1 (2.3%) Liaoning 1 (2%) 1 (2.3%) Jilin 1 (2%) 1 (2.3%) Jiangsu 3 (6%) 3 (6.8%) Zhejiang 2 (4%) 2 (4.5%) Anhui 2 (4%) 2 (4.5%) Fujian 1 (2%) 1 (2.3%) Shandong 1 (2%) 1 (2.3%) Henan 2 (4%) 2 (4.5%) Hubei 4 (8%) 4 (9.1%) Guangdong 1 (2%) 1 (2.3%) Sichuan 18 (36%) 13 (29.5%) Yunnan 1 (2%) 1 (2.3%) Shaanxi 1 (2%) 1 (2.3%) Gansu 1 (2%) 1 (2.3%) Qinghai 1 (2%) 1 (2.3%) Others 9 (18%) 8 (18.2%) Educational background Gerontology 4 (8%) 4 (9.1%) Disaster risk reduction 19 (38%) 16 (36.4%) Climate change 4 (8%) 4 (9.1%) Rehabilitation 1 (2%) 1 (2.3%) Disability 4 (8%) 3 (6.8%0 Administration & policymaking 5 (10%) 5 (11.1%) Medical sciences or public health 5 (10%) 4 (9.1%) Others 8 (16%) 7 (15.9%) Educational level Bachelors 7 (14%) 7 (15.9%) Masters 11 (22%) 9 (20.5%) PhD (Doctorate) 32 (64%) 28 (63.6%) Current job position University professor 24 (48%) 21 (47.7%) Policymaker 4 (8%) 4 (9.1%) Researcher 13 (26%) 12 (27.3%) Medical specialist 2 (4%) 2 (4.5%) Others 7 (14%) 5 (11.4%) Years of work experience =31 years 5 (10%) 4 (9.1%) As aforementioned, although there are no guidelines on the recommended sample size for Delphi studies [ 26 , 28 , 32 ], what is important is to recruit participants with sufficient knowledge and expertise about the subject matter under investigation. However, some earlier Delphi studies established that at least a minimum sample size of 10 representative experts is adequate for content validity and reaching consensus [ 32 , 33 ]. For this reason, a non-probability purposive sample of 150 experts within and outside China was initially invited via email to participate in R1. Due to the non-response, attrition, or dropout rate that was projected at 20% in both rounds, as has been witnessed in previous Delphi studies [ 33 , 34 ], 50 additional experts were identified and contacted to participate in the eDelphi survey. In total, 200 experts were recruited and considered appropriate to achieve the final consensus in the study. It should be noted that issues of diversity and representativeness when recruiting them were prioritized by taking into account the above-mentioned fields or specialties, gender, and at least one participant from each province or autonomous region of China. The eDelphi survey procedures The author (JKB) led the research team in administering the Qualtrics-generated survey via a link that was emailed to eDelphi experts who consented to participate in both eDelphi R1 and R2. However, experts who consented but did not complete R1 were not eligible to participate in R2, whereas those who did not complete the survey in R2 were also excluded. RI : In this round, which was implemented in November 2023, using a 5-point Likert scale, participants were asked to independently rate a total of 31 statements that were formulated in line with the proposed interventions for addressing the four categories of disabling conditions as noted above. R2 : This round was implemented in December, and it commenced immediately after R1 had ended. Since providing respondents with feedback on how their peers rated or voted for consensus building is the most important component of the Delphi methods [ 26 , 33 , 35 ], participants in R2 were able to view the aggregated response rate on 31 statements from R1. Again, a link to the Qualtrics-generated survey was emailed to participants so that they could reconsider and evaluate their previous rating in R1 still based on the 5-point Likert scale. Where possible, they also had an opportunity to state or elaborate on the rationale for their rating under the provision of free-text responses in the eDelphi survey. On a particular note, in R2, no additional statements were added or removed. This round's overall aim was to validate, revise, and ultimately acquire final consensus or any other vital suggestions from the eDelphi participants. In the end, this would help in identifying and prioritizing the most significant interventions for enhancing GRC for older adults within and outside China in managing or living with their disabling health conditions induced by floods. Data analysis Qualtrics XM was used to generate data reports, which informed the subsequent analyses. The level of participants’ consensus on each statement in R2 was determined by adopting a grading system denoted by U, A, B, and C for unanimous (100%), 90–99%, 78–89%, and 67–77% consensus, respectively, that has recently been used in a COVID-19-related Delphi study [ 36 ]. A minimum cut-off on a statement from the consensus of all the eDelphi participants was at ≥ 50%, and statements that attained the consensus below this percentage were excluded for analysis in R2. Positive or negative consensus was considered to be attained at ≥ = 70% if all participants agreed and strongly agreed or disagreed and strongly disagreed with statements in two rounds. Using Microsoft Excel (version 16), descriptive statistics were generated to present the demographic characteristics of participants and ratings for each statement, as well as calculate the percentage changes in statement rating between the two rounds. RESULTS Characteristics of participants : Table 1 presents the demographic characteristics of participants in each round, whereby 50 and 44 completed R1 and R2, respectively. A majority of experts were male (R1 = 64% and R2 = 61.4%); mean age = 42 [range: 25–74]; PhD holders (R1 = 64% and R2 = 63.6%); university professors (R1 = 48% and R2 = 47.7%); and involved in the field of DRR (R1 = 38% and R2 = 36.4%). More than half of the experts in either round was Chinese (R1 = 68% and R2 = 70.5%). Also, a majority of them across the two rounds had been working for the duration in their respective fields between < = 5 years and 6–10 years. Response rate to the eDelphi survey Two hundred experts were identified as eligible and invited to participate in the eDelphi process, as can be observed in Fig. 1 . Of these, 90 (45.0% response rate) consented to participating, but only 50 turned up and completed R1 (55.5% response rate). Fifty experts who completed R1 were again invited to participate in R2, and 44 completed the survey (88.0% response rate). The non-response and dropout rates, or incomplete surveys of experts who had consented to participating in the eDelphi survey, were 40 (out of 90) and 6 (out of 50) in R1 and R2, respectively. Consensus on statements: Consensus at ≥=70% was only attained on 4 (S1, S3, S6, and S12) and 9 statements (S1, S3, S4, S6, S7, S10, S12, S13, and S20) in R1 and R2, respectively, as observable in Figure 3. Two statements (S1 and S3) were rated in grade 'B', while four statements (S4, S6, S12, and S13) were rated in grade ‘C’ in R1. No statement achieved the expert consensus ranked under the ‘U’ grade. Six original statements (S5, S8, S14, S16, S19, and S21) from R1 with consensus rated at ≥=50% were excluded for R2. During this round, expert consensus at ≥=70% improved, as can be observed with the 9 statements above compared to R1. Accordingly, 1 (S3), 5 (S1, S4, S6, S12, and S13), and 3 (S7, S10, and S20) statements were rated by experts in grades ‘A’, ‘B’, and ‘C’, respectively (Figure 2). Similar to R1, no statement attained expert consensus ranked under the ‘U’ grade. The consensus on 6 out of 13 statements was below a ‘C’ grade. The mean consensus on ‘A’ in R1 and R2 was 58.7% and 62.1%, respectively, for 31 statements. This rose to 71.2% for 15 statements (with ≥=50%) in R2. Changes in consensus Apart from reducing the original statements in the survey from 44 to 31 following its pilot-testing (Fig. 2 ), no statements were suggested to be added or removed by eDelphi participants in R1 and R2. Two participants, however, in free-text provision in R1 proposed a slight revision or adjustment in one statement before it was included in the R2 survey. Based on Fig. 3, from R1 to R2, there was improvement in the experts’ consensus among twelve statements (n = 12). Based on Table 2 , this was especially registered with S20, S13, S4, S3, S12, and S18, with 42%, 24%, 17%, 15%, 14%, and 12%, respectively. In this case, there was no stability of expert consensus. On the other hand, S5, S21, S8, S8, and S16 achieved negative consensus from experts of -17%, -14%, -13%, -13%, and − 12%, respectively, between R1 and R2. Table 2 Consensus rating on 21 statements in two rounds by the eDelphi experts Statement Reference source Round 1 (n = 50) Round 2 (n = 44) % change in consensus between R1 and R2 Grade A (%) SA (%) D (%) SD (%) N/A (%) Grade A (%) SA (%) D (%) SD (%) N/A (%) S1 Community-based plans should consider the psychosocial needs and resources of older adults affected by floods B 83 10 4 2 0 B 88.6* 5 5 0 2 7% S2 Establish planned shelters with appropriate levels of personal, environmental, and healthcare support can ensure long-term physical health D 64 28 0 0 9 — 61.4* 27 0 0 11 -4% S3 Effectively allocate resources for older adults who are diagnosed with chronic diseases and without family support B 79 21 0 0 0 A 90.9* 9 0 0 0 15% S4 Empower family and strengthen communities for promoting older people’s psychosocial well-being and enhancing their resilience to floods D 68 32 0 0 0 B 75.9* 20 0 0 0 17% S5 Personal safety and reducing property losses for older adults in flooding areas improve or maintain their psychological health — 49 30 2 6 13 — 41 34 2 5 18 -17% S6 Medical resources should be made available in less developed and high-risk populations, with particular attention to chronic PTSD in older adults C 72 17 2 6 2 B 80* 14 2 5 0 10% S7 Environmental interventions of providing clean water, safe food, environmental hygiene, risk communication, and sufficient accommodation reduce the risk of psychological problems D 64 19 4 0 13 C 70.5* 16 5 0 9 10% S8 Tolerance of older adult’s behaviour to uncertainty can help decrease their ill mental wellbeing during stressful events — 34 36 2 6 21 — 29.5 36 2 7 25 -13% S9 Coping efficacy, trust and a closer psychological distance are protective factors for