Critical Decision Making in Alzheimer's Disease and Related Dementias in Mexican Americans

摘要 随着美国墨西哥裔美国人(MA)人口的持续增长和老龄化，我们将 查看阿尔茨海默病和阿尔茨海默病相关痴呆(AD/ADRD)的巨大扩展 这个重要的群体。了解和减少AD/ADRD在MA中的影响是 公共卫生和政策制定。目前，我们对深度和深度的理解存在严重差距 AD/ADRD随时间的差异的决定因素，以及减轻这些疾病影响的可能方法 在MA社区。AD/ADRD不仅影响患者，还影响家庭照顾者，他们在护理方面举步维艰 对于一个面临着不确定未来的亲人来说，他们的健康和安全面临着许多复杂的决定。这些 常见但困难的决定，如停止驾驶、安置疗养院和使用维持生命的 治疗可以通过以下方式对患者和照顾者产生巨大影响 地老天荒。需要更多关于不断增长的MA人口如何处理这些决策和 整合社会经济学、文化和家庭。这些信息对于制定未来的干预措施是必要的 支持这些艰难的决定。马文化还具有强烈的家庭支持价值观，这可能会对 对这些决定的影响，并有助于减轻照看的一些负面方面。使用 以人口为基础的MA和非西班牙裔白人(NHW)队列由非常成功的 “墨西哥裔美国人的认知障碍：一项基于人群的研究(R01 NS100687)，我们将扩大 队列后续行动，以便随着时间的推移加强对AD/ADRD中的种族差异的了解。这个 对这一队列的长期跟踪将使我们能够评估认知障碍的长期轨迹 影响MA患者和照顾者，并了解种族因素的患病率、决定因素和影响 围绕AD/ADRD的共同决定的差异。该项目将实现以下目标：1) 将对进展轨迹和特定种族的预测因素的长期评估扩展到AD/ADRD，AS 以及AD/ADRD对家庭和照顾者的长期生活影响 德克萨斯州努切斯县的墨西哥裔美国人和非西班牙裔白人；2)评估决定因素和 认知障碍患者面临的两个关键社区转型决策的影响： 停止驾驶并过渡到长期熟练护理设施；以及3)检查#年的种族差异 社区AD/ADRD患者及其照顾者的临终治疗偏好 一群人。本提案将阐明种族和社会经济因素对AD/ADRD及其相关因素的影响 跨年龄阶段的决策制定，并协助开发有针对性的决策支持 在不同人群中进行干预。

Abstract With the continued growth and aging of the Mexican American (MA) population in the United States, we will see a tremendous expansion of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) in this important group. Understanding and reducing the impact of AD/ADRD in MAs is an important priority for public health and policy making. Currently, there is a critical gap in our understanding of the depth and determinants of disparities in AD/ADRD over time, and potential ways to lessen the impact of these disorders in MA communities. AD/ADRD affects not only the patient, but also family caregivers, who struggle with caring for a loved one facing an uncertain future with many complex decisions about their health and safety. These common yet difficult decisions such as driving cessation, nursing home placement, and use of life-sustaining treatments can have tremendous impact on both patient and caregiver across the spectrum of disease through the end of life. More data are needed on how the growing population of MAs approach these decisions and integrate socioeconomics, culture, and family. This information is necessary to develop future interventions to support these difficult decisions. MA culture also has strong values of family support that may have a positive influence on these decisions and help mitigate some of the negative aspects of caregiving. Using the population-based cohort of MAs and non-Hispanic whites (NHWs) assembled from the highly successful “Cognitive impairment in Mexican Americans: a population-based study (R01 NS100687), we will extend the cohort follow-up to allow for enhanced understanding of ethnic disparities in AD/ADRD over time. The extended follow-up of this cohort will allow us to assess the longer-term trajectory of cognitive impairment affecting MA patients and caregivers and understand the prevalence, determinants, and impact of ethnic disparities in common decisions surrounding AD/ADRD. This project will address the following aims: 1) To extend the long-term assessment of trajectory and ethnic-specific predictors of progression to AD/ADRD, as well as the long-term life impact of AD/ADRD on families and caregivers, among a community-based cohort of Mexican Americans and non-Hispanic Whites in Nueces County, Texas; 2) To assess the determinants and impact of decisions regarding two critical community transitions facing individuals with cognitive impairment: cessation of driving and transition to long-term skilled nursing facilities; and 3) To examine ethnic disparities in end-of-life treatment preferences among individuals with AD/ADRD and their caregivers in a community-based cohort. This proposal will elucidate the impact of ethnicity and socioeconomic factors on AD/ADRD and related decision making across the aging spectrum and assist in the development of targeted decision support interventions among diverse populations.