The effects of the Covid-19 pandemic on formal and informal care among adults with dementia

Covid-19 大流行对成年痴呆症患者正式和非正式护理的影响

• 批准号: 10518303
• 负责人: HwaJung Choi
• 金额: $ 53.23万
• 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: 2022-09-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10518303
• 关键词: Address; Admission activity; Adult; Adverse effects; Affect; Alzheimer' s disease related dementia; Area; COVID-19; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 patient; COVID-19 vaccination; Caring; Code; Cognitive; County; Data; Dementia; Distance Learning; Economics; Event; Exposure to; Family; Family member; Gender; Geographic Locations; Geography; Grain; Health; Health Care Costs; Health Policy; Healthcare; Healthcare Systems; Home Care Services; Home Nursing Care; Hospital Nursing; Hospitalization; Hospitals; Individual; Job loss; Measures; Mediating; Nursing Homes; Outcome; Persons; Physical Function; Policies; Resources; Risk; Role; Time; Variant; Virus; Virus Diseases; care systems; cognitive function; disparity reduction; ethnic minority; experience; health care disparity; health care service utilization; improved; in-home care; infection rate; infection risk; informal care; innovation; insight; intervention program; long term consequences of COVID-19; mortality; pandemic disease; primary caregiver; racial and ethnic; social; sociodemographics; socioeconomics

PROJECT SUMMARY/ABSTRACT Adults with Alzheimer’s diseases and related dementia (ADRD) are among the most vulnerable individuals from the pandemic. Both formal and informal care for adults with ADRD has been profoundly affected by the Covid-19 pandemic. Despite the need of frequent hands-on care for these adults due to their limitations in physical and cognitive functioning, in-home care services are limited and nursing home care has been risky during the pandemic. The social and economic circumstances of many families also have been changed due to the pandemic and hence their resources to care for a family member with ADRD. Disrupted care for adults with ADRD may have adverse health consequences that may last beyond the pandemic period. A better understanding of the effects of the pandemic on the dynamics between formal and informal care is critically important to address unmet care needs for adults with ADRD during and after the pandemic. We will first create a contextual measure of exposure to the pandemic (pre-, low-, high-, post-exposure) by taking into account the infection risks of the virus in the local area and develop a tailored geographic boundary for each individual that encompasses health and healthcare implications more directly relevant to the individual. We will then examine differences in healthcare utilization associated with the level of exposure to the pandemic. We will also assess the mediating and moderating role of formal and informal care resources (e.g., hospital capacity, family availability) in the pandemic’s effects on healthcare utilization. It will then examine the extent to which health, mortality, and healthcare costs of adults with ADRD were affected by the exposure to the pandemic, including potential differential effects across demographic (gender, racial/ethnic) and economic groups. The proposed study uses an innovative, comprehensive approach to assess the Covid-19 pandemic effects. It will develop a fine-grained contextual measure of exposure to the pandemic by using a daily infection risk in a local area (tract, ZIP code, county) where an adult with ADRD lives and addressing spillover effects of neighboring areas. It provides a nuanced understanding of the pandemic’s effect on healthcare utilization by incorporating information on the time-course of dementia (exposure at the onset vs. exposure during the subsequent years of dementia). The study will provide important data on the underlying mechanisms of the pandemic’s effect on healthcare utilization and health, and will identify sociodemographic and economic groups that are the most affected. Therefore, it will inform health policies and intervention programs aimed at improving healthcare systems to mitigate adverse effects of the pandemic and to reduce disparities in healthcare and health outcomes. 1

项目总结/摘要 患有阿尔茨海默病和相关痴呆症（ADRD）的成年人是最脆弱的个体之一 从流行病。ADRD成人的正式和非正式护理都受到了 新型冠状病毒肺炎大流行。尽管由于这些成年人的局限性，他们需要经常亲自护理， 身体和认知功能，家庭护理服务是有限的，养老院护理一直有风险 在大流行期间。许多家庭的社会和经济状况也因 因此，他们的资源，以照顾家庭成员与ADRD。对有以下情况的成年人的中断护理 ADRD可能会对健康造成不良影响，这种影响可能会持续到大流行期之后。更好的 了解这一流行病对正式和非正式护理之间动态的影响至关重要， 重要的是要解决成人ADRD患者在大流行期间和之后未得到满足的护理需求。 我们将首先通过以下方式创建一个大流行暴露的背景测量（暴露前、低、高、后）： 考虑到病毒在当地的感染风险，并制定一个量身定制的地理边界 对每个人来说，包括健康和医疗保健的影响，更直接相关的， 单独的.然后，我们将研究与暴露水平相关的医疗保健利用的差异， 大流行病我们还将评估正式和非正式护理资源的中介和调节作用 (e.g.,医院的能力，家庭的可用性）在大流行对医疗保健利用的影响。然后它将 检查成人ADRD患者的健康、死亡率和医疗保健费用受以下因素影响的程度： 对大流行病的暴露，包括对人口统计学（性别、种族/族裔）的潜在不同影响 经济集团。 拟议的研究采用了一种创新的、全面的方法来评估新冠肺炎大流行的影响。它 将通过使用每日感染风险， 成人ADRD患者居住的当地地区（区域、邮政编码、县），并解决 邻近地区。它提供了一个微妙的理解大流行对医疗保健利用的影响， 纳入关于痴呆症时间进程的信息（发病时的暴露与 老年痴呆症（Dementia）。 这项研究将提供关于大流行对医疗保健影响的潜在机制的重要数据 这将是一项关于利用率和健康状况的研究，并将确定受影响最严重的社会人口和经济群体。 因此，它将为旨在改善医疗保健系统的卫生政策和干预计划提供信息， 减轻大流行病的不利影响，并减少医疗保健和健康结果方面的差距。 1