Pain in Homebound Older Adults: Association With Race and Ethnicity and Neighborhood Socioeconomic Deprivation

摘要 西奈山老年人独立中心赠款（P30 AG 028741）旨在研究 疼痛对老年人的生活质量、独立性、功能和残疾的影响。这样做的目的 P30 AG 028741的行政补充提案是将父母补助金的重点扩大到 在全国有代表性的居家老年人样本中描述疼痛，评估种族差异 和种族，并检查邻里社会经济剥夺对疼痛的影响。有超过7 在美国，有100万老年人在家。尽管有明显的多发病和高风险， 在住院率和死亡率方面，只有11%的人口在家中获得医疗护理。新的家庭模式- 为满足这一人群的复杂需求，需要提供基于家庭的护理，包括基于家庭的姑息治疗 并应通过对国家代表性样本进行的强有力的流行病学研究提供信息。鉴于其 患病率，对幸福的影响，以及在国家调查中的可用性，疼痛是一个理想的衡量标准， 居家老年人对居家姑息治疗的需求。到目前为止，还没有研究表明， 描述疼痛及其在全国代表性老年人样本中的差异。遵循一 国家少数民族健康和健康差异研究所提供的概念模型 框架，我们提出的研究旨在描述疼痛的一个全国代表性的样本， 老年人，并特别检查（i）种族和民族与疼痛之间的关联;以及（ii） 邻里社会经济剥夺和疼痛之间的联系。研究样本将从 全国代表性的国家健康和老龄化趋势研究，包括1730名老年人分类 在2015年回家。在这项横断面研究中，我们将进行双变量和多变量分析， 来自国家健康和老龄化趋势研究的调查数据和来自美国社区调查的相关数据 研究种族和民族之间的联系，邻里社会经济剥夺（测量为 人口普查区社会发展指数）和自我/代理报告的疼痛。该提案直接针对 特别关注通知（NOSI，NOT-AG-22-005）的目的是加强对 机制（个人，邻里）潜在的疼痛经验，告知战略，以防止和 管理疼痛，并解决居家老年人的疼痛公平问题。这项研究将是第一个 在全国范围内具有代表性的居家老年人样本中检查疼痛， 向描述居家老年人的症状需求和扩大证据基础迈出了一步 来计划家庭姑息治疗结果将提供重要的洞察力的差异，疼痛在这一点上， 人口和邻里社会经济剥夺和症状之间的关联。此外，本发明还 我们创建的多级链接数据集将为未来研究邻里关系的影响奠定基础。 影响居家老年人不同结局的因素。

ABSTRACT The Mount Sinai Older Adults Independence Center grant (P30AG028741) aims to examine the relationship of pain to quality of life, independence, function, and disability in older adults in general. The purpose of this proposal, for an administrative supplement to P30AG028741, is to expand the focus of the parent grant to characterize pain in a nationally representative sample of homebound older adults, assess disparities by race and ethnicity, and examine the impact of neighborhood socioeconomic deprivation on pain. There are over 7 million homebound older adults in the US. Despite having significant multimorbidity and high risk of hospitalization and mortality, just 11% of this population access medical care in the home. New models of home- based care, including home-based palliative care, are needed to address the complex needs of this population and should be informed by robust epidemiological studies in nationally representative samples. Given its prevalence, impact on well-being, and ready availability in national surveys, pain is an ideal metric to estimate the need for home-based palliative care in homebound older adults. To date, there have been no studies characterizing pain and its disparities in a nationally representative sample of older adults. Guided by a conceptual model informed by the National Institute of Minority Health and Health Disparities Research Framework, our proposed study aims to characterize pain in a nationally representative sample of homebound older adults and specifically examine (i) the association between race and ethnicity and pain; and (ii) the association between neighborhood socioeconomic deprivation and pain. The study sample will be drawn from the nationally representative National Health and Aging Trends Study and include 1730 older adults classified as homebound in 2015. In this cross-sectional study, we will undertake bivariate and multivariable analyses of survey data from the National Health and Aging Trends Study and linked data from American Community Survey to examine the association between race and ethnicity, neighborhood socioeconomic deprivation (measured as census tract Social Deprivation Index), and self/proxy-reported pain. This proposal directly addresses the objectives of the Notice of Special Interest (NOSI, NOT-AG-22-005) in enhancing understanding of the mechanisms (individual, neighborhood) underlying the pain experience, informing strategies to prevent and manage pain, and addressing equity in pain among homebound older adults. The study will be the first to examine pain in a nationally representative sample of homebound older adults and represents an important first step towards characterizing the symptom needs of homebound older adults and expanding the evidence base to plan home-based palliative care. The results will provide important insights into disparities in pain in this population and the association between neighborhood socioeconomic deprivation and symptoms. Additionally, the multilevel linked dataset we create will lay the groundwork for future research on the impact of neighborhood factors on diverse outcomes among homebound older adults.