Building Community Capacity for Disability Prevention for Minority Elders

项目总结 尽管少数族裔老年人是美国老龄化人口中增长最快的部分，但他们拥有的财富较少 获得心理保健和预防残疾，远远落后于非拉丁裔白人，并遭受痛苦 巨大的差距。黑人和拉丁裔有最大的残疾风险，在健康方面存在显著差异 衰老。这包括老年移民表现出更高的抑郁和焦虑症状，以及更高的 他们的伤残率高于当地出生人口；然而，他们往往得不到诊断或诊断不足。这是一个 错失了机会，因为情绪障碍的治疗已经被证明可以减少残疾天数，而且 残疾的几个风险因素，如功能活动能力，是可以改变的。研究表明， 促成因素可能是专业提供者的供应不足，以及缺乏证据 向少数族裔老年人提供并为其接受的治疗。国际移民组织的一个委员会最近报告说，严重的 为老年人提供心理健康护理方面的劳动力短缺需要新的方法来解决。至 为了解决这些差距并预防少数族裔老年人中的残疾，拟议的R01审查了如何 成功地为提供循证心理健康和残疾提供协作研究 以社区为基础的环境中的预防治疗。一些国际研究表明，有希望的结果表明 改善心理健康成果的获取和质量，并在采取干预措施时减少残疾 由社区卫生工作者提供，但关于CHW领导的有效性的证据有限且不一致 在美国背景下的干预依然存在。虽然以社区为基础的健康干预措施的数量有所增加 为了解决这些服务差异，缺乏系统地评估它们是否 导致社区能力的提高和系统的改变，以及它们是否改善了护理和医疗质量 可能会潜在地减少残疾。我们提议的研究致力于解决这一局限性。因此， 拟议的R01将是同时研究以下三个组成部分的少数努力之一 成功干预：有效性，因为干预必须起作用，在客户中可接受，和可行性 和组织内部的可持续性。它试图了解伙伴关系在增加 社区对心理健康和残疾预防综合干预的能力，并评估 社区卫生工作者和运动训练师实施干预的可接受性、有效性、可行性和可持续性 拉美裔、非裔美国人和亚洲老年人，有中度到严重的情绪症状和残疾风险。

PROJECT SUMMARY Although minority elders represent the fastest growing segment of an aging US population, they have less access to mental health care and prevention of disability, lagging well behind non-Latino whites, and suffering significant disparities. Blacks and Latinos have the greatest risk for disability, with striking disparities in healthy aging. This includes elderly immigrants who exhibit elevated depressive and anxiety symptoms, and higher rates of disability than the native-born population; yet, they often go undiagnosed or underdiagnosed. This is a missed opportunity given that mood disorder treatment has been shown to reduce disability days and that several risk factors for disability, such as functional mobility are modifiable. Research suggests that a contributing factor may be an insufficient supply of professional providers and the inability of evidence based treatments to reach and be acceptable to minority elders. An IOM committee recently reported that the severe workforce shortages in providing mental health care to elder adults required novel approaches to resolve. To address these disparities and prevent disability among minority elders, the proposed R01 examines how to successfully build collaborative research for the provision of evidence-based mental health and disability prevention treatments in community-based settings. Promising results in a few international studies show improved access and quality of mental health outcomes and reduced disability when interventions are delivered by Community Health Workers, but limited and inconsistent evidence of the efficacy of CHW-led interventions in the US context remains. While the number of community-based health interventions has grown exponentially to address these service disparities, there is a lack of systematic assessment of whether they lead to increased community capacity and systems change, and whether they improve the quality of care and could potentially decrease disability. Our proposed study endeavors to address this limitation. As such, the proposed R01 will be one of few efforts that simultaneously study the three components necessary for a successful intervention: efficacy, since the intervention must work, acceptability among clients, and feasibility and sustainability within the organization. It seeks to understand the role of the partnerships in increasing community capacity for a combined mental health and disability prevention intervention, and evaluating the acceptability, efficacy, feasibility and sustainability of the intervention delivered by CHWs and exercise trainers to Latino, African American and Asian elders with moderate to severe mood symptoms and at risk of disability.