The Risk of Long-Term Care in Older Mexican-American Families

描述（由申请人提供）：墨西哥裔老年人是美国人口中增长最快的群体之一，预计到2050年，他们的数量将增长7倍。这种人口爆炸将对长期护理系统提出严峻的要求，从家庭护理人员到联邦资助的护理来源。墨西哥裔美国人患糖尿病等致残疾病的比例过高，这增加了他们在养老院或辅助生活机构接受护理的风险。然而，这一人群的功能衰退与随后的机构化之间的关系可能在很大程度上受到多种因素的影响，包括经济资源和家庭和社会支持网络。这些因素可能会因出生、移民年龄和文化适应而有所不同。迄今为止，很少有研究测试了预测模型，即移民相关因素、经济资源和家庭支持如何汇聚在一起，决定功能状态下降的墨西哥裔老年个体的护理和生活安排（即独自生活、与配偶或家人一起生活或制度化）。本研究的总体目标是阐明与老年墨西哥裔美国人的护理和生活安排变化相关的最重要因素。我们将评估一个新的经验模型，以确定移民因素（例如，出生、移民年龄、文化适应）和家庭资源（例如，经济安全、家庭和社会支持网络）如何调节功能状态的变化如何导致美国老年墨西哥裔美国人在护理和生活安排方面的变化。研究的主要目的是：(1)考虑移民因素，研究1993 - 2008年墨西哥裔美国老年人的身体和认知功能轨迹；(2)通过移民因素评估老年墨西哥裔美国人功能状态的下降与护理和生活安排的变化之间的关系；(3)估计家庭资源和移民因素对墨西哥裔美国老年人使用养老院和辅助生活设施的共同影响。我们将使用标准的人口统计学和流行病学技术来分析西班牙裔老年人流行病学研究（H-EPESE）中包括的3,952名个体，这是对墨西哥裔美国老年人纵向健康的最大和最具代表性的调查。结果将确定墨西哥裔美国人的护理和生活安排的关键预测因素，包括养老院和辅助生活设施的使用，为未来影响所有老年家庭的社会过程提供重要见解。这项研究还将为决策者和最佳实践模式提供信息，以减少未满足的长期护理服务需求的差异。

DESCRIPTION (provided by applicant): Older people of Mexican origin make up one of the fastest -growing segments of the U.S. population, and their numbers are projected to increase sevenfold by 2050. This demographic explosion will place serious demands on the long-term care system, from family caregivers to federally sponsored sources of care. Mexican Americans suffer disproportionately from disabling conditions like diabetes that increase their risk of care in a nursing home or assisted-living facility. The relationship between functional decline and subsequent institutionalization for this population, however, may be largely influenced by a combination of factors, including economic resources and family and social support network. These factors may, in turn, vary by nativity, age at migration, and acculturation. To date, few studies have tested predictive models on how immigration-related factors, economic resources, and family support converge to determine care and living arrangements (i.e., living alone, living with spouse or family, or institutionalization) in elderly Mexican-origin individuals with declining functional status. The overall goal of this study is to clarify the most important factors associated with changes in the care and living arrangements of elderly Mexican Americans. We will evaluate a new empirical model to determine how immigration factors (e.g., nativity, age at migration, acculturation) and family resources (e.g., financial security, family and social support network) moderate how changes in functional status induce changes in care and living arrangements among older Mexican Americans in the United States. The specific aims are to: (1) examine the physical and cognitive functioning trajectories of elderly Mexican Americans between 1993 and 2008, by immigration factors; (2) assess how declines in functional status of elderly Mexican Americans relate to changes in care and living arrangements, by immigration factors; and (3) estimate the joint effect of family resources and immigration factors on use of nursing homes and assisted- living facilities by elderly Mexican Americans. We will use standard demographic and epidemiological techniques to analyze 3,952 individuals included in the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE), the largest and most representative survey on the longitudinal health of older Mexican Americans. The results will identify key predictors of Mexican Americans' care and living arrangements, including the use of nursing homes and assisted-living facilities, providing important insights into social processes that will affect all aging families in the future. The study will also inform policy makers and best practice models in reducing disparities in unmet long-term care service needs. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE This research will provide invaluable information regarding long-term care for the older Hispanic population in the United States, and specifically the region closest to Mexico, the Southwestern United States, which suffers greatly on most socioeconomic indicators. For cultural reasons, Mexican Americans are much less likely to use formal institutional care as they become infirm with age, regardless of the level of their disability. Traditionally they rely on family for their care which thereby creates a potential dependency burden on these caregivers and social agencies. The ultimate goal of the research is to identify mechanisms for reducing disparities in options in long-term care.