Long Distance Caregiving: Unique Challenges and Service Needs

 描述(由调查员提供)：虽然我们已经建立了丰富的关于对虚弱老年人的家庭照料以及旨在支持照顾者的干预措施的知识库，但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家庭照顾者住在离护理接受者两个小时以上的地方。我们对这一日益增长的现象知之甚少，特别是当它适用于不同社会经济地位和种族/民族群体的照顾者时。此R21应用程序旨在通过专门关注远程照顾者(LDC)，将先前发现的家庭护理的范围扩展到受损的老年人。拟议研究计划的长期目标是开发一个知识库，用于使现有的循证照顾者干预措施(例如，REACH模型)适应最不发达国家的需求，并最终在实地测试适应的模型。R21应用是这一进程的第一步；项目目标是深入审查液晶显示器的经验，以了解最不发达国家如何应对距离的结构性限制并受到其影响，以及经验如何因关键特征而有所不同。具体目标是：(1)审查远程照看的后果(即照顾者的幸福感、服务需求)，并确定与种族和社会经济地位、性别、与照顾者的距离(旅行时间)、家庭主义的文化价值和老年人的认知状况有关的亚群差异。(2)查明最不发达国家经历的主要压力源(如照料参与和负担)和次要压力源(如工作/家庭冲突)，以及为处理这些压力源和确定分组差异而采取的战略。(3)确定主要和次要应激源与照料结果之间的联系的内部和外部资源(例如，应对技能和社会支持)，包括以旅行距离、种族/社会经济地位、性别、家族主义和老年人认知状况为重要外生因素的模型。(4)为了确定征聘战略可能如何影响调查结果，探讨我们的主要最不发达国家样本与从具有代表性的社区小组招募的第二样本最不发达国家之间在照顾者福祉和服务使用方面的差异。这项研究的创新之处在于其独特的样本(具有主要/共同责任的不同族裔和SES最不发达国家)，并侧重于与最不发达国家最相关的问题(例如，通信、技术)，而不是措施/方法。将对300个最不发达国家(2小时以上)进行深入的电话采访。为接受正式住宿或以家庭为基础的长期护理服务的不同族裔/种族的老年人提供主要/共同主要照顾者。第二样本(n=50)将从具有代表性的以社区为基础的中老年人样本中抽取。研究采用混合方法设计，访谈采用开放式和结构化的部分，并采用相应的定性(主题)和定量(SEM)方法进行数据编码和分析。

 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.