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

描述(申请人提供)：多样性、其增长和复杂性是世界范围内人口急剧老龄化的显著特征。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更高。国家卫生研究院致力于减少和消除健康差距。疾病控制和预防中心指出，与性取向有关的健康差距是健康差距研究中的主要差距之一。现有证据表明，女同性恋者、男同性恋者和双性恋者(LGB)老年人是一个高危、调查不足和健康服务不足的不同人群。这项研究将检查影响LGB老年人健康的决定因素，以评估随着时间的推移健康和生活质量(QOL)的变化。基于创新的复原力概念框架，提出的纵向研究将获得参与原始研究的2000名LGB老年人的数据，以使我们能够了解风险和保护因素之间的相互关系，以及随着时间的推移影响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这种多学科合作通过确定随着时间的推移影响健康和生活质量的可修改机制来解决一个关键差距。该项目的主要目标如下：1)调查终生受害、日常歧视、压力(感觉到的压力和对压力的生理反应)和健康行为变化如何随时间影响LGB老年人的健康和生活质量；2)评估社会关系(随时间变化)和性身份管理(随时间变化)如何影响日常歧视、压力、健康和生活质量之间的关系；以及，3)测试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(例如，性身份披露时间、终身受害)的经验差异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费用将继续上升。为了应对这一日益增长的公共卫生挑战，必须查明差异的高风险群体，并确定随着年龄的增长影响其健康和生活质量的可改变的机制。该项目的调查结果将产生所需的信息，以直接告知和指导制定量身定制的干预措施，这些干预措施可以在以社区为基础的机构环境中有效地提供，以改善人口结构多样化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.