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

项目摘要/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人群之一 从流行病中解脱出来。对成人ADRD的正式和非正式护理都受到了 新冠肺炎大流行。尽管由于这些成年人的限制，他们需要经常亲身护理 身体和认知功能，家庭护理服务有限，养老院护理一直存在风险 在大流行期间。许多家庭的社会和经济状况也因 因此，他们为照顾患有ADRD的家庭成员提供了资源。中断了对成年人的护理， ADRD可能会产生不良的健康后果，可能会持续到大流行期间之后。更好的 了解大流行对正规护理和非正规护理之间的动态的影响至关重要 在大流行期间和之后解决成人ADRD未得到满足的护理需求非常重要。 我们将首先通过以下方式创建暴露于大流行的背景测量(暴露前、暴露低、暴露高、暴露后) 考虑到病毒在当地的感染风险，制定量身定做的地理边界 对于每个包含更直接相关的健康和医疗保健影响的个人 个人的。然后，我们将检查与接触以下物质的水平相关的医疗利用的差异 大流行。我们还将评估正式和非正式护理资源的调解和协调作用。 (例如，医院能力、家庭可获得性)反映了大流行对医疗保健利用的影响。到时候它会的 检查成人ADRD患者的健康、死亡率和医疗费用受 接触这一流行病，包括人口(性别、种族/族裔)之间的潜在差异影响 和经济团体。 拟议的研究使用了一种创新的全面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来开发接触大流行的细粒度上下文测量 成人ADRD患者居住的当地地区(地区、邮政编码、县)，并解决 邻近地区。它提供了对大流行对医疗保健利用的影响的细微差别的理解，通过 纳入关于痴呆症的时间-病程的信息(发病时的暴露与 随后几年的痴呆症)。 这项研究将提供有关大流行对医疗保健影响的潜在机制的重要数据 利用和健康，并将确定受影响最大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，以 减轻大流行的不利影响，减少医疗保健和健康结果方面的差距。 1

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