中老年 LGBTQ 和性与性别多样化照顾者随时间推移的身心健康相关生活质量的关键决定因素。
Key Determinants of Physical and Psychological Health-Related Quality of Life Over Time Among Midlife and Older LGBTQ and Sexual and Gender-Diverse Caregivers.
机构信息
School of Social Work, University of Washington, Seattle, Washington, USA.
School of Social Welfare, The University of Kansas, Lawrence, Kansas, USA.
出版信息
Gerontologist. 2023 May 9;63(4):751-761. doi: 10.1093/geront/gnac112.
BACKGROUND AND OBJECTIVES
Prior research has shown informal caregiving among older adults can negatively affect the caregiver's physical and psychological health. However, little is known about protective and risk factors associated with the health-related quality of life (HRQOL) of lesbian, gay, bisexual, transgender, and queer (LGBTQ) caregivers.
RESEARCH DESIGN AND METHODS
Informed by the Health Equity Promotion Model and Caregiver Stress Process Model and utilizing longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this analysis examined modifiable risk and protective factors associated with psychological and physical HRQOL over time among 754 LGBTQ caregivers aged 50-98.
RESULTS
Psychological and physical HRQOL declined over a 3-year period. After controlling for background characteristics, mastery, social support, socialization, LGBTQ community engagement, and physical activity were positively associated with psychological HRQOL while day-to-day discrimination, identity stigma, and insufficient food intake were negatively associated. Steeper declines were observed for older and with no physical activity. Mastery, social support, socialization, and physical activity were positively associated with physical HRQOL while day-to-day discrimination and insufficient food intake were negatively associated. Steeper declines were found for those with high mastery and no physical activity.
DISCUSSION AND IMPLICATIONS
Although generalized factors including mastery, socialization, and social support are protective for HRQOL among LGBTQ caregivers, factors including day-to-day discrimination and identity stigma are more unique to historically disadvantaged populations and should be considered in future research and practice. Caregiving interventions incorporating physical activity are promising given its buffering effect for decreased physical and psychological HRQOL over time.
背景与目的
先前的研究表明，老年人中的非正式护理会对护理人员的身心健康产生负面影响。然而，对于与女同性恋、男同性恋、双性恋、跨性别和酷儿（LGBTQ）护理人员的健康相关生活质量（HRQOL）相关的保护和风险因素知之甚少。
研究设计与方法
本研究以健康公平促进模型和护理人员压力过程模型为指导，利用来自“自豪老龄化：国家健康、老龄化和性别研究”的纵向数据，对 754 名年龄在 50-98 岁之间的 LGBTQ 护理人员进行了分析，考察了可改变的风险和保护因素与心理和身体 HRQOL 随时间的变化关系。
结果
在 3 年的时间里，心理和身体 HRQOL 都有所下降。在控制了背景特征后，掌握、社会支持、社交、LGBTQ 社区参与和身体活动与心理 HRQOL 呈正相关，而日常歧视、身份污名和食物摄入不足则与心理 HRQOL 呈负相关。对于年龄较大和没有身体活动的人，下降幅度更大。掌握、社会支持、社交和身体活动与身体 HRQOL 呈正相关，而日常歧视和食物摄入不足与身体 HRQOL 呈负相关。对于那些掌握程度高且没有身体活动的人，下降幅度更大。
讨论与意义
尽管掌握、社交和社会支持等一般因素对 LGBTQ 护理人员的 HRQOL 具有保护作用，但日常歧视和身份污名等因素更具独特性，且与历史上处于劣势地位的人群有关，因此应该在未来的研究和实践中考虑这些因素。考虑到身体活动对身体和心理 HRQOL 随时间下降的缓冲作用，包含身体活动的护理干预措施具有广阔前景。
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