Understanding and addressing the impact of stressful live events on the mental health of older adults in Colombia

哥伦比亚自20世纪50年代以来一直遭受政治暴力，特别是暴力事件，最近贩毒集团和移民流动有关。这严重影响了公民。哥伦比亚人目前正受到全球COVID-19大流行的影响。目前尚不清楚这些事件如何影响居民的心理健康和福祉，特别是老年人。预计到2050年，哥伦比亚老年人的比例将从10%增加到20%。这种增长对哥伦比亚人的影响越来越大，特别是在像安蒂奥基亚省乌拉巴这样的地区，由于国家的忽视和长期政治冲突的持续存在，这些地区在历史上一直遭受着不平等和缺乏发展的痛苦，从而加深了这些结构性不平等。60岁以上的人作为受害者或肇事者（对于那些参加武装团体的人）目睹了该国的暴力历史。这说明他们对冲突有着复杂的理解，并使他们成为和平的倡导者，因为他们目睹了战争的可怕后果-他们遭受了战争的痛苦并从中幸存下来。从这个意义上说，哥伦比亚的老年人是编织冲突生活故事记忆的人，但他们承受着后果。Uraba Antioqueno是过去60年来受哥伦比亚武装冲突影响最严重的地区之一。它被认为是安蒂奥基亚省因武装冲突或暴力而被驱逐人数最多的地区之一，但与此同时，它也是太平洋地区和大西洋沿岸乔科受害者的主要接收地之一，也是非洲和拉丁美洲外国人试图前往美国的移民过境地之一。2020年，413，397名居民（占该地区总人口525，685人的78.6%）登记为武装冲突的受害者。在图尔博，这一比例为64.5%（83 993名受害者）。在该地区，9.7%（n= 14，425）被归类为老年人，生活在城市，农村，城郊和分散的农村地区。我们的建议嵌入了与公共和专业顾问的合作制作。我们已谘询本地长者和专业人士，以决定有关方法和设计项目。这项建议将收集和联合收割机的主要现有数据集，并结合使用心理健康调查、个别访谈和焦点小组收集的新信息，以绘制老年人的心理健康状况和压力，这些老年人经历了数十年的冲突，现在又患上了COVID 19。这些研究结果将与对中低收入国家（LMICs）老年人心理健康干预措施的系统性审查相联系，特别关注冲突幸存者，并与国际学术专家的深入访谈相联系。证据摘要，结合定量和定性数据从涡轮将被用来共同设计和测试基于社区的心理社会护理策略和干预，并为涡轮老年居民，以减少和管理心理健康问题。它将处理在Turbo研究阶段在家庭和社区一级确定的情况，与不同的区域卫生和福利系统和数据集联系起来。然后，当局会就试验计划的成本效益、对精神健康的影响和其他主要因素，以及专业人士和服务使用者的接受程度，进行评估。调查结果将用于为更广泛人群的更大规模的正式试验补助金申请提供信息;以及更广泛地实施该方法的指南，以支持其在哥伦比亚和其他LMIC内的其他人群中的应用;以及从英格兰开始的高收入国家，重点关注解决经历过冲突的移民的心理健康需求。

Colombia has suffered political violence since the 1950s notably la violencia, more recently drug cartel and migrant flows linked. These severely impact citizens. Colombians are now being affected by the global COVID-19 pandemic. It remains unclear how these events are affecting residents' mental health and wellbeing, particularly older adults. The proportion of Colombian older adults is expected to double from 10% to 20% by 2050. This rise increasingly impacting upon Colombians, particularly in regions like Urabá in the Department of Antioquia, that have suffered throughout their history from inequality and lack of development due to inattention from the state and the constant presence of prolonged political conflict that deepens these structural inequalities. Those over 60 years of age have witnessed the history of violence in the country, as victims or perpetrators (for those who were part of armed groups). These account for a complex understanding of the conflict and turn them into the advocates for peace, as they have witnessed the dire consequences of war -they have suffered and survived them. In this sense, the elderly in Colombia are the ones who weave the life-story memories of the conflict, but suffer consequences.Our research centres on the municipality of Turbo, typical of such regions and populations. Uraba Antioqueno has been one of the territories most affected by the Colombian armed conflict in the last six decades. It is considered one of the regions of the Department of Antioquia with the highest numbers of expulsion of people for reasons related to the armed conflict or violence, though at the same time it is one of the main receiving areas for victims from Choco in the Pacific region and the Atlantic coast, as well as the migratory transit of foreigners from Africa and Latin America who seek reaching the United States. In 2020 413,397 inhabitants (78.6% of the total regional population of 525,685) were registered as victims of the armed conflict. In Turbo, the proportion is 64.5% (83,993 victims). In the region, 9.7% (n=14,425) are classed as older adults, living in urban, rural, peri-urban and dispersed rural areas.Our proposal embeds co-production with public and professional advisors throughout. We have already been undertaking consultations with local older residents and professionals in determining the approach and designing the project.This proposal will collect and combine key existing datasets added to new information collected using mental health surveys and both individual interviews and focus groups to map the mental health condition and pressures on older adults, suffering from decades of conflict and now COVID19. These findings will link with a systematic review of interventions to support the mental health of older adults in lower and middle income countries (LMICs), with a particular focus on conflict survivors, linked to in-depth interviews with international academic experts. The evidence summary, combined with quantitative and qualitative data from Turbo will be used to co-design and test a community-based psychosocial care strategy and intervention with, and for, Turbo older residents to reduce and manage mental health problems. It will address the situations identified at family and community levels in the Turbo research phases, linking with different regional health and welfare systems and datasets. This will then be evaluated as a pilot for its cost effectiveness, impact on mental health and other key factors as well as acceptability to professionals and service users. The findings will be used to inform a larger formal trial grant application across wider populations; as well as guides to implementing the approach more widely to support its application across other populations, within Colombia and other LMICs; as well as higher income countries, starting with England, with a focus on addressing the mental health needs of migrants who have experienced conflict.