The Importance of the Neighborhood Environment in Determining Health and Well-being among Persons with Dementia and their Caregivers

项目总结 美国阿尔茨海默病和相关痴呆症(ADRD)人口的快速增长 构成了迫在眉睫的公共卫生危机。痴呆症是一种进行性认知障碍综合征， 导致老年人残疾、丧失独立性、住院和死亡的主要原因。ADRD影响 超过500万65岁以上的美国成年人，但也影响到估计1600万家庭和朋友，作为 主要照顾者身心健康不良和社会孤立的风险增加。流行率 随着人口老龄化，痴呆症的发病率预计会增加，目前还没有已知的治疗方法可以 治愈或显著减缓其进展。因此，公共卫生的首要任务是确定如何改善 痴呆症患者(PWD)的生活，以减少痴呆症对PWD及其患者的影响 照顾者。社区的社会、物理、建筑和服务环境的特点可能会提供必要的 对残疾人及其照顾者的支持，或者，相反，加剧了痴呆症的不利影响。这个 拟议的研究将确定以社区为基础的支持因素(例如，送餐、家庭健康 护理、便利设施、可步行)和压力源(如缺乏安全、混乱、噪音、交通)影响健康和健康- 身处残障人士及其照顾者之列。我们利用了来自两家具有全国代表性的大型企业的数据 纵向调查收集了数千名残疾人及其照顾者的信息，并提供了 关于他们居住地的信息：健康和退休研究(HRS)和国民健康和退休 老龄化趋势研究(NHATS)。我们将首先创建一个全国性的、纵向的邻里数据库 理论和研究表明，反映身体活动、社交活动机会的特征 参与、精神刺激、支持性服务和资源，以及心理社会压力源。使用这个 新的数据资源，将提供给研究界，我们将评估 社区层面的健康和幸福多个维度的因素(例如，脆弱、社会参与度、 机构)为残疾人士及其照顾者服务。我们将进一步确定健康和幸福是否存在差异 按种族/民族、社会经济地位、独居和居住在城市/农村地区界定的各种群体 并评估社区在造成这种不平等中的作用。据我们所知，这将是第一次 在全国范围内考察社区如何提高残疾人和残疾人的生活质量的实证研究 他们的照顾者。这项拟议的研究很及时，因为越来越多的城市和社区 致力于变得更有利于痴呆症的努力。该项目将确定社区的各个方面，并 支持痴呆症患者良好生活的社区，并为政策和计划提供信息以降低成本和 痴呆症对个人、家庭和社区的负担。

PROJECT SUMMARY The rapid increase in the population with Alzheimer’s disease and related dementias (ADRD) in the United States constitutes a looming public health crisis. Dementia is a syndrome of progressive cognitive impairment and a leading cause of disability, loss of independence, institutionalization, and death in older adults. ADRD affect more than 5 million U.S. adults over age 65, but also impact an estimated 16 million family and friends who, as primary caregivers, are at increased risk of poor physical and mental health and social isolation. The prevalence of dementia is expected to increase as the population ages, and there is currently no known treatment that can cure or substantially slow its progression. A top public health priority, therefore, is to determine how to improve the lives of persons living with dementia (PWD) in order reduce the impact of dementia on PWD and their caregivers. Features of the neighborhood social, physical, built, and service environment may provide necessary support to PWD and their caregivers, or, alternatively, exacerbate the adverse impacts of dementia. The proposed study will determine how neighborhood-based supportive factors (e.g., meal delivery, home health care, amenities, walkability) and stressors (e.g., lack of safety, disorder, noise, traffic) affect health and well- being among PWD and their caregivers. We leverage data from two large, nationally representative, and longitudinal surveys that have collected information on thousands of PWD and their caregivers and provide information on their place of residence: the Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS). We will first create a national, longitudinal database of neighborhood characteristics that, as indicated by theory and research, reflect opportunities for physical activity, social engagement, and mental stimulation, supportive services and resources, and psychosocial stressors. Using this new data resource, which will be made available to the research community, we will estimate the impact of neighborhood-level factors on multiple dimensions of health and well-being (e.g., frailty, social engagement, institutionalization) for both PWD and their caregivers. We will further determine if health and well-being vary across groups defined by race/ethnicity, socioeconomic status, living alone, and residence in urban/rural areas and assess the role of the neighborhood in generating this inequality. To our knowledge, this will be the first empirical study to examine, in a national context, how neighborhoods can engender quality of life in PWD and their caregivers. The proposed study is timely because an increasing number of cities and communities are engaged in efforts to become more dementia-friendly. This project will identify aspects of neighborhoods and communities that support living well with dementia and inform policies and programs to reduce the costs and burden of dementia on individuals, families, and communities.