mental and psychological problems — 49 40 0 0 11 — 54.5* 39 0 0 7 11% S10 Early and effective psychological interventions prevent PTSD and anxiety among older adult survivors in the long run D 66 32 0 0 2 C 72.7* 27 0 0 0 10% S11 Clinical attention should be paid to PTSD patients who suffer a high intensity of trauma characterized by nervousness traits or a shortage of social support D 60 38 0 0 2 D 63.6* 34 0 0 2 6% S12 Timely psychological interventions for flood survivors, including cognitive behavioral therapy, are effective for treatment of PTSD and anxiety disorders C 70 21 0 0 9 B 79.5* 18 0 0 2 14% S13 Social participation helps in the recovery from PTSD D 68 21 0 2 9 B 84.1* 14 0 0 2 24% S14 Rebuilding a high-quality life after a disaster with help from society or the government can reduce the development of chronic PTSDs — 55 19 0 11 15 — 47.7 16 18 9 9 -13% S15 Psychological intervention, social support, mitigation strategies and access to quality healthcare services are essential in prevention of chronic non-infectious diseases — 51 45 0 2 2 — 52.3* 43 0 2 2 2% S16 Intervention strategies considering demographic characteristics of older adults reduce the health impact they face — 49 32 0 4 15 — 43.2 32 0 7 18 -12% S17 Consider the prevention of infectious and parasitic diseases, as well as injury, poisoning, and chronic non-infectious disease — 57 17 9 0 17 — 52.3* 18 7 5 18 -8% S18 Public health education can influence the prevention and preparedness of older adults with and without chronic disease — 57 36 0 6 0 — 63.6* 32 0 5 0 12% S19 Understanding individuals’ sentiments in disaster-stricken areas is useful for effective communication with the public and controlling their hysteria — 40 30 13 2 15 — 36.4 36 16 0 11 -9% S20 Monitoring the recovery situation in the post-disaster period based on social media data can provide a reference for timely assistance to victims in improving their living conditions — 53 21 9 4 13 C 75* 0 5 14 7 42% S21 Symptom screening is helpful and effective in quickly screening flood-related PTSD — 45 34 0 2 19 — 38.6 36 0 2 23 -14% Note: Grey colour and *show the 15 statements on which the eDelphi expert consensus was attained at ≥=50%, and “—” denotes ineligible to the grading used. Consensus on the interventions Of the 15 statements that were considered finally in R2, the highest expert consensus rated resource allocation (S3), followed by psychosocial needs and resources (S1), social participation (S13), family and community empowerment (S4), medical resources (S6), and early and effective psychological care (S12) (Table 2 ). In summary, these interventions revolved around bolstering timely social support for Chinese older adults from their families or communities to manage or live with disabling conditions induced by floods. Moreover, the expert consensus on 15 statements for GRC interventions can address more than one disabling condition across the four categories of physical, cognitive and intellectual, mental and psychosocial, and chronic and terminal illnesses (Fig. 2 ). DISCUSSIONS The final consensus reached in the two-round eDelphi study on 31 statements most importantly highlights the need for timely psychosocial care, adequate resource allocation, as well as social support and participation for older adults to manage or live with their disabling health conditions induced by floods. Indeed, these interventions, which are undeniably intertwined with the others that attained ≥ = 50% consensus, are pivotal in supporting the delivery of GRC through the interprofessional collaboration of both healthcare and non-healthcare professionals like gerontologists, general practitioners, rehabilitation therapists, or counsellors. Moreover, the three interventions are in concordance with the findings of what were identified in the previous expert-based studies as some of the programs, characteristics, or services of GRC [ 37 – 39 ]. Psychosocial care involves the process of providing treatment, specialist care, and support to a person who experiences or demonstrates any of the early symptoms of ill mental health or a disabling condition before it gets worse [ 37 , 40 ]. It necessitates reaching out to older adults who are at high risk of developing health problems in the aftermath of floods with improved diagnosis, treatment, or referral to specialist services, including GRC, in a timely manner before they culminate in serious, persistent, or lifelong disabling conditions. Moreover, timely psychosocial care is critical in preventing not only the progression of mental and disabling comorbidities that are common in ageing people but can also reduce the medical and economic burden on their family, friends, and entire community [ 41 ]. At this particular moment, it is therefore warranted for China, the world's largest and fastest-growing ageing country, when it continues to be affected by floods at the same time [ 3 – 5 ]. Apart from isolation, social disconnection or a lack of social support were reported to be salient determinants of greater susceptibility to chronic stressors, morbidity, and mortality among Americans and Japanese community-dwelling older adults [ 40 , 42 ]. As such, many older people, especially those who are isolated, ill, have dementia, live alone, or are reliant on medical equipment, should be provided extra social support to cater for their clinical, emotional, and spiritual needs, as well as safeguard them from adverse health effects or disabling conditions of floods or other disasters. In turn, this can increase their recognition, happiness, sense of belongingness, and confidence, and also encourage them to contribute ideas and participate in socioeconomic, cultural, spiritual, and civic affairs [ 43 , 44 ], which are predictors of positive wellbeing, life satisfaction, and healthy and successful ageing. Social support is, therefore, a critical service in China, where floods over the last decades have heavily plunged its populations, including older adults, with more than 3.4 million people affected and the number of deaths, displaced, and injured extending into the thousands [ 14 , 17 ]. We, however, note that social support for Chinese older adults could be undermined by the ongoing social-demographic shifts in China, in particular the declining births, childless couples, and rural-urban migrations among the youths [ 6 – 9 ]. Crucially, adequate resource allocation, as underscored by eDelphi experts, is one of the nitty-gritties of the effectiveness of healthcare systems. At its simplest, we can define resource allocation as a process through which available resources, for example, finances, the human workforce, medical supplies, infrastructure, and equipment, are distributed between competing uses. Floods and other climate hazards create an overwhelming burden on healthcare systems, which can make resource allocation a perplexing challenge for disaster responders and healthcare providers. This, was similarly decried three decades ago by Callahan (1993), who noted that resource allocation to rehabilitation can be beset with many difficulties [ 45 ]. In particular, this is a big challenge for many developing settings where the healthcare systems are still fragile, and under-funded and -resourced to effectively deliver a full spectrum of healthcare services, including rehabilitation in disaster and emergency crises [ 19 , 23 ]. During disasters or emergencies, the needs of older adults or other high-risk groups oftentimes are overlooked or left out in prehospital and hospital-based preparedness and response plans [ 23 ]. Consequently, this deprives them not only of their right to access essential healthcare services in the aftermath of floods but also makes them less prepared to evacuate, protect themselves, and recover from their effects. For this reason, beyond flood emergencies, the Chinese healthcare system should be well-resourced and equipped to support effective delivery of preventive, curative, rehabilitative, assistive, and palliative care in a sustainable and long-term manner [ 46 ]. Needless to say, resource allocation amid their shortages, which is indispensable in the aftermath of floods and disasters, should be pro-poor centered to earmark their needs and unimpeded access to quality and affordable services, including clinical, shelter, and environmental services, as were also proffered on by the eDelphi experts among the final 15 statements in R2. Finally, in the recent past, social media has been reported as part of revolving digital applications with tangible benefits involving the delivery of rehabilitation care [ 41 ]. By eDelphi experts underscoring overwhelmingly in R2, the role of social media in providing timely assistance to improve the living conditions of Chinese older adults with disabling conditions resulting from floods is prompt. This, is also proposed when China’s progress is unprecedented in innovation and development of mobile and high-tech applications, such as WeChat, Weibo, and Baidu, which are largely used by Chinese populations [ 41 , 47 ]. As mentioned earlier, some of the challenges experienced by ageing people, like isolation and loneliness, may end up inhibiting their access to essential services and causing social disconnection. Therefore, the above social media and others, which have now become part of our lives and literally revolutionized everything, can be leveraged to not only ease older people’s access to essential healthcare services, including digitized GRC services, but also bridge the social disconnection gap between them and their close family, health service providers, or community [ 41 , 48 ]. Additionally, social media has the potential to contribute to disease prevention and public health education as part of the interventions the eDelphi experts also opinioned on for promoting the GRC for Chinese older adults. To effectively leverage social media for GRC, it is important to engage older adults at the community level to