HEALTH CARE PARTNERSHIPS AND SELF CARE OF OLDER ADULTS

我们将研究医疗保健合作伙伴（初级保健医生和健康重要其他人）的反应和老年人（80岁以上）进行的自我护理如何减少慢性疾病对他们功能的不利影响，并帮助最大限度地提高他们的生活质量。 医生、患者和健康重要的其他人被视为护理的合作伙伴，健康护理合作伙伴的响应能力增强了患者的预防和纠正自我护理。 将从老年人获得有关自我保健目标和策略的广泛数据，与医疗保健合作伙伴，其他提供者和非专业健康顾问的协商模式，以及有关医疗保健合作伙伴的感知响应。 一个主要的创新重点的研究处理之间的相互影响的响应的医疗保健合作伙伴的支持使用模式的长者。将考虑患者与医生和健康重要其他人互动的补充和补偿模型。 我们将对居住在阳光地带退休社区的老年人和广泛的城市老年人和少数民族进行长期纵向随访。 我们将根据对佛罗里达约350名受访者和克利夫兰约350名受访者的家庭访谈，每年收集四次数据。 这些老年人构成承诺队列中的两个概率样本的社区为基础的老年人。 根据先前的自然减员率，预计第四年随访的合并样本量为527名老年人。 我们还将每年与基层保健医生和健康重要其他人进行电话调查，以确定在病人知识，参与和沟通方面的反应。 我们将使用最小二乘回归、结构方程、潜在增长曲线分析和事件历史分析来测试我们关于残疾级联缓冲区的综合因果模型。 具体而言，我们将研究患者响应式医疗护理，外行支持和主动适应从慢性疾病到残疾和生活质量下降的进展的缓冲作用。 还将获得关于医疗保健满意度、死亡率和护理费用（基于医疗保险记录的信息）的数据，作为突出的医疗结局变量。

We will examine how responsiveness of Health Care Partners (Primary Care Physicians and Health Significant Others) and self- care undertaken by old-old adults (80+) lessens the adverse impact of chronic illness on their ability to function and help maximize the quality of their lives. Physicians, patients, and Health Significant Others are seen as partners in care, with responsiveness of Health Care Partners enhancing preventive and corrective self-care by patients. Extensive data will be obtained from elders about self-care goals and strategies, patterns of consultation with Health Care Partners, other providers, and lay health consultants, and about perceived responsiveness of Health Care Partners. A major innovative focus of the study deals with mutual influences between responsiveness of Health Care Partners on patterns of support use by elders. Complementary and compensatory models of patient interaction with physicians and Health Significant Others will be considered. We will obtain a long term longitudinal follow-up of old-old adults living in sunbelt retirement communities and a broad cross-section of urban elderly and racial minorities. We will collect four annual waves of data based on in-home interviews of an estimated 350 respondents in Florida and 350 respondents in Cleveland. These elderly constitute committed cohorts in two probability samples of community-based elders. Based on prior attrition rates, a combined sample size of 527 elderly persons is projected for the fourth year follow-up. We will also conduct annual telephone surveys with Primary Care Physicians and Health Significant Others of respondents to ascertain responsiveness in terms of patient knowledge, involvement and communication. We will use least squares regression, structural equations, latent growth curve analysis, and event history analysis to test our comprehensive causal model regarding buffers of the Disability Cascade. Specifically, we will examine the buffering effects of patient-responsive medical care, lay support, and proactive adaptation on the progression from chronic illness to disability and diminished quality of life. Data will also be obtained on satisfaction with health care, mortality and cost of care (information based on Medicare records) as salient medical outcome variables.