Daily Dynamics and Long-Term Trajectories of Elder Abuse and Neglect in the Family Caregiving

家庭护理中虐待和忽视老年人的日常动态和长期轨迹

基本信息

批准号：
10224951
负责人：
Carolyn E Ziminski Pickering
金额：
$ 25.45万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-08-07
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10224951
关键词：
Address Alzheimer&apos s Disease American Attention Behavioral Symptoms Caregiver Burden Caregivers Caring Characteristics Cohort Studies Collaborations Communities Cross-Sectional Studies Data Data Collection Dementia Dementia caregivers Dependence Development Dimensions Elder Abuse Etiology Event Family Caregiver Family Violence Family member Future Goals Health Health Policy Individual Individual Differences Intake Intervention Life Life Experience Link Longitudinal Studies Mandatory Reporting Measurement Measures Methodology Modeling Nature Participant Pathway interactions Pattern Periodicity Personal Attribute Personal Satisfaction Persons Pilot Projects Policies Predisposition Prevalence Prevention Probability Public Health Questionnaires Reporting Research Risk Risk Factors Risk Reduction Series Social Power Stress Surveys Technology Telephone Testing Time Work abuse neglect base care recipients caregiving contextual factors control theory dementia care design diaries emotional abuse experience family caregiving follow-up health assessment innovation mild cognitive impairment modifiable risk multilevel analysis person centered personalized approach physical abuse preventive intervention prospective protective factors psychologic psychological neglect social cognitive theory social learning stress symptom stressor theories therapy development

项目摘要

Over 47% of family members who care for a relative with Alzheimer’s disease or a related dementia (ADRD) engage in physical or psychological abuse or neglect. Cross-sectional studies report caregiver stress and behavioral symptoms of dementia are correlated with elder abuse and neglect (EAN), making the caregiver burden theory the leading explanation for EAN. Our pilot work found that the causal pathway between caregiver burden and EAN may only hold true under certain situations with evidence that the subtypes of EAN (physical abuse, psychological abuse, neglect) are enacted through different mechanisms. This suggests that the caregiver burden theory may not wholly explain EAN by ADRD family caregivers, and that other explanations offered for family violence (power and control, social learning, ecological frameworks) may explain EAN in situations when the caregiver burden theory does not. Accordingly, our project will develop a more nuanced understanding of how, when and for whom the caregiver burden theory does apply and identify alternative explanations for when the burden theory does not fit our data. To achieve our goal of understanding the contextual-dependency of modifiable risk and protective factors in predicting EAN events within ADRD family caregiving, our prospective observational cohort study will employ an innovative multi-time series design with three measurement periods over the course of a year. English and Spanish speaking family caregivers of those with ADRD or mild cognitive impairment (N=760) will complete surveys to capture long-term patterns in health and wellbeing at intake, month 6 and 12. Immediately following each time point, participants will complete 21daily diary surveys to capture varying daily dynamics of caregivers’ experiences. We will use multi-level models (HLM) to account for the daily observations in three follow up periods nested in people. In aim 1, we will evaluate the direct and interaction effects of various daily dynamics (care and non-care related stressors, contextual moderators) in predicting EAN events, testing hypotheses offered by the caregiver burden theory. In aim 2, using the 6-month measures we will evaluate the effects of various long-term patterns in health and wellness, testing hypotheses offered by the caregiver burden theory. We will also test for cross-level interactions consistent with the ecological framework. In aim 3, using data collected at intake we will examine the extent to which person-level attributes predict EAN events, testing hypotheses offered by the caregiver burden, social learning and power and control theories. Finally, because the ecological framework suggests that these theories are not mutually exclusive, we will test for cross-level interactions in this 3-level HLM to predict EAN events. The study findings will significantly impact the field, by laying the groundwork for further intervention development to support ADRD caregivers and care recipients, and serving as a methodological model for understanding EAN in other contexts. The framework will inform intervention strategies on multiple levels, spanning from individualized person-centered approaches to public health programming and policy.

超过47％的家庭成员关心患有阿尔茨海默氏病的亲戚或相关痴呆症（ADRD）从事身体或心理虐待或忽视。横断面研究报告了护理人员的压力和痴呆症的行为症状与旧的虐待和忽视（EAN）相关，使护理人员伯恩理论成为EAN的主要解释。我们的飞行员工作发现，护理人员伯恩和EAN之间的因果途径只有在某些情况下才能实现，并证明EAN的亚型（身体虐待，心理虐待，忽视）是通过不同的机制制定的。这表明，护理人员伯恩理论可能无法完全解释ADRD家庭护理人员的EAN，并且对于家庭暴力（权力和控制，社会学习，生态框架）提供的其他解释可能会在照料者伯恩理论没有的情况下解释EAN。据此，我们的项目将对照顾者燃烧理论的何时，何时以及为谁适用并确定何时燃烧理论不符合我们的数据的替代解释。为了实现我们了解可修改风险和保护因素在预测ADRD家庭护理中的EAN事件时的上下文依赖性的目标，我们的前瞻性观察群体研究将采用创新的多时间系列设计，并在一年的时间内采用三个测量期。英语和西班牙语的家庭护理人员对患有ADRD或轻度认知障碍的人（n = 760）将完成调查，以捕获第6个月和第12个月的健康和福祉的长期模式。在每个时间点之后，参与者将完成21天的日记调查，以捕捉各种护理人员的日常动态。我们将使用多级模型（HLM）来说明嵌套在人中的三个随访期内的每日观察。在AIM 1中，我们将评估各种日常动态（护理和非护理相关的压力源，上下文主持人）的直接和相互作用效应，在预测EAN事件，测试护理人员Burnen理论提供的假设。在AIM 2中，使用6个月的措施，我们将评估各种长期模式对健康和保健的影响，并测试护理人员伯恩理论提供的假设。我们还将测试与生态框架一致的跨层次相互作用。在AIM 3中，使用摄入量收集的数据，我们将研究人级属性预测EAN事件的程度，测试Caregiver Burnen提供的假设，社会学习，权力和控制理论。最后，由于生态框架表明这些理论不是相互排斥的，因此我们将在此3级HLM中测试跨层次相互作用，以预测EAN事件。研究结果将通过为进一步的干预开发奠定基础来支持ADRD护理人员和护理人员，并作为在其他情况下理解EAN的方法论模型，从而对该领域产生重大影响。该框架将在多个层面上为干预策略提供信息，涵盖以个人为中心的方法到公共卫生计划和政策。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Dynamic structural equation modelling evaluating the progressively lowered stress threshold as an explanation for behavioural symptoms of dementia.

DOI：
10.1111/jan.15173
发表时间：
2022-08
期刊：
JOURNAL OF ADVANCED NURSING
影响因子：
3.8
作者：
Pickering, Carolyn E. Z.;Yefimova, Maria;Wang, Danny;Maxwell, Christopher D.;Jablonski, Rita
通讯作者：
Jablonski, Rita

Early Stages of COVID-19 Pandemic Had No Discernable Impact on Risk of Elder Abuse and Neglect Among Dementia Family Caregivers: A Daily Diary Study.

DOI：
10.1007/s10896-022-00392-8
发表时间：
2022-05-11
期刊：
JOURNAL OF FAMILY VIOLENCE
影响因子：
3.8
作者：
Pickering, Carolyn E Z;Maxwell, Christopher D;Yefimova, Maria;Wang, Danny;Puga, Frank;Sullivan, Tami
通讯作者：
Sullivan, Tami