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

项目摘要 美国阿尔茨海默病和相关痴呆症（ADRD）患者人数迅速增加 构成了一场迫在眉睫的公共卫生危机痴呆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、机构化和死亡的主要原因。ADRD影响 超过500万65岁以上的美国成年人，但也影响了估计1600万家庭和朋友， 主要照顾者的身心健康状况不佳和被社会孤立的风险增加。之时尚 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 治愈或大大减缓其进展。因此，公共卫生的首要任务是确定如何改善 老年痴呆症患者的生活，以减少老年痴呆症对老年痴呆症及其 照顾者社区的社会、物理、建筑和服务环境的特征可以提供必要的 对残疾人及其照顾者的支持，或者，替代地，加剧痴呆症的不利影响。的 所提出的研究将确定如何基于邻里的支持因素（例如，送餐、家庭保健 护理、便利设施、步行性）和压力源（例如，缺乏安全、混乱、噪音、交通）影响健康和良好， 在残疾人和他们的照顾者中。我们利用来自两个大型的、具有全国代表性的数据， 纵向调查收集了数千名残疾人及其照顾者的信息， 关于他们居住地的信息：健康和退休研究（HRS）和国家健康和 老龄化趋势研究。我们将首先建立一个全国性的纵向邻里数据库， 理论和研究表明，这些特征反映了体育活动、社会活动和 参与、精神刺激、支持性服务和资源以及心理社会压力因素。使用此 新的数据资源，这将提供给研究界，我们将估计的影响， 关于健康和幸福的多个维度的邻里水平因素（例如，脆弱，社会参与， 机构化）。我们将进一步确定健康和福祉是否会因 按种族/民族、社会经济地位、独居和居住在城市/农村地区划分的群体 并评估邻里在产生这种不平等中的作用。据我们所知，这将是第一个 实证研究，以检查，在全国范围内，如何社区可以产生生活质量的残疾人， 他们的照顾者。这项研究是及时的，因为越来越多的城市和社区 致力于变得对痴呆症更友好。该项目将确定社区的各个方面， 支持痴呆症患者生活良好的社区，并为降低成本的政策和计划提供信息， 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.