The Caregiving Trajectory for Community-Dwelling Mexican-American Elders

描述（由申请人提供）：西班牙裔护理人员的护理负担是一个鲜为人知的问题。因此，研究解决照顾者负担和防止这些人口的机构是至关重要的。据估计，美国有超过4200万拉美裔人，65岁以上的人群预计将比任何其他种族或族裔群体增长更快，到2050年将增加两倍。13%的西班牙裔家庭目前为50岁或以上的成年人提供护理，到2050年，他们的预期寿命将增加到87岁，超过所有其他族裔。考虑到人口结构的这种巨大变化，越来越多的西班牙裔家庭将被置于一个新的角色。本研究的目的是通过描述护理人员负担/压力的水平、情况和后果，并确定文化和背景变量对护理人员负担和护理人员收益的影响，沿着导致入住疗养院的因素，来调查这一高危人群的护理负担。该项目是一项纵向混合方法描述性研究，旨在深入探讨墨西哥裔美国人家庭中的护理，护理负担和压力，护理人员的收益和入住养老院的自然过程。将入组110例接受治疗的患者，并随访15个月。将在基线和每10周完成一次访谈和标准化问卷，如果入住疗养院，则需要额外的测量点。我们将比较和对比的过渡和转折点在收容轨迹（考虑到文化适应，照顾者的关系，性别，功能和认知状态的性质，和抑郁症）;确定支持收容的因素;并确定哪些因素是最重要的延迟机构化。核心组成部分将是一个面向案例的方法，也就是说，一个密集的，质量驱动的，案件的研究，着眼于配置的相似性和差异。一个同步的、互补的、定量驱动的、面向变量的组件将寻找跨案例的广泛模式，并能够根据这些广泛模式进行推断。这些方法将贯穿于研究的分析和解释阶段。这种深入的，系统的研究，到养老的轨迹应该证明是有用的，在设计干预措施，定时发生的同时，与已知的危机点，并帮助保持老人在家里或帮助家庭承认，当正式的养老院护理应该寻求。项目叙述使用生命历程的角度来看，这个纵向的，描述性的，混合方法的研究，旨在探讨自然的过程中，110个墨西哥裔美国家庭的养老院，负担和应变，照顾者的收益，并入场。核心组成部分将是一个面向案例的方法，也就是说，一个密集的，质量驱动的，案件的研究，着眼于配置的相似性和差异。一个同步的、互补的、定量驱动的、面向变量的组件将寻找跨案例的广泛模式，并能够根据这些广泛模式进行推断。我们将比较和对比的过渡和转折点的康复轨迹（考虑到文化适应，护理接受者的关系，性别，功能和认知状态的性质，和抑郁症）;确定支持康复的因素;并确定哪些因素是最重要的延迟疗养院入院。

DESCRIPTION (provided by applicant): Caregiving burden among Hispanic caregivers is a little understood and growing problem. As a result, research to address caregiver burden and prevent institutionalization in these populations is critical. It is estimated that there are over 42 million Hispanics in the U.S. and the cohort over age 65 is expected to grow faster than any other racial or ethnic group, tripling in number by 2050. Thirteen percent of Hispanic households currently provide care to an adult aged 50 or older whose life expectancy will increase to 87 years by 2050, surpassing all other ethnic groups. Given this dramatic shift in demographics, a burgeoning number of Hispanic families will be placed in a caregiving role. The purpose of this proposed study is to investigate the burden of caregiving in this at-risk population by describing the level, circumstances, and consequences of caregiver burden/strain, and determining the impact of cultural and contextual variables on caregiving and caregiver gain, along with factors that lead to nursing home admission. This proposed project is a longitudinal mixed methods descriptive study designed to intensively explore the natural course of caregiving, caregiving burden and strain, caregiver gain, and admission to nursing homes among Mexican-American families. One hundred ten caregiver-care recipient cases will be enrolled and followed for 15 months. Interviews and standardized questionnaires will be completed at baseline and every 10 weeks, with an additional measurement point if nursing home admission occurs. We will compare and contrast transitions and turning points in the caregiving trajectory (taking into account acculturation, the nature of the caregiver-care recipient relationship, gender, functional and cognitive status, and depression); identify factors that support caregiving; and determine what factors are most important in delaying institutionalization. The core component will be a case-oriented approach, that is, an intensive, qualitatively-driven, study of cases with an eye toward configurations of similarities and differences. A simultaneous, complementary, quantitatively-driven variable-oriented component will look for broad patterns across cases and enable the drawing of inferences based on these broad patterns. These approaches will be integrated throughout the analytic and interpretive phases of the study. This in-depth, systematic research into the caregiving trajectory should prove useful in designing interventions that are timed to occur simultaneously with known crisis points and help keep elders at home or to help families acknowledge when formal nursing home care should be sought. PROJECT NARRATIVE Using life course perspective, this longitudinal, descriptive, mixed methods study is designed to explore the natural course of caregiving, caregiving burden and strain, caregiver gain, and admission to nursing homes among 110 Mexican-American families. The core component will be a case-oriented approach, that is, an intensive, qualitatively-driven, study of cases with an eye toward configurations of similarities and differences. A simultaneous, complementary, quantitatively-driven variable-oriented component will look for broad patterns across cases and enable the drawing of inferences based on these broad patterns. We will compare and contrast transitions and turning points in the caregiving trajectory (taking into account acculturation, the nature of the caregiver-care recipient relationship, gender, functional and cognitive status, and depression); identify factors that support caregiving; and determine what factors are most important in delaying nursing home admission.