Chronic Conditions and Mutuality of Care in Late Life Marriage:A Multi-method App

描述(申请人提供)：据估计，88%的老年人至少患有一种慢性病，69%的老年人患有一种以上的慢性病，33%的老年人患有功能性残疾。因此，已婚老年人不仅可能应对自己的慢性病和残疾，还可能应对配偶的慢性病和残疾。了解婚姻中的支持力度如何影响每个伴侣的健康，将为帮助夫妇在晚年保持更健康和功能独立提供极大的洞察力。拟议的导师研究科学家发展奖(MRSDA)的目的是培训候选人在衰老流行病学和先进的二元数据分析技术方面的知识，以建立她在实验研究方面的专业知识，并了解晚年婚姻中的相互护理如何影响健康，特别是心血管健康和抑郁症，以及长寿。这项拟议的研究关注的是双方都患有慢性病和残疾的老年夫妇，根据社区关系理论，相互照顾被定义为双方从对方那里获得高度平衡的工具和情感支持。通过这个MRSDA，候选人将(1)从专家导师和顾问那里学习老龄化流行病学和先进的统计技术来分析二元数据，(2)对大型流行病学二元数据集进行二次分析，以检查老年婚姻中的相互护理如何影响长期健康和寿命，并将进行一项实验，以检验拟议的机制，心血管压力恢复，(3)完成老龄流行病学、高级流行病学统计学和研究伦理学的课程，以及(4)参加关于二元数据分析的研讨会。耶鲁大学在老龄化流行病学、流行病学数据分析统计、实验关系研究和心血管心理生理学方面拥有广泛的资源，因此是进行这项培训的一个现象级环境。这位候选人有一个最先进的观察和心理生理学实验室，她将在这个项目中使用。耶鲁大学公共卫生学院和耶鲁大学克劳德·D·佩珀老年美国人独立中心都有出色的初级教师指导计划。这位候选人的主要导师、耶鲁大学公共卫生学院的贝卡·利维博士在将实验和流行病学方法结合起来研究老年人(包括双胞胎)的心理社会因素和健康方面拥有丰富的专业知识。理查德·舒尔茨博士将担任联合导师，因为他是心血管健康影响研究的主要研究员，该研究将用于拟议研究的研究1，并且是进行大型纵向研究的专家。耶鲁大学公共卫生学院(Yale School Of Public Health)的二元数据分析专家特蕾西·克肖博士也将担任共同导师。拟议的培训将在以下背景下进行：(1)对夫妻双方都有慢性病和残疾的已婚夫妇进行纵向研究(研究1；照顾者健康影响研究；n=819对夫妇；心血管健康研究的辅助研究)，研究相互支持对健康轨迹的影响(例如，临床和亚临床指标 (2)研究心血管压力恢复的实验研究(研究2；n=100对夫妇)，这是研究1中提出的相互护理和心血管健康之间联系的建议机制。在实验研究中，每个伴侣都将讨论与健康相关的压力源，相互支持将被操纵并与对照和单方面支持条件进行比较，以检验对心血管压力恢复的影响。与国家老龄问题研究所概述的优先事项一致，拟议的MRSDA有可能解决老龄化背景下人际关系与健康之间的联系机制(RFA：PA-11-128)。此外，培训和研究的结合将成为候选人独立研究生涯的跳板，以阐明人际关系如何影响老年人的健康。

DESCRIPTION (provided by applicant): It is estimated that 88% of all older adults have at least one chronic condition, 69% have more than one chronic condition, and 33% experience functional disability. Thus, married older adults are not only likely to cope with chronic conditios and disability of their own but also their spouse's. Understanding how support dynamics in marriage influence each partner's health will provide great insight into helping couples stay healthier and functionally independent into late life. The aim of the proposed Mentored Research Scientist Development Award (MRSDA) is to train the candidate in epidemiology of aging and advanced dyadic data analysis techniques to build on her expertise in experimental research and to understand how mutual care in late-life marriage influence health, particularly cardiovascular health and depression, and longevity. The proposed research focuses on older couples in which both partners suffer from chronic conditions and disability, and drawing from communal relationships theory, mutual care is defined as both partners receiving high levels of balanced instrumental and emotional support from one another. Through this MRSDA, the candidate will (1) learn from expert mentors and consultants about the epidemiology of aging and advanced statistical techniques to analyze dyadic, longitudinal data, (2) conduct secondary analysis on a large epidemiologic dyadic data set to examine how mutual care in older adult marriages influences long-term health and longevity and an experiment to examine a proposed mechanism, cardiovascular stress recovery, (3) complete coursework in epidemiology of aging, advanced epidemiologic statistics, and research ethics, and (4) attend workshops on dyadic data analysis. Yale University is a phenomenal environment to pursue this training as it has extensive resources in epidemiology of aging, statistics for analyzing epidemiologic data, experimental relationships research, and cardiovascular psychophysiology. The candidate has a state-of-the- art observational and psychophysiology lab that she will utilize for this project. Th Yale School of Public Health and the Claude D. Pepper Older American's Independence Center at Yale have excellent junior faculty mentoring programs. The candidate's primary mentor, Dr. Becca Levy at Yale School of Public Health has extensive expertise in bridging experimental and epidemiological methods to study psychosocial factors and health in older adults, including dyads. Dr. Richard Schulz will serve as a co-mentor, as he is the primary investigator for the Cardiovascular Health Effects Study which will be used for Study 1 of the proposed research and is an expert in conducting large, longitudinal studies. Dr. Trace Kershaw, an expert in dyadic data analysis at Yale School of Public Health, will also be a co-mentor. The proposed training will occur in the context of (1) a longitudinal study of married couples in which both members of the couple have chronic conditions and disability (Study 1; The Caregiver Health Effects Study; n=819 couples; an ancillary study to the Cardiovascular Health Study) examining the influence of mutual support on health trajectories (e.g. clinical and subclinical indicators of cardiovascular disease, clinical depression, and self-reported health) and longevity, and (2) an experimental study (Study 2; n=100 couples) examining cardiovascular stress recovery, a proposed mechanism for the link between mutual care and cardiovascular health proposed in Study 1. In the experimental study each partner will discuss a health-related stressor, and mutual support will be manipulated and compared to a control and one-sided support conditions to examine the effects on cardiovascular stress recovery. Consistent with the priorities outlined by the National Institute on Aging, the proposed MRSDA has the potential to address mechanisms for links between interpersonal relationships and health in the context of aging (RFA: PA-11-128). Further, the combination of training and research will serve as a spring board for the candidate's independent research career to elucidate how interpersonal relationships influence health among older adults.