Function, caregiving and adequacy of support before and after the transition to institutional settings

过渡到机构环境之前和之后的功能、照顾和支持的充分性

• 批准号: 10518344
• 负责人: Kenneth Lam
• 金额: $ 16.15万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10518344
• 关键词: Activities of Daily Living; Age; Aging; Anecdotes; Assisted Living Facilities; Award; Bathing; Caregivers; Caring; Complex; Data; Data Aggregation; Decision Aid; Dementia; Elderly; Family; Feedback; First Aid; Foundations; Friends; Future; Geriatrics; Goals; Grant; Growth; Health; Health Professional; Home; Home Nursing Care; Hour; Impairment; Institution; Institutionalization; Institutionalized Persons; Interview; Life; Living Arrangement; Low income; Measures; Mentors; Methods; Normalcy; Nursing Homes; Outcome; Palliative Care; Patients; Persons; Population Heterogeneity; Positioning Attribute; Process; Qualitative Methods; Race; Randomized Controlled Trials; Research; Role; Sampling; Service delivery model; Specific qualifier value; Subgroup; Surveys; Testing; Training; United States National Institutes of Health; Vulnerable Populations; Work; base; career; caregiving; cohort; ethnic diversity; experience; functional disability; improved; instrumental activity of daily living; lens; programs; recruit; residential care facility; sex; trend

PROJECT SUMMARY/ABSTRACT When functional impairments in later life overwhelm available caregiving, older persons and their caregivers commonly consider if moving from home into an institution, such as a nursing home, assisted living facility or residential care facility for the elderly, is best for them. Persons and caregivers hope clinicians will help them decide, but evidence and frameworks that clinicians can use to provide guidance are largely absent. We could improve how clinicians help patients and caregivers navigate this process through a decision aid, but an aid first requires data on how person- and caregiver-centered measures change with institutionalization and a better understanding of what information persons and caregivers want. The objective of this proposal is to supply those data and that understanding through mixed methods. Aim 1 will produce the first nationally representative descriptions of trajectories in function, caregiving, and adequacy of support (eg, did persons bathe less than they wanted due to lack of help) in the year before and after institutionalization and examine if trajectories meaningfully differ in pre-specified subgroups (eg, by age, race, or type of institution). Aim 2 will explore the experience of recently institutionalized older persons and their caregivers to understand the role of function, caregiving and inadequate support in their transition and what information (if any) was and would have been useful. We integrate our methods by using results from Aim 1 to inform sampling and by presenting findings from Aim 1 to interviewees in Aim 2; by exploring feedback to a concrete example, we will gain a better understanding of what kinds of information are useful to persons navigating this transition. Together, these aims will be the foundation for future work developing decision aids for the institutionalization process and then implementing and evaluating them in randomized controlled trials.

项目概要/摘要 当晚年的功能障碍压垮了现有的护理人员时，老年人及其护理人员 通常考虑是否从家里搬到某个机构，例如疗养院、辅助生活设施或 为老年人提供的住宿护理设施，是最适合他们的。个人和护理人员希望临床医生能够帮助他们 决定，但临床医生可以用来提供指导的证据和框架基本上不存在。我们可以 改善临床医生如何帮助患者和护理人员通过决策辅助来引导这一过程，但辅助 首先需要有关以个人和护理人员为中心的措施如何随着制度化和 更好地了解人员和护理人员想要什么信息。该提案的目的是 通过混合方法提供这些数据和理解。目标1将生产全国第一 对功能、护理和充分支持方面的轨迹的代表性描述（例如，人们是否 由于缺乏帮助，洗澡次数少于他们想要的）在收容机构之前和之后的一年中，并检查是否 在预先指定的亚组中（例如，按年龄、种族或机构类型），轨迹存在显着差异。目标2将 探讨最近入院的老年人及其照顾者的经历，以了解老年人的作用 其过渡过程中的职能、照顾和支持不足，以及过去和将来的信息（如果有） 很有用。我们通过使用目标 1 的结果来通知抽样并通过呈现来整合我们的方法 目标 1 向目标 2 受访者提供的调查结果；通过探索对具体示例的反馈，我们将获得 更好地了解哪些信息对人们进行这一转变有用。一起， 这些目标将成为未来为制度化进程制定决策辅助工具的工作的基础 然后在随机对照试验中实施和评估它们。