follow the best practices to increase their digital use and self-efficacy, as a previous systematic review agitated [ 49 ]. Our study has a few limitations that should be kept in mind. Since there are no guidelines on the threshold of participant sample sizes in Delphi studies, the consensus gathered from a few experts, especially in relevant fields to the study theme like rehabilitation, gerontology, and disability, may have slightly affected the findings herein. More so, caution should be considered when generalizing the study results to China since the expert sample size was not representative enough after we failed to recruit at least a single expert from some Chinese provinces despite sending two reminders to those who were initially identified, invited, or consented to participate in the survey. Nevertheless, despite no statement that attained unanimous agreement, the level of consensus in R1 and R2 from the composition of experts both within and outside China that tended to be either maintained or increased, with a low attrition rate, is a strength to validate that the study results are reliable. CONCLUSIONS As the global ageing population increases, particularly in China and East Asia, Chinese older adults are at high risk of being disproportionately affected by extreme climate events such as floods that have increasingly plunged China over the last decades. While the consensus on enhancing the GRC for Chinese older adults in managing or living with the disabling health conditions induced by floods attained on the final 15 statements dwelt more on timely psychosocial care, adequate resource allocation, as well as social support and participation, other interventions, including those that did not attain ≥ 50% consensus in R2, should be researched further. This will contribute to more evidence for promoting the GRC of older adults in China and other settings that witness not only the rapid ageing population but also climate extreme events, especially floods, to ultimately enable them to achieve and maintain their optimal independence, functioning, full physical, mental, and social ability, inclusion, and participation in all aspects of life and environments. Declarations Acknowledgment: All eDelphi experts who participated in the two rounds are sincerely appreciated. Author contributions: JKB conceptualized the study, developed the study design, oversaw implementation of eDelphi survey process, data analysis, reviewed, wrote, and revised the manuscript. YZ and PF assisted in identification and recruitment of eDelphi experts, data acquisition for eDelphi survey, translation, and interpretation. JKB and DELP developed the design, reviewed and provided final edits and approval. JKB and JBO reviewed the manuscript and provided final edits and approval. All authors reviewed the manuscript and provided final edits and approval. Funding: This work was part of a bigger project supported by the Asia-Pacific Network for Global Change Research (CBA2019-04MY-Balikuddembe). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Availability of data and materials: Availability of data and materials: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Ethics approval and consent to participate: Ethics approval: Prior to the commencement of the study, ethics approval was sought and granted by the Office of Scientific Research Management at Sichuan University. All eDelphi participants provided informed consent before participating in the 1st eDelphi survey round. Their data was handled in accordance with the data protection regulations of Sichuan University and the People’s Republic of China. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. References Christensen K et al. Ageing populations: the challenges ahead. Lancet. 2009. 374(9696). Tu WJ, Zeng X, Liu Q. Aging tsunami coming: the main finding from China's seventh national population census. 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Social Support, Isolation, Loneliness, and Health Among Older Adults in the PRISM Randomized Controlled Trial. Front Psychol. 2021. 12(728658). Lindsay Smith G et al. The association between social support and physical activity in older adults: a systematic review. Int J Behav Nutr Phys Act. 2017. 14(56). Callahan D. Allocating health care resources. The vexing case of rehabilitation. Am J Phys Med Rehabil. 1993;72(2):101–5. WHO. Ageing. 2023 [cited 2024 January 2023]; Available from: https://www.who.int/europe/health-topics/ageing#tab=tab_1 . Ma T et al. The new role of nursing in digital inclusion: Reflections on smartphone use and willingness to increase digital skills among Chinese older adults. Geriatr Nurs. 2022. 48: 118–26. Pilotto A, Boi R, Petermans J. Technology in geriatrics. Age Ageing. 2018;47(6):771–4. Sen K, Prybutok G, Prybutok V. The use of digital technology for social wellbeing reduces social isolation in older adults: A systematic review. SSM Popul Health. 2021. 17(101020). Cui K, Sim T. Older people’s psychosocial needs in a post-disaster rural community of China: an exploratory study. Nat Hazards. 2017;85:1577–90. Wu J, et al. Planned sheltering as an adaptation strategy to climate change: Lessons learned from the severe flooding in Anhui Province of China in 2016. Sci Total Environ. 2016;694(133586):1–11. Wu J et al. A cross-sectional survey on the health status and the health-related quality of life of the elderly after flood disaster in Bazhong city, Sichuan, China. BMC Public Health. 2015. 15(163). Wang Z, et al. Psychological challenges and related factors of ordinary residents after 7.20 heavy rainstorm disaster in Zhengzhou: a cross-sectional survey and study. BMC Psychol. 2023;11(3):1–13. Chen L et al. Prevalence and Determinants of Chronic Post-Traumatic Stress Disorder After Floods. Disaster Med Public Health Prep. 2015. 9(5): 508–8. Shuang Z, et al. Assessing the effectiveness and pathways of planned shelters in protecting mental health of flood victims in China. Environ Res Lett. 2020;15(125006):1–16. Liu N, Ma Z. Psychiatric reactions among the non-exposed population who viewed disaster-related short videos: Evidence from the 2021 Henan floods. J Psychiatric Res. 2022;150(21–33):1–13. Liang Y, et al. Latent profiles of psychological status among populations cumulatively exposed to a flood and the recurrence of the COVID-19 pandemic in China. Inter J Disaster Risk Reduct. 2023;85(103520):1–0. Dai W, et al. Long-term psychological outcomes of flood survivors of hard-hit areas of the 1998 Dongting Lake flood in China: Prevalence and risk factors. PLoS ONE. 2017;12(2):e0171557. Hu S, Tan H, et al. Recovery from post-traumatic stress disorder after a flood in China: a 13-year follow-up and its prediction by degree of collective action. BMC Public Health. 2015;15(615):1–7. Li X, et al. Years of potential life lost in residents affected by floods in Hunan, China. Trans R Soc Trop Med Hyg. 2007;102(3):299–304. Abuaku BK, et al. Morbidity and mortality among populations suffering floods in Hunan, China: the role of socioeconomic status. J Flood Risk Manage. 2009;2:222–8. Qin Y-J, et al. Disaster preparedness among populations in Shenzhen, China, with and without chronic disease. Disaster Med Public Health Prep. 2021;17(e82):1–8. Tan L, Schultz DM. Damage classification and recovery analysis of the Chongqing, China, floods of August 2020 based on social-media data. J Clean Prod. 2021;313(127882):1–12. Liu A, et al. A short DSM-IV screening scale to detect posttraumatic stress disorder after a natural disaster in a Chinese population. Psychiatry Res. 2008;159(3):376–81. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4021080","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":277831888,"identity":"097fc759-c63a-41ea-aaaf-a5609f0b0dee","order_by":0,"name":"Joseph Kimuli Balikuddembe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIiWNgGAWjYBACxhkMjAcSDjAwNhxgYAPyE+RAogce4NfCgKLFGKwlAZ81EkAFDEhaEhtAovi0MM9ufnDgwZnDsn3Hu9MefGBIS58fdvgh0BY7Od0GHA6bc8zgQMKNw8Yzz5zdbjiDISd34+00oAhDsrHZAVx+SQAq+HA4ccON3G3SPAwVuRtng0QYDiRuw6kl/QNEy/2326T/MFSkG84GieDVkgN2GNAW3m3SDAw5CfLSOQRsmXOm4EDCmXSgX3K3G/YYpBlukM4Bihjg9ovh7PaND38cswaG2NltD35UJMvLz07f/OFDhZ0cTi0NKFwDIDoAZeAC8pgiDZiqRsEoGAWjYGQDAHV6dk25ZzC2AAAAAElFTkSuQmCC","orcid":"","institution":"Sichuan University-The Hong Kong Polytechnic University","correspondingAuthor":true,"prefix":"","firstName":"Joseph","middleName":"Kimuli","lastName":"Balikuddembe","suffix":""},{"id":277831889,"identity":"a74fded3-1eb4-4390-a62d-c4a29b6e548c","order_by":1,"name":"Yafang Zheng","email":"","orcid":"","institution":"Sichuan University-The Hong Kong Polytechnic University","correspondingAuthor":false,"prefix":"","firstName":"Yafang","middleName":"","lastName":"Zheng","suffix":""},{"id":277831890,"identity":"f5ff2695-cf2a-43d0-9765-434afdf16076","order_by":2,"name":"Pengbo Fu","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Pengbo","middleName":"","lastName":"Fu","suffix":""},{"id":277831891,"identity":"4b8673a6-321e-49dd-99cb-9ba65e53428d","order_by":3,"name":"Jerico B Ogaya","email":"","orcid":"","institution":"Far Eastern University","correspondingAuthor":false,"prefix":"","firstName":"Jerico","middleName":"B","lastName":"Ogaya","suffix":""},{"id":277831892,"identity":"fd77218b-d102-4195-8c20-469d1543d44f","order_by":4,"name":"Don Eliseo Lucero Prisno III","email":"","orcid":"","institution":"University of the Philippines Open University","correspondingAuthor":false,"prefix":"","firstName":"Don","middleName":"Eliseo Lucero Prisno","lastName":"III","suffix":""}],"badges":[],"createdAt":"2024-03-06 13:15:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4021080/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4021080/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52401572,"identity":"d8ad910b-f5da-4d6d-ac50-9e8ce9950b8f","added_by":"auto","created_at":"2024-03-11 07:45:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51486,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart