Diabetes, Dementia, and Aging at Home

项目摘要 管理糖尿病可能是老年人在家衰老的一个重要障碍，特别是对于那些 阿尔茨海默病或相关痴呆症（ADRD）。超过40%的低收入老年人 医疗保险和医疗补助有糖尿病，但家庭和社区医疗补助有限 服务（HCBS），可以帮助完成胰岛素注射、膳食准备和监测等日常任务 葡萄糖水平尽管25-40%的痴呆症患者也患有糖尿病，但人们对糖尿病知之甚少。 糖尿病管理在这个人群中。没有家庭成员或其他照顾者的帮助，低收入 患有糖尿病的老年人可能面临不必要的糖尿病住院和进入疗养院。 低血糖可导致福尔斯、受伤和意识丧失，对老年人来说是一个很大的健康风险 糖尿病患者，特别是黑人，使用胰岛素或患有痴呆症。 这些问题在东南部尤其令人担忧，因为该地区的高流行率， 糖尿病和ADRD。南方社区队列研究，一项针对低收入白色人群的前瞻性队列研究 和黑人东南部居民，其中包括超过12,000名65岁及以上的糖尿病患者， 提供了一个独特的机会，了解糖尿病相关的障碍，生活在家里。通过链接调查数据 根据索赔数据，这项研究将研究哪些因素，包括痴呆症和有限的社会支持，预测 最初使用医疗补助HCBS和疗养院服务。在15年的时间里，这项研究将分析 更慷慨的医疗补助HCBS福利覆盖范围是否与疗养院的变化有关 入院、住院和急诊室使用以及低血糖治疗。为了更好地了解哪些因素 可能会阻止老年人使用可能降低低血糖风险的简单胰岛素方案， 一项研究将检查更简单的胰岛素选择的自付费用是否与更多的使用有关 以及这些关联对于患有痴呆症或社会支持有限的老年人是否不同 他们可能更难获得药物的好处。最后，该研究将评估更好的覆盖范围是否 更简单的胰岛素选择与住院、急诊室就诊、 低血糖和进入疗养院研究结果将提供新的证据，说明医疗保险和 医疗补助政策可能能够解决老年糖尿病患者的需求，因为他们在家里变老， 预防不良的健康结果，特别是对那些患有痴呆症或社会支持有限的人。

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.