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 阿尔茨海默病和阿尔茨海默病相关痴呆症（AD/ADRD）的巨大扩张， 这一重要群体。了解和减少反倾销/反倾销和反倾销对管理协定的影响是一个重要的优先事项， 公共卫生和政策制定。目前，我们对深度和广度的理解存在严重差距， 随着时间的推移，AD/ADRD差异的决定因素，以及减少这些疾病影响的潜在方法 在MA社区。AD/ADRD不仅影响患者，还影响家庭照顾者，他们在照顾方面挣扎 对于一个面临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，如驾驶停止，养老院安置，并使用生命维持 治疗可以对整个疾病谱的患者和护理人员产生巨大的影响， 生命的终结需要更多的数据来说明越来越多的医学硕士如何处理这些决定， 将社会经济、文化和家庭结合起来。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。MA文化也有强烈的家庭支持价值观，这可能对我们的生活产生积极的影响。 影响这些决定，并帮助减轻一些负面的影响。使用 基于人群的MA和非西班牙裔白人（NHW）队列， “墨西哥裔美国人的认知障碍：一项基于人群的研究（R 01 NS 100687），我们将延长 队列随访，以增强对AD/ADRD随时间推移的种族差异的理解。的 对这一队列的长期随访将使我们能够评估认知障碍的长期轨迹 影响MA患者和护理人员，并了解种族歧视的患病率、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） 扩展对AD/ADRD进展轨迹和种族特异性预测因子的长期评估， 以及AD/ADRD对家庭和照顾者的长期生活影响， 墨西哥裔美国人和非西班牙裔白人在Nueces县，得克萨斯州; 2）评估的决定因素， 对认知障碍者面临的两个关键社区转变的决策的影响： 停止驾驶和过渡到长期熟练的护理设施;和3）检查种族差异， 在基于社区的研究中，AD/ADRD患者及其护理人员的临终治疗偏好 队列。本提案将阐明种族和社会经济因素对AD/ADRD及相关疾病的影响。 决策跨老化谱，并协助发展有针对性的决策支持 对不同人群的干预。

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.