Older Adults Living with Dementia and Their Informal Caregivers: Reciprocal Impacts of Caregiving and Serious Illness on Health Care Outcomes

患有痴呆症的老年人及其非正式护理人员：护理和严重疾病对医疗保健结果的相互影响

• 批准号: 10347854
• 负责人: Lianlian Lei
• 金额: $ 10.44万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-10 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10347854
• 关键词: Adverse effects; Affect; Age; Aging; Alzheimer' s Disease; Applications Grants; Area; Attention; Award; Caregivers; Caring; Chronic; Clinical; Complex; Contracts; Data; Data Analytics; Daughter; Dementia; Dementia caregivers; Deterioration; Disease; Econometric Models; Economics; Elderly; Emergency department visit; Emotional; Exposure to; Family member; Foundations; Friends; Funding; Future; Gatekeeping; Geriatric Psychiatry; Goals; Health; Health Promotion; Health Services; Health Services Research; Health and Retirement Study; Healthcare; Healthcare Systems; Hip Fractures; Hospitalization; Hour; Impaired cognition; Impairment; Intervention; Knowledge; Leadership; Light; Link; Long-Term Care; Longitudinal Surveys; Medical; Medicare; Medicare claim; Mentorship; Methodology; Methods; Modeling; Morbidity - disease rate; Myocardial Infarction; Outcome; Outpatients; Pathway interactions; Personal Satisfaction; Persons; Phase; Pneumonia; Policies; Population; Professional Competence; Public Health; Research; Research Personnel; Research Training; Self Care; Shock; Solid; Source; Spouses; Stroke; Surveys; Training; Visit; Wife; Work; care outcomes; career; caregiver interventions; caregiving; cost; experience; functional decline; health care service utilization; high risk; informal care; informal caregiver; informal caregiving; innovation; member; mortality risk; pressure; programs; skills; trend

PROJECT SUMMARY Alzheimer’s disease and other dementias are a growing public health concern, currently affecting nearly 8 million older adults and 16 million informal caregivers in the U.S. Informal caregiving—unpaid care by family members or friends—for persons living with dementia (PLWD) is uniquely demanding, with significant financial and emotional impacts. While the population continues to age and the number of PLWD requiring assistance grows, the pool of potential informal caregivers is also contracting, creating intense pressure to maintain the health and wellbeing of both caregivers and the PLWD for whom they provide care. There is an urgent need to understand how informal caregiving impacts both PLWD and caregiver health care use, and how serious illness for a PLWD or caregiver impacts the health care use of the other member of the dyad, to inform future caregiver interventions and policy. The goal of this K99/R00 Pathway to Independence Award is to prepare Dr. Lianlian Lei for a career as a successful independent health services investigator focused on disentangling the links between informal caregiving and how PLWD and their caregivers engage and interact with the health care system. Dr. Lei’s background and training in health services research, policy, and economics provide her with a solid foundation for the proposed work, but in order to transition to independence she requires additional skills and experience that will be gained through a coordinated program of research, mentorship, and didactics during the K99 phase of the award period. This will include training and experiences in: (1) clinical exposure to caregivers of PLWD; (2) skills to analyze complex, nationally representative survey data; (3) advanced methods of causal inference using econometric models; and (4) career skills needed to transition to independence, including research-related leadership and grantsmanship. Building on her previous research and training examining health care use and costs for PLWD, Dr. Lei’s research will use data from nationally representative surveys, including the National Health and Aging Trends Study and the Health and Retirement Study, both linked with Medicare claims data to identify the impact of informal caregiving on health care use of both PLWD (Aim 1.1) and caregivers (Aim 1.2), comparing instrumental variable (e.g., number of daughters, market supply of formal care) models and panel data fixed effects models. Aim 2 will further apply the panel data fixed effects models in HRS-linked Medicare claims to examine the impact of caregiver serious illness on PLWD health care use, while Aim 3 will examine the impact of PLWD serious illness on caregiver health care use. Upon successful completion of the study, findings will yield key knowledge of informal caregiving and serious illness to enable better identification of high-risk PLWD and caregivers, and will inform future targeted interventions to promote the health and wellbeing of both PLWD and caregivers. These results will provide the basis for a future R01 grant application targeting high-risk PLWD and caregivers following serious illness.

项目摘要 阿尔茨海默病和其他痴呆症是一个日益增长的公共卫生问题，目前影响近8 在美国，有100万老年人和1600万非正式照顾者。 成员或朋友-对于痴呆症患者（PLWD）来说， 和情感上的影响。虽然人口继续老龄化，需要援助的艾滋病患者人数 增长，潜在的非正式护理人员也在收缩，造成了维持 护理人员及其护理对象的健康和福祉。迫切需要 了解非正式医疗服务如何影响PLWD和照顾者的医疗服务使用，以及 PLWD或护理人员的疾病会影响二人组其他成员的医疗保健使用， 护理人员的干预措施和政策。这个K99/R 00独立之路奖的目标是准备博士。 Lianlian Lei作为一名成功的独立卫生服务调查员的职业生涯，专注于解开 非正式咨询与PLWD及其护理人员如何参与卫生保健并与之互动之间的联系 系统雷博士在卫生服务研究、政策和经济学方面的背景和培训为她提供了 为拟议的工作奠定坚实的基础，但为了过渡到独立，她需要更多的 技能和经验，将通过研究，指导和教学的协调计划获得 在K99的奖励期内。这将包括以下方面的培训和经验：（1）临床接触 （2）分析复杂的、具有全国代表性的调查数据的技能;（3）先进的 使用计量经济模型进行因果推理的方法;（4）过渡到 独立性，包括与研究相关的领导力和专业知识。基于她之前的研究 和培训检查医疗保健的使用和成本的PLWD，雷博士的研究将使用数据， 代表性的调查，包括国家健康和老龄化趋势研究和健康和退休 研究，两者都与医疗保险索赔数据相关联，以确定非正式医疗服务对医疗保健使用的影响。 PLWD（目标1.1）和护理人员（目标1.2），比较工具变量（例如，女儿的数量， 正式护理的市场供应）模型和面板数据固定效应模型。目标2将进一步应用面板 在与人力资源相关的医疗保险索赔中建立数据固定效应模型，以检查护理人员严重疾病对 目标3将审查艾滋病患者严重疾病对照顾者医疗保健的影响 使用.在成功完成研究后，研究结果将产生关于非正式协商的关键知识， 严重疾病，以便更好地识别高风险PLWD和护理人员，并将告知未来的目标 采取干预措施，促进艾滋病毒/艾滋病感染者和照料者的健康和福祉。这些结果将提供 这是今后针对高危艾滋病患者和重病后照顾者的R 01赠款申请的基础。