Building Community Capacity for Disability Prevention for Minority Elders

描述（由申请人提供）：虽然少数族裔老年人是美国老龄化人口中增长最快的部分，但他们获得精神卫生保健和预防残疾的机会较少，远远落后于非拉丁裔白人，并且存在显著差异。黑人和拉丁裔残疾的风险最大，而且在残疾方面存在显着差异 健康老龄化这包括老年移民，他们表现出更高的抑郁和焦虑症状，残疾率高于本土出生的人口;然而，他们往往未被诊断或诊断不足。这是一个错失的机会，因为情绪障碍治疗已被证明可以减少残疾天数，并且残疾的几个风险因素，如功能性活动是可以改变的。研究表明，一个促成因素可能是专业提供者供应不足，以及基于证据的治疗无法达到少数族裔老年人并为他们所接受。国际移民组织的一个委员会最近报告说，在为老年人提供心理保健方面，劳动力严重短缺，需要采取新的方法来解决。为了解决这些差异，并防止少数民族老年人的残疾，拟议的R 01研究如何成功地建立合作研究，以提供基于证据的精神健康和残疾预防治疗，在社区为基础的设置。一些国际研究的可喜成果表明，社区卫生工作者采取干预措施后，心理健康成果的可及性和质量得到改善，残疾人数减少。然而，有限的和不一致的证据CHW领导的干预措施在美国的情况下仍然有效。虽然为解决这些服务差距而采取的社区保健干预措施的数量呈指数级增长，但缺乏系统评估，以确定这些措施是否提高了社区能力和系统变革，以及是否提高了护理质量并有可能减少残疾。我们提出的研究努力解决这一限制。因此，拟议的R 01将是同时研究成功干预所必需的三个组成部分的少数努力之一：有效性，因为干预必须有效，客户的可接受性，以及组织内的可行性和可持续性。它旨在了解伙伴关系在提高社区心理健康和残疾预防综合干预能力方面的作用，并评估社区卫生工作者和运动教练向拉丁美洲、非洲裔美国人和亚洲老年人提供的干预措施的可接受性、有效性、可行性和可持续性，这些老年人有中度至重度情绪症状和残疾风险。

DESCRIPTION (provided by applicant): Although minority elders represent the fastest growing segment of an aging US population, they have less access to mental health care and prevention of disability, lagging well behind non-Latino whites, and suffering significant disparities. Blacks and Latinos have the greatest risk for disability, with striking disparities in healthy aging. This includes elderly immigrants who exhibit elevated depressive and anxiety symptoms, and higher rates of disability than the native-born population; yet, they often go undiagnosed or underdiagnosed. This is a missed opportunity given that mood disorder treatment has been shown to reduce disability days and that several risk factors for disability, such as functional mobility are modifiable. Research suggests that a contributing factor may be an insufficient supply of professional providers and the inability of evidence based treatments to reach and be acceptable to minority elders. An IOM committee recently reported that the severe workforce shortages in providing mental health care to elder adults required novel approaches to resolve. To address these disparities and prevent disability among minority elders, the proposed R01 examines how to successfully build collaborative research for the provision of evidence-based mental health and disability prevention treatments in community-based settings. Promising results in a few international studies show improved access and quality of mental health outcomes and reduced disability when interventions are delivered by Community Health Workers. Yet limited and inconsistent evidence of the efficacy of CHW-led interventions in the US context remains. While the number of community-based health interventions has grown exponentially to address these service disparities, there is a lack of systematic assessment of whether they lead to increased community capacity and systems change, and whether they improve the quality of care and potentially decrease disability. Our proposed study endeavors to address this limitation. As such, the proposed R01 will be one of few efforts that simultaneously study the three components necessary for a successful intervention: efficacy, since the intervention must work, acceptability among clients, and feasibility and sustainability within the organization. It seeks to understand the role of the partnerships in increasing community capacity for a combined mental health and disability prevention intervention, and evaluating the acceptability, efficacy, feasibility and sustainability of the intervention delivere by CHWs and exercise trainers to Latino, African American and Asian elders with moderate to severe mood symptoms and at risk of disability.