Elders Marshalling Responsive Care & Enhancing Quality of Life in the Final Years

描述（由申请人提供）：随着越来越多的人活到老年，确定能够在生命的最后几年维持良好生活质量的资源对于那些致力于提高公共卫生的人来说越来越重要。我们目前对有助于在生命的最后几年和几个月促进身体舒适，心理健康和意义的保健因素的认识存在重大差距。我们提出并旨在测试一个概念模型，重点是积极主动的适应患者和他们的正式和非正式的护理提供者的反应，发挥关键作用，提高生活质量接近生命的尽头。我们提出了一个为期四年的纵向研究的代表性样本不同的老年人居住在三个城市的设置，检查生活质量的轨迹和他们的决定因素。每年的面对面访谈和四个月和八个月的电话随访访谈将与900名老年人（75岁以上）进行，他们是我们正在进行的NIA资助的成功老龄化研究的参与者。我们的前瞻性研究将通过与在本研究过程中死亡的受访者的近亲进行访谈来补充，以便对老年人的临终关怀进行回顾性描述。在研究结束时，我们将能够描述研究期间死亡和幸存者的健康状况，功能状态，社会支持和生活质量轨迹。拟议的研究将提供有关健康状况不佳和重大事件造成的压力源变化的性质，改善资源使用的变化，以及种族多样性老年人生活质量结果的信息。我们的概念框架和措施，我们选择将使我们能够提供一个更全面的观点的交叉点的医疗保健和维护的完整性的人，遵循传统的护理研究。这项研究的结果应该产生系统的指导方针，护理干预措施的基础上，病人的教育和专门培训的护士和其他医疗保健提供者，可以帮助促进以病人为中心的医疗保健。

DESCRIPTION (provided by applicant): As more people live to old age, identifying resources that enable maintenance of good quality of life during the final years of life assumes increasing importance for those committed to enhancing public health. Major gaps exist in our current knowledge of factors that contribute to health care that promotes physical comfort, psychological well-being and meaningfulness during the final years and months of life. We propose and aim to test a conceptual model focused on proactive adaptations by patients and responsiveness of their formal and informal care providers, as playing key roles in enhancing quality of life close to the end of life. We propose a four year longitudinal study of a representative sample of diverse older adults dwelling in three urban settings, to examine quality of life trajectories and their determinants. Annual face-to-face interviews and four and eight month telephone follow-up interviews will be conducted with 900 older adults (age 75+) who are participants in our ongoing NIA funded study of successful aging. Our prospective study will be complemented by interviews with next of kin of respondents who die during the course of this study in order to obtain a retrospective account of the older person's end of life care. At the conclusion of the study, we will be able to describe health, functional status, social support, and quality of life trajectories of respondents who die during the study and those who survive. The proposed study will provide information on the nature of changes in stressors posed by ill health and critical incidents, changes in ameliorative resource use, and in quality of life outcomes for racially diverse older adults. Our conceptual framework and measures we selected will allow us to offer a more holistic view of the intersection of health care and maintenance of the integrity of the person that follow from traditions of nursing research. Findings of the study should yield systematic guidelines for nursing interventions based on patient education and specialized training for nurses and other health care providers that can help promote patient-centered health care.