Long Distance Caregiving: Unique Challenges and Service Needs

 描述（由研究者提供）：虽然我们已经开发了一个丰富的知识库，家庭照顾体弱的老人，以及旨在支持照顾者的干预措施，迄今为止，大多数研究都集中在主要的，地理上接近的照顾者。然而，据估计，在美国，多达11%的家庭照顾者和9%的为痴呆症患者提供护理的人，与护理接受者的距离超过两个小时。我们对这一日益增长的现象缺乏深入的了解，特别是它适用于不同社会经济地位和种族/民族群体的照顾者。此R21应用程序旨在通过专门关注远程照顾者（LDC），将先前关于家庭护理的发现范围扩展到受损老年人。拟议研究计划的长期目标是开发一个知识库，用于调整现有的循证护理干预措施（例如，最不发达国家的需求，并最终在实地测试经调整的模式。这一R21应用是这一进程的第一步;项目的目标是深入研究最不发达国家的经验，以了解最不发达国家如何处理距离的结构性制约因素并受其影响，以及这些经验如何因关键特征而有所不同。具体目标是：（1）研究长距离飞行的后果（即，照顾者的福祉，服务需求），并确定与种族和社会经济地位，性别，距离照顾接受者（旅行时间），家庭主义的文化价值和老年人的认知状况相关的亚组差异。(2)识别主要压力源（例如，参与和负担）和次要压力源（例如，工作/家庭冲突）的影响，以及处理这些压力因素和确定分组差异所采用的战略。(3)确定内部和外部资源（例如，应对技能和社会支持），其介导了初级和次级压力源与生存结果之间的关联，包括将旅行距离、种族/社会经济地位、性别、家庭主义和老年认知状况作为重要外生因素的模型。(4)为了确定如何，如果在所有，招聘策略可能会影响调查结果，探讨照顾者的福祉和服务使用之间的差异，我们的主要样本的最不发达国家的老年人与正规服务和二次样本的最不发达国家从一个有代表性的社区小组招募。这项研究的创新之处在于其独特的样本（不同种族和社会经济地位最不发达国家负有主要/共同责任），并侧重于与最不发达国家最相关的问题（例如，技术，而不是方法。将对300个最不发达国家进行深入的电话采访（2小时以上）。（a）将主要/共同主要照顾者（旅行）的年龄分配给接受正式住宿或家庭长期护理服务的族裔/种族多样化的老年人样本。次要样本（n=50）将从中年和老年人的代表性社区样本中抽取。采用混合方法设计，开放和结构化的部分访谈和相应的定性（专题）和定量（SEM）的方法来编码和分析数据。

 DESCRIPTION (provided by investigator): While we have developed a rich knowledge base on family caregiving to frail elders, as well as on interventions designed to support caregivers, most research to date has focused on the primary, geographically proximate caregiver. Yet, it is estimated that as many as 11% of family caregivers in the U.S, and 9% of those providing care to persons with dementia, live more than two hours away from the care receiver. We have little in-depth knowledge about this growing phenomenon, especially as it applies to caregivers across diverse SES and racial/ethnic groups. This R21 application seeks to extend the scope of prior discoveries regarding family care to impaired elders by specifically focusing on the long-distance caregiver (LDC). The long-term goal of the proposed research program is to develop a knowledge base that will be used to adapt existing evidence-based caregiver interventions (e.g., REACH models) to the needs of LDCs and, ultimately, to test adapted models in the field. This R21 application is the first step in this process; with the project goal of examining LCD experiences in-depth to understand how LDCs, deal with, and are affected by, the structural constraint of distance and how the experience differs by key characteristics. The specific objectives are: (1) To examine the long-distance caregiving consequences (i.e., caregiver well-being, service needs) and identify subgroup differences related to ethnic and socioeconomic status, gender, distance to the care recipient (travel hours), the cultural value of familism, and cognitive status of the elder. (2) To identify the primary stressors (e.g., caregiving involvement and burden) and secondary stressors (e.g., work/family conflict) experienced by LDCs, the strategies employed to deal with these stressors and to identify subgroup differences. (3) To determine the internal and external resources (e.g., coping skills and social support) which mediate the association between primary and secondary stressors and caregiving outcomes, including models with travel distance, ethnic/socioeconomic status, gender, familism, and elder cognitive status as important exogenous factors. (4) In order to determine how, if at all, recruitment strategy may influence findings, to explore differences in caregiver well-being and service use between our primary sample of LDCs to elders linked to formal services and a secondary sample of LDCs recruited from a representative community panel. The innovation of this research lies in its unique sample (diverse ethnic and SES LDCs with primary/shared responsibility) and focus on issues most relevant to LDCs (e.g., communication, technology) rather than measures/methods. In-depth telephone interviews will be conducted with 300 LDCs (2+ hrs. travel) who are primary/co-primary caregivers to an ethnically/racially diverse sample of elders who receive formal residential or home-based long-term care services. A secondary sample (n=50) will be drawn from a representative community-based sample of middle- age and older adults. A mixed method design is used, with open and structured parts of the interview and corresponding qualitative (thematic) and quantitative (SEM) approaches to data coding and analyses.