"Improving Health Equity in Long-Term Care Residents with Dementia: The Role of Race and Ethnicity in Resident-to-Resident Aggression"

长期护理(LTC)中的居民对居民攻击(RRA)与可预防的伤害、痛苦、 以及严重的心理困扰。疗养院(NH)的居民中有五分之一的人在给定的 月份。患有阿尔茨海默病和相关痴呆症(ADRD)的居民患RRA的风险更高 由于认知障碍相关症状。然而，RRA仍然鲜为人知。这场比赛和 居民的种族可能在RRA的启动和升级、风险/复原力因素、 后果，以及NH反应系统。随着NH人口变得越来越种族/民族 多样化，注重种族/族裔在RRA中的作用，允许制定有针对性的预防和 进行干预以识别和解决它，因为参与RRA的许多居民患有ADRD，无法说话 为了他们自己。这个以公平为导向的项目的目标是系统地调查种族/族裔在 使用RRA第一次流行队列研究的RRA的类型、模式和环境 收集其他利益相关者的意见，明确考虑患有ADRD的居民的需求，以 开发、改进和试行一种新的干预措施。在目标1中，我将利用第一个也是唯一一个由NIH资助的RRA 流行队列研究，以定性地确定背景并定量检查种族/民族在 跨个人、二元和设施级别的RRA。目标2，我将收集多个NH利益相关者的意见，以 提高对种族/族裔在RRA中的作用的理解，并确定当前和最佳的干预措施和 通过混合方法对患有和不患有ADRD的居民采取预防策略。在目标3a和3b中， 目标1和目标2的调查结果将用于制定和完善工作人员教育干预措施，重点是 种族/民族在RRA中的作用，可能会被整合到现有的RRA干预计划中，而不是 目前有关于种族/民族的信息。作为一名受过公共卫生研究培训的社会科学家，我 鉴于我在社会决定因素方面的富有成效的记录，我非常适合带头进行这一领域的研究 健康与虐待老年人的研究。在整个获奖期内，我将在之前培训的基础上 发展长期护理研究方面的新知识和技能(目标1；培训目标1)；保健公平 研究(目标1；培训目标2)；长期护理政策制定、宣传和领导(目标2； 培训目标3)；行为干预和实施科学(目标3a、3b；培训目标 3)。职业发展活动将包括正式课程、体验式学习和研究 机会和来自虐待老年人、RRA研究、健康差距和 行为干预的发展。这个奖项将帮助我实现我的长期职业目标，即成为一名 独立调查员，拥有长期护理研究的有效计划，专注于股权驱动的、 循证预防和干预虐待老年人的发展和实施 种族/族裔多样化的老年人患有ADRD。

Resident-to-resident aggression (RRA) in long-term care (LTC) is associated with preventable injury, suffering, and serious psychological distress. One in five residents in nursing homes (NH) experiences RRA in a given month. Residents with Alzheimer's Disease and Related Dementias (ADRD) are at an even higher risk of RRA due to cognitive impairment-related symptoms. However, RRA remains poorly understood. The race and ethnicity of residents may play an important role in RRA initiation and escalation, risk/resilience factors, consequences, and NH response systems. As NH populations are becoming increasingly racially/ethnically diverse, focusing on the role of race/ethnicity in RRA allows for the development of a tailored prevention and intervention to identify and address it, as many residents involved in RRA have ADRD and are unable to speak for themselves. The goal of this equity-driven project is to systematically investigate the role of race/ethnicity in the types, patterns, and circumstances surrounding RRA using the first prevalence cohort study of RRA, and collecting additional stakeholder input with explicit consideration of the needs of residents with ADRD, to develop, refine, and pilot-test a novel intervention. In Aim 1, I will leverage the first and only NIH-funded RRA prevalence cohort study to qualitatively contextualizing and quantitatively examining the role of race/ethnicity in RRA across individual, dyadic, and facility levels. Aim 2, I will gather input from multiple NH stakeholders to improve understanding of the role of race/ethnicity in RRA, and to identify current and optimal intervention and prevention strategies in residents with and without ADRD via mixed methods approach. In Aims 3a and 3b, findings from Aim 1 and Aim 2 will be used to develop and refine a staff education intervention focused on the role of race/ethnicity in RRA that may be integrated into an existing RRA intervention program that does not currently have information regarding race/ethnicity. As a social scientist trained in public health research, I am ideally positioned to spearhead this line of research, given my productive track record in social determinants of health and elder mistreatment research. Through the award period, I will build upon my prior training to develop new knowledge and skills in long-term care research (Aim 1; Training Objective 1); health equity research (Aim 1; Training Objective 2); long-term care policy-making, advocacy, and leadership (Aim 2; Training Objective 3); and behavioral intervention and implementation science (Aim 3a, 3b; Training Objective 3). Career development activities will consist of formal coursework, experiential learning and research opportunities, and mentorship from experts in elder mistreatment, RRA research, health disparities, and behavioral intervention development. This award will help me achieve my long-term career goal of being an independent investigator with an impactful program of long-term care research focused on equity-driven, evidence-based elder abuse prevention and intervention development and implementation for racially/ethnically diverse older persons with ADRD.