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

1.项目总结/摘要 这个NIA职业发展奖将建立博士。 医学在罗切斯特大学（UR），作为一个独立的研究人员与认知领域的专业知识， 包括阿尔茨海默病和相关痴呆症（ADRD）在内的老龄化，以及医疗保险计划中的消费者选择。 在该奖项的支持下，McGarry博士将开展一项培训计划，重点是：1） ADRD，2）ADRD家庭的宣传和研究，3）定性研究方法，4）领导的一个 多学科研究团队。该培训将使McGarry博士能够进行多学科，混合方法 研究ADRD对Medicare选择和结果的影响。它建立在他目前的领域， 专业知识，包括医疗保险政策和福利设计以及定量医疗服务研究。麦加里医生 利用UR提供的大量资源，组建了一个国家认可的多学科团队， 专家Kathi Heffner博士是主要的职业发展导师，她是一位社会心理学家，擅长认知心理学。 老龄化和ADRD照顾者的研究。海伦娜Temkin-Greener博士，主要的方法导师，是一个健康 服务研究员，在老年人和混合方法的卫生服务的交付和质量方面具有专业知识 research.他们将共同领导一个导师团队，在定性研究方法方面拥有额外的专业知识， 功能性认知能力的测量，ADRD患者的诊断和临床护理，以及 与医疗保险索赔相关的全国调查数据，以研究老年人的健康结果。 医疗保险计划取决于消费者的选择，但对老年人的能力知之甚少， ADRD来驾驭这种复杂性。现有证据表明，该人群的次优风险增加 覆盖范围的选择，但很少有人知道这些风险如何演变的疾病过程和他们的健康， 财务影响。这项混合方法研究将检查ADRD患者的医疗保险覆盖范围选择 在整个病程中（目标1）。与医疗保险索赔相关的健康和退休研究（HRS）将被 用于描述处于不同阶段的ADRD患者的Medicare覆盖范围和做出改变的倾向 认知能力下降分析还将检查认知能力下降的影响是否受到 提供家庭照顾者和社会经济资源。与患有糖尿病的个人的照顾者进行定性访谈 ADRD将增加深度并支持定量结果的解释。使用相同的HRS数据， 由于ADRD对健康和财务结果的影响， 使用准实验设计（目标2）。研究结果将为政策制定者提供关于 医疗保险计划设计对ADRD患者福祉的影响。与指导培训相结合， 这项研究将构成R 01提案的基础，该提案将评估潜在政策改革的效果，这些政策改革旨在 支持ADRD家庭的医疗保险选择，以及这些人群对此类改革的接受程度。

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.