Bewildered, bereft and often cut off from any family support, they have suffered more than most from the terrible deprivation wrought by the wall of water that engulfed the coast of northeast Japan a week ago.

Like many towns and villages in the region, the quiet port of Miyako had a large elderly population as, over the years, an increasing number of younger people had moved elsewhere in search of work.

Helpless in the face of the speed and destructive power of the tsunami, they figure highly in the ever-growing estimates of the dead and missing.

"Many old people tried to run away, but I think a lot of them died," said Kohe Katzuyama, a long-time Miyako resident in his late sixties.

For many like Katzuyama, survival has been a bitter blessing.

Those who made it to the government shelters have struggled in the harsh conditions, with little or no power or water, and a sudden cold snap that saw the region swept by snowstorms and plummeting temperatures.

For those on prescription medicines, the chances of getting the treatment they need have ranged from slim to non-existent, throwing up yet another obstacle to their efforts to keep going until the situation improves.

And the longer-term future is equally bleak for those of an age that precludes any real chance of starting over and rebuilding their former lives.

Keiko Okashi, in her seventies, could barely take in the enormity of the challenge ahead when she finally found the place she once called home in Miyako.

All that was left was a roof on a pile of rubble that reached no higher than her waist.

With little hope of any immediate help from their children who live down south in Tokyo and further inland in Morioka, Okashi and her husband have seen their joint outlook pared down to the barest of essentials.

"Rebuilding? First we have to survive," she said.

But despite all the hardship, Okashi still managed a warm smile as she suddenly met up with an old friend she hadn't seen since the disaster struck.

For a moment the two women simply stood and held hands, amazed they had both made it out alive from the devastation all around them.

Many of the elderly residents of Miyako lived frugal lives, their limited means reflected in the cheap construction of the only homes they had been able to afford.

Some were made of little more than reinforced plywood with siding that had been punctured through and through -- the walls warped like corrugated cardboard.

"Everything is all a big mess... I lost so many things," said Okashi who nevertheless held on to the seemingly futile hope of retrieving something, including her savings which, like many elderly Japanese, she stashed at home rather than in a bank.

The search was a risky one and Okashi watched anxiously as her husband trod gingerly across an unstable mass of splintered boards, bent metal siding and snapped power lines.

"Are you OK?" she cried out every time he disappeared from view behind the collapsed roof of their home. At one point, his head popped out from behind a large chunk of masonry and he held up a book -- his first find.

Other shell-shocked survivors wandered through the streets of Miyako, searching for anything the tsunami may have spared.

On one street corner, several large safes stood together, waiting for their owners to unlock them with the right combination.

One man anxiously looked for an elderly woman who had been his neighbour, even as emergency workers warned that hopes of pulling out any new survivors were virtually non-existent.

Okashi's friend, Taeko Yosuka, also in her seventies, struck an emotional and defiant pose, vowing to persevere even in the face of such an unimaginable disaster.

"Yes, it's difficult, but you need to work, do anything you can. And as long as I can eat, everything will be fine," she said, while struggling to hold back tears.

"You need to take a little bit of time at first to reflect on all this, to think about everyday problems, because you need to survive."

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