Prognostic Significance of Family Caregiver Factors for Older Adult Health Events

 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和对医疗保健权利计划可持续性的持续关注，使服务有效地针对那些最受益的人成为高度优先事项。大多数残疾老年人住在家里，接受家庭照顾者的帮助。有强有力的证据表明，家庭照顾者对残疾老年人发生一系列不良健康事件的风险起着重要作用。虽然家庭照顾者的具体特征可能会影响残疾老年人经历不良事件的程度，但缺乏有力的证据。由于残疾老年人有极高的不良健康事件发生率，这些证据可以阐明一个潜在的强大的，但未被认识到的高风险人群的风险领域。风险预测工具（“预后模型”）被广泛用于确定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。现有的工具包括广泛的生物医学风险措施，但不包括家庭照顾者报告的信息。在这项研究中，我们将利用全国调查的残疾老年人家庭照顾者的二人组，全面和系统地阐明家庭照顾者的因素，残疾老年人的风险的潜在意义的各种和相应的不良健康事件，财政和公共卫生的重要性。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因住院，长期入住养老院和死亡的风险，控制残疾老年人风险因素。在目标2中，我们确定了一组可有效用于风险预测的简化度量。我们为每种结果开发了两个预后模型，包括：（1）仅残疾老年人因素，以及（2）残疾老年人和家庭照顾者因素。通过比较两个预后指标的表现，我们将确定将家庭照顾者的信息，以补充传统的评估残疾老年人的预测效益。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-家庭照顾者二元组报告的社会，经济，认知，健康和人际风险领域的信息，这些二元组回答了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）。所有三个调查波将与医疗保险索赔，最小数据集评估和死亡率/生命统计文件相关联，这将有助于老年人健康事件的纵向信息。总之，这些研究目标将填补提供有关家庭照顾者因素的相关性，残疾老年人之间的各种和相应的事件的新知识，以及开发实用的工具，将这些知识转化为临床实践

 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