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

项目总结 在新冠肺炎大流行的头几个月里，老年人的日常生活显著中断 医疗保健，因为卫生保健提供者暂停服务，人口与社会保持距离，以降低风险 新冠肺炎的传播。即使在医疗设施重新开放后，医生和门诊量 来访人数有所增加，但在几个月内仍低于大流行前的观察水平。其中 患有糖尿病的老年人，这种突然停止和推迟常规医疗护理的做法引起了人们对 潜在的不利健康后果，特别是对结果不佳风险较高的人群。老年人 由于痴呆症、独居或受限，可能会在导航提供商和设施变更方面遇到更大困难 社会经济资源。黑人老年人也可能在常规医疗中经历了更大的干扰 鉴于黑人社区的感染率和死亡率较高，在大流行期间提供了更多的护理。因为 新冠肺炎疫情摧毁了养老院、辅助生活设施和居家护理 安排，拥有医疗补助资助的长期服务和支持的老年人面临着巨大的风险 与非新冠-10病毒相关的卫生保健服务中断。 本申请建议为正在进行的R01项目-糖尿病、痴呆症、 和家庭老龄化，这项研究考察了老年南方社区队列研究中的长期服务使用情况 (SCCS)糖尿病和痴呆症患者。SCCS是一项纵向健康差距调查， 在2002-2009年间，从南方12个州招募了8.4万名年龄在40-79岁的白人和黑人成年人。通过 使用2020年的季度联邦医疗保险报销数据更新现有的SCCS Medicare和Medicaid数据链接， 该项目将评估某些人群，如患有痴呆症的老年人或低收入老年人， 更有可能经历医疗服务使用的下降，远程医疗服务的替代较少， 在新冠肺炎大流行期间，入院时的敏锐度更高。对于患病风险较高的老年人 糟糕的结果，自付费用的财政援助可能是一个重要的安全网，可以保护 获得常规医疗服务，因此我们将检查接受医疗补助和D部分的老年人是否较低 收入补贴福利在医疗保健使用方面经历这些中断的可能性较小。这项研究将 通过确定哪些人口将从基本支持中受益，提供可操作的、及时的证据 新冠肺炎大流行仍在继续。 2.

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