Older Adults Living with Alzheimer's Disease and their Caregivers: Testing an Evidence-Based Intervention for Underserved Populations

医学研究所认为，性/性别少数民族老年人是最多的 服务不足的人群，健康差距很大。这一高危群体面临着严重的 获得医疗保健的障碍、卫生环境中的偏见以及缺乏具有文化能力的护理。 患有阿尔茨海默病及其相关疾病的性/性别少数老年人人数 痴呆症(AD/RD)及其照顾者(CG)正在迅速增长，到#年将超过400万。 2060年。缺乏有效的以研究为基础的干预措施来减少残疾和 抑郁，并改善这些患有AD/RD和他们的CG的老年人的生活质量，是 这是一个重大的公共卫生问题。研究已经证明了CGs在糖尿病中的保护作用 患有AD/RD的老年人的健康状况以及CGs在照顾方面的困难和挑战 以及照料对健康恶化的影响。照顾如此脆弱的老年人 AD/RD尤其令人担忧，因为这一人群的跨代率较低 关系以及他们的社会耻辱和孤立，这可能是持续照顾的障碍 两性关系。这个项目建立在NIH两个主要项目的成功基础上，骄傲的老龄化： 国家健康、老龄化和性行为/性别研究(2R01AG026526；K.Fredriksen-Goldsen， PI)和减少阿尔茨海默病中的残疾(RDAD)；R01 AG10845；L.Teri，Pi)和 将测试增强的RDAD干预对污名化人群的有效性 身份管理、历史创伤和多样化的同伴支持网络。该项目将 实现以下目标：目标1.测试RDAD的翻译和增强功能，旨在 增加这些易患AD/RD的老年CRS及其CGs的体力活动 。 目标 2.评估增强型和标准型RDAD对小学生的短期和长期影响 (体力活动和功能、CGs的感知压力、CRS的制度化)和 次要结果(HRQOL、抑郁症状、CRS的行为障碍)。 目的3.检验CR-CG特征的调节作用，例如，CR-CG关系的类型， 性别、CRAD/RD严重程度对标准和增强型RDAD治疗效果的影响。这 国家公认的专家团队有20多年的阿尔茨海默氏症和 少数族裔老龄化研究，具有必要的专业知识和建立的关系，以测试 首个以证据为基础的干预措施，针对居住在人口统计上多样化的弱势老年人 AD/RD和他们的CG。这项研究的结果将通过护理得到充分传播 以及老龄化机构、基于社区的组织和研究网络 站点和设置。

The Institute of Medicine identifies sexual/gender minority older adults as one of the most underserved populations, with significant health disparities. This at-risk group faces serious barriers to healthcare access, bias in health settings, and a lack of culturally competent care. The number of sexual/gender minority older adults living with Alzheimer's disease and related dementias (AD/RD) and their caregivers (CGs) are growing rapidly, and will exceed 4 million by 2060. The lack of efficacious research-based interventions implemented to reduce disability and depression, and improve quality of life for these older adults living with AD/RD and their CGs,is a significant public health problem. Research has documented the protective role of CGs in the health of older adults living with AD/RD as well as CGs' hardships and challenges in caregiving and the impact of caregiving on health deterioration. Caregiving of such vulnerable older adults with AD/RD is particularly of concern due to this population's lower rate of cross-generational ties and their social stigma and isolation, which may be barriers to sustaining caregiving relationships. This project builds on the success of two major NIH projects, Aging with Pride: National Health, Aging, and Sexuality/Gender Study (2R01 AG026526; K. Fredriksen-Goldsen, PI) and Reducing Disabilities in Alzheimer's Disease (RDAD); R01 AG10845; L. Teri, PI) and will test the efficacy of an enhanced RDAD intervention for stigmatized populations addressing identity management, historical trauma and diverse peer support networks. The project will address the following aims: Aim 1. Test the translation and enhancement of RDAD designed to increase physical activities of these vulnerable older adult CRs with AD/RD and their CGs . Aim 2. Evaluate the short- and long-term effect of the enhanced and standard RDAD on primary (physical activity and functioning, perceived stress for CGs, institutionalization for CRs) and secondary outcomes (HRQOL, depressive symptomatology, behavioral disturbances for CRs). Aim 3. Test the moderating roles of CR-CG characteristics, e.g., type of CR-CG relationship, sex, severity of CR AD/RD, on the treatment effect of the standard and enhanced RDAD. This team of nationally recognized experts has more than 20 years of conducting Alzheimer's and minority aging research, with the expertise and established relationships necessary to test the first evidence-based intervention for demographically diverse vulnerable older adults living with AD/RD and their CGs. The findings from this study will be fully disseminated through caregiving and aging agencies, community-based organizations, and research networks across multiple sites and settings.