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

“改善患有痴呆症的长期护理居民的健康公平：种族和民族在居民之间的攻击行为中的作用”

• 批准号: 10644715
• 负责人: E-Shien Chang
• 金额: $ 12.15万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10644715
• 关键词: Active Learning; Address; Administrator; Advocacy; Aggressive behavior; Alzheimer' s disease related dementia; Automobile Driving; Award; Basic Science; Behavior Therapy; Behavioral Symptoms; Caring; Certification; Characteristics; Cluster randomized trial; Cohort Studies; Competence; Conflict (Psychology); Data; Data Set; Dementia; Development; Discipline; Discipline of Nursing; Disinhibition; Education; Educational Intervention; Elder Abuse; Elder abuse prevention; Elderly; Equity; Ethnic Origin; Feedback; Focus Groups; Funding; Goals; Health; Impaired cognition; Individual; Injury; Intervention; Knowledge; Lead; Leadership; Learning Module; Long-Term Care; Measurable; Mentors; Mentorship; Methods; Minority; Modeling; Nursing Homes; Pattern; Play; Policy Making; Population; Positioning Attribute; Prevalence; Prevention; Prevention strategy; Productivity; Prospective Studies; Provider; Race; Research; Research Personnel; Risk; Role; Safety; Scientist; Societies; Summary Reports; Surveys; Symptoms; System; Testing; Time; Training; United States National Institutes of Health; Violence; Work; acceptability and feasibility; career; career development; community setting; design; efficacy evaluation; ethnic diversity; ethnic health disparity; ethnic minority; evidence base; experience; feasibility testing; health disparity; health equity; high risk; implementation science; improved; intervention program; maltreatment; mild cognitive impairment; multilevel analysis; novel; pilot test; prevent; programs; prospective; psychological distress; public health priorities; public health research; racial diversity; racial health disparity; racial minority; racism; resilience factor; response; skills; social; social health determinants; therapy development; trend; verbal

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.

长期护理（LTC）中的居民间攻击（RRA）与可预防的伤害，痛苦， 和严重的心理困扰五分之一的疗养院居民（NH）在给定的时间内经历RRA。 月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 因为认知障碍相关的症状然而，对拉汉温抵抗军的了解仍然很少。比赛和 居民的种族可能在RRA的启动和升级，风险/弹性因素， 后果和NH响应系统。随着NH人口在种族/民族上变得越来越多， 多样性，注重种族/族裔在风险抵抗中的作用，可以制定有针对性的预防措施， 由于许多参与拉汉温抵抗军的居民患有ADRD，无法说话， 为自己这个公平驱动的项目的目标是系统地调查种族/民族在以下方面的作用： 使用RRA的第一次患病率队列研究，了解RRA的类型、模式和环境，以及 收集更多利益相关者的意见，明确考虑ADRD居民的需求， 开发、完善和试点测试一种新的干预措施。在目标1中，我将利用第一个也是唯一一个由NIH资助的RRA 流行率队列研究，以定性地分析和定量地检查种族/族裔在 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， 提高对种族/民族在RRA中作用的认识，并确定当前和最佳干预措施， 通过混合方法在有和没有ADRD的居民中实施预防策略。在目标3a和3b中， 目标1和目标2的研究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/族裔在RRA中的作用，可纳入现有的RRA干预计划， 目前有关于种族/民族的信息。作为一名受过公共卫生研究训练的社会科学家， 理想的定位，带头这一系列的研究，鉴于我的生产记录的社会决定因素， 健康和虐待老年人研究。在整个获奖期间，我将在我之前的培训基础上， 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）;健康公平 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，以及来自虐待老人、RRA研究、健康差距和 行为干预发展。这个奖项将帮助我实现我的长期职业目标， 独立调查员，具有长期护理研究的影响力计划，专注于股权驱动， 制定和实施基于证据的虐待老年人预防和干预措施， 不同种族/民族的ADRD老年人。