"Improving Health Equity in Long-Term Care Residents with Dementia: The Role of Race and Ethnicity in Resident-to-Resident Aggression"

“改善患有痴呆症的长期护理居民的健康公平：种族和民族在居民之间的攻击行为中的作用”

• 批准号: 10644715
• 负责人: E-Shien Chang
• 金额: $ 12.15万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10644715
• 关键词: Active Learning; Address; Administrator; Advocacy; Aggressive behavior; Alzheimer' s disease related dementia; Automobile Driving; Award; Basic Science; Behavior Therapy; Behavioral Symptoms; Caring; Certification; Characteristics; Cluster randomized trial; Cohort Studies; Competence; Conflict (Psychology); Data; Data Set; Dementia; Development; Discipline; Discipline of Nursing; Disinhibition; Education; Educational Intervention; Elder Abuse; Elder abuse prevention; Elderly; Equity; Ethnic Origin; Feedback; Focus Groups; Funding; Goals; Health; Impaired cognition; Individual; Injury; Intervention; Knowledge; Lead; Leadership; Learning Module; Long-Term Care; Measurable; Mentors; Mentorship; Methods; Minority; Modeling; Nursing Homes; Pattern; Play; Policy Making; Population; Positioning Attribute; Prevalence; Prevention; Prevention strategy; Productivity; Prospective Studies; Provider; Race; Research; Research Personnel; Risk; Role; Safety; Scientist; Societies; Summary Reports; Surveys; Symptoms; System; Testing; Time; Training; United States National Institutes of Health; Violence; Work; acceptability and feasibility; career; career development; community setting; design; efficacy evaluation; ethnic diversity; ethnic health disparity; ethnic minority; evidence base; experience; feasibility testing; health disparity; health equity; high risk; implementation science; improved; intervention program; maltreatment; mild cognitive impairment; multilevel analysis; novel; pilot test; prevent; programs; prospective; psychological distress; public health priorities; public health research; racial diversity; racial health disparity; racial minority; racism; resilience factor; response; skills; social; social health determinants; therapy development; trend; verbal

Resident-to-resident aggression (RRA) in long-term care (LTC) is associated with preventable injury, suffering, and serious psychological distress. One in five residents in nursing homes (NH) experiences RRA in a given month. Residents with Alzheimer's Disease and Related Dementias (ADRD) are at an even higher risk of RRA due to cognitive impairment-related symptoms. However, RRA remains poorly understood. The race and ethnicity of residents may play an important role in RRA initiation and escalation, risk/resilience factors, consequences, and NH response systems. As NH populations are becoming increasingly racially/ethnically diverse, focusing on the role of race/ethnicity in RRA allows for the development of a tailored prevention and intervention to identify and address it, as many residents involved in RRA have ADRD and are unable to speak for themselves. The goal of this equity-driven project is to systematically investigate the role of race/ethnicity in the types, patterns, and circumstances surrounding RRA using the first prevalence cohort study of RRA, and collecting additional stakeholder input with explicit consideration of the needs of residents with ADRD, to develop, refine, and pilot-test a novel intervention. In Aim 1, I will leverage the first and only NIH-funded RRA prevalence cohort study to qualitatively contextualizing and quantitatively examining the role of race/ethnicity in RRA across individual, dyadic, and facility levels. Aim 2, I will gather input from multiple NH stakeholders to improve understanding of the role of race/ethnicity in RRA, and to identify current and optimal intervention and prevention strategies in residents with and without ADRD via mixed methods approach. In Aims 3a and 3b, findings from Aim 1 and Aim 2 will be used to develop and refine a staff education intervention focused on the role of race/ethnicity in RRA that may be integrated into an existing RRA intervention program that does not currently have information regarding race/ethnicity. As a social scientist trained in public health research, I am ideally positioned to spearhead this line of research, given my productive track record in social determinants of health and elder mistreatment research. Through the award period, I will build upon my prior training to develop new knowledge and skills in long-term care research (Aim 1; Training Objective 1); health equity research (Aim 1; Training Objective 2); long-term care policy-making, advocacy, and leadership (Aim 2; Training Objective 3); and behavioral intervention and implementation science (Aim 3a, 3b; Training Objective 3). Career development activities will consist of formal coursework, experiential learning and research opportunities, and mentorship from experts in elder mistreatment, RRA research, health disparities, and behavioral intervention development. This award will help me achieve my long-term career goal of being an independent investigator with an impactful program of long-term care research focused on equity-driven, evidence-based elder abuse prevention and intervention development and implementation for racially/ethnically diverse older persons with ADRD.

长期护理（LTC）中居民至居民侵略（RRA）与可预防的伤害，痛苦， 和严重的心理困扰。疗养院（NH）的五分之一居民在给定的 月。患有阿尔茨海默氏病和相关痴呆症（ADRD）的居民的RRA风险更高 由于认知障碍相关的症状。但是，RRA仍然很熟悉。比赛和 居民的种族可能在RRA的启动和升级，风险/弹性因素， 后果和NH响应系统。随着NH人口在种族/种族上的越来越多 多元化，专注于种族/民族在RRA中的作用，可以开发量身定制的预防和 干预措施来识别和解决它，因为参与RRA的许多居民都没有说话，无法说话 自己。这个股权驱动项目的目标是系统地研究种族/种族在 RRA围绕RRA的类型，模式和环境，使用RRA的首次流行研究和 收集其他利益相关者的投入，并明确考虑ADRD居民的需求， 开发，完善和进行试验测试一种新颖的干预措施。在AIM 1中，我将利用第一个也是唯一由NIH资助的RRA 普遍队列研究以定性上下文化和定量研究种族/民族在 RRA跨越个体，二元和设施水平。目标2，我将收集来自多个NH利益相关者的意见 提高对种族/种族在RRA中的作用的了解，并确定当前和最佳的干预措施以及 通过混合方法方法，有和没有ADRD的居民的预防策略。在AIMS 3A和3B中， AIM 1和AIM 2的发现将用于开发和完善专注于的员工教育干预措施 种族/民族在RRA中的作用可能将其纳入现有的RRA干预计划中 目前有有关种族/种族的信息。作为接受公共卫生研究培训的社会科学家，我是 鉴于我在社会决定因素的富有成效的往绩记录中，理想地将这一研究率先 健康与老年人的虐待研究。在整个奖项期间，我将在先前的培训基础上进行 在长期护理研究中发展新的知识和技能（AIM 1；培训目标1）；健康平等 研究（目标1;培训目标2）；长期护理政策制定，倡导和领导力（AIM 2； 培训目标3）;以及行为干预和实施科学（AIM 3A，3B；培训目标 3）。职业发展活动将包括正式的课程，体验式学习和研究 老年人虐待，RRA研究，健康差异的机会和指导 行为干预发展。这个奖项将帮助我实现自己的长期职业目标 具有影响力的长期护理研究计划的独立研究人员，集中于股权驱动， 循证虐待老年人的预防和干预开发和实施 种族/种族多样化的老年人与ADRD。