Function, caregiving and adequacy of support before and after the transition to institutional settings

过渡到机构环境之前和之后的功能、照顾和支持的充分性

• 批准号: 10687131
• 负责人: Kenneth Lam
• 金额: $ 0.55万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10687131
• 关键词: Activities of Daily Living; Age; Aging; Anecdotes; Assisted Living Facilities; Award; Bathing; Caregivers; Caring; Complex; Data; Data Aggregation; Decision Aid; Dementia; Elderly; Family; Feedback; First Aid; Foundations; Friends; Future; Geriatrics; Goals; Grant; Growth; Health; Health Professional; Home; Home Nursing Care; Hour; Impairment; Institution; Institutionalization; Institutionalized Persons; Interview; Life; Living Arrangement; Low income; Measures; Mentors; Methods; Normalcy; Nursing Homes; Outcome; Palliative Care; Patients; Persons; Population Heterogeneity; Positioning Attribute; Process; Qualitative Methods; Race; Randomized, Controlled Trials; Research; Role; Sampling; Service delivery model; Specific qualifier value; Subgroup; Surveys; Testing; Training; United States National Institutes of Health; Vulnerable Populations; Work; career; caregiving; cohort; ethnic diversity; experience; functional disability; improved; instrumental activity of daily living; lens; programs; recruit; residential care facility; sex; trend

PROJECT SUMMARY/ABSTRACT When functional impairments in later life overwhelm available caregiving, older persons and their caregivers commonly consider if moving from home into an institution, such as a nursing home, assisted living facility or residential care facility for the elderly, is best for them. Persons and caregivers hope clinicians will help them decide, but evidence and frameworks that clinicians can use to provide guidance are largely absent. We could improve how clinicians help patients and caregivers navigate this process through a decision aid, but an aid first requires data on how person- and caregiver-centered measures change with institutionalization and a better understanding of what information persons and caregivers want. The objective of this proposal is to supply those data and that understanding through mixed methods. Aim 1 will produce the first nationally representative descriptions of trajectories in function, caregiving, and adequacy of support (eg, did persons bathe less than they wanted due to lack of help) in the year before and after institutionalization and examine if trajectories meaningfully differ in pre-specified subgroups (eg, by age, race, or type of institution). Aim 2 will explore the experience of recently institutionalized older persons and their caregivers to understand the role of function, caregiving and inadequate support in their transition and what information (if any) was and would have been useful. We integrate our methods by using results from Aim 1 to inform sampling and by presenting findings from Aim 1 to interviewees in Aim 2; by exploring feedback to a concrete example, we will gain a better understanding of what kinds of information are useful to persons navigating this transition. Together, these aims will be the foundation for future work developing decision aids for the institutionalization process and then implementing and evaluating them in randomized controlled trials.

项目摘要/摘要 当晚年的功能障碍压倒了现有的照顾者时，老年人及其照顾者 通常考虑是否从家里搬到养老院、辅助生活设施或 为老年人提供住宿照顾设施，对他们来说是最好的。患者和照顾者希望临床医生能帮助他们 决定，但临床医生可以用来提供指导的证据和框架基本上是缺乏的。我们可以 改善临床医生通过决策辅助工具帮助患者和护理人员驾驭这一过程的方式 首先需要有关以人为中心和以照顾者为中心的措施如何随着制度化和 更好地了解个人和照顾者想要的信息。这项建议的目的是 通过混合方法提供这些数据和理解。AIM 1将在全国范围内生产第一辆 在功能、照料和支持充分性方面的代表性描述(例如，人是否 因缺乏帮助而洗澡比他们想要的少)，检查是否 在预先指定的子组中，轨迹有意义地不同(例如，年龄、种族或机构类型)。目标2将 探索最近住院的老年人及其照顾者的经历，以了解 他们在过渡过程中的职能、照料和不充分的支持，以及什么信息(如果有)是和将是 都是有用的。我们通过使用来自目标1的结果来提供采样信息并通过呈现 从目标1到目标2的受访者的调查结果；通过探索对具体例子的反馈，我们将获得 更好地理解哪些类型的信息对经历这种过渡的人是有用的。一起， 这些目标将成为今后为制度化进程制定决策辅助工具工作的基础。 然后在随机对照试验中实施和评估它们。