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部分之一，预计到2050年，他们的人数将增加七倍。这种人口爆炸将对长期护理系统提出严重的要求，从家庭护理人员到联邦资助的护理来源。墨西哥裔美国人不成比例地患有糖尿病等残疾，这增加了他们在养老院或辅助生活设施中接受护理的风险。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经济资源以及家庭和社会支持网络等因素的综合影响。这些因素可能，反过来，不同的出生，年龄在迁移，和文化适应。到目前为止，很少有研究测试了移民相关因素，经济资源和家庭支持如何融合以确定护理和生活安排的预测模型（即，单独生活、与配偶或家人生活、或机构化）的墨西哥裔老年人功能状态下降。这项研究的总体目标是澄清与老年墨西哥裔美国人的护理和生活安排的变化相关的最重要的因素。我们将评估一个新的经验模型，以确定如何移民因素（例如，出生地、移民年龄、文化适应）和家庭资源（例如，经济保障、家庭和社会支持网络）调节功能状态的变化如何引起美国墨西哥裔美国老年人的护理和生活安排的变化。具体目标是：（1）通过移民因素检查1993年至2008年期间墨西哥裔美国老年人的身体和认知功能轨迹;（2）通过移民因素评估墨西哥裔美国老年人功能状态的下降与护理和生活安排的变化之间的关系;以及（3）估计家庭资源和移民因素对墨西哥裔美国老人使用疗养院和辅助生活设施的联合影响。我们将使用标准的人口统计学和流行病学技术来分析3,952人，这些人包括在西班牙裔老年人流行病学研究（H-EPESE）中，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。研究结果将确定墨西哥裔美国人护理和生活安排的关键预测因素，包括使用养老院和辅助生活设施，为未来影响所有老龄化家庭的社会进程提供重要见解。这项研究还将为决策者提供信息，并为减少长期护理服务需求未得到满足方面的差距提供最佳做法模式。 公共卫生相关性：项目叙述这项研究将提供有关长期护理的西班牙裔老年人在美国的宝贵信息，特别是最接近墨西哥的地区，美国西南部，这在大多数社会经济指标上受到极大的影响。由于文化原因，墨西哥裔美国人不太可能使用正式的机构护理，因为他们随着年龄的增长而变得虚弱，无论他们的残疾程度如何。传统上，他们依靠家庭照顾，从而给这些照顾者和社会机构造成了潜在的依赖负担。研究的最终目标是确定减少长期护理选择差异的机制。

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.