Routine Care during COVID-19 pandemic for Low-income Older Adults with Diabetes and Dementia

COVID-19 大流行期间患有糖尿病和痴呆症的低收入老年人的常规护理

• 批准号: 10307304
• 负责人: Laura Margaret Keohane
• 金额: $ 11.11万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10307304
• 关键词: Adult; Age; Aging; Assisted Living Facilities; COVID-19; COVID-19 pandemic; Caring; Cohort Studies; Communities; Data; Data Linkages; Dementia; Diabetes Mellitus; Elderly; Financial Support; Funding; Health; Health Personnel; Health care facility; Healthcare; Home; Hospitalization; Infection; Link; Low income; Medicaid; Medical; Medicare claim; Medicare/Medicaid; Nursing Homes; Outcome; Outpatients; Participant; Physicians; Population; Provider; Research; Resources; Risk; SARS-CoV-2 transmission; Services; Social Distance; Surveys; Time; Update; Visit; base; caregiving; cost; experience; health care service; health care service utilization; health disparity; high risk; mortality; pandemic disease; recruit; routine care; safety net; socioeconomics; telehealth

PROJECT SUMMARY During the early months of the COVID-19 pandemic, older adults experienced significant disruptions in routine medical care as health care providers suspended services and the population socially distanced to reduce risk of COVID-19 transmission. Even after health care facilities reopened, the volume of physician and outpatient visits increased but for several months still remained lower than levels observed prior to the pandemic. Among older adults with diabetes, this abrupt cessation and postponement of routine medical care raises alarm about potential adverse health consequences, especially for populations at higher risk of poor outcomes. Older adults may have greater difficulty navigating provider and facility changes due to dementia, living alone, or limited socioeconomic resources. Black older adults also may have experienced greater disruptions in routine medical care during the pandemic given higher infection and mortality rates among Black communities. Because the COVID-19 pandemic devastated nursing homes, assisted living facilities, and home-based caregiving arrangements, older adults with Medicaid-funded long-term services and supports faced significant risk of disruption of non-COVID-10 related health care services. This application proposes supplemental COVID-19 research for an ongoing R01 project, Diabetes, Dementia, and Aging at Home, that examines long-term services use among older Southern Community Cohort Study (SCCS) participants with diabetes and dementia. The SCCS is a longitudinal health disparities survey that recruited 84,000 white and Black adults age 40-79 between the years 2002-2009 from 12 Southern states. By updating existing SCCS Medicare and Medicaid data linkages with quarterly 2020 Medicare claims data, this project will assess whether certain populations, such as older adults with dementia or low-income older adults, were more likely to experience declines in health care services use, less substitution of telehealth services, and greater acuity upon hospital admission during the COVID-19 pandemic. For older adults at greater risk of poor outcomes, financial assistance with out-of-pocket costs may be an important safety net that protects access to routine medical care, so we will examine whether older adults who had Medicaid and Part D Low Income Subsidy benefits were less likely to experience these disruptions in health care use. This study will provide actionable, timely evidence by identifying which populations would benefit from essential support as the COVID-19 pandemic continues. 2

项目概要 在 COVID-19 大流行的最初几个月，老年人的日常生活受到了严重干扰 医疗服务，因为医疗保健提供者暂停了服务，并且人们保持社交距离以降低风险 COVID-19 传播。即使医疗机构重新开放后，医生和门诊病人的数量 访问量有所增加，但几个月来仍低于大流行前的水平。之中 对于患有糖尿病的老年人来说，这种突然停止和推迟常规医疗护理引起了人们的警惕 潜在的不良健康后果，特别是对于不良结果风险较高的人群。老年人 由于痴呆症、独居或能力有限，可能会更难以适应提供者和设施的变化 社会经济资源。黑人老年人的日常医疗也可能经历了更大的干扰 鉴于黑人社区的感染率和死亡率较高，大流行期间的护理。因为 COVID-19 大流行摧毁了疗养院、辅助生活设施和家庭护理 安排，接受医疗补助资助的长期服务和支持的老年人面临重大风险 非 COVID-10 相关医疗保健服务中断。 本申请建议对正在进行的 R01 项目进行补充性 COVID-19 研究，即糖尿病、痴呆症、 和在家老龄化，该研究调查了南方社区老年群体研究中的长期服务使用情况 (SCCS) 患有糖尿病和痴呆症的参与者。 SCCS 是一项纵向健康差异调查， 2002 年至 2009 年间，从南方 12 个州招募了 84,000 名 40 至 79 岁的白人和黑人成年人。经过 更新现有 SCCS 医疗保险和医疗补助数据与 2020 年季度医疗保险索赔数据的链接，这 项目将评估某些人群（例如患有痴呆症的老年人或低收入老年人）是否 更有可能经历医疗保健服务使用量下降、远程医疗服务替代减少、 COVID-19 大流行期间入院时的敏锐度更高。对于面临更大风险的老年人 如果结果不佳，自付费用的财政援助可能是一个重要的安全网，可以保护 获得常规医疗护理，因此我们将检查老年人是否享受医疗补助和 D 部分 低 收入补贴福利不太可能在医疗保健使用中遇到这些干扰。这项研究将 通过确定哪些人群将受益于基本支持，提供可采取行动的及时证据 COVID-19 大流行仍在继续。 2