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

老年人数量和多样性的急剧增加正在定义世界范围内的 人口。研究表明，来自边缘化和弱势群体的老年人 加速衰老和过早死亡的风险增加。美国国立卫生研究院致力于 减少和消除健康差距，并认识到男女之间的健康差距 性别少数群体是卫生研究中的主要差距之一。最近的基于人口的研究已经 证明了性和性别少数的老年人患慢性健康疾病的风险增加， 残疾和与身心健康相关的不良生活质量(HRQOL)。建议的纵向 这项研究将跟踪调查从所有人中招募的2300多名年龄在50岁或以上的不同人口统计的LGBT成年人 美国人口普查部门。以创新的健康公平促进框架为基础，纳入了生命过程 从发展的角度来看，本研究将探讨影响健康和健康的风险和保护因素。 随着时间的推移成为LGBT老年人。这个多学科的国家研究团队，与 基于社区的合作伙伴机构，通过确定可修改的影响机制来解决关键差距 随着时间的推移，健康和HRQOL。利用8年的纵向调查数据和客观数据(生物标志物和 身体和认知测量)，并与医疗保险和医疗补助中心的管理数据链接 服务，该项目的主要目标是：1)通过调查轨迹确定高危LGBT老年人 随时间推移的健康结果，它们与耻辱的关系，以及压力的中介作用；2)理解 通过检查以下因素的作用来解释健康结果变化的可变性的可修改机制 身份管理、社交网络、体力活动以及卫生保健和卫生服务的障碍 利用；以及3)按人口统计因素(年龄)检查多发病、残疾和HRQOL的差异 队列、性别、性别认同、性取向和种族/民族)以及风险和保护因素 健康差距的问题。这项研究还与外部基于人口的数据相一致，包括健康和 退休研究、国家健康访谈调查和美国社区调查，以加强研究 并确保成本效益。随着老年人口的增加，与以下方面相关的医疗成本 健康差距将继续扩大。为了应对这一日益增长的公共卫生挑战，必须 确定差异的高风险群体，并确定影响其健康的可修改机制 以及随着年龄的增长而变得幸福。这项研究的发现将产生急需的信息，以直接 告知和指导制定可在社区内有效提供的量身定做的干预措施- 以机构设置为基础，以改善人口结构多样化的老年人的健康和生活质量。

The dramatically escalating number and diversity of older adults are defining features of the world-wide population. Research demonstrates that older adults from marginalized and disadvantaged populations are at elevated risk of accelerated aging and premature death. The National Institutes of Health are committed to reducing and eliminating health disparities and have recognized that health disparities among sexual and gender minority people are one of the main gaps in health research. Recent population-based studies have demonstrated that sexual and gender minority older adults are at elevated risks of chronic health conditions, disability, and poor physical and mental health-related quality of life (HRQOL). The proposed longitudinal research will follow more than 2,300 demographically diverse LGBT adults aged 50 or older recruited from all U.S. Census divisions. Based on an innovative health equity promotion framework incorporating a life course development perspective, this study will examine the risk and protective factors affecting the health and well- being of LGBT older adults over time. This multidisciplinary national research team, in collaboration with community-based partner agencies, addresses a critical gap by identifying modifiable mechanisms impacting health and HRQOL over time. Utilizing 8 years of longitudinal survey data and objective data (biomarkers and physical and cognitive measures) and linking with administrative data from Centers for Medicare & Medicaid Services, the primary aims of the project are: 1) Identify at-risk LGBT older adults by investigating trajectories of health outcomes over time, their relationships with stigma, and the mediating roles of stress; 2) Understand modifiable mechanisms accounting for variability in changes in health outcomes by examining the roles of identity management, social networks, physical activity, and barriers to health care as well as health service utilization; and 3) Examine disparities in multimorbidity, disability, and HRQOL by demographic factors (age cohort, sex, gender identity, sexual orientation, and race/ethnicity) and risk and protective factors that account for health disparities. This study also harmonizes with external population-based data including Health and Retirement Study, National Health Interview Survey, and American Community Survey to enhance the study and ensure cost efficiency. As the older adult population increases, the health care costs associated with health disparities will continue to rise. To respond to this growing public health challenge it is imperative to identify groups at high risk of disparities and to determine the modifiable mechanisms impacting their health and well-being as they age. The findings from this research will generate much 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 quality of life of demographically diverse older adults.