Understanding the varied experiences of frailty in older age with respect to ethnicity: a mixed methods approach

虽然照顾和管理老年人的虚弱越来越重要，但黑人、亚洲人和少数族裔(BAME)的虚弱经历没有得到充分的研究，因此在旨在支持虚弱老年人的社会政策或临床护理中通常没有考虑到这一点。在日常语言中，“虚弱”这个词经常被用来形容行动不便和独立困难的老年人。这也是卫生专业人员越来越多地使用的一个术语。现在，英国的老年患者在例行的医疗预约中会被筛查是否虚弱。虽然虚弱并不是老年人独有的经历，但它往往与生命的尽头和晚年相关，并在生命的尽头经历。这种体验因人而异，取决于各种因素。这些因素包括个人身体，但也包括种族、男性或女性、教育、住房和环境、文化信仰和宗教、家庭和社会网络、经济状况和爱好/兴趣等因素。当对老年人进行筛查时，这些问题与脆弱之间的关系往往被忽视，但可能会对他们的脆弱体验产生有害影响。出于这些原因，脆弱的经历并不是所有人都一样的。很少有研究探索这种关系，更少的研究明确讨论种族如何影响衰老和虚弱的经历。因此，白人和BAME老年人之间的健康差距持续存在，在晚年尤为明显。因此，该项目试图通过与来自不同种族的广泛老年人交谈，探索在脆弱的经历和管理中重要的因素。要做到这一点，我们将首先分析一项大型研究的数据，该研究涉及40,000户家庭，其中约11,500名参与者来自少数民族背景，该研究名为“理解社会”，旨在强调脆弱与种族之间的关系。我们将利用这些信息来选择特定的老年人群体进行交谈，以便更深入地探讨这一问题。参与者的选择将根据突出对脆弱生活经历的特殊影响的因素，包括种族和性别、阶级、地点和社会背景。我们将研究来自不同族裔背景的老年人所经历的不同经历，包括孟加拉国人、印度人、巴基斯坦人、加勒比黑人和非洲人，以便进行对比和比较，并阐明少数民族老年脆弱经历的独特性质、脆弱性和优势以及如何更好地支持这些经验。在定性研究的第一阶段，我们将对老年人进行光声研究。这将包括给他们相机，让他们拍摄他们脆弱的经历，并谈论这些照片显示了什么和意味着什么。然后，我们将在两年的时间里采访其中一些参与者，以说明任何变化，并梳理出可能支撑这些变化的因素，包括与老年独特相关的风险，但也反映了一生的经历。我们还将采访医疗保健专业人员，探索他们对脆弱的理解。为了提高人们对脆弱体验的重要性的认识，尤其是BAME的体验，我们将利用我们的研究成果来产生以下干预措施：1)在人群层面上了解脆弱的原因的脆弱指数；2)用于临床教育的教育工具包；3)公开展示所拍摄的照片；以及4)在患者层面上以人为中心的“文化能力”工具。我们将与那些参与照顾和支持老年人的人、参与者和其他人分享我们的发现，包括使用短片。

While the care and management of frailty in older people is increasingly important, Black, Asian and Minority Ethnic (BAME) experiences of frailty are under researched and thus generally not accounted for in social policy or clinical care designed to support frail older people. In everyday language, 'frail' is a term that is often used to describe older people struggling with mobility and independence. It is also a term that is increasingly used by health professionals. Older patients in the UK are now screened for frailty in routine healthcare appointments. Although frailty is not an experience that is exclusive to older people, it is often associated with, and experienced towards, the end of life and in deep old age. This experience is different for different people and depends on a variety of factors. These factors include individual bodies but also things like ethnicity, being male or female, education, housing and environment, cultural beliefs and religion, family and social networks, economic situation and hobbies/interests. The relationship between such issues and frailty are often missed when older people are screened but can have a detrimental impact on their experience of frailty. For these reasons, the experience of frailty is not equal for all. Few studies have explored this relationship and fewer still have explicitly addressed how ethnicity affects the experience of ageing and frailty. As a result there is a persistent health gap between White and BAME older people particularly striking in later life. Consequently, this project seeks to explore the factors that are important in the experience and management of frailty by talking to a wide range of older people from different ethnicities. To do this, we will first analyse data from a large study of 40,000 households, of which about 11,500 participants are from an ethnic minority background, called 'Understanding Society' to highlight the relationship between frailty and ethnicity. We will use this information to select particular groups of older people to talk to in order to explore this in more depth. Participants will be selected in accordance with factors that highlight a particular impact on the experience of living with frailty, including ethnicity and gender, class, place and social context. We will look at the different experiences experienced by older people from a variety of ethnic backgrounds, including Bangladeshi, Indian, Pakistani, Black Caribbean and African, in order to draw out contrasts and comparisons and illuminate the unique nature of ethnic minorities' experiences of frailty in old age, the vulnerabilities as well as strengths and how to better support these. In the first stage of our qualitative research we will conduct a photovoice study with the older people. This will involve giving them cameras, asking them to take photographs of their experience of frailty and talking about what the photographs show and mean. We will then interview some of these participants over a two year period to account for any changes and to tease out the factors that may underpin these, including risks uniquely associated with old age but also reflecting back over a lifetime of experience. We will also interview healthcare professionals to explore their understanding of frailty. To raise awareness of the things that are important to the experience of frailty, and the BAME experience in particular, we will use our research findings to generate the following interventions: 1) a frailty index to understand the causes of frailty at a population level; 2) an educational toolkit to be used in clinical education; 3) a public exhibition of the photographs taken; and 4) a person-centred 'cultural competence' tool for understanding frailty at patient level. We will share our findings with those involved in the care and support of older people and older people themselves, participants and others, including by use of a short animation.