Family care to nursing home residents and state essential caregiver programs during the COVID-19 pandemic: impact on dementia care, outcomes, and disparities

项目总结/摘要 美国目前约有650万老年人患有阿尔茨海默氏症 疾病或相关痴呆症（ADRD），这一数字预计将增加到1270万 到2050年大多数ADRD患者在治疗过程中需要疗养院（NH）护理。 疾病，其中约70%死于NHS。在新罕布什尔州居民中，近50%的人得到了诊断 的ADRD。少数民族患痴呆症的风险高于非西班牙裔白人， 和少数种族/民族的ADRD经历更高水平的认知障碍， 痴呆症的行为和精神症状患病率较高。所有这些 增加种族/少数民族老年人的NH安置风险，以及NH水平 安置后需要的护理。然而，强有力的证据表明，种族/少数民族 患有ADRD的NH居民接受的护理不足（例如，更多地使用饲管）， 与非西班牙裔白色ADRD相比，健康结局更差（例如，住院率更高） 居民非正式护理，或由家庭成员或朋友提供的无偿护理， 有和没有ADRD的NH居民。然而，对NH居民的家庭照顾严重 于2019冠状病毒病大流行期间因新罕布什尔州延长封锁而中断。减轻 家庭护理中断，18个州在2020-21年期间建立了基本护理人员（EC）计划 允许NH居民亲自接触家庭或其他照顾者， 国家突发公共卫生事件。本研究旨在确定（1）非正式的影响， 家庭护理对有和没有ADRD的NH居民的健康结果，他们的家庭 护理人员和ADRD种族/民族居民;和（2）国家EC协会 2019冠状病毒病大流行期间，与居民和家庭的非正式接触计划， 照顾者的健康结果。本项目将采用2008-22健康与退休研究 (HRS)调查数据和其他现有数据文件，以解决研究目标。研究结果将 提供关键的见解，家庭支持的作用，以健康的NH居民与ADRD 和他们的家庭，以及旨在促进家庭的国家政策的潜在影响， 在未来突发公共卫生事件中，

Project Summary/Abstract Approximately 6.5 million older adults in the United States currently live with Alzheimer's Disease or Related Dementia (ADRD) and this number is projected to increase to 12.7 million by 2050. Most persons with ADRD require nursing home (NH) care during the course of their illness, and about 70% of them die in NHs. Among NH residents, almost 50% have a diagnosis of ADRD. The risk of dementia is higher for racial/ethnic minorities than non-Hispanic whites, and racial/ethnic minorities with ADRD experience higher levels of cognitive impairment and higher prevalence of behavioral and psychiatric symptoms of dementia. Together, these increase the risk of NH placement for racial/ethnic minority older adults, and the level of NH care they need after placement. However, strong evidence suggests that racial/ethnic minority NH residents with ADRD receive less adequate care (e.g. more feeding tube use) and have worse health outcomes (e.g. higher hospitalization rate) than non-Hispanic white ADRD residents. Informal care, or unpaid care provided by family members or friends, is common for NH residents with and without ADRD. However, family care to NH residents was seriously disrupted during the COVID-19 pandemic due to extended NH lockdown. To mitigate the disrupted family care,18 states established essential caregiver (EC) programs during 2020-21 which allowed NH residents to have in-person access to family or other caregivers under national public health emergency. This study proposes to determine (1) the impacts of informal family care on the health outcomes of NH residents with and without ADRD, their family caregivers, and racial/ethnic residents with ADRD; and (2) the associations of state EC programs with informal caregiving during the COVID-19 pandemic, and with resident and family caregiver health outcomes. This project will employ the 2008-22 Health and Retirement Study (HRS) survey data and other existing data files to address study aims. Findings of the study will provide critical insights into the role of family caregiving to the health of NH residents with ADRD and their families, and into the potential impact of state policies designed to foster family caregiving in NHs during future public health emergencies.