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

• 批准号: 10224951
• 负责人: Carolyn E Ziminski Pickering
• 金额: $ 25.45万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-08-07
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224951
• 关键词: Address; Alzheimer' 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; 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; preventive intervention; prospective; protective factors; psychologic; psychological neglect; social cognitive theory; social learning; stress symptom; stressor; theories; therapy development

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.

照顾阿尔茨海默病或相关痴呆症(ADRD)亲属的家庭成员中，超过47%的人遭受身体或心理虐待或疏忽。横断面研究报告称，照顾者压力和痴呆症的行为症状与虐待和忽视老年人(EAN)相关，这使得照顾者负担理论成为EAN的主要解释。我们的试点工作发现，只有在某些情况下，照顾者负担和EAN之间的因果关系才有效，有证据表明EAN的亚型(身体虐待、心理虐待、忽视)是通过不同的机制产生的。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，而其他对家庭暴力(权力和控制、社会学习、生态框架)的解释可能在照顾者负担理论无法解释的情况下解释EAN。因此，我们的项目将对照顾者负担理论如何、何时以及适用于谁产生更微妙的理解，并为负担理论何时不符合我们的数据确定替代解释。为了实现我们的目标，即了解ADRD家庭护理中可改变的风险和保护因素在预测EAN事件中的上下文依赖性，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，在一年中有三个测量期。说英语和西班牙语的ADRD或轻度认知障碍患者(N=760)的家庭照顾者将完成调查，以获取摄入后6个月和12个月的健康和幸福感的长期模式。紧接着每个时间点，参与者将完成21项每日日记调查，以记录照顾者经历的不同每日动态。我们将使用多水平模型(HLM)来解释嵌套在人中的三个跟踪期的每日观察。在目标1中，我们将评估不同的日常动力(护理和非护理相关的压力源、情境调节因素)在预测EAN事件中的直接和交互作用，检验照顾者负担理论提供的假说。在目标2中，使用6个月的测量，我们将评估健康和健康的各种长期模式的影响，检验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互动。在目标3中，我们将使用在摄入时收集的数据，检验个人水平属性预测EAN事件的程度，检验由照顾者负担、社会学习以及权力和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是相互排斥的，我们将在这个3级HLM中测试跨级别的交互作用来预测EAN事件。研究结果将对该领域产生重大影响，为进一步制定干预措施以支持ADRD照顾者和接受者奠定基础，并作为在其他背景下理解EAN的方法模型。该框架将在多个层面上为干预战略提供信息，范围从个性化的以人为中心的方法到公共卫生规划和政策。

项目成果

Dynamic structural equation modelling evaluating the progressively lowered stress threshold as an explanation for behavioural symptoms of dementia.

动态结构方程模型评估逐渐降低的应力阈值作为痴呆症行为症状的解释。

• DOI: 10.1111/jan.15173
• 发表时间: 2022-08
• 期刊: JOURNAL OF ADVANCED NURSING
• 影响因子: 3.8
• 作者: Pickering, Carolyn E. Z.;Yefimova, Maria;Wang, Danny;Maxwell, Christopher D.;Jablonski, Rita
• 通讯作者: Jablonski, Rita

Early Stages of COVID-19 Pandemic Had No Discernable Impact on Risk of Elder Abuse and Neglect Among Dementia Family Caregivers: A Daily Diary Study.

• DOI: 10.1007/s10896-022-00392-8
• 发表时间: 2022-05-11
• 期刊: JOURNAL OF FAMILY VIOLENCE
• 影响因子: 3.8
• 作者: Pickering, Carolyn E Z;Maxwell, Christopher D;Yefimova, Maria;Wang, Danny;Puga, Frank;Sullivan, Tami
• 通讯作者: Sullivan, Tami