Migration and outcomes among older adults with and without ADRD from Puerto Rico

来自波多黎各患有和不患有 ADRD 的老年人的迁移和结果

• 批准号: 10658334
• 负责人: Maricruz Rivera-Hernandez
• 金额: $ 178.86万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-15 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10658334
• 关键词: Address; Adult; Aging; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Area; Caring; Cause of Death; Chronic Disease; Clinical; Complex; Congresses; Continuity of Patient Care; Data; Diagnosis; Disabled Persons; Disasters; Disparate; Disparity population; Elderly; Etiology; Exclusion; Face; Funding; Goals; Health; Health Care Rationing; Health Expenditures; Health Services Accessibility; Healthcare; Home; Home Nursing Care; Hospitalization; Hurricane; Immigrant; Incentives; Intervention; Island; Life Cycle Stages; Long-Term Care; Low income; Medicaid; Medicare; Medicare/Medicaid; Migrant; Morbidity - disease rate; Natural Disasters; Nonmigrant; Out-Migrations; Outcome; Patients; Pattern; Persons; Population; Poverty; Puerto Rican; Puerto Rico; Quality of Care; Research; Services; Social support; United States National Institutes of Health; Visually Impaired Persons; Work; access disparities; beneficiary; complex chronic conditions; court; disability; dual eligible; experience; health care availability; health care service utilization; health disparity; human old age (65+); improved; interest; medical specialties; migration; mortality; older driver; programs; response; service delivery; socioeconomics

PROJECT SUMMARY Recent socio-economic and natural disasters, including Hurricane Maria, have exacerbated the exodus of Puerto Rican residents to the US mainland and has led to a “historic net migration loss.” Worse living conditions, ineligibility to low-income subsidies, high poverty rates and limited access to health services may be important drivers for older adults to migrate from Puerto Rico to the US mainland, particularly among those with chronic illness, and complex health care needs. People with Alzheimer’s Disease and Related Dementias (ADRD) have high health care spending, poor outcomes, often require long-term services and supports. The Medicaid program in Puerto Rico does not cover long-term care, which may compel older adults with ADRD to seek long-term care outside of Puerto Rico. However, little is known about drivers of migration and outcomes following migration among Puerto Rican older adults with and without ADRD. Thus, there is a crucial need to understand the aging experience across the life-course, migration patterns and outcomes among older adults from Puerto Rico. Using data for Medicare patients ages 65 and older (since 2010) with rich clinical and socioeconomic variables that allow us to track migration patterns, mortality, utilization of long-term services and supports, our specific aims are as follows: AIM 1) Estimate migration rates and identify drivers of migration among Puerto Rican Medicare beneficiaries with and without a diagnosis of ADRD. Our working hypotheses are that out-migration rates will be higher among older adults following an ADRD diagnosis compared to those without an ADRD diagnosis (H1); Hurricane Maria will have exacerbated out-migration of preexisting ADRD patients relative to the pre-disaster period (H2); People who migrated will be more likely to be black, have lower income, greater social support and higher rates of health care utilization compared to persons who do not migrate, and the effect of these factors will be greater among migrants with preexisting ADRD diagnosis (H3); and AIM2) Examine whether migration moderates the effect of ADRD on mortality, morbidity and hospitalizations among beneficiaries from Puerto Rico. Our working hypotheses are that migration will moderate the effect of ADRD on health decline, mortality and hospitalizations and that these declines will be higher among people with preexisting ADRD diagnosis (H1); migrants with preexisting ADRD will have higher rates of dual eligibility, healthcare expenditures and utilization compared to persons with preexisting ADRD who did not migrate (H2). This proposal is a direct response to the FOA (PAR-21-080) “Addressing the Etiology of Health Disparities and Health Advantages Among Immigrant Populations.” Results from this research could guide interventions 1) to assist older adults residing in Puerto Rico who may want to continue aging at home, so they do not have to migrate; 2) to target any gaps in service delivery that new migrants with ADRD and/or complex chronic conditions may face after arriving to the US; and 3) to restructure Medicare and Medicaid benefits and funding in Puerto Rico; and 4) to provide incentives to increase specialized care in Puerto Rico.

项目摘要 最近发生的社会经济和自然灾害，包括“玛丽亚”飓风，加剧了流离失所者的外流， 波多黎各居民前往美国大陆，并导致了“历史性的净移民损失”。更糟的生活 条件、无资格获得低收入补贴、高贫困率和获得保健服务的机会有限， 是老年人从波多黎各移民到美国大陆的重要驱动力，特别是在那些 患有慢性病和复杂的医疗保健需求。阿尔茨海默病和相关痴呆症患者 （ADRD）的医疗保健支出高，结果差，往往需要长期的服务和支持。的 波多黎各的医疗补助计划不包括长期护理，这可能迫使患有ADRD的老年人 在波多黎各以外寻求长期护理。然而，人们对移徙的驱动因素和结果知之甚少， 在有和没有ADRD的波多黎各老年人中，因此，迫切需要 了解老年人在整个生命过程中的老龄化经历、迁移模式和结果 来自波多黎各。使用65岁及以上的医疗保险患者的数据（自2010年以来）， 社会经济变量，使我们能够跟踪移民模式，死亡率，长期服务的利用率， 我们的具体目标如下：目标1）估计迁移率，确定迁移的驱动因素 在波多黎各医疗保险受益人中，有和没有ADRD的诊断。我们的工作假设 在ADRD诊断后，老年人的外移率将高于 没有ADRD诊断（H1）;飓风玛丽亚将加剧先前存在的ADRD的向外迁移 相对于灾前时期（H2）的患者人数;移民的人更有可能是黑人， 较低的收入，更大的社会支持和更高的医疗保健利用率相比， 不移民，并且这些因素对先前患有ADRD诊断的移民的影响会更大 (H3)和AIM 2）检查移民是否缓和ADRD对死亡率，发病率和死亡率的影响。 来自波多黎各的受益人中的住院人数。我们的工作假设是， 缓解ADRD对健康下降、死亡率和住院率的影响，这些下降将 在既存ADRD诊断（H1）的人群中较高;既存ADRD的移民将有较高的 与既存ADRD患者相比的双重资格、医疗支出和利用率 没有迁移的人（H2）。本提案是对FOA（PAR-21-080）“解决病因学”的直接回应 移民人口的健康差异和健康优势。这项研究的结果可以 指导干预措施：1）帮助居住在波多黎各的老年人，他们可能想在家里继续变老， 因此，他们不必移徙; 2）针对服务提供方面的任何差距， 抵达美国后可能面临复杂的慢性疾病; 3）重组医疗保险和医疗补助 波多黎各的福利和资金; 4）提供激励措施，以增加波多黎各的专门护理。