Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference?
Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference?
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DOI：
10.1016/j.socscimed.2009.12.005
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发表时间：
2010-04
影响因子：
5.4
通讯作者：
Hedeker, Donald
中科院分区：
文献类型：
--
作者：
Muramatsu, Naoko;Yin, Hongjun;Hedeker, Donald
关键词：
本研究探讨了老年人及其配偶与功能下降相关的急性和慢性压力是如何通过非正式和正式的支持环境来调节的。在美国，各州对残疾老年人家庭和社区服务（HCBS）的支持差异很大。这种州与州之间的差异使我们能够研究生活在一个支持HCBS的社会中对老年人心理健康的影响，这些老年人在日常活动和认知能力方面的功能低下或下降的风险很高。使用一个为期10年的面板研究的全国代表性样本的最老的老人（>=70岁），涵盖1993年至2002年期间，我们进行了混合效应logistic回归分析，以纳入随时间变化的个人和国家的特点。老年人及其配偶的日常生活和认知功能低下和下降构成了显著的压力源。结果表明，非配偶家庭/朋友的非正式支持在降低抑郁症中的重要作用。生活在一个支持HCBS的状态与经历持续低水平功能或最近功能下降的老年人的抑郁症降低有关，特别是那些没有非正式支持的老年人。我们的研究结果与正式支持的缓和或缓冲模型一致，表明国家HCBS支持主要是在高水平的压力源条件下有效。我们需要政治意愿来帮助美国社会做好准备，共同支持社区的长期需求，因为我们很难为晚年生活中常见但往往意想不到的功能衰退做好充分准备。
This study examines how acute and chronic stresses associated with functional declines in seniors and their spouses are moderated by their informal and formal support contexts. In the United States, states vary greatly in their support for home and community-based services (HCBS) for seniors with disabilities. This state-to-state variation allowed us to examine mental health effects of living in a society supportive of HCBS for the oldest old, who are at high risk for low or declining functions in daily activities and cognitive abilities. Using a ten-year panel study of a nationally representative sample of the oldest old (>=70 years old) covering the period 1993 to 2002, we conducted mixed-effects logistic regression analysis to incorporate time-varying characteristics of persons and states. As expected, low and declining functions in daily living and cognition constituted significant stressors among seniors and their spouse. Results demonstrated the important role of informal support available from non-spouse family/friends in lowering depression. Living in a state supportive of HCBS was associated with lower depression among seniors experiencing consistently low levels of function or recent functional declines, especially among those without informal support. Our findings were consistent with moderating or buffering models of formal support, suggesting that state HCBS support is effective mainly under conditions of high levels of stressors. Political will is needed to prepare US society to collectively support community-based long-term needs, given the difficulty of preparing ourselves fully for common, but often unexpected, functional declines in later life.
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影响因子：
5.7
作者：
Jang, Y;Haley, WE;Mortimer, JA
通讯作者：
Mortimer, JA
DOI：
10.5034/inquiryjrnl_40.4.375
发表时间：
2003-12-01
影响因子：
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DOI：
10.1093/geronb/58.6.p320
发表时间：
2003-11-01
影响因子：
6.2
作者：
Fiske, A;Gatz, M;Pedersen, NL
通讯作者：
Pedersen, NL
DOI：
10.1093/geronb/52b.6.p284
发表时间：
1997-11-01
影响因子：
6.2
作者：
Krause, N
通讯作者：
Krause, N