Function, caregiving and adequacy of support before and after the transition to institutional settings

项目总结/摘要 当老年人晚年的功能障碍压倒了现有的生计时，老年人及其照顾者 通常考虑是否从家里搬到一个机构，如养老院，辅助生活设施或 老人院舍是最适合他们的。个人和护理人员希望临床医生能帮助他们 决定，但临床医生可以用来提供指导的证据和框架在很大程度上缺乏。我们可以 改善临床医生如何帮助患者和护理人员通过决策辅助工具导航这一过程， 首先需要关于以个人和个人为中心的衡量标准如何随着制度化而变化的数据， 更好地了解人们和护理人员需要什么信息。这项建议的目的是 通过混合方法提供这些数据和理解。目标1将产生第一个全国性的 对功能轨迹的代表性描述、康复和支持的充分性（例如， 由于缺乏帮助，他们洗澡的次数少于他们想要的次数）， 在预先指定的亚组中，轨迹有意义地不同（例如，按年龄、种族或机构类型）。目标2将 探讨最近入住养老院的老年人及其照顾者的经验， 在他们的过渡过程中，有哪些信息（如果有的话）是和将 都很有用我们整合我们的方法，使用目标1的结果来通知抽样，并提出 目标1中的调查结果到目标2中的受访者;通过探索对一个具体例子的反馈，我们将获得 更好地了解哪些类型的信息对应对这一转变的人有用。在一起， 这些目标将成为今后为机构化进程开发决策辅助工具的基础 然后在随机对照试验中实施和评估它们。

PROJECT SUMMARY/ABSTRACT When functional impairments in later life overwhelm available caregiving, older persons and their caregivers commonly consider if moving from home into an institution, such as a nursing home, assisted living facility or residential care facility for the elderly, is best for them. Persons and caregivers hope clinicians will help them decide, but evidence and frameworks that clinicians can use to provide guidance are largely absent. We could improve how clinicians help patients and caregivers navigate this process through a decision aid, but an aid first requires data on how person- and caregiver-centered measures change with institutionalization and a better understanding of what information persons and caregivers want. The objective of this proposal is to supply those data and that understanding through mixed methods. Aim 1 will produce the first nationally representative descriptions of trajectories in function, caregiving, and adequacy of support (eg, did persons bathe less than they wanted due to lack of help) in the year before and after institutionalization and examine if trajectories meaningfully differ in pre-specified subgroups (eg, by age, race, or type of institution). Aim 2 will explore the experience of recently institutionalized older persons and their caregivers to understand the role of function, caregiving and inadequate support in their transition and what information (if any) was and would have been useful. We integrate our methods by using results from Aim 1 to inform sampling and by presenting findings from Aim 1 to interviewees in Aim 2; by exploring feedback to a concrete example, we will gain a better understanding of what kinds of information are useful to persons navigating this transition. Together, these aims will be the foundation for future work developing decision aids for the institutionalization process and then implementing and evaluating them in randomized controlled trials.