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Daily Dynamics and Long-Term Trajectories of Elder Abuse and Neglect in the Family Caregiving

家庭护理中虐待和忽视老年人的日常动态和长期轨迹

基本信息

批准号：
9764225
负责人：
Carolyn E Ziminski Pickering
金额：
$ 51.7万
依托单位：
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2019-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9764225
关键词：
Address Alzheimer&apos s Disease American Attention Behavioral Symptoms Caregiver Burden Caregivers Caring Characteristics Cohort Studies Collaborations Communities Cross-Sectional Studies Data Data Collection Dementia Dementia caregivers Dependence Development Dimensions Elder Abuse Etiology Event Family Caregiver Family Violence Family member Future Goals Health Health Policy Individual Individual Differences Intake Intervention Life Life Experience Link Longitudinal Studies Mandatory Reporting Measurement Measures Methodology Modeling Nature Participant Pathway interactions Pattern Periodicity Personal Attribute Personal Satisfaction Persons Pilot Projects Policies Predisposition Prevalence Prevention Preventive Intervention Probability Public Health Questionnaires Reporting Research Risk Risk Factors Risk Reduction Series Social Power Stress Surveys Technology Telephone Testing Time Work abuse neglect base care recipients caregiving contextual factors control theory dementia care design diaries emotional abuse experience family caregiving follow-up health assessment innovation mild cognitive impairment modifiable risk multilevel analysis person centered personalized approach physical abuse prospective protective factors psychologic psychological neglect social cognitive theory social learning stress symptom stressor theories therapy development

项目摘要

Over 47% of family members who care for a relative with Alzheimer’s disease or a related dementia (ADRD) engage in physical or psychological abuse or neglect. Cross-sectional studies report caregiver stress and behavioral symptoms of dementia are correlated with elder abuse and neglect (EAN), making the caregiver burden theory the leading explanation for EAN. Our pilot work found that the causal pathway between caregiver burden and EAN may only hold true under certain situations with evidence that the subtypes of EAN (physical abuse, psychological abuse, neglect) are enacted through different mechanisms. This suggests that the caregiver burden theory may not wholly explain EAN by ADRD family caregivers, and that other explanations offered for family violence (power and control, social learning, ecological frameworks) may explain EAN in situations when the caregiver burden theory does not. Accordingly, our project will develop a more nuanced understanding of how, when and for whom the caregiver burden theory does apply and identify alternative explanations for when the burden theory does not fit our data. To achieve our goal of understanding the contextual-dependency of modifiable risk and protective factors in predicting EAN events within ADRD family caregiving, our prospective observational cohort study will employ an innovative multi-time series design with three measurement periods over the course of a year. English and Spanish speaking family caregivers of those with ADRD or mild cognitive impairment (N=760) will complete surveys to capture long-term patterns in health and wellbeing at intake, month 6 and 12. Immediately following each time point, participants will complete 21daily diary surveys to capture varying daily dynamics of caregivers’ experiences. We will use multi-level models (HLM) to account for the daily observations in three follow up periods nested in people. In aim 1, we will evaluate the direct and interaction effects of various daily dynamics (care and non-care related stressors, contextual moderators) in predicting EAN events, testing hypotheses offered by the caregiver burden theory. In aim 2, using the 6-month measures we will evaluate the effects of various long-term patterns in health and wellness, testing hypotheses offered by the caregiver burden theory. We will also test for cross-level interactions consistent with the ecological framework. In aim 3, using data collected at intake we will examine the extent to which person-level attributes predict EAN events, testing hypotheses offered by the caregiver burden, social learning and power and control theories. Finally, because the ecological framework suggests that these theories are not mutually exclusive, we will test for cross-level interactions in this 3-level HLM to predict EAN events. The study findings will significantly impact the field, by laying the groundwork for further intervention development to support ADRD caregivers and care recipients, and serving as a methodological model for understanding EAN in other contexts. The framework will inform intervention strategies on multiple levels, spanning from individualized person-centered approaches to public health programming and policy.

超过47%的照顾患有阿尔茨海默病或相关痴呆症（ADRD）的亲属的家庭成员参与身体或心理虐待或忽视。横断面研究报告照顾者的压力和痴呆症的行为症状与老年虐待和忽视（EAN）相关，使照顾者负担理论成为EAN的主要解释。我们的试点工作发现，照顾者负担和EAN之间的因果关系路径可能只在某些情况下成立，有证据表明EAN的亚型（身体虐待，心理虐待，忽视）通过不同的机制制定。这表明，照顾者负担理论可能无法完全解释EAN由ADRD家庭照顾者，和家庭暴力（权力和控制，社会学习，生态框架）提供的其他解释可以解释EAN的情况下，照顾者负担理论不。因此，我们的项目将开发一个更细致入微的理解如何，何时和谁的照顾者负担理论适用，并确定替代解释时，负担理论不适合我们的数据。为了实现我们的目标，即了解ADRD家族中预测EAN事件的可改变风险和保护因素的背景依赖性，我们的前瞻性观察性队列研究将采用创新的多时间序列设计，在一年内有三个测量期。ADRD或轻度认知障碍患者（N=760）的讲英语和西班牙语的家庭护理人员将完成调查，以获取摄入时、第6个月和第12个月的长期健康和福祉模式。在每个时间点之后，参与者将立即完成21个每日日记调查，以捕获护理人员经验的不同每日动态。我们将使用多水平模型（HLM）来解释嵌套在人群中的三个随访期内的每日观察结果。在目标1中，我们将评估各种日常动态（护理和非护理相关的压力源，上下文主持人）在预测EAN事件中的直接和相互作用的影响，测试由照顾者负担理论提供的假设。在目标2中，我们将使用6个月的措施来评估各种长期模式对健康和保健的影响，测试照顾者负担理论提供的假设。我们还将测试与生态框架一致的跨级别交互。在目标3中，使用在摄入量收集的数据，我们将研究在何种程度上人的水平属性预测EAN事件，测试提供的假设照顾者的负担，社会学习和权力和控制理论。最后，因为生态框架表明，这些理论并不相互排斥，我们将测试跨级别的相互作用，在这个3级HLM预测EAN事件。该研究结果将显著影响该领域，为进一步的干预发展奠定基础，以支持ADRD护理人员和护理接受者，并作为在其他情况下理解EAN的方法模型。该框架将为多个层面的干预战略提供信息，从个性化的以人为本的方法到公共卫生规划和政策。