about recruitment and participation of experts in R1 and R2\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4021080/v1/2e5bd8f7b355069f8106c20b.png"},{"id":52401573,"identity":"27891d0e-f76d-4fef-a7b2-d05717c76ddf","added_by":"auto","created_at":"2024-03-11 07:45:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35193,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram illustrating the statement formulation in the eDelphi expert survey\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4021080/v1/0bade731f5bec4dc019c14ec.png"},{"id":52401574,"identity":"a634c07e-0d6e-40b9-ac87-4d9a1ea0c3ad","added_by":"auto","created_at":"2024-03-11 07:45:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":74218,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of consensus attained from eDelphi experts on statements in R1 and R2 based on Likert scale\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4021080/v1/70dafee0414726214460e9a9.png"},{"id":56786650,"identity":"0882c82b-2196-452b-817d-863938bbbac2","added_by":"auto","created_at":"2024-05-20 12:52:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":947913,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4021080/v1/0298bbde-eb6e-4416-abb9-8655cac5640a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A multistakeholder eDelphi consensus on geriatric rehabilitation care for Chinese older adults in contexts of flooding","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eOver the past decades, there has been an increase in life expectancy, whereby most people can expect to live into their sixties and beyond. While this is one of the remarkable gains of the 20th century [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], it has also led to what has been described as the ageing tsunami [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Ageing shifted from being a common challenge for industrialized economies to also being a challenge for developing countries like China, with their ageing population in recent years reported at 264.02\u0026nbsp;million (18.7% of the total population). This is comparable to other countries within the East Asia region that have witnessed exponentially ageing populations, such as Japan and South Korea, with 35.8% and 25.5% of their population, respectively, aged 60 years or older [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Aside from its previous one-child policy and the current universal two-child policy, which have plummeted birth rates to 6.39 births from 6.77 births per 1,000 people in 2022 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], other factors have also accelerated the ageing population in China. They include low mortality and fertility rates and low immigration of foreigners, as well as socioeconomic transitions that have led many young adults and married couples or spouses to resort to childlessness [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on the World Bank reports, over 211\u0026nbsp;million people aged 65 or older who lived in East Asia and the Pacific in 2010, including 130\u0026nbsp;million in China alone, accounted for 36% of the global ageing population and were anticipated to rise between 12% and 26% by 2050 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This projection tallies with the statistics in the most recent 2020 census in China, whereby the proportion of Chinese aged 65 years old and above increased by 13.26\u0026ndash;18.70% between 2010 and 2020, respectively [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the face of ageing population, extreme climate events and their associated impacts, in particular floods, continue to ravage China. This has been attributed, among other factors, to China\u0026rsquo;s close location to the Pacific Ocean, the South China Sea, and the Mediterranean-Himalayan belts [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which subject it to climatic, geophysical, and hydrometeorological hazards. As such, China is one of the countries most exposed to frequent and severe floods in Asia, whereby two-thirds of its territory and over 68% of its population, especially in urban areas, are at high risk, given that they increasingly occurred between 1990 and 2021 [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe role of healthcare systems is indispensable in promoting healthy lives for people as they grow older, which may also coincide with their experiencing an increasing burden of diseases and disabling conditions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This can become a critical challenge in the aftermath of floods, where there is a great need to care for older people who are disproportionately affected compared to younger adults [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Accordingly, extreme climate events, limited not only to floods, which are increasingly occurring, affect mostly high-risk groups like older adults, the disabled, and people with chronic health conditions, especially in developing settings [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. After their occurrences, as reported in some previous studies, floods induce various injuries and wounds, bodily pain, post-traumatic stress disorder, depression, dementia, insomnia, hypertension, and cardiovascular and respiratory complications [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. With this in mind, how can geriatric rehabilitation care (GRC) for older adults be enhanced to manage or live with the disabling health conditions induced by floods in settings like China that have not only witnessed the rapid ageing populations but also have become prone to floods over the recent past years? To address this, we identified and engaged experts from within and outside China to seek their consensus on prior interventions we identified in a prior systematic review for enhancing GRC for Chinese older adults to manage or live with disabling health conditions induced by floods.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e \u003cstrong\u003eStudy design\u003c/strong\u003e \u003cp\u003eThis study used the Delphi method technique, which has become increasingly embraced in health science disciplines. The method was employed based on two modified rounds of online surveys (herein referred to as the eDelphi survey) to achieve the study objective. The Delphi technique involves iterative or structured processes designed to collect the opinions, views, or feedback of experts on a particular research question where uncertain, complex, or incomplete knowledge and information exist [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The aggregated group answers in each round are sent back to participants so that they can reconsider their opinions or judgments on the basis of the feedback received and revise them if necessary to resolve any disagreements before arriving at group consensus or salient recommendations [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. As such, we considered the Delphi method appropriate to ultimately attain the consensus of multi-stakeholder experts from within and outside China and across diverse professional fields on interventions for enhancing GRC for older adult Chinese in managing or living with disabling health conditions induced by floods.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e While some studies have proposed some guidelines for conducting Delphi studies, there are still no specified criteria or guidelines about the number of Delphi rounds, sample size, or how to organize them. In this case, we only conducted two rounds of eDelphi expert consultations, whereby the first one was informed by the findings of a systematic review conducted a priori.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDevelopment of the eDelphi survey\u003c/strong\u003e \u003cp\u003eThe survey was designed and distributed online using the Qualtrics\u003csup\u003eXM\u003c/sup\u003e platform (Provo, USA) in both Chinese and English by the research team, drawing on their prior experience and knowledge in conducting mixed-method research, including Delphi methods and systematic reviews in fields like disaster risk reduction (DRR), health-related rehabilitation, disability, and emergency medicine [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Aside from the participants\u0026rsquo; demographic and informed consent sections, the survey consisted of 4 domains of statements about the proposed interventions in prior systematic review to address a) cognitive and intellectual; b) physical; c) mental and psychosocial; and d) chronic and terminal conditions among Chinese older adults in contexts of flooding. The demographic part aimed at capturing the information of eDelphi participants, for example, about their age, gender, nationality, province or location, educational level and background, current work position, and years of experience.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe study team jointly constructed and refined the statements on GRC interventions in the first draft of the eDelphi survey, which contained 44 statements based on four categories of disabling conditions that were identified in an earlier systematic review. Afterwards, the 2nd version of the multilingual eDelphi survey (both Chinese and English) was pilot-tested with 4 international academics (excluded from participating in R1 and R2) who are actively involved in research related to the study theme. This helped to modify and improve the structure and readability of some statements, as well as determine whether some were to be either added or removed. As a result, 13 statements were removed, and the final version of the eDelphi survey that was disseminated to the experts in R1 consisted of a list of 31 statements (S). On top of that, following the pilot-testing of the eDelphi survey, these statements were listed in general, unlike their previous grouping under the four domains as aforementioned.