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

项目摘要/摘要 在患有痴呆症的黑人和拉丁裔患者中，疗养院(NH)的使用不成比例地增加 (PLWD)反映了现有计划和政策的不足，无法支持大多数人就地老龄化 很脆弱。促进社区老龄化和防止可避免的NH安置被广泛认为是一种 联邦、州和地方实体以及家庭和老年人的优先事项。然而，目前还不清楚需要什么。 支持黑人和拉丁裔PLWD留在社区。虽然还有许多看似合理的下一步措施 解决这个知之甚少的问题，开发一种工具来确定哪些未得到满足的需求 不成比例地推动可避免的NH安置是缩小男女之间差距的重要可行步骤 黑人和拉丁裔PLWD。这个为期5年的拟议项目的目标是：1)开发和测试可行性， 评估工具的可接受性、可靠性和有效性，旨在解决未得到满足的需求 推动黑人和拉丁裔PLWD经历可避免的NH安置，比率高于他们的白人 同行采用探索性的顺序混合方法进行研究设计，并2)初步翻译 将调查结果作为一个政策问题提上公共议程。目标1将使用定性访谈来描述未满足的情况 需要驱动这些安置点。对目标1得出的定性结果进行综合分析将为 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中进行心理测量学测试。 这项研究的初步结果将被用来产生可操作的、基于证据的政策建议 以解决NH安置方面的差异。与NIA的战略优先事项保持一致，以解决所经历的差异 少数患有阿尔茨海默病或相关痴呆症(ADRD)的老年人，这项研究将形成基础 对于后续的R01，将为社区居住的黑人和拉丁裔PLWD量身定做，并调查 这些可操作的未得到满足的需求将他们置于NH安置的最大风险中。 应聘者茉莉·特拉弗斯博士，医学博士，MHS，是一名老年护理从业者和助理 纽约大学(NYU)罗里·迈尔斯护理学院教授。特拉弗斯博士的长期目标是 建立一个独立的研究事业，专注于开发创新的方法来消除差距 黑人和拉丁裔PLWD通过以下途径获得以人为中心的长期护理的机会和质量 使用混合方法。在一群在老年学方面有专长的模范导师和科学顾问的带领下， ADRD、混合方法、政策、调查设计和心理测量评估，特拉弗斯博士将在她的基础上 关于在获得社区长期护理以实现小学培训目标方面的差距的初步工作 涉及脆弱的PLWD、混合方法、政策和领导力发展的研究。纽约大学提供了一个 为完成拟议的研究和已经开始的特拉弗斯博士提供的特殊环境 在老龄化和长期护理领域成为领先的差异研究人员。

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.