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Effects of Informal Care for persons with Alzheimer's Disease and related dementias

非正式护理对阿尔茨海默病和相关痴呆症患者的影响

基本信息

批准号：
9756265
负责人：
Norma B Coe
金额：
$ 62.36万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-30 至 2021-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9756265
关键词：
Address Advocate Age Alzheimer&apos s disease related dementia American Area Assisted Living Facilities Budgets Care given by nurses Caregivers Caring Clinical Communities Cost of Illness Country Data Data Set Databases Dedications Direct Costs Disease Economics Effectiveness Elderly Emergency department visit Emotional Evaluation Experimental Designs Facilities and Administrative Costs Family Financial Hardship Formal caregiver Friends Goals Government Financing Health Health Resources Health and Retirement Study Healthcare Home Nursing Care Home environment Hospitalization Independent Living Individual Industry Intuition Long-Term Care Longevity Measures Medicaid Medicare Medicare/Medicaid Memory Mental Health Methods Nature Nursing Homes Outcome Patient Self-Report Patients Persons Play Policies Population Prevalence Privatization Psyche structure Research Residential Treatment Resources Retirement Role Sampling Science Severity of illness Source Techniques Training Work aged care costs care outcomes care providers care recipients cost disability experience functional disability health care availability health care service utilization informal care informal caregiver informal support instrument patient oriented person centered physical conditioning psychologic social trend

项目摘要

Effects of Informal Care for persons with Alzheimer's Disease and Related Dementias The current debate about how best to meet the growing demand for patient-centered, high-quality long- term care for persons with ADRD in the least restrictive setting possible has centered almost solely on the direct and indirect costs of each type of care. A crucial missing piece is a comparison of the benefits. While receiving informal care may seem intuitively appealing, we currently know surprisingly little about the implications of this choice for outcomes of the individuals receiving the care. Our study would be the first to measure the causal impact of receiving informal versus formal long-term care on key and multi-faceted outcomes for the care recipient, primarily using the Health and Retirement Study, a nationally-representative dataset of Americans age 50+. Our analysis would include all individuals receiving long-term care, as well as a sub-sample of individuals living with ADRD, since informal care costs account for approximately half the total costs of the disease. Our health outcomes include a rich set of self-reported physical, mental, emotional, and social health measures, as well as self-reported and administrative health care utilization measures. In order to estimate the causal impact of formal and informal care, we employ instrumental variable techniques and a set of instruments that have been successfully used to predict informal care receipt in previous work using the same dataset. In addition, we propose new and promising instruments, including the supply of formal care available in the market. Finally, our study is the first to take a comprehensive look at all forms of formal care, including the plethora of private-pay residential care options. To do so, this research brings together the Area Health Resource Files (AHRF) and the NIC-MAP database, the industry's premiere dataset concerning the long-term care market. Using this approach, our study proposes to address the following specific aims: to describe comprehensively an expanded profile of the supply of publicly and privately financed formal care in local markets and its correlation with informal care, and to quantify the difference in care recipient outcomes caused by receiving informal versus formal care. This proposal will inform the policy tradeoffs between supporting informal care providers and expanding publicly financed formal care options.

非正式护理对阿尔茨海默病和相关痴呆症患者的影响目前关于如何最好地满足对以患者为中心的高质量长期在尽可能少的限制性环境中对ADRD患者的长期护理几乎完全集中在直接以及每种护理的间接成本。一个关键的缺失是利益的比较。同时接收非正式护理可能看起来直观上很有吸引力，但我们目前对这一点的影响知之甚少，选择接受护理的个人的结果。我们的研究将是第一个衡量接受非正式与正式长期教育的因果影响的研究。为护理对象提供关键和多方面的护理结果，主要使用健康和退休研究，这是一个全国性的50岁以上美国人数据集。我们的分析将包括所有接受长期护理以及ADRD患者的子样本，因为非正式护理费用占约占疾病总成本的一半。我们的健康结果包括一组丰富的自我报告的身体，心理、情感和社会健康指标，以及自我报告和行政卫生保健利用率措施为了估计正式和非正式护理的因果影响，我们采用工具变量技术和一套工具，已成功地用于预测非正式护理接收在以前的使用相同的数据集。此外，我们提出了新的和有希望的手段，包括供应市场上的正规护理。最后，我们的研究是第一次全面审视各种形式的正规护理，包括过多的私人付费住宿护理选择。为此，这项研究汇集了地区卫生资源文件（AHRF）和NIC-MAP数据库，该行业的首要数据集，长期护理市场。使用这种方法，我们的研究提出了以下具体目标：全面扩大地方市场上公共和私人资助的正规保健的供应情况及其与非正式护理的相关性，并量化由以下因素引起的护理接受者结果的差异：接受非正式和正式的护理。这一建议将告知支持非正规教育和保健提供者和扩大公共资助的正式保健选择。