The Impact of Alzheimer's Disease and Related Dementias on Older Adults' Medicare Coverage Choices, Financial Well-being, and Health

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1. PROJECT SUMMARY/ABSTRACT This NIA career development award will establish Dr. McGarry, an Assistant Professor in the Department of Medicine at the University of Rochester (UR), as an independent investigator with expertise in the areas of cognitive aging, including Alzheimer’s Disease and related dementias (ADRD), and consumer choice in the Medicare program. With support from the award, Dr. McGarry will undertake a training plan that focuses on: 1) the clinical trajectory of ADRD, 2) ADRD family caregiving and research, 3) qualitative research methods, and 4) leadership of a multidisciplinary research team. This training will enable Dr. McGarry to conduct multidisciplinary, mixed-methods research examining the impact of ADRD on Medicare choices and resultant outcomes. It builds off his current areas of expertise, including Medicare policy and benefit design and quantitative health services research. Dr. McGarry has leveraged the considerable resources available at UR to assemble a multidisciplinary team of nationally-recognized experts. Dr. Kathi Heffner, the primary career development mentor, is a social psychologist with expertise in cognitive aging and the study of caregivers with ADRD. Dr. Helena Temkin-Greener, the primary methods mentor, is a health services researcher with expertise in the delivery and quality of health services for older adults and mixed methods research. Together they will lead a mentorship team with additional expertise in qualitative research methods, the measurement of functional cognitive abilities, the diagnosis and clinical care of individuals with ADRD, and the use of national survey data linked with Medicare claims to study health outcomes in older adults. The Medicare program depends on consumer choice, yet little is known about the ability of older adults with ADRD to navigate this complexity. Available evidence suggests this population is at increased risk of suboptimal coverage choices, yet little is known about how these risks evolve over the disease course and their health and financial effects. This mixed-methods study will examine the Medicare coverage choices of individuals with ADRD throughout the disease course (Aim 1). The Health and Retirement Study (HRS) linked with Medicare claims will be used to describe the Medicare coverage, and propensity to make changes, of individuals with ADRD at various stages of cognitive decline. Analyses will also examine whether the impacts of cognitive declines are moderated by the availability of family caregivers and socioeconomic resources. Qualitative interviews with caregivers of individuals with ADRD will add depth and support the interpretation of the quantitative results. Using the same HRS data, the effects of impaired household Medicare decision making due to ADRD on health and financial outcomes will be estimated using a quasi-experimental design (Aim 2). Study results will provide critical information to policy makers about the effects of Medicare program design on the well-being of individuals with ADRD. In combination with mentored training, this research will form the basis of an R01 proposal that will evaluate the effects of potential policy reforms designed to support Medicare choices in households with ADRD and the acceptability of such reforms to this population.