\u003c/p\u003e \u003cp\u003eThe survey was designed in such a way that, after consenting, participants were also required to provide their email(s) so that the eDelphi survey in the two rounds (R1 and R2) could be emailed to them and contacted in case of any further clarifications. A provision for a free-text response was included in the eDelphi survey for participants to elaborate on and explain their rating or make any comments they felt were necessary on any statements. It is worth noting that although three rounds were originally planned to be conducted, the third was foregone because a majority consensus on statements was achieved in the first two rounds. Additionally, since the statements were constructed from the findings of a systematic review conducted a priori, two survey rounds were also deemed enough for eDelphi participants to reflect on their rating before reaching optimal consensus.\u003c/p\u003e \u003cp\u003eThe eDelphi participants were required to independently rank the statements based on a 5-point Likert scale (agree, somewhat agree, disagree, somewhat disagree, and neither agree nor disagree). The Likert scale has been disclosed to be favorable and reliable for Delphi studies because it measures the extent to which participants agree with a statement and determines the degree to which they agree with each other [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The entire process of drafting, pilot testing, reviewing, revising, and coming up with the last version of the eDelphi survey happened between September and October 2023. All authors actively participated in these processes, and disagreements about the statement formulation were resolved through consensus. Each eDelphi round was estimated to take between 10 and 15 minutes and be completed within a month. Two email reminders were to be sent to respondents during either round to complete the eDelphi survey if no responses had not been received from them two weeks after launching the round, and the second reminder one week before the round closure.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecruitment of the eDelphi experts: The\u003c/b\u003e distinguished experts the research team identified through their online publications and biographies, and also through a snowballing approach, were invited by email to participate in the study with a short explanation about the study background. As the criteria for their selection, we explicitly recruited those who are knowledgeable and whose scholarship, research, or policymaking undertakings, particularly in China, revolved around the fields of ageing, gerontology, rehabilitation, disability, DRR, climate change, public health, and others, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. They also had to be aged 18 years and older, widely published in renown journals, possess the requisite work experience spanning at least 3 years, be fluent in Chinese or English, be affiliated with notable policy, academic, research, or organizational institutions within and outside China, and agree to participate in all two rounds of the eDelphi survey.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of eDelphi experts who participated in R1 and R2\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRound 1 \u003cem\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRound 2 \u003cem\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (61.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (38.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChinese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (70.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmerican\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBritish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKorean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"16\" rowspan=\"17\"\u003e \u003cp\u003eProvince\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShanxi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiaoning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJilin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJiangsu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZhejiang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnhui\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFujian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShandong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHenan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHubei\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuangdong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSichuan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYunnan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShaanxi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGansu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQinghai\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eEducational background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGerontology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisaster risk reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClimate change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (6.8%0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdministration \u0026amp; policymaking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical sciences or public health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhD (Doctorate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eCurrent job position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (47.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolicymaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eYears of work experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;=5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=31 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs aforementioned, although there are no guidelines on the recommended sample size for Delphi studies [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], what is important is to recruit participants with sufficient knowledge and expertise about the subject matter under investigation. However, some earlier Delphi studies established that at least a minimum sample size of 10 representative experts is adequate for content validity and reaching consensus [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. For this reason, a non-probability purposive sample of 150 experts within and outside China was initially invited via email to participate in R1. Due to the non-response, attrition, or dropout rate that was projected at 20% in both rounds, as has been witnessed in previous Delphi studies [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], 50 additional experts were identified and contacted to participate in the eDelphi survey. In total, 200 experts were recruited and considered appropriate to achieve the final consensus in the study. It should be noted that issues of diversity and representativeness when recruiting them were prioritized by taking into account the above-mentioned fields or specialties, gender, and at least one participant from each province or autonomous region of China.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eThe eDelphi survey procedures\u003c/strong\u003e \u003cp\u003e The author (JKB) led the research team in administering the Qualtrics-generated survey via a link that was emailed to eDelphi experts who consented to participate in both eDelphi R1 and R2. However, experts who consented but did not complete R1 were not eligible to participate in R2, whereas those who did not complete the survey in R2 were also excluded.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eRI\u003c/b\u003e: In this round, which was implemented in November 2023, using a 5-point Likert scale, participants were asked to independently rate a total of 31 statements that were formulated in line with the proposed interventions for addressing the four categories of disabling conditions as noted above.\u003c/p\u003e \u003cp\u003e \u003cb\u003eR2\u003c/b\u003e: This round was implemented in December, and it commenced immediately after R1 had ended. Since providing respondents with feedback on how their peers rated or voted for consensus building is the most important component of the Delphi methods [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], participants in R2 were able to view the aggregated response rate on 31 statements from R1. Again, a link to the Qualtrics-generated survey was emailed to participants so that they could reconsider and evaluate their previous rating in R1 still based on the 5-point Likert scale. Where possible, they also had an opportunity to state or elaborate on the rationale for their rating under the provision of free-text responses in the eDelphi survey. On a particular note, in R2, no additional statements were added or removed. This round's overall aim was to validate, revise, and ultimately acquire final consensus or any other vital suggestions from the eDelphi participants. In the end, this would help in identifying and prioritizing the most significant interventions for enhancing GRC for older adults within and outside China in managing or living with their disabling health conditions induced by floods.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData analysis\u003c/strong\u003e \u003cp\u003eQualtrics\u003csup\u003eXM\u003c/sup\u003e was used to generate data reports, which informed the subsequent analyses. The level of participants\u0026rsquo; consensus on each statement in R2 was determined by adopting a grading system denoted by U, A, B, and C for unanimous (100%), 90\u0026ndash;99%, 78\u0026ndash;89%, and 67\u0026ndash;77% consensus, respectively, that has recently been used in a COVID-19-related Delphi study [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. A minimum cut-off on a statement from the consensus of all the eDelphi participants was at \u0026ge;\u0026thinsp;50%, and statements that attained the consensus below this percentage were excluded for analysis in R2. Positive or negative consensus was considered to be attained at \u0026ge;\u0026thinsp;=\u0026thinsp;70% if all participants agreed and strongly agreed or disagreed and strongly disagreed with statements in two rounds. Using Microsoft Excel (version 16), descriptive statistics were generated to present the demographic characteristics of participants and ratings for each statement, as well as calculate the percentage changes in statement rating between the two rounds.