Access and use of long-term services and supports for older adults living alone with Alzheimer's disease and related dementias from four racial/ethnic groups

在美国，三分之一患有阿尔茨海默病和相关痴呆症（ADRD）的老年人生活在 一个人先前的研究表明，独居的ADRD老年人具有高健康风险 威胁因为他们缺乏同居者，而同居者通常提供大部分非正式的无偿长期生活支助， 独居的ADRD患者获得LTSS的机会往往有限，这增加了他们的痛苦。这也增加了成本 不必要的住院和收容因此，大量老年人 独居的ADRD可能有大规模的服务不足的需求，构成了一个紧迫的公共卫生问题， 但对他们获得和使用基本LTSS的情况知之甚少。此外，增加获取机会的战略 对LTS来说，基本上是缺乏和未知的。这些知识差距阻碍了发展， 实施政策，确保独居的老年ADRD患者获得基本的长期社会支持服务， 特别是与白人相比，ADRD风险增加的种族/族裔少数群体，通常独自生活 而且往往得不到更好的服务。因此，本项目的目标是阐明具体的障碍， 在独居ADRD老年人与独居ADRD老年人中获得和使用LTSS的促进者 与其他人，并比较这些障碍和促进因素如何可能不同的种族/族裔群体。我们将 然后应用这些知识来制定政策建议，以增加获得和使用LTSS， 强调种族/族裔少数群体和独居的老年人。基于Goldberg-Huxley模型，我们 将利用我们的初步研究进行纵向混合方法研究， 第一至第三年的独立定量目标（目标1）和定性目标（目标2），随后是第二年的政策目标（目标3）。 4-5年。该项目的设计和承诺得到了我们社区咨询委员会的认可。我们 跨学科团队在老龄化、LTSS、ADRD、健康差异和政策方面的专业知识使我们处于有利地位 以实现目标。具体目的是：1）量化LTSS使用的多层次障碍和促进因素 在患有ADRD的老年人中，这些LTSS使用的预测因素在多大程度上因生活而异 安排（单独生活vs.与他人生活）和种族/民族。2)深入阐明障碍， 协助者通过与ADRD老年人的半结构化访谈访问和使用LTSS， 提供者和管理员。3)制定政策建议，以增加获得 在患有ADRD的老年人中使用LTSS，强调种族/民族少数和老年人生活在 一个人我们的研究结果将为制定政策提供信息，以提高美国LTSS的绩效。 调查结果将支持政策，以增加老年人获得，负担能力，接受和使用基本LTSS ADRD成人，尤其是独居和少数种族/民族。因此，拟议项目将 可能会减少健康差距。此外，该项目可能会减少不必要的住院治疗， 机构化，这将提高ADRD老年人的福祉并降低成本。

One-third of older adults with Alzheimer's disease and related dementias (ADRD) in the United States (US) live alone. Previous studies have shown that older adults with ADRD who live alone have high risk for health threats. Because they lack cohabitants, who typically provide most of informal unpaid LTSS, older adults with ADRD living alone often have limited access to LTSS, which increases their distress. This also increases costs for unnecessary hospitalizations and institutionalizations. Therefore, the large population of older adults with ADRD living alone likely has large-scale underserved needs that constitute an urgent public health problem, but little is known about their access to, and use of, essential LTSS. Moreover, strategies for increasing access to LTSS are largely lacking and unknown. These knowledge gaps impede development, and thus implementation, of policies to ensure access to essential LTSS to older adults with ADRD living alone, especially with respect to racial/ethnic minorities who have increased risk of ADRD vs. Whites, often live alone and often have worse access to services. This project's objective is thus to elucidate specific barriers and facilitators to access to and use of LTSS among older adults with ADRD living alone vs those with ADRD living with others, and to compare how these barriers and facilitators may differ among racial/ethnic groups. We will then apply this knowledge to develop policy recommendations to increase access to and use of LTSS, emphasizing racial/ethnic minorities and older adults living alone. Building on the Goldberg-Huxley model, we will leverage our preliminary studies to conduct a longitudinal mixed-method study with convergent and independent quantitative (Aim 1) and qualitative aims (Aim 2) in Years 1-3, followed by a policy aim (Aim 3) in Years 4-5. The design and promise of this project were endorsed by our Community Advisory Board. Our interdisciplinary team's expertise in aging alone, LTSS, ADRD, health disparities, and policy positions us well to achieve the aims. The Specific Aims are: 1) To quantify multi-level barriers and facilitators of LTSS use among older adults with ADRDs and the extent to which these predictors of LTSS use vary by living arrangement (living alone vs. living with others) and race/ethnicity. 2) To elucidate in depth the barriers and facilitators to accessing and using LTSS via semi-structured interviews with older adults with ADRD, informants, and LTSS providers and administrators. 3) To develop policy recommendations to increase access to and use of LTSS among older adults with ADRD, emphasizing racial/ethnic minorities and older adults living alone. Our findings will inform development of policies to enhance the performance of LTSS in the US. Findings will support policies to increase access, affordability, acceptance, and use of essential LTSS for older adults with ADRD, especially those living alone and racial/ethnic minorities. Thus, the proposed project will likely reduce health disparities. Furthermore, this project will likely reduce unnecessary hospitalizations and institutionalizations, which will enhance the wellbeing of older adults with ADRD and reduce costs.