Diabetes, Dementia, and Aging at Home

项目总结 管理糖尿病可能是老年人在家中衰老的一个重要障碍，特别是对那些 患有阿尔茨海默病或相关痴呆症(ADRD)。超过40%的低收入老年人患有 Medicare和Medicaid患有糖尿病，但获得以家庭和社区为基础的Medicaid的机会有限 可协助完成胰岛素注射、餐饮准备和监测等日常任务的服务(HCBS) 血糖水平。尽管25%-40%的痴呆症患者也患有糖尿病，但人们对此知之甚少 这一人群中的糖尿病管理。没有家人或其他照顾者的帮助，低收入者 患有糖尿病的老年人可能会因为糖尿病而面临不必要的住院治疗和疗养院的进入。 低血糖会导致跌倒、受伤和意识丧失，对老年人来说是一个很大的健康风险。 糖尿病患者，尤其是黑人、使用胰岛素或患有痴呆症的患者。 这类问题在东南部尤其令人担忧，因为该地区有很高的 糖尿病和ADRD。南方社区队列研究，低收入白人的前瞻性队列研究 以及东南部黑人居民，其中包括超过12000名65岁及以上的糖尿病患者， 为了解与糖尿病相关的居家障碍提供了一个独特的机会。通过链接调查数据 对于索赔数据，这项研究将检验哪些因素，包括痴呆症和有限的社会支持，可以预测 初步使用医疗补助、医疗补助、家庭保健和养老院服务。在15年的时间里，这项研究将分析 更慷慨的医疗补助和医疗补助福利覆盖范围是否与疗养院的变化有关 入院、住院和急诊室使用，以及低血糖治疗。为了更好地了解哪些因素 可能会阻止老年人使用简单的胰岛素方案，这可能会降低他们患低血糖的风险， 研究将检验更简单的胰岛素选择的自付成本较低是否与更多的使用相关 以及这些关联对于患有痴呆症或社会支持有限的老年人是否有所不同 他们可能在浏览药品福利方面有更大的困难。最后，这项研究将评估更好的覆盖范围 更简单的胰岛素选择与较低的住院、急诊室就诊、 低血糖，疗养院入院。这一结果将为医疗保险和医疗保险如何 医疗补助政策可能能够满足患有糖尿病的老年人的需求，因为他们在家和 预防不良的健康结果，特别是对于痴呆症患者或社会支持有限的人。

PROJECT SUMMARY Managing diabetes may be a significant barrier to aging at home for older adults, especially for those with Alzheimer’s disease or related dementias (ADRD). Over 40% percent of low-income older adults with Medicare and Medicaid have diabetes, but there is limited access to Medicaid home-and-community-based services (HCBS) that can assist with daily tasks like insulin injections, meal preparation, and monitoring glucose levels. Even though 25-40% of patients with dementia also have diabetes, little is known about diabetes management in this population. Without family members or other caregivers to assist, low-income older adults with diabetes may face unnecessary hospitalizations for diabetes and nursing home entry. Hypoglycemia, which can lead to falls, injuries, and loss of consciousness, is a large health risk for older adults with diabetes, especially if they are black, use insulin, or have dementia. Such issues are particularly concerning in the Southeast due to the region’s high prevalence of diabetes and ADRD. The Southern Community Cohort Study, a prospective cohort study of low-income white and black Southeastern residents that includes over 12,000 participants age 65 and above with diabetes, provides a unique opportunity to understand diabetes-related barriers to living at home. By linking survey data to claims data, this study will examine which factors, including dementia and limited social support, predict initial use of Medicaid HCBS and nursing home services. Over a fifteen-year period, the study will analyze whether more generous coverage of Medicaid HCBS benefits is associated with changes in nursing home entry, inpatient and emergency room use, and treatment for hypoglycemia. To better understand what factors may prevent older adults from using simpler insulin regimens that may lower their risk for hypoglycemia, the study will examine whether lower out-of-pocket costs for simpler insulin options are associated with greater use of these drugs, and whether these associations differ for older adults with dementia or limited social support who may have more difficulty navigating drug benefits. Finally, the study will assess whether better coverage of simpler insulin options is associated with lower risk of hospitalizations, emergency room visits, treatment for hypoglycemia, and nursing home entry. The results will provide novel evidence about how Medicare and Medicaid policies may be able to address the needs of older adults with diabetes as they age at home and prevent poor health outcomes, especially for those with dementia or limited social support.