\u003c/p\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of participants\u003c/strong\u003e: Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic characteristics of participants in each round, whereby 50 and 44 completed R1 and R2, respectively. A majority of experts were male (R1\u0026thinsp;=\u0026thinsp;64% and R2\u0026thinsp;=\u0026thinsp;61.4%); mean age\u0026thinsp;=\u0026thinsp;42 [range: 25\u0026ndash;74]; PhD holders (R1\u0026thinsp;=\u0026thinsp;64% and R2\u0026thinsp;=\u0026thinsp;63.6%); university professors (R1\u0026thinsp;=\u0026thinsp;48% and R2\u0026thinsp;=\u0026thinsp;47.7%); and involved in the field of DRR (R1\u0026thinsp;=\u0026thinsp;38% and R2\u0026thinsp;=\u0026thinsp;36.4%). More than half of the experts in either round was Chinese (R1\u0026thinsp;=\u0026thinsp;68% and R2\u0026thinsp;=\u0026thinsp;70.5%). Also, a majority of them across the two rounds had been working for the duration in their respective fields between \u0026lt;\u0026thinsp;=\u0026thinsp;5 years and 6\u0026ndash;10 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResponse rate to the eDelphi survey\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo hundred experts were identified as eligible and invited to participate in the eDelphi process, as can be observed in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Of these, 90 (45.0% response rate) consented to participating, but only 50 turned up and completed R1 (55.5% response rate). Fifty experts who completed R1 were again invited to participate in R2, and 44 completed the survey (88.0% response rate). The non-response and dropout rates, or incomplete surveys of experts who had consented to participating in the eDelphi survey, were 40 (out of 90) and 6 (out of 50) in R1 and R2, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsensus on statements:\u003c/strong\u003e Consensus at \u0026ge;=70% was only attained on 4 (S1, S3, S6, and S12) and 9 statements (S1, S3, S4, S6, S7, S10, S12, S13, and S20) in R1 and R2, respectively, as observable in Figure 3. Two statements (S1 and S3) were rated in grade 'B', while four statements (S4, S6, S12, and S13) were rated in grade \u0026lsquo;C\u0026rsquo; in R1. No statement achieved the expert consensus ranked under the \u0026lsquo;U\u0026rsquo; grade. Six original statements (S5, S8, S14, S16, S19, and S21) from R1 with consensus rated at \u0026ge;=50% were excluded for R2. During this round, expert consensus at \u0026ge;=70% improved, as can be observed with the 9 statements above compared to R1. Accordingly, 1 (S3), 5 (S1, S4, S6, S12, and S13), and 3 (S7, S10, and S20) statements were rated by experts in grades \u0026lsquo;A\u0026rsquo;, \u0026lsquo;B\u0026rsquo;, and \u0026lsquo;C\u0026rsquo;, respectively (Figure 2). Similar to R1, no statement attained expert consensus ranked under the \u0026lsquo;U\u0026rsquo; grade. The consensus on 6 out of 13 statements was below a \u0026lsquo;C\u0026rsquo; grade. The mean consensus on \u0026lsquo;A\u0026rsquo; in R1 and R2 was 58.7% and 62.1%, respectively, for 31 statements. This rose to 71.2% for 15 statements (with \u0026ge;=50%) in R2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChanges in consensus\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApart from reducing the original statements in the survey from 44 to 31 following its pilot-testing (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e), no statements were suggested to be added or removed by eDelphi participants in R1 and R2. Two participants, however, in free-text provision in R1 proposed a slight revision or adjustment in one statement before it was included in the R2 survey. Based on Fig.\u0026nbsp;3, from R1 to R2, there was improvement in the experts\u0026rsquo; consensus among twelve statements (n\u0026thinsp;=\u0026thinsp;12). Based on Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, this was especially registered with S20, S13, S4, S3, S12, and S18, with 42%, 24%, 17%, 15%, 14%, and 12%, respectively. In this case, there was no stability of expert consensus. On the other hand, S5, S21, S8, S8, and S16 achieved negative consensus from experts of -17%, -14%, -13%, -13%, and \u0026minus;\u0026thinsp;12%, respectively, between R1 and R2.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" style=\"width: 1003px;\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eConsensus rating on 21 statements in two rounds by the eDelphi experts\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 379px;\" colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eStatement\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eReference source\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 166px;\" colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eRound 1 \u003cem\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 176.771px;\" colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eRound 2 \u003cem\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e% change in consensus between R1 and R2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eGrade\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003eA (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003eSA (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003eD (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003eSD (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"left\"\u003e\n\u003cp\u003eN/A (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eGrade\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003eA (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003eSA (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003eD (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003eSD (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"left\"\u003e\n\u003cp\u003eN/A (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eCommunity-based plans should consider the psychosocial needs and resources of older adults affected by floods\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e88.6*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eEstablish planned shelters with appropriate levels of personal, environmental, and healthcare support can ensure long-term physical health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e61.4*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e-4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eEffectively allocate resources for older adults who are diagnosed with chronic diseases and without family support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e90.9*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e15%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eEmpower family and strengthen communities for promoting older people\u0026rsquo;s psychosocial well-being and enhancing their resilience to floods\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e75.9*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e17%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003ePersonal safety and reducing property losses for older adults in flooding areas improve or maintain their psychological health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e-17%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eMedical resources should be made available in less developed and high-risk populations, with particular attention to chronic PTSD in older adults\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e80*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eEnvironmental interventions of providing clean water, safe food, environmental hygiene, risk communication, and sufficient accommodation reduce the risk of psychological problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e70.5*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eTolerance of older adult\u0026rsquo;s behaviour to uncertainty can help decrease their ill mental wellbeing during stressful events\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e29.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e-13%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eCoping efficacy, trust and a closer psychological distance are protective factors for mental and psychological problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e54.5*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e11%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS10\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eEarly and effective psychological interventions prevent PTSD and anxiety among older adult survivors in the long run\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e72.7*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS11\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eClinical attention should be paid to PTSD patients who suffer a high intensity of trauma characterized by nervousness traits or a shortage of social support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e63.6*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS12\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eTimely psychological interventions for flood survivors, including cognitive behavioral therapy, are effective for treatment of PTSD and anxiety disorders\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e79.5*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e14%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS13\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eSocial participation helps in the recovery from PTSD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e84.1*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e24%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS14\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eRebuilding a high-quality life after a disaster with help from society or the government can reduce the development of chronic PTSDs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e47.