Aging in Place: A Cross-Sector Partnership of Housing and Health Care

就地养老：住房和医疗保健的跨部门合作

• 批准号: 10189162
• 负责人: Lesli Elizabeth Skolarus
• 金额: $ 19.5万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-15 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10189162
• 关键词: Academic support; Administrator; Adoption; African American; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Behavior Therapy; Blood Pressure; Caring; Clinic; Clinic Visits; Cognitive; Communities; Community Health Aides; Community Health Services; Elderly; Electronic Health Record; Equilibrium; Evaluation; Federally Qualified Health Center; Geriatrics; Health Services Research; Health behavior; Healthcare; High Prevalence; Home; Home visitation; Household; Housing; Impairment; Interview; Location; Low income; Measures; Medical; Methods; Michigan; Modeling; Modification; Penetration; Physical Function; Physical environment; Poverty; Provider; Research; Resources; Risk Factors; Safety; Social Environment; Social isolation; Social support; Structure; Testing; U.S. Department of Housing and Urban Development; Visit; Vulnerable Populations; Work; aging in place; blood pressure reduction; cognitive function; community engagement; design; disability; disability risk; experience; high risk; implementation framework; implementation outcomes; implementation science; safety net; social engagement; social interventions

Abstract/Project Summary Many older adults prefer to remain in their homes as they age. The ability to age in place is a balance between the amount of cognitive and physical function, the physical environment, and the social environment available to stay in their homes. Black older adults and the poor experience greater physical impairment and a higher prevalence of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRDs) than their counterparts resulting in greater challenges to aging in place. Bold ideas to facilitate aging in place, particularly among vulnerable populations, are needed. To promote aging in place, we present the Unite care model, a community-initiated, academic supported, dual- sector initiative that combines two sectors: housing and health care. The Unite care model co-locates a Federally Qualified Health Center (FQHC) clinic on an older adult affordable housing campus, home to over 700 predominately Black older adults in Flint, Michigan. The Unite care model will promote aging in place by optimizing: 1) medical care including onsite clinic and home visits; 2) the physical environment through referrals for home safety evaluations and facilitating environmental modifications and; 3) the social environment by community health worker led health behavior and social interventions. Overall, the Unite care model will flip the paradigm that asks the most vulnerable older adults to seek out the medical safety net. Instead, the Unite care model will bring the safety net to older adults to support aging in place. The objective of this proposal is to assess how well the Unite care model is implemented, identify which older adults utilize it, with particular emphasis on older adults with activity limitations or AD/ADRD, and whether the model promotes aging in place. In aim 1, through a concurrent exploratory mixed methods design guided by the Proctor implementation outcomes framework, we seek to determine how much and for whom (i.e., penetration) and how well (i.e., adoption and acceptability) the Unite care model is implemented. In aim 2, we will determine which older adults utilize the Unite care model and assess whether the Unite care model promotes aging in place through blood pressure reduction, a measure of medical care and an important predictor of disability, and changes to the physical and social environment. We have worked in partnership with the Flint community for over a decade and have specifically worked on this project with our housing and healthcare partners for two years. This proposal will inform other communities contemplating new models of care to promote aging in place among older adults living in poverty and older Black Americans and suggest whether larger-scale testing of this model of care is warranted. .

摘要/项目摘要 许多老年人更喜欢留在家里，因为他们的年龄。就地老化的能力是一种平衡， 认知和身体功能的数量，可用的物理环境和社会环境 待在自己家里黑人老年人和穷人经历更大的身体损伤和更高的 阿尔茨海默病和阿尔茨海默病相关痴呆（AD/ADRD）的患病率高于其 同行导致更大的挑战，老龄化的地方。大胆的想法，以促进老龄化的地方，特别是 在弱势群体中，这是必要的。 为了促进老龄化的地方，我们提出了团结护理模式，社区发起，学术支持，双重， 这是一项将住房和保健两个部门结合起来的部门倡议。Unite护理模式将 联邦合格的健康中心（UHC）诊所在一个老年人负担得起的住房校园，家里超过 700名主要是密歇根州弗林特的黑人老年人。Unite护理模式将通过以下方式促进就地老龄化： 优化：1）医疗护理，包括现场诊所和家访; 2）物理环境， 家庭安全评估和促进环境改造的转介; 3）社会 环境卫生工作者主导的健康行为和社会干预。总体而言，联合护理 这一模式将颠覆要求最脆弱的老年人寻求医疗安全网的范式。 相反，联合护理模式将为老年人提供安全网，以支持就地老龄化。 该提案的目的是评估联合护理模式的实施情况，确定哪些老年人 成年人使用它，特别强调活动受限或AD/ADRD的老年人，以及 模式促进就地老化。在aim 1中，通过由 在普罗克特实施成果框架中，我们寻求确定多少和为谁（即， 穿透）以及穿透的程度（即，采用和可接受性），实施联合护理模式。在目标2中，我们 将确定哪些老年人使用联合护理模式，并评估联合护理模式是否 通过降低血压促进就地老化，这是一种医疗保健措施，也是一种重要的 残疾的预测因素，以及物质和社会环境的变化。我们已经与 弗林特社区超过十年，并专门致力于这个项目与我们的住房和 医疗保健合作伙伴两年。这一建议将告知其他社区， 关心促进生活在贫困中的老年人和老年黑人美国人的老龄化，并建议 是否有必要对这种护理模式进行更大规模的测试。 .