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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.

在照顾患有阿尔茨海默病或相关痴呆症（ADRD）的亲属的家庭成员中，超过47%的人遭受身体或心理虐待或忽视。横断面研究报告，照顾者压力和痴呆行为症状与老年人虐待和忽视（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，照顾者负担与EAN之间的因果关系可能仅在某些情况下成立，证据表明EAN的亚型（身体虐待，心理虐待，忽视）通过不同的机制发生。这表明照顾者负担理论可能不能完全解释ADRD家庭照顾者的EAN，而其他关于家庭暴力的解释（权力与控制、社会学习、生态框架）可以解释照顾者负担理论不能解释的情况下的EAN。因此，我们的项目将对照顾者负担理论如何、何时以及对谁适用进行更细致的理解，并确定负担理论何时不符合我们的数据的替代解释。为了了解预测ADRD家庭护理中EAN事件的可改变风险和保护因素的环境依赖性，我们的前瞻性观察队列研究将采用创新的多时间序列设计，在一年的过程中有三个测量期。患有ADRD或轻度认知障碍患者的英语和西班牙语家庭护理人员（N=760）将完成调查，以获取入院、第6个月和第12个月时健康和幸福的长期模式。紧接着每个时间点，参与者将完成21份每日日记调查，以捕捉护理人员不同的日常动态体验。我们将使用多层次模型（HLM）来解释在人类中嵌套的三个后续时期的日常观察。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，情境调节因子）在预测EAN事件中的直接和相互作用，测试照顾者负担理论提供的假设。在目标2中，使用6个月的测量方法，我们将评估各种长期模式对健康和健康的影响，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层次相互作用。在目标3中，使用在入院时收集的数据，我们将检查个人层面属性预测EAN事件的程度，测试由照顾者负担、社会学习和权力与控制理论提供的假设。最后，由于生态框架表明这些理论并不相互排斥，我们将在这个3层HLM中测试跨层相互作用来预测EAN事件。研究结果将对该领域产生重大影响，为进一步发展干预措施奠定基础，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。