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e-13%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS15\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003ePsychological intervention, social support, mitigation strategies and access to quality healthcare services are essential in prevention of chronic non-infectious diseases\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e52.3*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS16\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eIntervention strategies considering demographic characteristics of older adults reduce the health impact they face\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e43.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e-12%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS17\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eConsider the prevention of infectious and parasitic diseases, as well as injury, poisoning, and chronic non-infectious disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e52.3*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e-8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS18\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003ePublic health education can influence the prevention and preparedness of older adults with and without chronic disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e63.6*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e12%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS19\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eUnderstanding individuals\u0026rsquo; sentiments in disaster-stricken areas is useful for effective communication with the public and controlling their hysteria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e36.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e-9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS20\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eMonitoring the recovery situation in the post-disaster period based on social media data can provide a reference for timely assistance to victims in improving their living conditions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003eC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e75*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e42%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 23px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eS21\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 356px;\" align=\"left\"\u003e\n\u003cp\u003eSymptom screening is helpful and effective in quickly screening flood-related PTSD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 66px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026mdash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n\u003cp\u003e38.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 25px;\" align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 27px;\" align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 29.7709px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 111px;\" align=\"left\"\u003e\n\u003cp\u003e-14%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e Grey colour and *show the 15 statements on which the eDelphi expert consensus was attained at \u0026ge;=50%, and \u0026ldquo;\u0026mdash;\u0026rdquo; denotes ineligible to the grading used.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsensus on the interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 15 statements that were considered finally in R2, the highest expert consensus rated resource allocation (S3), followed by psychosocial needs and resources (S1), social participation (S13), family and community empowerment (S4), medical resources (S6), and early and effective psychological care (S12) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). In summary, these interventions revolved around bolstering timely social support for Chinese older adults from their families or communities to manage or live with disabling conditions induced by floods. Moreover, the expert consensus on 15 statements for GRC interventions can address more than one disabling condition across the four categories of physical, cognitive and intellectual, mental and psychosocial, and chronic and terminal illnesses (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"DISCUSSIONS","content":"\u003cp\u003eThe final consensus reached in the two-round eDelphi study on 31 statements most importantly highlights the need for timely psychosocial care, adequate resource allocation, as well as social support and participation for older adults to manage or live with their disabling health conditions induced by floods. Indeed, these interventions, which are undeniably intertwined with the others that attained\u0026thinsp;\u0026ge;\u0026thinsp;=\u0026thinsp;50% consensus, are pivotal in supporting the delivery of GRC through the interprofessional collaboration of both healthcare and non-healthcare professionals like gerontologists, general practitioners, rehabilitation therapists, or counsellors. Moreover, the three interventions are in concordance with the findings of what were identified in the previous expert-based studies as some of the programs, characteristics, or services of GRC [\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePsychosocial care involves the process of providing treatment, specialist care, and support to a person who experiences or demonstrates any of the early symptoms of ill mental health or a disabling condition before it gets worse [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. It necessitates reaching out to older adults who are at high risk of developing health problems in the aftermath of floods with improved diagnosis, treatment, or referral to specialist services, including GRC, in a timely manner before they culminate in serious, persistent, or lifelong disabling conditions. Moreover, timely psychosocial care is critical in preventing not only the progression of mental and disabling comorbidities that are common in ageing people but can also reduce the medical and economic burden on their family, friends, and entire community [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. At this particular moment, it is therefore warranted for China, the world's largest and fastest-growing ageing country, when it continues to be affected by floods at the same time [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eApart from isolation, social disconnection or a lack of social support were reported to be salient determinants of greater susceptibility to chronic stressors, morbidity, and mortality among Americans and Japanese community-dwelling older adults [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. As such, many older people, especially those who are isolated, ill, have dementia, live alone, or are reliant on medical equipment, should be provided extra social support to cater for their clinical, emotional, and spiritual needs, as well as safeguard them from adverse health effects or disabling conditions of floods or other disasters. In turn, this can increase their recognition, happiness, sense of belongingness, and confidence, and also encourage them to contribute ideas and participate in socioeconomic, cultural, spiritual, and civic affairs [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], which are predictors of positive wellbeing, life satisfaction, and healthy and successful ageing. Social support is, therefore, a critical service in China, where floods over the last decades have heavily plunged its populations, including older adults, with more than 3.4\u0026nbsp;million people affected and the number of deaths, displaced, and injured extending into the thousands [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. We, however, note that social support for Chinese older adults could be undermined by the ongoing social-demographic shifts in China, in particular the declining births, childless couples, and rural-urban migrations among the youths [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCrucially, adequate resource allocation, as underscored by eDelphi experts, is one of the nitty-gritties of the effectiveness of healthcare systems. At its simplest, we can define resource allocation as a process through which available resources, for example, finances, the human workforce, medical supplies, infrastructure, and equipment, are distributed between competing uses. Floods and other climate hazards create an overwhelming burden on healthcare systems, which can make resource allocation a perplexing challenge for disaster responders and healthcare providers. This, was similarly decried three decades ago by Callahan (1993), who noted that resource allocation to rehabilitation can be beset with many difficulties [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In particular, this is a big challenge for many developing settings where the healthcare systems are still fragile, and under-funded and -resourced to effectively deliver a full spectrum of healthcare services, including rehabilitation in disaster and emergency crises [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. During disasters or emergencies, the needs of older adults or other high-risk groups oftentimes are overlooked or left out in prehospital and hospital-based preparedness and response plans [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Consequently, this deprives them not only of their right to access essential healthcare services in the aftermath of floods but also makes them less prepared to evacuate, protect themselves, and recover from their effects. For this reason, beyond flood emergencies, the Chinese healthcare system should be well-resourced and equipped to support effective delivery of preventive, curative, rehabilitative, assistive, and palliative care in a sustainable and long-term manner [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Needless to say, resource allocation amid their shortages, which is indispensable in the aftermath of floods and disasters, should be pro-poor centered to earmark their needs and unimpeded access to quality and affordable services, including clinical, shelter, and environmental services, as were also proffered on by the eDelphi experts among the final 15 statements in R2.