The Effects of the COVID-19 Pandemic on Long-Term Care for High-Need Older Adults with and without Alzheimer’s Disease and Related Dementias

项目摘要 近2000万65岁及以上的成年人（38%）在一项或多项自我护理活动方面存在限制（例如， 十个老年人中就有一个患有老年痴呆症和相关疾病。 痴呆症（ADRD）。这两个重叠的“高需求”老年人群体通常依赖于 各种长期护理来源，以协助日常活动，包括家庭和无偿护理， 家庭护理、寄宿护理，如辅助生活和疗养院护理。护理不当可能导致 对日常自我护理和可避免的卫生保健利用造成不良后果。突然爆发的新冠病毒- 19大流行可能深刻影响了LTC的获得和使用，并导致进一步的不利影响。 对高需求老年人的后果，特别是对那些患有ADRD的人。该项目将借鉴 两个互补的纵向，全国代表性的老年人调查-健康和退休 研究（HRS）和国家健康和老龄化趋势研究（NHATS）-与地理数据和 医疗保险索赔。使用统计方法，加强我们的能力，得出因果推论，我们将：1） 评估2019冠状病毒病疫情对长期护理服务使用类型和数量的短期影响（2018-2020年）， 比较有和没有ADRD的高需求老年人，并确定更有可能“稳定”的安排 改变的风险更低。2)确定护理轨迹是否在开始后中断， 大流行，比较2016年至2024/2025年有和没有ADRD的高需求老年人。3)评估 2019冠状病毒病对高需求老年人护理缺口相关不良后果的影响， 没有ADRD。我们将估计COVID-19大流行对未满足需求的自我报告的影响（使用 NHATS）和基于索赔的可避免住院和急诊就诊措施（使用 对于那些有和没有ADRD的人来说，HRS）。详细的地理数据将使我们能够考虑到当地的 同时确定更“脆弱”的护理安排，这些安排具有更高的不利后果风险。 该项目的结果将全面了解COVID-19大流行对 LTC的短期和长期结果。这项研究符合NIA的优先事项，以了解社区 对痴呆症护理的支持，特别是LTC可用性的决定因素，LTC利用率以及如何影响 社区层面的因素，包括基础设施和风险环境。

PROJECT SUMMARY Nearly 20 million adults (38%) aged 65 and older have limitations with one or more self-care activities (e.g., dressing, getting out of bed) and one in ten older adults are living with Alzheimer’s Disease and Related Dementias (ADRD). Together these two overlapping groups of “high-need” older adults typically rely on a variety of long-term care (LTC) sources to assist with daily activities, including family and unpaid care, paid care in the home, residential care such as assisted living and nursing home care. Inadequate care may lead to adverse consequences in daily self-care and avoidable health care utilization. The sudden onset of the COVID- 19 pandemic may have profoundly affected access to and use of LTC and contributed to further adverse consequences for high-need older adults, particularly for those living with ADRD. This project will draw upon two complementary longitudinal, nationally representative surveys of older adults–the Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS)–linked to geographic data and Medicare claims. Using statistical approaches that strengthen our ability to draw causal inferences, we will: 1) Evaluate the short-term impact (2018-2020) of the COVID-19 pandemic on the type and amount of LTC use, comparing high-need older adults with and without ADRD and identify arrangements more likely to be “stable” with lower risks of change. 2) Determine whether care trajectories were disrupted after the start of the pandemic, comparing high-need older adults with and without ADRD from 2016 through 2024/2025. 3) Assess the impact of COVID-19 on adverse consequences related to care gaps among high-need older adults with and without ADRD. We will estimate the effect of the COVID-19 pandemic on self-reports of unmet need (using NHATS) and claims-based measures of avoidable hospitalizations and emergency department visits (using HRS) for those with and without ADRD. Detailed geographic data will allow us to take into account local conditions while identifying more “vulnerable” care arrangements with higher risks of adverse consequences. The results of this project will provide a comprehensive understanding of the COVID-19 pandemic’s impact on LTC outcomes in the short and longer term. This study aligns with NIA’s priority to understand community support for dementia care, in particular the determinants of availability LTC, LTC utilization and how the effects of community level factors including infrastructure and risk environment.