Diabetes, Dementia, and Aging at Home

项目总结

PROJECT SUMMARY Managing diabetes may be a significant barrier to aging at home for older adults, especially for those with Alzheimer’s disease or related dementias (ADRD). Over 40% percent of low-income older adults with Medicare and Medicaid have diabetes, but there is limited access to Medicaid home-and-community-based services (HCBS) that can assist with daily tasks like insulin injections, meal preparation, and monitoring glucose levels. Even though 25-40% of patients with dementia also have diabetes, little is known about diabetes management in this population. Without family members or other caregivers to assist, low-income older adults with diabetes may face unnecessary hospitalizations for diabetes and nursing home entry. Hypoglycemia, which can lead to falls, injuries, and loss of consciousness, is a large health risk for older adults with diabetes, especially if they are black, use insulin, or have dementia. Such issues are particularly concerning in the Southeast due to the region’s high prevalence of diabetes and ADRD. The Southern Community Cohort Study, a prospective cohort study of low-income white and black Southeastern residents that includes over 12,000 participants age 65 and above with diabetes, provides a unique opportunity to understand diabetes-related barriers to living at home. By linking survey data to claims data, this study will examine which factors, including dementia and limited social support, predict initial use of Medicaid HCBS and nursing home services. Over a fifteen-year period, the study will analyze whether more generous coverage of Medicaid HCBS benefits is associated with changes in nursing home entry, inpatient and emergency room use, and treatment for hypoglycemia. To better understand what factors may prevent older adults from using simpler insulin regimens that may lower their risk for hypoglycemia, the study will examine whether lower out-of-pocket costs for simpler insulin options are associated with greater use of these drugs, and whether these associations differ for older adults with dementia or limited social support who may have more difficulty navigating drug benefits. Finally, the study will assess whether better coverage of simpler insulin options is associated with lower risk of hospitalizations, emergency room visits, treatment for hypoglycemia, and nursing home entry. The results will provide novel evidence about how Medicare and Medicaid policies may be able to address the needs of older adults with diabetes as they age at home and prevent poor health outcomes, especially for those with dementia or limited social support.