Unmet Need: An Acute/Chronic Care Link

描述（由申请人提供）：未满足的需求：急性/慢性护理链接 老年人口的空前增长，加上离婚率上升、家庭规模缩小、独居者增多和女性工作者增多等人口趋势，表明未来几十年，残疾老年人对家庭护理的需求将进一步增加。尽管强烈倾向于留在家里，目前的政策不鼓励资助和使用家庭护理服务，反映了占主导地位的公共保险机制的机构和严重的护理偏见。该提案概述了一个全面的研究议程，通过分析作为第二次老龄问题纵向研究（LSOA II）的一部分收集的数据，审查家庭护理不足的长期后果，以及保护未满足需求及其后果的网络的特征和战略，这是一项对70岁及以上的基线进行的纵向调查（SOA II）。本研究的目的如下：1.）描述基线时日常生活活动受限的老年人的全国样本中四年内的健康、医疗保健和长期护理利用轨迹，按他们接受的帮助的需求和充分性分层，即，不需要帮助、满足的帮助需要和未满足的帮助需要; 2）通过多变量建模调查未满足需要的纵向健康状况和急性和长期护理利用结果; 3）识别对家庭护理不足特别敏感的利用相关诊断，即“家庭护理敏感”诊断，（例如，骨折、肺炎、脱水、感染等）用于定位和监测家庭护理干预工作;以及4.）找出在基线时与未满足需要最密切相关的网络特征，并找出对受损长者日益增长的需要的可持续网络反应，以保护未满足的需要及其随时间的推移而产生的后果。

DESCRIPTION (provided by applicant): Unmet Need: An Acute/Chronic Care Link Unprecedented increases in the elderly population, combined with demographic trends toward higher rates of divorce, smaller families, more people living alone, and more women working suggest that unmet need for care at home among the elderly population with disabilities will escalate in coming decades. In spite of strong preferences to remain at home, current policies discourage funding and use of home care services, reflecting the institutional and acute care bias that dominates public insurance mechanisms. This proposal outlines a comprehensive research agenda to examine the long-term consequences of inadequate care at home, as well as the features and strategies of caregiving networks that are protective of unmet need and its consequences, through analyses of data collected as part of the Second Longitudinal Study on Aging (LSOA II), a longitudinal survey of individuals age 70 and over at baseline (the SOA II). The aims of this study are as follows: 1.) To describe the health, health care and long-term care utilization trajectories over four years in a national sample of elders with limitations in daily living activities at baseline, stratified by the need for and adequacy of help they receive, i.e., no need for help, met need for help, and unmet need for help; 2) To investigate through multivariate modeling the longitudinal health status and acute and long-term care utilization outcomes of unmet need; 3) To identify utilization-related diagnoses that are particularly sensitive to inadequate care in the home, that is, "home care sensitive" diagnoses, (e.g., fractures, pneumonia, dehydration, infection, etc.) for use in targeting and monitoring home care intervention efforts; and 4.) To identify network features that are most strongly related to unmet need at baseline, and to identify caregiving network responses to impaired elders' increasing need that are protective of unmet need and its consequences over time.