Intrainstitutional Relocation and Psychological Outcomes

这项拟议的研究是为了响应NIA试点资助计划对“跨长期护理环境的过渡”的研究请求。我们建议研究机构内迁移在认知表现、情绪、行为问题和社会参与方面的变化。搬迁被定义为“出于各种原因从一个环境搬到另一个环境”。我们建议研究机构内搬迁，即设施内的移动。这可能需要从一个房间移动到另一个房间，从一个单元移动到另一个单元，或者从一个楼层移动到另一个楼层——这是本提案中使用的定义。在同一设施内搬迁可能会使老年人感到非常不安。正如Everard， Rowles和High（1994:520）所说，对于长期护理的居民来说，“房间可能相当于家”。房间可以“成为充满意义和重要性的地方，相当于那些在以前的社区住宅中发展起来的地方。”换房间可能会导致与熟悉的工作人员失去联系，担心财产丢失/损坏，不喜欢新室友，等等。还有一种观点认为，老年人应对搬迁的能力可能有限，可能会导致一种综合症。重新安置压力综合症是“个体因从一个环境转移到另一个环境而经历生理和/或心理障碍的一种状态”。这一领域的许多先前研究存在的一个问题是检测变化的能力。大多数研究的样本量都很小。我们建议使用最新可用的最小数据集（MDS），代表新泽西州的50,000名养老院居民。因此，本研究有更大的能力来检测搬迁的影响。此外，许多研究现在都过时了。在对文献的回顾中，我们发现大多数搬迁研究都是在1985年之前进行的。从那时起，养老院和养老院的居民发生了很大的变化。居民现在病得更重，这可能使他们更容易受到搬迁的影响。了解机构内搬迁是否会导致心理健康问题是很重要的。如果机构内搬迁被证明会促进心理健康下降，那么谨慎搬迁的更有力的理由可能会出现。据推测，随着有心理健康问题的居民数量的减少，养老院可能会更好地为受损居民提供心理健康（和其他）服务。接受机构间搬迁的居民通常在搬迁前参加一个准备计划。我们不知道这些项目在机构内部调动中的使用程度，但坊间证据表明，这种情况很少见。如果发现存在重新安置的机构内影响，这些方案的发展将是适当的下一步。

This proposed research is in response to the NIA Pilot Grant Program request for research of "transitions across long-term care settings." We propose to examine changes in cognitive performance mood, behavior problems, and social engagement as outcomes of intrainstitutional relocations. Relocation is defined as "moving from one environment to another for various reasons." We propose to examine intrainstitutional relocation, which is movement within a facility. This can entail moving from one room to another, from one unit to another, or from one floor to another - and is the definition used in this proposal. Relocation within the same facility may be very disturbing to the elderly. As Everard, Rowles, and High (1994:520) state, "rooms may constitute the equivalent of homes" to long-term care residents. Rooms can "become places imbued with meanings and significance equivalent to those that evolved in their former community residences." Changing rooms may entail loss of connections with familiar staff members, worry of loss/breakages of possessions, wont' over new roommates, to name just a few. There is also a belief that elders' ability to cope with relocation may be limited and may result in a syndrome. Relocation stress syndrome is "a state in which an individual experiences physiological and/or psychological disturbances as a result of a transfer from one environment to another." One problem with many previous studies in this area is the power to detect change. Most studies have low sample sizes. . We propose to use the newly available Minimum Data Set (MDS), representing 50,000 nursing home residents in New Jersey. Thus this study has greater power to detect effects of relocation. Also, many studies are now dated. In a review of the literature we found the majority of relocation studies to be conducted prior to 1985. Nursing homes and residents in nursing homes have changed considerably since this time. Residents are now sicker, this may make them more susceptible to any effects of relocation. Understanding whether intrainstitutional relocation contributes to mental health problems is important. If intra-institutional relocation is shown to promote mental health decline a more powerful rationale for careful relocation may develop. Presumably, with a concomitant reduction in residents with mental health problems, nursing homes may then better provide mental health (and other) services to impaired residents. Residents who undergo interinstitutional relocation often partake in a preparatory program prior to relocation. We do not know the extent of use of these programs for intra-institutional relocation but anecdotal evidence would suggest they are rare. If intra-institutional effects of relocation are found to exist development of these programs would be an appropriate next step.