The influence of social and cultural context on life course pathways for Alzheimer's disease, related dementias, and care resources for older Mexican adults

社会和文化背景对阿尔茨海默病、相关痴呆症以及墨西哥老年人护理资源生命历程的影响

• 批准号: 10213435
• 负责人: Brian Gregory Downer
• 金额: $ 104.42万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10213435
• 关键词: Adult; Adult Children; Age; Aging; Alzheimer' s Disease Pathway; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Caring; Child; Childhood; Cognitive; Country; Data; Data Files; Dementia; Disadvantaged; Economic Conditions; Economics; Education; Elderly; Event; Exposure to; Extended Family; Family; Family Planning Policy; Family Sizes; Friends; Generations; Health; Health Insurance; Health Services Accessibility; Health Status; Health behavior; Health care facility; Healthcare; Housing; Incidence; Individual; Inequality; Infrastructure; Institution; Insurance Coverage; Knowledge; Latin America; Life; Life Cycle Stages; Life Expectancy; Link; Long-Term Care; Medicine; Mexican; Mexican Americans; Mexico; Migration Policy; Participant; Pathway interactions; Pensions; Persons; Policies; Population; Public Health; Research; Resources; Risk; Risk Factors; Series; Shock; Social Change; Testing; Time; Work; aged; aging population; care burden; care systems; caregiving; contextual factors; cultural values; dementia care; dementia risk; expectation; family support; health care service; health knowledge; human old age (65+); informal care; middle age; protective factors; social

ABSTRACT Many older Mexican adults rely on adult children, extended family, and friends (i.e., informal care resources) to meet financial, housing, and daily needs. Older adults with strong networks may not worry about having few financial resources, living in poor housing, or not being able to access long-term care services, because they expect that these needs will be met by their adult children. However, this expectation may become less realistic as family sizes have become smaller, adult children are increasingly moving away for work, and cultural values change. Additionally, Mexico has limited healthcare resources and infrastructure (i.e., formal care resources) to meet the needs of an aging population. This is concerning because the incidence of Alzheimer's disease and related dementias (ADRD) in Mexico is among the highest in Latin America. This has important implications for the demand for healthcare services and the need for support from family. The life course is the temporal sequence of events, transitions, and trajectories in important life domains, such as education, family composition, and health. A person's life course is shaped by contextual factors. In Mexico, contextual factors that have likely shaped ADRD risk and the availability of care resources in old age include migration policies, family planning policies, economic shocks, and healthcare and pension reforms. These events have caused successive generations of older adults to be born into and age within very different contexts. Knowledge of contextual and individual life course factors that influence ADRD risk, access to care resources, and use of care resources are established gaps in aging research. We will use the Mexican Health and Aging Study to complete three specific aims. (1) Identify life course pathways for ADRD in an older adult population that has overcome social, economic, and health disadvantages in childhood and middle age. (2) Determine how changing social and cultural contexts over the life course have impacted the availability of informal and formal care resources for older adults in Mexico. (3) Determine how older adults in a country with a poor infrastructure for an aging population meet their long-term care needs as they transition from cognitively unimpaired to ADRD. This project is expected to produce evidence on the life course pathways that influence ADRD risk as well as the availability and use of care resources for older adults in a country with low institutional support, high inequality, and the likely high care burden of ADRD for families and institutions. The expected findings of this research are also relevant to the US. Poor economic conditions and rejoining family are among the many factors that motivate Mexicans to migrate to the US. This, along with the aging of the Mexican-American population, makes it critical to understand how risk factors across life stages impact older adults' risk for ADRD.

摘要 许多墨西哥老年人依赖成年子女、大家庭和朋友（即，非正规护理资源）， 满足财务、住房和日常需求。拥有强大网络的老年人可能不会担心网络数量少 经济资源，生活在贫困的住房中，或者无法获得长期护理服务，因为他们 他们希望这些需求能够得到成年子女的满足。不过，这种期待可能会变得不那么现实 随着家庭规模越来越小，成年子女越来越多地外出工作， 变化此外，墨西哥的医疗资源和基础设施有限（即，正式护理资源）， 满足人口老龄化的需要。这是令人担忧的，因为阿尔茨海默病的发病率和 墨西哥的ADRD是拉丁美洲发病率最高的国家之一。这对以下方面具有重要意义： 对医疗服务的需求和对家庭支持的需要。 生命历程是重要生命领域中事件、转变和轨迹的时间序列， 比如教育、家庭组成和健康。一个人的生命历程是由环境因素塑造的。在墨西哥， 可能影响ADRD风险和老年护理资源可用性的背景因素包括 移民政策、计划生育政策、经济冲击以及医疗和养老金改革。这些事件 导致一代又一代的老年人在截然不同的环境中出生和衰老。 了解影响ADRD风险的背景和个人生命过程因素、获得护理资源的机会， 和护理资源的使用是老龄化研究中的既定空白。我们将使用墨西哥健康和老龄化 学习要完成三个具体目标。(1)确定老年人群中ADRD的生命过程途径 它克服了儿童和中年时期的社会、经济和健康劣势。(2)确定如何 生活过程中不断变化的社会和文化背景影响了非正式和正式的可用性， 为墨西哥的老年人提供护理资源。(3)确定在基础设施薄弱的国家， 满足老年人从认知未受损向ADRD过渡时的长期护理需求。 该项目预计将产生影响ADRD风险的生命过程途径的证据， 在一个机构支助低、机构支助高、 不平等，以及ADRD对家庭和机构可能造成的高护理负担。预期的调查结果 研究也与美国有关。经济条件差和重新加入家庭是许多因素之一 促使墨西哥人移民到美国。这一点，沿着墨西哥裔美国人的老龄化， 因此，了解不同生命阶段的风险因素如何影响老年人患ADRD的风险至关重要。