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

了解不同种族的老年衰弱经历：混合方法

• 批准号: ES/W012510/1
• 负责人: Susan Pickard
• 金额: $ 117.79万
• 依托单位: University of Liverpool
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FW012510%2F1
• 关键词: Understanding; varied; experiences; frailty; older

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.

虽然老年人衰弱的护理和管理越来越重要，但黑人、亚洲人和少数族裔 (BAME) 的衰弱经历仍在研究中，因此通常不会在旨在支持衰弱老年人的社会政策或临床护理中得到考虑。在日常用语中，“虚弱”这个词经常用来形容在行动能力和独立性方面挣扎的老年人。这也是卫生专业人员越来越多地使用的一个术语。英国的老年患者现在在常规医疗预约中接受身体虚弱筛查。虽然衰弱并不是老年人独有的经历，但它通常与生命的终结和老年时的经历有关，并且经常经历。这种体验对于不同的人来说是不同的，并且取决于多种因素。这些因素包括个人身体，还包括种族、男性或女性、教育、住房和环境、文化信仰和宗教、家庭和社交网络、经济状况和爱好/兴趣等。当老年人接受筛查时，这些问题与虚弱之间的关系常常被忽视，但可能会对他们的虚弱经历产生不利影响。由于这些原因，脆弱的经历并不是对所有人来说都是平等的。很少有研究探讨这种关系，也很少有研究明确探讨种族如何影响衰老和虚弱的经历。因此，白人和少数族裔老年人之间持续存在健康差距，在晚年生活中尤其显着。因此，该项目旨在通过与来自不同种族的广泛老年人交谈，探索对衰弱的经历和管理而言重要的因素。为此，我们将首先分析一项名为“理解社会”的大型研究的数据，该研究涉及 40,000 个家庭，其中约 11,500 名参与者来自少数民族背景，以强调脆弱与种族之间的关系。我们将利用这些信息来选择特定的老年人群体进行交谈，以便更深入地探讨这一问题。参与者将根据强调对脆弱生活经历的特殊影响的因素进行选择，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所经历的不同经历，包括孟加拉国人、印度人、巴基斯坦人、加勒比黑人和非洲人，以进行对比和比较，阐明少数族裔老年衰弱经历的独特性、脆弱性和优势以及如何更好地支持这些经历。在我们定性研究的第一阶段，我们将对老年人进行照片语音研究。这将包括给他们相机，要求他们拍摄自己脆弱经历的照片，并谈论照片所显示的内容和含义。然后，我们将在两年内采访其中一些参与者，以解释任何变化，并梳理出可能支撑这些变化的因素，包括与老年相关的独特风险，但也反映了一生的经历。我们还将采访医疗保健专业人士，探讨他们对虚弱的理解。为了提高人们对脆弱体验（尤其是少数族裔体验）的重要性的认识，我们将利用我们的研究结果制定以下干预措施：1）脆弱指数，以了解人群层面脆弱的原因； 2）用于临床教育的教育工具包； 3）所拍摄照片的公开展览； 4) 以人为本的“文化能力”工具，用于了解患者层面的虚弱状况。我们将与那些参与老年人护理和支持的人员以及老年人本身、参与者和其他人分享我们的发现，包括使用动画短片。