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

老年人的数量和多样性急剧增加是世界范围内老年人的特征， 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， 性别少数群体是卫生研究的主要空白之一。最近的人口研究表明， 表明性和性别少数的老年人患慢性疾病的风险较高， 残疾，以及与身体和精神健康相关的生活质量（HRQOL）差。建议纵向 研究将跟踪2,300多名年龄在50岁或以上的人口统计学上不同的LGBT成年人，他们从所有 美国人口普查司。基于纳入生命历程的创新性健康公平促进框架 从发展的角度来看，这项研究将探讨影响健康和良好的风险和保护因素， 随着时间的推移，LGBT老年人。这个多学科的国家研究小组，与 以社区为基础的伙伴机构，通过确定可修改的机制， 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相关联 服务，该项目的主要目的是：1）通过调查轨迹识别处于风险中的LGBT老年人 随着时间的推移，他们与耻辱的关系，以及压力的中介作用; 2）了解 可修改的机制，通过审查的作用， 身份管理、社交网络、身体活动以及获得医疗保健和医疗服务障碍 利用率; 3）检查人口统计学因素（年龄）在多重性、残疾和HRQOL方面的差异 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。这项研究还与外部基于人群的数据相一致，包括健康和 退休研究，全国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， 健康差距将继续扩大。为了应对这一日益严重的公共卫生挑战， 确定差异风险高的群体，并确定影响其健康的可改变机制 和幸福感。这项研究的结果将产生急需的信息， 为制定可在社区内有效实施的量身定制的干预措施提供信息和指导， 基于机构设置，以改善人口统计学上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.