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(ADRD)的老年人 独自一人。先前的研究表明，独居的老年ADRD患者对健康的风险很高 威胁。因为他们没有同居者，他们通常提供大部分非正式的无偿LTS，老年人有 独居的ADRD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。 用于不必要的住院和收容。因此，有大量老年人患有 独居的ADRD可能有大规模的未得到满足的需求，这构成了一个紧迫的公共卫生问题， 但人们对他们获得和使用基本的LTS知之甚少。此外，增加准入的战略 TO LTSS在很大程度上是缺乏的，也是未知的。这些知识差距阻碍了发展，因此 执行政策，确保患有ADRD独居的老年人获得基本的长期社会保障， 特别是对于那些与白人相比，患有ADRD风险更高的种族/少数民族，他们通常独自生活 而且通常获得服务的机会更差。因此，该项目的目标是阐明特定的障碍和 ADRD独居老年人与ADRD独居老年人接触和使用LTSS的促进者 并比较这些障碍和促进者在不同种族/族裔群体之间的差异。我们会 然后应用这些知识来制定政策建议，以增加对LTS的获取和使用， 强调种族/民族少数群体和独居老年人。在戈德堡-赫胥黎模型的基础上，我们 将利用我们的初步研究进行纵向混合方法研究， 1-3年独立的数量目标(目标1)和定性目标(目标2)，随后是#年的政策目标(目标3) 4-5岁。这个项目的设计和承诺得到了我们的社区咨询委员会的认可。我们的 跨学科团队在老龄化、LTSS、ADRD、健康差距和政策方面的专业知识使我们处于有利地位 来实现这些目标。具体目标是：1)量化长期服务使用的多层次障碍和促进者 在患有ADRDS的老年人中，以及这些预测LTSS使用的程度因生活而异 安排(独居与与人同住)和种族/民族。2)深入阐明障碍和 促进者通过与患有ADRD的老年人进行半结构化访谈来访问和使用LTSS， 告密者、LTSS提供商和管理员。3)制定政策建议，以增加准入 在患有ADRD的老年人中使用LTSS，强调种族/民族少数群体和生活在 独自一人。我们的发现将为制定政策以提高LTSS在美国的表现提供参考。 研究结果将支持增加老年人获得、负担、接受和使用基本LTSS的政策 患有ADRD的成年人，特别是那些独居和种族/族裔少数群体。因此，拟议的项目将 可能会缩小健康差距。此外，该项目可能会减少不必要的住院和 制度化，这将提高患有ADRD的老年人的福祉，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.