HEALTH CARE PARTNERSHIPS AND SELF CARE OF OLDER ADULTS

我们将研究卫生保健伙伴(初级保健医生和健康重要人员)和老年人(80)进行的自我护理如何减少慢性病对其功能能力的不利影响，并帮助最大限度地提高他们的生活质量。医生、患者和健康重要的其他人被视为护理方面的合作伙伴，卫生保健合作伙伴的响应能力加强了患者的预防性和纠正性自我护理。将从老年人那里获得关于自我护理目标和战略、咨询健康护理伙伴、其他提供者和非专业健康顾问的模式，以及关于健康护理伙伴感知反应的广泛数据。这项研究的一个主要创新焦点是卫生保健伙伴的响应性对老年人支持使用模式的相互影响。补充和补偿模式的患者与医生和健康重要的其他互动将被考虑。我们将对居住在阳光地带退休社区的老年人以及广泛的城市老年人和少数族裔进行长期纵向跟踪。我们将基于对佛罗里达州约350名受访者和克利夫兰350名受访者的家庭访谈，收集四波年度数据。这些老年人在两个以社区为基础的老年人的概率样本中构成忠诚的队列。根据先前的自然流失率，预计第四年的后续行动将有527名老年人参加。我们亦会每年进行电话调查，与基层健康护理医生及其他重要受访者进行电话调查，以确定他们对病人的知识、参与程度及沟通的反应。我们将使用最小二乘回归、结构方程、潜在增长曲线分析和事件历史分析来测试我们关于残疾级联缓冲的综合因果模型。具体地说，我们将研究在从慢性病到残疾和生活质量下降的过程中，对患者反应的医疗护理、提供支持和主动适应的缓冲作用。还将获得关于医疗保健满意度、死亡率和护理成本(基于医疗保险记录的信息)的数据，作为显著的医疗结果变量。

We will examine how responsiveness of Health Care Partners (Primary Care Physicians and Health Significant Others) and self- care undertaken by old-old adults (80+) lessens the adverse impact of chronic illness on their ability to function and help maximize the quality of their lives. Physicians, patients, and Health Significant Others are seen as partners in care, with responsiveness of Health Care Partners enhancing preventive and corrective self-care by patients. Extensive data will be obtained from elders about self-care goals and strategies, patterns of consultation with Health Care Partners, other providers, and lay health consultants, and about perceived responsiveness of Health Care Partners. A major innovative focus of the study deals with mutual influences between responsiveness of Health Care Partners on patterns of support use by elders. Complementary and compensatory models of patient interaction with physicians and Health Significant Others will be considered. We will obtain a long term longitudinal follow-up of old-old adults living in sunbelt retirement communities and a broad cross-section of urban elderly and racial minorities. We will collect four annual waves of data based on in-home interviews of an estimated 350 respondents in Florida and 350 respondents in Cleveland. These elderly constitute committed cohorts in two probability samples of community-based elders. Based on prior attrition rates, a combined sample size of 527 elderly persons is projected for the fourth year follow-up. We will also conduct annual telephone surveys with Primary Care Physicians and Health Significant Others of respondents to ascertain responsiveness in terms of patient knowledge, involvement and communication. We will use least squares regression, structural equations, latent growth curve analysis, and event history analysis to test our comprehensive causal model regarding buffers of the Disability Cascade. Specifically, we will examine the buffering effects of patient-responsive medical care, lay support, and proactive adaptation on the progression from chronic illness to disability and diminished quality of life. Data will also be obtained on satisfaction with health care, mortality and cost of care (information based on Medicare records) as salient medical outcome variables.