Intergenerational Antecedents of Care to Older Adults Approaching the End of Life With and Without Dementia

对患有或不患有痴呆症的临终老年人的护理的代际背景

• 批准号: 9808440
• 负责人: Merril D. Silverstein
• 金额: $ 20.96万
• 依托单位: SYRACUSE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9808440
• 关键词: 19 year old; Acute; Adolescent and Young Adult; Adopted; Adult Children; Age; Aging; Alzheimer' s Disease; Baby Booms; Biological; Biological Aging; Caring; Cause of Death; Cessation of life; Child; Chronic; Cognitive; Cognitive deficits; Data; Dementia; Diagnosis; Disabled Persons; Elderly; Emotions; Family; Family Life Cycle; Fathers; Financial Support; Generations; Goals; Health; Impaired cognition; Insurance; Investigation; Investments; Knowledge; Life; Life Cycle Stages; Light; Link; Long-Term Care; Longitudinal Studies; Longitudinal Surveys; Marriage; Measurement; Measures; Methodology; Methods; Modeling; Mothers; Parents; Patient Self-Report; Phase; Process; Proxy; Public Policy; Reporting; Research; Research Personnel; Resources; Rewards; Running; Source; Testing; Time; Uncertainty; Update; base; care delivery; career; caregiving; disability; end of life; experience; family structure; frailty; functional disability; improved; indexing; innovation; interest; intergenerational; intimate behavior; middle age; mortality; novel; public health relevance; rate of change; response; social; social deficits; theories; time use

ABSTRACT Based on the framework of social exchange, we hypothesize that early investments made in children will later be reciprocated in the form of instrumental care as parental needs increase. We will examine time-to-death as either an alternative or complementary approach to the use of proxy and self-reports about functional and cognitive impairment to assess vulnerability in older adults in relation to the care-careers of their adult children. The models tested will inform theory about how children serve as conditional resources—responding to their parents’ early investments when triggered by parental need—rendering an improved depiction of intergenerational relationships over the family life cycle. The goals of the research are to: (1) link early transfers of valued resources of time, money, and emotion to rates of change in the amount of care adult children provide to their vulnerable older parents; (2) test a novel methodological approach—the “countdown model”—that uses time-to-death to represent a global form of vulnerability that triggers the delivery of care to older parents; and (3) identify whether care to older parents is more strongly associated with time-to-death from Alzheimer's disease and other dementia-related causes compared to other causes. The countdown model uses time-to-death as an alternative, objectively derived metric of biological vulnerability to represent the need for care by aging parents. Our application of this model provides a unique marriage of theory and method that enhances understanding of long-term intergenerational exchange dynamics that unfold over many decades in families, and represents progressive vulnerability of parents using knowledge about the timing and (dementia and non-dementia) causes of their death. Data for this project are derived from the Longitudinal Study of Generations (LSOG), a multi-panel and multi- generational study that has collected data on three-generation families from 1971 to 2016. Focusing on the middle-generation, which averaged 19 years of age in 1971, we examine trajectories of care provided by these children to older mothers and fathers between 1985 and 2016 as a function of accelerating parental vulnerabilities, and their interaction with early investments of time (shared activities), money (financial support), and emotion (intimacy) made in them by their parents in 1971. Using previously collected mortality information about parents from the National Death Index in 2016—combined with an updated NDI search to 2019—we test the utility of time-to-death as a representation of growing cognitive and physical frailty that stimulates children to provide increasing amounts of care. This research is timely in light of growing uncertainty about the family as a reliable source of extended care in later life.

摘要 基于社会交换的框架，我们假设，早期的投资，在儿童后来会得到回报的形式，工具性照顾父母的需求增加。我们将研究死亡时间作为替代或补充的方法，使用代理和自我报告功能和认知障碍，以评估老年人的脆弱性，他们的成年子女的护理职业。测试的模型将告知理论儿童如何作为有条件的资源响应父母的早期投资时，父母的需要引发呈现在家庭生命周期的代际关系的改善描述。研究的目标是：（1）将时间、金钱和情感等宝贵资源的早期转移与成年子女向其脆弱的老年父母提供的护理量的变化率联系起来;（2）测试一种新的方法论方法--“倒计时模型”--该模型使用死亡时间来代表一种全球形式的脆弱性，从而触发向老年父母提供护理;以及（3）确定与其他原因相比，对老年父母的照顾是否与阿尔茨海默病和其他痴呆相关原因的死亡时间更密切相关。倒计时模型使用死亡时间作为替代的、客观推导的生物脆弱性指标，以代表年迈父母的护理需求。我们的应用这个模型提供了一个独特的婚姻的理论和方法，增强了对长期代际交换动态的理解，在家庭中展开了几十年，并代表了渐进的脆弱性的父母使用知识的时间和（痴呆症和非痴呆症）的原因，他们的死亡。该项目的数据来自世代纵向研究（LSOG），这是一项多面板和多代研究，收集了1971年至2016年三代家庭的数据。我们以1971年平均年龄为19岁的中间一代为重点，研究了1985年至2016年期间这些儿童向年长母亲和父亲提供的护理轨迹，作为加速父母脆弱性的函数，以及他们与早期时间投资的相互作用。（共同的活动），金钱（经济支持）和情感（亲密）在他们的父母在1971年。使用之前收集的2016年国家死亡指数中有关父母的死亡率信息-结合更新的NDI搜索到2019年-我们测试了死亡时间的效用，作为不断增长的认知和身体虚弱的代表，刺激儿童提供越来越多的护理。这项研究是及时的，因为人们越来越不确定家庭是否是晚年延长护理的可靠来源。