Building Community Capacity for Disability Prevention for Minority Elders

建设少数民族老年人残疾预防的社区能力

• 批准号: 9266764
• 负责人: MARGARITA ALEGRIA
• 金额: $ 75.84万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-31 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9266764
• 关键词: Activities of Daily Living; Acute; Address; Adopted; Adoption; Adult; Affect; African American; Aging; Alcohol or Other Drugs use; Asians; Caring; Chronic; Client; Clinic; Communities; Community Health; Community Health Aides; Depressed mood; Development; Elderly; Emotional; Employee Strikes; Environment; Evidence based intervention; Evidence based treatment; Exercise; Exhibits; Generic Drugs; Health; Healthcare; Human Resources; Immigrant; Improve Access; International; Intervention; Knowledge; Language; Latino; Lead; Life; Long-Term Care for Elderly; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Minority; Modeling; Mood Disorders; Native-Born; Neighborhoods; Outcome; Patients; Population; Prevention; Preventive Intervention; Primary Health Care; Provider; Psyche structure; Quality of Care; Relative Risks; Reporting; Research; Research Personnel; Research Support; Resources; Risk; Risk Factors; Role; Services; Source; System; Testing; Training; Treatment Efficacy; Work; aging population; anxiety symptoms; base; bilingualism; body system; burden of illness; community building; community setting; depressive symptoms; disability; disparity reduction; efficacy testing; evidence base; healthy aging; improved; low income country; mental development; mood symptom; novel strategies; premature; prevent; prevention service; programs; public health relevance; social stigma; successful intervention

DESCRIPTION (provided by applicant): Although minority elders represent the fastest growing segment of an aging US population, they have less access to mental health care and prevention of disability, lagging well behind non-Latino whites, and suffering significant disparities. Blacks and Latinos have the greatest risk for disability, with striking disparities in healthy aging. This includes elderly immigrants who exhibit elevated depressive and anxiety symptoms, and higher rates of disability than the native-born population; yet, they often go undiagnosed or underdiagnosed. This is a missed opportunity given that mood disorder treatment has been shown to reduce disability days and that several risk factors for disability, such as functional mobility are modifiable. Research suggests that a contributing factor may be an insufficient supply of professional providers and the inability of evidence based treatments to reach and be acceptable to minority elders. An IOM committee recently reported that the severe workforce shortages in providing mental health care to elder adults required novel approaches to resolve. To address these disparities and prevent disability among minority elders, the proposed R01 examines how to successfully build collaborative research for the provision of evidence-based mental health and disability prevention treatments in community-based settings. Promising results in a few international studies show improved access and quality of mental health outcomes and reduced disability when interventions are delivered by Community Health Workers. Yet limited and inconsistent evidence of the efficacy of CHW-led interventions in the US context remains. While the number of community-based health interventions has grown exponentially to address these service disparities, there is a lack of systematic assessment of whether they lead to increased community capacity and systems change, and whether they improve the quality of care and potentially decrease disability. Our proposed study endeavors to address this limitation. As such, the proposed R01 will be one of few efforts that simultaneously study the three components necessary for a successful intervention: efficacy, since the intervention must work, acceptability among clients, and feasibility and sustainability within the organization. It seeks to understand the role of the partnerships in increasing community capacity for a combined mental health and disability prevention intervention, and evaluating the acceptability, efficacy, feasibility and sustainability of the intervention delivere by CHWs and exercise trainers to Latino, African American and Asian elders with moderate to severe mood symptoms and at risk of disability.

描述（由申请人提供）：尽管少数族裔长者代表了美国老年人口中增长最快的部分，但他们获得了精神保健和预防残疾的机会，远远落后于非Latino白人，并且存在很大的差异。黑人和拉丁美洲人的残疾风险最大，差距明显 健康衰老。这包括与本地出生的人群相比，老年移民表现出抑郁症和焦虑症状升高，残疾率更高。然而，他们经常没有被诊断或诊断不足。鉴于情绪障碍的治疗已被证明减少了残疾天数，并且有几种残疾风险因素（例如功能活动性）是可修改的，这是一个错过的机会。研究表明，一个促成因素可能是专业提供者的供应不足，并且无法获得基于证据的治疗方法无法接触并被少数族裔长者接受。 IOM委员会最近报告说，向老年人提供精神卫生保健的严重劳动力短缺需要解决新的方法来解决。为了解决这些差异并防止少数族裔长者之间的残疾，拟议的R01研究了如何成功建立协作研究，以在基于社区的环境中提供基于证据的心理健康和残疾预防治疗。在一些国际研究中，有希望的结果表明，当社区卫生工作者提供干预措施时，心理健康成果的获取和质量减少了。然而，有限且不一致的证据证明了CHW领导的干预措施在美国的情况下仍然存在。尽管基于社区的健康干预措施的数量已成倍增长，以解决这些服务差异，但缺乏系统的评估，即它们是否导致社区能力和系统变化，以及它们是否改善了护理质量并可能降低残疾。我们提出的研究努力解决这一局限性。因此，拟议的R01将是同时研究成功干预所需的三个组成部分的少数努力之一：疗效，因为干预必须起作用，客户之间的可接受性以及组织内部的可行性和可持续性。它试图了解伙伴关系在提高社区心理健康和残疾预防干预措施的能力中的作用，并评估CHW和运动培训者对拉丁裔，非裔美国人和亚洲长者的可接受性，有效性，有效性，可行性和可持续性，具有严重的情绪症状和不受欢迎的风险。