The impact of facility characteristics on racial disparities in ADRD mortality in nursing homes

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ABSTRACT This mentored Ruth L. Kirschstein National Research Service Award will provide the trainee, a PhD student in epidemiology at UCSF, necessary training in social inequalities in nursing home (NH) care delivery, determinants of mortality risk for older adults with Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD), and quantitative skills for analyzing and accounting for bias in large administrative datasets. Guided by a team of expert mentors, the trainee will gain the skills, practical experience, and knowledge to launch a successful academic research career dedicated to the application of rigorous epidemiologic methods to study the social systems of aging and health services in the context of ongoing social inequity, health inequality, and institutional and structural racism. The COVID-19 pandemic heightened the burden on NHs and increased variation in facility characteristics including staffing ratios and average nurse hours per resident day. The resulting systemic stress can highlight institutional drivers of long-standing health inequities among NH residents with AD/ADRD by race/ethnicity. While large racial inequalities in excess mortality occurred during the COVID-19 pandemic, the determinants of these inequalities—particularly among NH residents living with AD/ADRD—are not known. Prior studies of excess mortality in NHs have not explored the effects of time-varying, policy-relevant variables like NH occupancy and staffing characteristics. Building on prior work of the trainee, this F31 uses linked administrative datasets including comprehensive mortality data for the state of California and NH facility data from the Centers for Medicare and Medicaid Services to: (Aim 1) estimate pandemic-era excess mortality overall and stratified by race/ethnicity among all NH residents, NH residents with AD/ADRD, and multimorbid NH residents with AD/ADRD, and (Aim 2) identify time-invariant and time-varying facility/staffing characteristics linked to excess mortality and racial disparities in excess mortality in these populations. This analysis will deliver policy- relevant evidence on NH characteristics that put older adults at risk and fulfill the candidate’s training aims to position her for ongoing research to improve the lives of Black and Latinx older adults with AD/ADRD living in NHs. This proposal’s major strengths are: (1) a state-level census of mortality in California dating back to 2016; (2) longitudinal census data of all NH facilities in California over the same period; and (3) innovative hypotheses focusing on gaps in health equity research for highly vulnerable older adults. Knowledge gained from this research will advance the NIA’s mission to identify and evaluate structural factors that produce disparities in quality and access to care in old age. Guided by an exemplary mentorship team, the proposed training will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as an independent academic researcher focused on improving health equity for older adults.