Determinants of End-of-Life Care Experiences among Assisted Living Residents with Alzheimer's Disease and Related Dementia

项目摘要 越来越多患有阿尔茨海默病和相关痴呆症（ADRD）的老年人正在接受护理 临终时，应助其生。到2015年，18.4%的社区死亡发生在按服务收费的医疗保险中， 受益人接受临终关怀发生在AL。最近的一些研究引起了人们的关注， 在AL中提供的临终关怀的质量。例如，在临终关怀中的AL居民不太可能接受 阿片类药物对疼痛的治疗效果比家庭临终关怀的患者好。此外，考虑到对临终关怀索赔数据的依赖， 到目前为止，为了研究AL的临终关怀，我们对没有临终关怀而死亡的AL居民的了解有限 服务如果我们要告知政策和实践，促进AL中更高质量的临终关怀， 迫切需要研究的决定因素，死亡的经验，为AL居民与ADRD，全国。使用 我们的团队开发了一种方法，用于识别居住在大型AL社区的Medicare受益人 (25（+病床），我们建议识别在急症室逗留的死者，并研究他们的临终护理 经验本申请的总体目标是确定更好的临终关怀的决定因素 通过行政索赔数据，对AL管理人员的调查，以及对 死者的近亲我们计划通过以下方式实现整体研究目标： 方法的具体目标是：1）检查生命最后一个月在AL中花费的时间， 对于一个可能负担沉重的护理（即生命最后三天的过渡和反复住院）， ADRD AL死亡队列，并确定有和无支持性终点的状态之间是否存在差异- 生命法规，2）使用AL全国调查数据记录生命终末护理过程 管理员，并检查这些过程之间的关联，国家法规，并在AL花费的时间 在生命的最后一个月和ADRD死者队列的繁重过渡，以及3）探索感知 ADRD AL死者通过深入的定性访谈获得的临终关怀的质量， 近亲，来自有目的的AL样本，在各州建立了更多与更少的临终关怀流程 不管有没有支持性的报废条例该提案的预期成果包括： 了解国家法规和护理流程，这将改善对在以下情况下死亡的ADRD患者的护理 AL.拟议的研究将最终指导政策和实践决策，以确保AL居民 获得高质量的临终关怀。

PROJECT SUMMARY A growing number of older adults with Alzheimer’s Disease and Related Dementias (ADRD) are receiving care and dying in assisted living (AL). By 2015, 18.4% of community deaths among fee-for-service Medicare beneficiaries receiving hospice took place in AL. A number of recent studies have raised concerns about the quality of end-of-life care delivered in AL. For example, AL residents on hospice were less likely to receive opioids for pain than were individuals with home hospice. Moreover, given the reliance on hospice claims data to study end-of-life care in AL to date, we have limited knowledge about AL residents who die without hospice services. If we are to inform policies and practices that promote better quality end-of-life care in AL, there is a critical need to examine the determinants of dying experiences for AL residents with ADRD, nationally. Using a methodology developed by our team to identify Medicare beneficiaries who resided in large AL communities (25+ beds), we propose to identify decedents with a stay in AL, and to examine their end-of-life care experiences. The overall objective of this application is to identify the determinants of better end-of-life care experiences in AL through administrative claims data, a survey of AL administrators, and interviews with the next of kin of AL decedents. We plan to accomplish the overall research objective by pursuing a mixed- methods approach to the following specific aims: 1) examine time spent in AL during the last month of life and potentially burdensome care (i.e. transitions in last three days of life and repeated hospitalizations) for an ADRD AL decedent cohort and determine if differences exist between states with and without supportive end- of-life regulations, 2) document end-of-life care processes using data from a national survey of AL administrators, and examine the association between these processes, state regulations, and time spent in AL in the last month of life and burdensome transitions for an ADRD decedent cohort, and 3) explore perceptions of the quality of end-of-life care received by ADRD AL decedents through in-depth qualitative interviews with next of kin, from a purposeful sample of ALs with more vs. less established end-of-life care processes in states with and without supportive end-of-life regulations. The expected outcomes from this proposal include a better understanding of state regulations and processes of care that will improve care of persons with ADRD dying in AL. The proposed research will ultimately guide policy and practice decisions to ensure that AL residents receive high quality end-of-life care.