Access and use of long-term services and supports for older adults living alone with Alzheimer's disease and related dementias from four racial/ethnic groups

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One-third of older adults with Alzheimer's disease and related dementias (ADRD) in the United States (US) live alone. Previous studies have shown that older adults with ADRD who live alone have high risk for health threats. Because they lack cohabitants, who typically provide most of informal unpaid LTSS, older adults with ADRD living alone often have limited access to LTSS, which increases their distress. This also increases costs for unnecessary hospitalizations and institutionalizations. Therefore, the large population of older adults with ADRD living alone likely has large-scale underserved needs that constitute an urgent public health problem, but little is known about their access to, and use of, essential LTSS. Moreover, strategies for increasing access to LTSS are largely lacking and unknown. These knowledge gaps impede development, and thus implementation, of policies to ensure access to essential LTSS to older adults with ADRD living alone, especially with respect to racial/ethnic minorities who have increased risk of ADRD vs. Whites, often live alone and often have worse access to services. This project's objective is thus to elucidate specific barriers and facilitators to access to and use of LTSS among older adults with ADRD living alone vs those with ADRD living with others, and to compare how these barriers and facilitators may differ among racial/ethnic groups. We will then apply this knowledge to develop policy recommendations to increase access to and use of LTSS, emphasizing racial/ethnic minorities and older adults living alone. Building on the Goldberg-Huxley model, we will leverage our preliminary studies to conduct a longitudinal mixed-method study with convergent and independent quantitative (Aim 1) and qualitative aims (Aim 2) in Years 1-3, followed by a policy aim (Aim 3) in Years 4-5. The design and promise of this project were endorsed by our Community Advisory Board. Our interdisciplinary team's expertise in aging alone, LTSS, ADRD, health disparities, and policy positions us well to achieve the aims. The Specific Aims are: 1) To quantify multi-level barriers and facilitators of LTSS use among older adults with ADRDs and the extent to which these predictors of LTSS use vary by living arrangement (living alone vs. living with others) and race/ethnicity. 2) To elucidate in depth the barriers and facilitators to accessing and using LTSS via semi-structured interviews with older adults with ADRD, informants, and LTSS providers and administrators. 3) To develop policy recommendations to increase access to and use of LTSS among older adults with ADRD, emphasizing racial/ethnic minorities and older adults living alone. Our findings will inform development of policies to enhance the performance of LTSS in the US. Findings will support policies to increase access, affordability, acceptance, and use of essential LTSS for older adults with ADRD, especially those living alone and racial/ethnic minorities. Thus, the proposed project will likely reduce health disparities. Furthermore, this project will likely reduce unnecessary hospitalizations and institutionalizations, which will enhance the wellbeing of older adults with ADRD and reduce costs.