\u003c/p\u003e \u003cp\u003eFinally, in the recent past, social media has been reported as part of revolving digital applications with tangible benefits involving the delivery of rehabilitation care [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. By eDelphi experts underscoring overwhelmingly in R2, the role of social media in providing timely assistance to improve the living conditions of Chinese older adults with disabling conditions resulting from floods is prompt. This, is also proposed when China\u0026rsquo;s progress is unprecedented in innovation and development of mobile and high-tech applications, such as WeChat, Weibo, and Baidu, which are largely used by Chinese populations [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. As mentioned earlier, some of the challenges experienced by ageing people, like isolation and loneliness, may end up inhibiting their access to essential services and causing social disconnection. Therefore, the above social media and others, which have now become part of our lives and literally revolutionized everything, can be leveraged to not only ease older people\u0026rsquo;s access to essential healthcare services, including digitized GRC services, but also bridge the social disconnection gap between them and their close family, health service providers, or community [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Additionally, social media has the potential to contribute to disease prevention and public health education as part of the interventions the eDelphi experts also opinioned on for promoting the GRC for Chinese older adults. To effectively leverage social media for GRC, it is important to engage older adults at the community level to follow the best practices to increase their digital use and self-efficacy, as a previous systematic review agitated [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study has a few limitations that should be kept in mind. Since there are no guidelines on the threshold of participant sample sizes in Delphi studies, the consensus gathered from a few experts, especially in relevant fields to the study theme like rehabilitation, gerontology, and disability, may have slightly affected the findings herein. More so, caution should be considered when generalizing the study results to China since the expert sample size was not representative enough after we failed to recruit at least a single expert from some Chinese provinces despite sending two reminders to those who were initially identified, invited, or consented to participate in the survey. Nevertheless, despite no statement that attained unanimous agreement, the level of consensus in R1 and R2 from the composition of experts both within and outside China that tended to be either maintained or increased, with a low attrition rate, is a strength to validate that the study results are reliable.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eAs the global ageing population increases, particularly in China and East Asia, Chinese older adults are at high risk of being disproportionately affected by extreme climate events such as floods that have increasingly plunged China over the last decades. While the consensus on enhancing the GRC for Chinese older adults in managing or living with the disabling health conditions induced by floods attained on the final 15 statements dwelt more on timely psychosocial care, adequate resource allocation, as well as social support and participation, other interventions, including those that did not attain\u0026thinsp;\u0026ge;\u0026thinsp;50% consensus in R2, should be researched further. This will contribute to more evidence for promoting the GRC of older adults in China and other settings that witness not only the rapid ageing population but also climate extreme events, especially floods, to ultimately enable them to achieve and maintain their optimal independence, functioning, full physical, mental, and social ability, inclusion, and participation in all aspects of life and environments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eAll eDelphi experts who participated in the two rounds are sincerely appreciated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eJKB conceptualized the study, developed the study design, oversaw implementation of eDelphi survey process, data analysis, reviewed, wrote, and revised the manuscript. YZ and PF assisted in identification and recruitment of eDelphi experts, data acquisition for eDelphi survey, translation, and interpretation. JKB and DELP developed the design, reviewed and provided final edits and approval. JKB and JBO reviewed the manuscript and provided final edits and approval. All authors reviewed the manuscript and provided final edits and approval.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This work was part of a bigger project supported by the Asia-Pacific Network for Global Change Research (CBA2019-04MY-Balikuddembe). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Availability of data and materials: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: Ethics approval: Prior to the commencement of the study, ethics approval was sought and granted by the Office of Scientific Research Management at Sichuan University. All eDelphi participants provided informed consent before participating in the 1st eDelphi survey round. Their data was handled in accordance with the data protection regulations of Sichuan University and the People\u0026rsquo;s Republic of China.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChristensen K et al. Ageing populations: the challenges ahead. Lancet. 2009. 374(9696).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTu WJ, Zeng X, Liu Q. Aging tsunami coming: the main finding from China's seventh national population census. Aging Clin Exp Res. 2022;34(5):1159\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited Nations, Economic and Social Commission for Asia and the Pacific (ESCAP). Asia-Pacific Report on Population Ageing 2022: Trends, policies and good practices regarding older persons and population ageing. 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Damage classification and recovery analysis of the Chongqing, China, floods of August 2020 based on social-media data. J Clean Prod. 2021;313(127882):1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu A, et al. A short DSM-IV screening scale to detect posttraumatic stress disorder after a natural disaster in a Chinese population. Psychiatry Res. 2008;159(3):376\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Geriatric rehabilitation, ageing, flooding, China, eDelphi consensus","lastPublishedDoi":"10.21203/rs.3.rs-4021080/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4021080/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Rehabilitation care is indispensable in promoting the healthy lives of people as they grow older, especially when they are experiencing an increasing burden of disabling conditions, like in the aftermath of floods and disaster emergencies. We engaged experts to seek their consensus on the interventions that were identified in a prior systematic review for enhancing geriatric rehabilitation care (GRC) for Chinese older adults to manage or live with disabling health conditions induced by floods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted the eDelphi consensus study drawing a composition of international experts across diverse professional fields both within and outside China. Using a pilot-tested and Qualtrics-generated eDelphi survey that contained 31 statements on interventions identified earlier in a systematic review a priori, experts were invited by email to independently rate them based on a 5-point Likert scale in two rounds (R1 and R2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of the 200 eDelphi experts who were initially invited to participate in the study, 50 and 44 completed R1 and R2, respectively. A majority of them were male (R1 = 64% and R2 = 61.4%), Chinese (R1 = 68% and R2 = 70.5%), and work in disaster risk reduction field (R1 = 38% and R2 = 36.4%). Expert consensus at ≥=70% was only attained on 4 and 9 statements in R1 and R2, respectively. In R2, consensus dwelt on interventions for promoting timely psychosocial care, adequate resource allocation, as well as social support and participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e While this eDelphi study contributes knowledge on promoting GRC in China and other contexts that witness ageing population and extreme climate events like floods, it agitates for further research, especially on the interventions that did not attain ≥50% consensus in R2.\u003c/p\u003e","manuscriptTitle":"A multistakeholder eDelphi consensus on geriatric rehabilitation care for Chinese older adults in contexts of flooding","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-11 07:45:03","doi":"10.21203/rs.3.rs-4021080/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"278307f9-6fd9-435e-9896-b1641b050231","owner":[],"postedDate":"March 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-20T12:44:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-11 07:45:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4021080","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4021080","identity":"rs-4021080","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}