Older adults in vulnerable communities: Health and quality of life over time

描述（由申请人提供）：多样性，其增长和复杂性，是全球人口急剧老龄化的决定性特征。研究表明，来自弱势群体的老年人健康状况不佳、残疾和过早死亡的风险较高。美国国立卫生研究院致力于减少和消除健康差距。美国疾病控制与预防中心表示，与性取向有关的健康差异是健康差异研究中的主要差距之一。现有证据表明，女同性恋、男同性恋和双性恋（LGB）老年人是一个处于危险之中、调查不足、服务不足的健康差异人群。本研究将研究影响LGB老年人健康的决定因素，以评估健康和生活质量（QOL）随时间的变化。基于创新的弹性概念框架，本研究将从2000名参与原始研究的LGB老年人中获取数据，以了解风险因素和保护因素之间的相互关系以及随时间推移影响LGB老年人健康和生活质量的队列效应。华盛顿大学研究人员和社区合作者的多学科合作，通过确定影响健康和生活质量的可修改机制，解决了一个关键的差距。本研究的主要目标是：1)研究终身受害、日常歧视、压力（感知压力和对压力的生理反应）和健康行为改变对LGB老年人健康和生活质量的长期影响；2)评估社会关系（时变）和性别认同管理（时变）如何随时间影响日常歧视、压力、健康和生活质量之间的关联；3)检验健康和生活质量的总体水平和年龄增长轨迹是否存在队列异质性，以及婴儿潮和沉默一代LGB老年人在历史背景下的经历差异（如性别身份披露时间、终身受害）在多大程度上解释了这些队列效应。随着人口老龄化，与健康差距相关的医疗保健费用将继续上升。为了应对这一日益严重的公共卫生挑战，必须确定存在差异的高风险群体，并确定随着年龄增长影响其健康和生活质量的可改变机制。该项目的调查结果将产生所需的信息，直接为可在社区机构环境中有效实施的量身定制干预措施的制定提供信息和指导，以改善人口结构不同的老年人的健康和生活质量。

DESCRIPTION (provided by applicant): Diversity, its growth and complexity, are defining features of the dramatic aging of the world-wide population. Research demonstrates that older adults from disadvantaged populations are at elevated risk of poor health, disability and premature death. The National Institutes of Health are committed to reducing and eliminating health disparities. The Centers for Disease Control and Prevention state that health disparities related to sexual orientation are one of the main gaps in health disparities research. Existing evidence demonstrates that lesbian, gay and bisexual (LGB) older adults are an at-risk, under-investigated and under-served health disparate population. This study will examine the determinants of health impacting LGB older adults to assess change in health and quality of life (QOL) over time. Based on an innovative resilience conceptual framework, the pro- posed longitudinal research will obtain data from 2,000 LGB older adults who participated in the original study in order to allow us to understand the inter-relationships between risk and protective factors as well as cohort effects as they impact health and QOL of LGB older adults over time. This multidisciplinary collaboration of University of Washington researchers and community-based collaborators addresses a critical gap by identifying modifiable mechanisms impacting health and QOL over time. The primary goals of the project are as follows: 1) Investigate how lifetime victimization, everyday discrimination, stress (perceived stress and physiological response to stress) and health behavior change affects health and QOL of LGB older adults over time; 2) Evaluate how social relations (time-varying) and sexual identity management (time-varying) affect the associations among everyday discrimination, stress, health and QOL over time; and, 3) Test whether there is cohort heterogeneity in overall levels and age growth trajectories of health and QOL, and to what extent the differences in experiences within a historical context (e.g., time of sexual identity disclosure, lifetime victimization) between Baby Boom and Silent Generation LGB older adults account for these cohort effects. As the population ages, the health care costs associated with health disparities will continue to rise. To respond to this growing public health challenge it is imperative to identfy groups at high risk of disparities and to determine the modifiable mechanisms impacting their health and QOL as they age. The findings from this project will generate needed information to directly inform and guide the development of tailored interventions that can be effectively delivered within community-based agency settings to improve the health and QOL of demographically diverse older adults.