Identifying Unmet Needs Driving Disproportionate and Avoidable Nursing Home Placements among Black and Latino Persons Living With Dementia

项目概要/摘要 黑人和拉丁裔痴呆症患者使用疗养院 (NH) 的比例大幅上升 （PLWD）反映了现有计划和政策在支持大多数人就地老龄化方面的不足 脆弱。促进社区老龄化和防止可避免的 NH 安置被广泛认为是 联邦、州和地方实体以及家庭和老年人的优先考虑。但尚不清楚需要什么 支持黑人和拉丁裔 PLWD 留在社区。虽然有许多看似合理的后续步骤 解决这个人们知之甚少的问题，开发一个工具来确定哪些未满足的需求 不成比例地推动可避免的 NH 安置是减少男女之间差距的一个重要的、可行的步骤 黑人和拉丁裔 PLWD。这个为期 5 年的拟议项目的目标是 1) 开发并测试可行性， 旨在解决未满足需求的评估工具的可接受性、可靠性和有效性 推动黑人和拉丁裔 PLWD 以比白人更高的比例体验可避免的 NH 安置 同行使用探索性顺序混合方法研究设计，2）翻译初步 调查结果作为政策问题纳入公共议程。目标 1 将使用定性访谈来描述未满足的问题 需要推动这些展示位置。对目标 1 得出的定性结果进行综合分析将告知 未满足的需求评估工具，居家（确定帮助老年人维持日常生活的需求） 社区生活），将在目标 2 中开发、完善和试点，并在目标 3 中进行心理测量测试。 这项研究的初步结果将用于生成可操作的、基于证据的政策建议 解决 NH 安置方面的差异。与 NIA 的战略重点保持一致，以解决所经历的差异 由患有阿尔茨海默病或相关痴呆症 (ADRD) 的少数老年人进行，这项研究将构成基础 后续的 R01 将为社区居住的黑人和拉丁裔 PLWD 定制 IN-HOME 并进行调查 哪些可操作的未满足需求使他们面临 NH 安置的最大风险。 候选人 Jasmine Travers 博士，博士，MHS，是一名老年护士执业者和助理 纽约大学 (NYU) 罗里·迈耶斯护理学院教授。 Travers 博士的长期目标是 建立独立的研究生涯，专注于开发创新方法来消除差异 黑人和拉丁裔 PLWD 通过以下途径获得以人为本的长期护理的机会和质量 使用混合方法。在由具有老年学专业知识的模范导师和科学顾问组成的团队的领导下， Travers 博士将在 ADRD、混合方法、政策、调查设计和心理测量评估的基础上继续发展 就获得社区长期护理方面的差异开展初步工作，以实现小学培训目标 研究涉及弱势 PLWD、混合方法、政策和领导力发展。纽约大学提供 为完成拟议的研究以及已经开始的 Travers 博士提供了特殊的环境 成为老龄化和长期护理领域领先的差异研究者。

PROJECT SUMMARY/ABSTRACT The disproportionate rise in nursing home (NH) use among Black and Latino persons living with dementia (PLWD) reflects the inadequacy of existing programs and policies to support aging in place for the most vulnerable. Enabling aging in the community and preventing avoidable NH placements is widely considered a priority by federal, state, and local entities along with families and older adults. Yet, it is unclear what is needed to support Black and Latino PLWD to remain in the community. While there are many plausible next steps to addressing this poorly understood problem, developing an instrument to identify which unmet needs are disproportionately driving avoidable NH placements is an important actionable step in reducing disparities among Black and Latino PLWD. The objectives of this 5-year proposed project are to 1) develop and test the feasibility, acceptability, reliability, and validity of an assessment instrument aimed at addressing the unmet needs that drive Black and Latino PLWD to experience avoidable NH placements at greater rates than their White counterparts using an exploratory sequential mixed methods research design, and 2) translate preliminary findings onto the public agenda as a policy issue. Aim 1 will use qualitative interviews to describe the unmet needs driving these placements. An integrative analysis of qualitative findings derived from Aim 1 will inform an unmet needs assessment instrument, IN-HOME (Identifying Needs to Help Older adults Maintain Everyday community living), that will be developed, refined and piloted in Aim 2 and psychometrically tested in Aim 3. Preliminary findings from this study will be used to generate actionable, evidence-based policy recommendations to address disparities in NH placements. Aligned with NIA’s strategic priorities to address disparities experienced by minority older adults with Alzheimer’s Disease or Related Dementias (ADRD), this study will form the basis for a subsequent R01 that will tailor IN-HOME for community-dwelling Black and Latino PLWD and investigate which actionable unmet needs place them at greatest risk for NH placements. The candidate, Dr. Jasmine Travers, PhD, MHS, is a gerontological nurse practitioner and assistant professor at New York University (NYU) Rory Meyers College of Nursing. The long-term goal of Dr. Travers is to build an independent research career focused on developing innovative approaches to eliminate disparities in access to and quality of person-centered long term care experienced by Black and Latino PLWD through the use of mixed methods. Under a team of exemplary mentors and scientific advisors with expertise in gerontology, ADRD, mixed-methods, policy, survey design, and psychometric evaluation, Dr. Travers will build on her preliminary work on disparities in access to community long-term care to accomplish training goals in primary research involving vulnerable PLWD, mixed methods, policy, and leadership development. NYU provides an exceptional environment for the completion of the proposed research and for Dr. Travers who has already begun to emerge as a leading disparities researcher in the field of aging and long-term care.