Understanding the varied experiences of frailty in older age with respect to ethnicity: a mixed methods approach

虽然老年人虚弱的护理和管理越来越重要，但黑人、亚洲人和少数民族（BAME）的虚弱经历正在研究中，因此通常没有在旨在支持虚弱老年人的社会政策或临床护理中加以考虑。在日常语言中，“虚弱”一词通常用来形容行动不便、无法独立的老年人。它也是一个越来越多地被卫生专业人员使用的术语。在英国，老年患者现在在常规医疗保健预约中进行虚弱筛查。虽然脆弱并不是老年人独有的经历，但它往往与生命的终结和老年阶段有关。对于不同的人来说，这种体验是不同的，并且取决于各种因素。这些因素包括个人身体，也包括种族、性别、教育、住房和环境、文化信仰和宗教、家庭和社会网络、经济状况和爱好/兴趣。在对老年人进行筛查时，往往忽略了这些问题与虚弱之间的关系，但可能对他们的虚弱经历产生不利影响。由于这些原因，并非所有人都有同样的脆弱经历。很少有研究探索这种关系，更少有人明确指出种族如何影响衰老和虚弱的经历。因此，白人和白人老年人之间的健康差距持续存在，尤其是在晚年。因此，该项目试图通过与来自不同种族的广泛老年人交谈，探索在经历和管理虚弱方面的重要因素。为了做到这一点，我们将首先分析来自40,000个家庭的大型研究数据，其中约有11,500名参与者来自少数民族背景，称为“理解社会”，以突出脆弱和种族之间的关系。我们将使用这些信息来选择特定的老年人群体进行交谈，以便更深入地探索这个问题。参与者将根据对脆弱生活体验的特殊影响因素进行选择，包括种族和性别、阶级、地点和社会背景。我们将研究来自不同种族背景的老年人的不同经历，包括孟加拉国人、印度人、巴基斯坦人、加勒比黑人和非洲人，以便进行对比和比较，并阐明少数民族老年虚弱经历的独特性、弱点和优势以及如何更好地支持这些经历。在定性研究的第一阶段，我们将对老年人进行光声研究。这将包括给他们相机，让他们拍摄他们的脆弱经历的照片，并谈论照片显示和意味着什么。然后，我们将在两年的时间内采访其中一些参与者，以解释任何变化，并梳理出可能支持这些变化的因素，包括与老年特有的风险，但也反映了一生的经历。我们还将采访医疗保健专业人员，以探讨他们对脆弱的理解。为了提高人们对脆弱体验（尤其是BAME体验）的重要性的认识，我们将利用我们的研究结果产生以下干预措施：1)一个脆弱指数，以了解人口水平上的脆弱原因；2)用于临床教育的教育工具包；（三）公开展出所拍摄的照片；4)以人为本的“文化能力”工具，用于在患者层面上理解虚弱。我们将与那些参与老年人护理和支持工作的人、老年人本人、参与者和其他人分享我们的发现，包括使用一个简短的动画。

While the care and management of frailty in older people is increasingly important, Black, Asian and Minority Ethnic (BAME) experiences of frailty are under researched and thus generally not accounted for in social policy or clinical care designed to support frail older people. In everyday language, 'frail' is a term that is often used to describe older people struggling with mobility and independence. It is also a term that is increasingly used by health professionals. Older patients in the UK are now screened for frailty in routine healthcare appointments. Although frailty is not an experience that is exclusive to older people, it is often associated with, and experienced towards, the end of life and in deep old age. This experience is different for different people and depends on a variety of factors. These factors include individual bodies but also things like ethnicity, being male or female, education, housing and environment, cultural beliefs and religion, family and social networks, economic situation and hobbies/interests. The relationship between such issues and frailty are often missed when older people are screened but can have a detrimental impact on their experience of frailty. For these reasons, the experience of frailty is not equal for all. Few studies have explored this relationship and fewer still have explicitly addressed how ethnicity affects the experience of ageing and frailty. As a result there is a persistent health gap between White and BAME older people particularly striking in later life. Consequently, this project seeks to explore the factors that are important in the experience and management of frailty by talking to a wide range of older people from different ethnicities. To do this, we will first analyse data from a large study of 40,000 households, of which about 11,500 participants are from an ethnic minority background, called 'Understanding Society' to highlight the relationship between frailty and ethnicity. We will use this information to select particular groups of older people to talk to in order to explore this in more depth. Participants will be selected in accordance with factors that highlight a particular impact on the experience of living with frailty, including ethnicity and gender, class, place and social context. We will look at the different experiences experienced by older people from a variety of ethnic backgrounds, including Bangladeshi, Indian, Pakistani, Black Caribbean and African, in order to draw out contrasts and comparisons and illuminate the unique nature of ethnic minorities' experiences of frailty in old age, the vulnerabilities as well as strengths and how to better support these. In the first stage of our qualitative research we will conduct a photovoice study with the older people. This will involve giving them cameras, asking them to take photographs of their experience of frailty and talking about what the photographs show and mean. We will then interview some of these participants over a two year period to account for any changes and to tease out the factors that may underpin these, including risks uniquely associated with old age but also reflecting back over a lifetime of experience. We will also interview healthcare professionals to explore their understanding of frailty. To raise awareness of the things that are important to the experience of frailty, and the BAME experience in particular, we will use our research findings to generate the following interventions: 1) a frailty index to understand the causes of frailty at a population level; 2) an educational toolkit to be used in clinical education; 3) a public exhibition of the photographs taken; and 4) a person-centred 'cultural competence' tool for understanding frailty at patient level. We will share our findings with those involved in the care and support of older people and older people themselves, participants and others, including by use of a short animation.