Prognostic Significance of Family Caregiver Factors for Older Adult Health Events

家庭照顾者因素对老年人健康事件的预后意义

• 批准号: 9519773
• 负责人: Jennifer L. Wolff
• 金额: $ 33.03万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9519773
• 关键词: Adverse event; Affect; Age; Aging; American; Bathing; Budgets; Calibration; Clinical; Cognitive; Communities; Complement; Computer software; Computerized Medical Record; Consequentialism; Data Collection; Data Set; Demographic Aging; Diffusion; Disabled Persons; Discrimination; Eating; Economics; Elderly; Event; Family Caregiver; Family Characteristics; Future; Gender; Health; Health Status; Healthcare; Home environment; Hospitalization; Individual; Inpatients; Intervention; Knowledge; Light; Link; Long-Term Care; Measures; Medicare claim; Medicare/Medicaid; Nursing Homes; Outcome; Performance; Play; Policies; Policy Developments; Population; Predictive Factor; Predictive Value; Preventive service; Public Health; Reporting; Rewards; Risk; Risk Factors; Role; Self Care; Services; Sterile coverings; Surveys; Time; Translating; Vital Statistics; Work; base; care delivery; caregiving; clinical decision-making; clinical practice; disability; economic value; electronic data; experience; high risk population; improved; indexing; insight; mortality; novel; nursing home length of stay; payment; population based; predictive modeling; prognostic; prognostic significance; programs; public health relevance; social; targeted treatment; tool; trend

 DESCRIPTION (provided by applicant): Growing numbers of disabled older adults with extensive health needs and persistent concerns about the sustainability of health care entitlement programs make efficient targeting of services to those who will most benefit a high priority. Most disabled older adults live at home and receive assistance from family caregivers. There is strong evidence that family caregivers play an instrumental role to disabled older adults' risk for a range of adverse health events. Although specific characteristics of family caregivers are likely to affect the extent to which adverse events among disabled older adults are experienced, robust evidence is lacking. Because disabled older adults have exceedingly high rates of adverse health events, such evidence could illuminate a potentially powerful but under-recognized domain of risk for a high-risk population. Risk prediction tools ("prognostic models") are widely used to identify individuals who are at risk for adverse health events, and in turn, to guide clinical decision-making and targeting of therapeutic and preventive services. Existing tools incorporate extensive measures of biomedical risk but do not include information reported by family caregivers. In this study, we will draw on national surveys of disabled older adult-family caregiver dyads to comprehensively and systematically elucidate the potential significance of family caregiver factors to disabled older adults' risk for diverse and consequential adverse health events that are of both fiscal and public health importance. In Aim 1, we determine whether and which family caregiver factors predict disabled older adults' future risk of all-cause hospitalization, long-stay nursing home entry, and mortality, controlling for disabled older adult risk factors. In Aim 2, we identify a reduced set of measures that could be efficiently used for risk prediction. We develop two prognostic models for each outcome that include: (1) disabled older adult factors only, and (2) disabled older adult and family caregiver factors. By comparing performance of the two prognostic indices, we will identify the predictive benefit of incorporating information from family caregivers to complement traditional assessments of disabled older adults. To accomplish this work we will construct a unique population-based dataset with information on social, economic, cognitive, health, and interpersonal domains of risk reported by 3,023 disabled older adult-family caregiver dyads who responded to linked nationally representative disability and family caregiver surveys (the 1999 and 2004 National Long-Term Care Surveys, and 2011 National Health and Aging Trends Study). All three survey waves will be linked to Medicare claims, Minimum Data Set assessments, and mortality/vital statistics files, which will contribute longitudinal information o older adults' health events. Together, these study aims will fill provide new knowledge regarding the relevance of family caregiver factors to diverse and consequential events among disabled older adults, as well as develop practical tools to translate this knowledge into clinical practice

 描述(由申请人提供)：越来越多的残疾老年人具有广泛的健康需求，以及对医疗保健权利计划可持续性的持续关注，使有效地针对那些将最大限度地受益的人的服务成为优先事项。大多数残疾老年人住在家里，并接受家庭照顾者的帮助。有强有力的证据表明，家庭照顾者在残疾老年人发生一系列不良健康事件的风险方面发挥了重要作用。尽管家庭照顾者的具体特征可能会影响残疾老年人发生不良事件的程度，但缺乏强有力的证据。由于残疾老年人的不良健康事件发生率极高，这些证据可能会揭示出高危人群潜在的强大但未被认识到的风险领域。风险预测工具(“预测模型”)被广泛用于识别有不良健康事件风险的个人，进而指导临床决策以及治疗和预防服务的目标。现有的工具包含了对生物医学风险的广泛测量，但不包括家庭照顾者报告的信息。在这项研究中，我们将利用对残疾老年人-家庭照顾者二元的全国性调查，全面和系统地阐明家庭照顾者因素对残疾老年人发生各种和相应的不良健康事件的潜在意义，这些事件对财政和公共卫生都具有重要意义。在目标1中，我们确定是否以及哪些家庭照顾者因素预测残疾老年人未来全原因住院、长期住院疗养院和死亡率的风险，控制残疾老年人的危险因素。在目标2中，我们确定了一组可有效用于风险预测的减少的衡量标准。我们为每个结果建立了两个预测模型，其中包括：(1)仅残疾老年人因素，和(2)残疾老年人和家庭照顾者因素。通过比较两个预后指数的表现，我们将确定纳入家庭照顾者的信息以补充对残疾老年人的传统评估的预测益处。为了完成这项工作，我们将构建一个独特的基于人口的数据集，其中包含3,023名残疾老年人-家庭照顾者二人组报告的社会、经济、认知、健康和人际风险领域的信息，他们回应了具有全国代表性的残疾和家庭照顾者调查(1999年和2004年国家长期护理调查，以及2011年国家健康和老龄化趋势研究)。所有这三波调查都将与联邦医疗保险索赔、最低数据集评估和死亡率/生命统计文件联系在一起，这些文件将为老年人的健康事件提供纵向信息。这些研究目标将共同提供关于家庭照顾者因素与残疾老年人中不同和相应事件的相关性的新知识，并开发实用工具将这些知识转化为临床实践。

项目成果

Corrigendum: Change Over Time in Caregiving Networks for Older Adults With and Without Dementia.

勘误表：患有和不患有痴呆症的老年人的护理网络随时间的变化。

• DOI: 10.1093/geronb/gbz105
• 发表时间: 2020
• 期刊: The journals of gerontology. Series B, Psychological sciences and social sciences
• 作者: Spillman,BrendaC;Freedman,VickiA;Kasper,JudithD;Wolff,JenniferL
• 通讯作者: Wolff,JenniferL