The Caregiving Trajectory for Community-Dwelling Mexican-American Elders

描述（由申请人提供）：西班牙裔照顾者的照顾负担是一个鲜为人知且日益严重的问题。因此，在这些人群中进行解决照顾者负担和防止机构化的研究至关重要。据估计，美国有超过4200万西班牙裔美国人，65岁以上人群的增长速度预计将超过任何其他种族或族裔群体，到2050年将增加两倍。目前，13%的西班牙裔家庭为50岁或以上的成年人提供护理，这些人的预期寿命到2050年将增加到87岁，超过所有其他种族。考虑到人口结构的巨大变化，越来越多的西班牙裔家庭将承担照顾孩子的角色。本研究的目的是通过描述照顾者负担/紧张的水平、情况和后果，并确定文化和背景变量对照顾和照顾者收益的影响，以及导致养老院入院的因素，来调查这一高危人群的照顾负担。本研究是一项纵向混合方法描述性研究，旨在深入探讨墨西哥裔美国家庭的照护自然过程、照护负担和压力、照护者收益和进入养老院的情况。将登记110名接受护理者护理的病例，并对其进行15个月的随访。访谈和标准化问卷将在基线和每10周完成一次，如果发生疗养院入住，将有一个额外的测量点。我们将比较和对比照顾轨迹中的转变和转折点（考虑到文化适应、照顾者-被照顾者关系的性质、性别、功能和认知状态以及抑郁症）；确定支持照护的因素；并确定哪些因素是延迟制度化的最重要因素。核心组成部分将是一种面向案例的方法，即对案例进行深入的、以质量为导向的研究，着眼于相似性和差异性的配置。同时的、互补的、数量驱动的、面向变量的组件将跨案例寻找广泛的模式，并根据这些广泛的模式进行推断。这些方法将在整个研究的分析和解释阶段结合起来。这种对护理轨迹的深入、系统的研究在设计干预措施时应该证明是有用的，这些干预措施与已知的危机点同时发生，有助于将老年人留在家中，或帮助家庭认识到何时应该寻求正式的养老院护理。采用生命历程视角，本纵向、描述性、混合方法研究旨在探讨110个墨西哥裔美国家庭的照护自然历程、照护负担和压力、照护者收益和疗养院入院情况。核心组成部分将是一种面向案例的方法，即对案例进行深入的、以质量为导向的研究，着眼于相似性和差异性的配置。同时的、互补的、数量驱动的、面向变量的组件将跨案例寻找广泛的模式，并根据这些广泛的模式进行推断。我们将比较和对比照顾轨迹中的转变和转折点（考虑到文化适应、照顾者-被照顾者关系的性质、性别、功能和认知状态以及抑郁症）；确定支持照护的因素；并确定哪些因素是延迟入住养老院的最重要因素。

DESCRIPTION (provided by applicant): Caregiving burden among Hispanic caregivers is a little understood and growing problem. As a result, research to address caregiver burden and prevent institutionalization in these populations is critical. It is estimated that there are over 42 million Hispanics in the U.S. and the cohort over age 65 is expected to grow faster than any other racial or ethnic group, tripling in number by 2050. Thirteen percent of Hispanic households currently provide care to an adult aged 50 or older whose life expectancy will increase to 87 years by 2050, surpassing all other ethnic groups. Given this dramatic shift in demographics, a burgeoning number of Hispanic families will be placed in a caregiving role. The purpose of this proposed study is to investigate the burden of caregiving in this at-risk population by describing the level, circumstances, and consequences of caregiver burden/strain, and determining the impact of cultural and contextual variables on caregiving and caregiver gain, along with factors that lead to nursing home admission. This proposed project is a longitudinal mixed methods descriptive study designed to intensively explore the natural course of caregiving, caregiving burden and strain, caregiver gain, and admission to nursing homes among Mexican-American families. One hundred ten caregiver-care recipient cases will be enrolled and followed for 15 months. Interviews and standardized questionnaires will be completed at baseline and every 10 weeks, with an additional measurement point if nursing home admission occurs. We will compare and contrast transitions and turning points in the caregiving trajectory (taking into account acculturation, the nature of the caregiver-care recipient relationship, gender, functional and cognitive status, and depression); identify factors that support caregiving; and determine what factors are most important in delaying institutionalization. The core component will be a case-oriented approach, that is, an intensive, qualitatively-driven, study of cases with an eye toward configurations of similarities and differences. A simultaneous, complementary, quantitatively-driven variable-oriented component will look for broad patterns across cases and enable the drawing of inferences based on these broad patterns. These approaches will be integrated throughout the analytic and interpretive phases of the study. This in-depth, systematic research into the caregiving trajectory should prove useful in designing interventions that are timed to occur simultaneously with known crisis points and help keep elders at home or to help families acknowledge when formal nursing home care should be sought. PROJECT NARRATIVE Using life course perspective, this longitudinal, descriptive, mixed methods study is designed to explore the natural course of caregiving, caregiving burden and strain, caregiver gain, and admission to nursing homes among 110 Mexican-American families. The core component will be a case-oriented approach, that is, an intensive, qualitatively-driven, study of cases with an eye toward configurations of similarities and differences. A simultaneous, complementary, quantitatively-driven variable-oriented component will look for broad patterns across cases and enable the drawing of inferences based on these broad patterns. We will compare and contrast transitions and turning points in the caregiving trajectory (taking into account acculturation, the nature of the caregiver-care recipient relationship, gender, functional and cognitive status, and depression); identify factors that support caregiving; and determine what factors are most important in delaying nursing home admission.