Substance Use and Access to Care among Older Adults

项目摘要 由于阿片类药物中毒的增加，药物过量死亡率上升如此之快，以至于 美国人的平均预期寿命已经下降。尽管年长的美国人不太可能滥用 自1999年以来，在55岁至的人群中，阿片类药物、药物过量的比例上升最多，占所有人群的45% 阿片类药物死亡发生在45岁及以上的人群中。2018年，80%的美国阿片类药物使用障碍患者 (未接受治疗)。老年人尤其处于不利地位。2017年，只有35%的 治疗机构接受联邦医疗保险作为支付方式，而联邦医疗保险本身不包括美沙酮，美沙酮是一种经常 用于循证用药辅助治疗(MAT)。此外，缺乏地理上的通道 专科治疗是一个广泛的问题，美国85%的县都没有治疗中心 阿片类药物治疗计划。对于老年人来说，获取信息的挑战可能会加剧到大约25 65岁以上的美国人中有10%居住在小镇或其他农村地区；这一比例高于美国 更年轻的成年人。农村地区的物质滥用治疗(SAT)中心也往往较少，比率较高 服药过量。通常用于跟踪有执照的SAT中心的供应的数据-全国SAT调查 服务(N-SSATS)-不允许缺少区分中心所需的设施标识符 开闭和调查无反应。这一区别很重要，因为调查不答复会 并不意味着附近的设施(或通道)的实际数量发生了变化，而开业和关闭却发生了变化。这个 本R21的总体目标是增加对SAT设施和卫生保健地理准入的了解 治疗的保险覆盖范围，它是否与治疗的差异有关，以及如何改进政策 可获得性将影响老年人的长期健康结果和成本。我们的具体目标是： 目标1.使用这本小说跟踪并描述50岁以上老年人进入SAT中心的地理位置 心理健康和成瘾治疗跟踪库(MattR)链接到健康和退休 国家药物使用与健康调查研究。 目标2.根据以下数据确定老年人在获得SAT方面的差距程度 城乡区位和州级阿片类药物政策。 目标3.预测获得治疗方面的差距对健康轨迹和医疗费用的长期影响 使用微观模拟的方法，未来的老年人模型。 拟议的R21是在新的获得许可的SAT中心之间建立数据联系的必要的第一步 存储库和其他具有全国代表性的调查数据集，并将微观模拟建模应用于 政策努力在以后的生活中解决我们的问题。

Project Summary The rate of drug overdose deaths has increased so rapidly due to increases in opioid-poisonings that the average life expectancy in the United States has declined. Although older Americans are less likely to misuse opioids, rates of drug overdose have increased the most among those aged 55 to 64 since 1999 and 45% of all opioid deaths are among individuals age 45 and older. In 2018, 80% of Americans with opioid use disorders (OUD) received no treatment. Older adults are particularly disadvantaged. In 2017, only 35 percent of treatment facilities accepted Medicare as payment and Medicare itself does not cover methadone, a drug often used in the evidence-based medication assisted treatment (MAT). Additionally, lack of geographic access to specialty treatment is a broad problem with 85 percent of counties in the U.S. lacking a treatment center with an opioid treatment program. For older adults, access challenges may be exacerbated as approximately 25 percent of Americans older than age 65 live in a small town or other rural area; a rate that is higher than for younger adults. Rural areas also tend to have fewer substance abuse treatment (SAT) centers and higher rates of overdose. The data typically used to track the supply of licensed SAT centers – the National Survey of SAT Services (N-SSATS) – do not allow lack facility identifiers that are necessary to distinguish between centers opening and closing and survey non-response. This distinction is important because survey non-response does not mean the actual number of facilities nearby (or access) has changed whereas openings and closings do. The overall objective of this R21 is to increase understanding of geographic access to SAT facilities and to health insurance coverage of treatment, whether it is related to disparities in treatment and how policies to improve access will affect long-term health outcomes and costs among older adults. Our specific aims are to: Aim 1. Track and characterize geographic access to SAT centers for older adults age 50+ using the novel Mental health and Addiction Treatment Tracking Repository (MATTR) linked to the Health and Retirement Study and the National Survey of Drug Use and Health. Aim 2. Determine the extent to which disparities for older adults exist in the availability of SAT based on urban-rural location and state-level opioid policies. Aim 3. Project long-term effects of disparities in access to treatment on health trajectory and healthcare costs using a microsimulation approach, the Future Elderly Model. The proposed R21 is a necessary first step to creating data linkages between the novel licensed SAT center repository with other nationally representative survey datasets and to applying microsimulation modeling to policy efforts to address OUD in later life.