The impact of COVID-19 pandemic on community-dwelling older adults with ADRD

项目摘要。在冠状病毒病大流行下，ADRD患者面临着巨大的挑战 2019年(新冠肺炎)。首先，ADRD患者患新冠肺炎的风险很高，因为他们通常年龄较大 患有合并症的成年人。此外，患有ADRD的人可能难以理解疾病和 遵循安全程序，从而使他们更容易感染新冠肺炎。此外，将军 大流行产生的后果可能会影响ADRD患者接受的通常医疗护理。 ADRD患者通常有认知障碍，并有可能发展出破坏性行为。因此，他们 可能需要常规的医疗和/或精神科服务来管理他们的慢性病并解决他们的 心理健康问题。他们更有可能从面对面的医疗访问中受益，这已经大大 在大流行期间中断。尽管CMS扩大了远程医疗福利，但患有ADRD的人 可能会发现电信作为获得医疗保健的手段很困难。最后，大多数患有 ADRD生活在社区，他们可能需要面对面的长期服务和支持(LTSS)来协助 他们的日常生活和心理或情感护理需求。大流行可能减少了可获得性 这些支持和服务。此外，照顾者(不住在同一个家庭)可能必须穿着 个人防护装备提供服务，造成混乱和不安，引发行为问题 在病人中。护理上的这些变化可能使ADRD患者更难维持 社区生活，并可能加速制度化的可能性。冠状病毒大流行对人类健康的影响 患有ADRD的黑人可能特别重要。研究表明，患有ADRD的黑人往往有 与白人同龄人相比，他们的认知障碍水平更高。与此同时，据透露， 黑人感染新冠肺炎和死亡的风险高得不成比例。这些种族差异很可能是 由社会经济决定因素触发。例如，黑人倾向于聚集在弱势群体中 资源和支持较少、新冠肺炎感染率较高的社区。到目前为止，还不清楚 就新冠肺炎的风险和严重性而言，这一大流行对ADRD患者的影响是什么，例如 以及他们对日常医疗护理和长期护理的需要(与新冠肺炎没有直接关系)，以及 这些影响如何因个人种族而异。这项拟议的研究有两个目的：1)检查 新冠肺炎与社区老年人疾病严重程度(住院、重症监护病房、死亡)的关系 ADRD，以及个人种族的差异；2)检查这一大流行对非COVID的影响 这一人群的相关卫生保健利用情况(如住院、急诊室就诊、养老院安置)， 以及不同种族之间的差异。拟议的研究具有重要意义，因为研究结果将提供有价值的和 及时提供有关这场公共卫生危机如何影响患有ADRD的脆弱老年人口的信息，以及 告知今后旨在减少本已脆弱的人群在健康方面的种族差异的努力。

Project Summary. Persons with ADRD face significant challenges under the pandemic of coronavirus disease 2019 (COVID-19). First, persons with ADRD are at a high risk for COVID-19 because they are generally older adults with comorbidities. In addition, persons with ADRD may have difficulty understanding the disease and following the safety procedures, thus making them more susceptible to COVID-19. Furthermore, the general ramifications stemming from the pandemic may affect the usual medical care received by persons with ADRD. Persons with ADRD often have cognitive impairment and are likely to develop disruptive behaviors. Thus, they may need routine medical and/or psychiatric services to manage their chronic conditions and to address their mental health issues. They are more likely to benefit from in-person medical visits, which has been greatly interrupted during the pandemic. Although the CMS has expanded telemedicine benefits, persons with ADRD may find telecommunication as the means of receiving healthcare, difficult. Lastly, the majority of persons with ADRD live in community, and they may need in-person long-term services and supports (LTSS) to assist with their daily living and psychological or emotional care needs. The pandemic may have reduced the availability of these supports and services. In addition, caregivers (not residing in the same household) may have to wear personal protective equipment to deliver services, causing confusion and upset that trigger behavioral issues among patients. These changes in care may have made it more difficult for persons with ADRD to maintain community living and may accelerate the likelihood of institutionalization. The impact of COVID pandemic on blacks with ADRD could be particularly significant. It has been shown that blacks with ADRD tend to have higher levels of cognitive impairment than their white counterparts. At the same time, it has been revealed that blacks are at disproportionally high risks for COVID-19 infection and death. These racial differences are likely triggered by socioeconomic determinants. For example, blacks tend to aggregate in disadvantaged communities with fewer resources and supports and higher rates of COVID-19 infection. To date, it is unclear how this pandemic affects persons with ADRD, both regarding the risk of and severity of COVID-19, as well as their needs for usual medical care and LTSS (that are not directly related to COVID-19), and how such impacts vary by individual's race. This proposed study has two Aims: 1) to examine the risk of COVID-19 and the severity of illness (hospitalization, ICU, death) among community dwelling older adults with ADRD, and how that varies by individual's race; 2) to examine the impact of this pandemic on non-COVID related health care utilization (e.g. hospitalization, ER visits, nursing home placement) among this population, and how that varies by race. The proposed research is significant as the findings will provide valuable and timely information on how this public health crisis affects the vulnerable older population with ADRD, and inform future efforts aimed at reducing racial disparities in health among this already vulnerable population.