Healthcare use among older adults with dementia after large-scale disasters

大规模灾难后患有痴呆症的老年人的医疗保健使用情况

• 批准号: 10591812
• 负责人: Susan Anne Bell
• 金额: $ 15.6万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10591812
• 关键词: Activities of Daily Living; Acute; Affect; Aftercare; Alzheimer' s disease related dementia; American; Area; Care given by nurses; Caregivers; Caring; Chronic; Communities; Data; Data Set; Dementia; Dependence; Disasters; Disorientation; Distress; Elderly; Emergency Situation; Emergency department visit; Emotional Disturbance; Environment; Event; Evolution; Exhibits; Exposure to; Funding; Future; Goals; Health; Health Services; Healthcare; Home; Home Care Services; Hospitalization; Hospitals; Individual; Knowledge; Lead; Life; Long-Term Care; Measures; Medicare; Medicare claim; Methods; Nature; Office Visits; Outcome; Pathway interactions; Pattern; Personal Satisfaction; Persons; Play; Population; Quality of Care; Rehabilitation therapy; Research; Resources; Risk; Role; Sampling; Services; Visit; Vulnerable Populations; aging in place; climate change; cohort; end of life; end of life care; health care service; health care service utilization; health service use; healthy aging; hospice environment; innovation; medication administration; nursing skill; patient home care; poor health outcome; programs; protective factors

PROJECT ABSTRACT Background: There is a critical need to understand how disaster events affect individuals with Alzheimer’s disease and related dementias (ADRD), particularly around aging in place. Home health care is a critical mechanism to support aging in place for individuals with ADRD, where these services allow older adults to remain in their own homes for as long as possible. For people living with ADRD, the disruption in normal patterns of daily living caused by a disaster can be highly disorienting and lead to acute changes in health and well-being, leading to increased healthcare use. Our overall goal in conducting this project is to develop strategies to support older adults with ADRD, and their caregivers, to age in place after a disaster—staying out of the hospital and long-term care— through the use of home health care. We hypothesize that older Americans with ADRD are at particular risk for poor health outcomes that result from the disruption of a disaster, requiring increased healthcare resources at the end of life. Specific Aims: Aim 1 will determine whether home health care use reduces reliance on conventional healthcare services following a disruption in care (i.e., exposure to a disaster) among older adults with ADRD. Aim 2 will determine the extent to which home health care use is associated with additional healthcare use at the end of life and the quality of care among ADRD decedents, after a large-scale disaster. Project Methods: Using Medicare claims data, Aim 1 will identify older adults living with ADRD who use home health care, compared to those who do not using a propensity score matching approach, then use difference-in-difference methods to assess the effects of home health use in healthcare use (e.g., hospitalizations, emergency department visits) before and after a disaster. In Aim 2, using the same sample as in Aim 1 we will limit to those who died 6 months after the disaster to identify a decedent cohort, then assess the effects of home health use for end-of-life services during the last six months of life by difference-in-difference methods. Unique Features and Innovation: Examining the use of home health care in the intra-disaster period is an innovative method to begin to understand the ways in which disasters affect individuals with ADRD, and can lead to better supports for this vulnerable group in future disasters and other community emergencies. Examining outcomes of home health care users alone after disaster can be problematic in that users by their nature of needing home care may require more use of healthcare than those who do not use home health care. Studying this through a population of ADRD decedents is innovative in that it levels this playing field. Anticipated Impact: The proposed study will fill immediate and critical gaps in knowledge about the relationship between home health care and healthcare use after disasters, and provide evidence for the use home health care as a strategy to support individuals with ADRD and their caregivers to continue aging in place during a disaster.

项目摘要 背景：我们迫切需要了解灾难事件如何影响阿尔茨海默氏症患者 疾病和相关的痴呆症（ADRD），特别是在原地老化。家庭保健是一个关键 为ADRD患者提供适当的老龄化支持机制，这些服务允许老年人 尽可能长时间地呆在自己的家里。对于患有ADRD的人来说， 灾害造成的日常生活模式可能会使人高度迷失方向，并导致健康和 健康，导致医疗保健使用增加。我们进行这个项目的总体目标是开发 支持患有ADRD的老年人及其照顾者在灾难后就地养老的策略--外出 医院和长期护理-通过使用家庭保健。我们假设 患有ADRD的美国人尤其面临因治疗中断而导致健康状况不佳的风险 灾难，需要在生命结束时增加医疗资源。具体目标：目标1将决定 家庭医疗保健的使用是否减少了对传统医疗保健服务的依赖， 护理（即，暴露于灾难）在老年人与ADRD。目标2将决定 家庭医疗保健的使用与临终时的额外医疗保健使用和护理质量相关 在一场大规模的灾难之后，项目方法：使用医疗保险索赔数据，目标1 将识别使用家庭医疗保健的ADRD老年人，与不使用家庭医疗保健的老年人相比， 倾向得分匹配法，然后使用差异中的差异方法来评估家庭的影响， 保健用途中的保健用途（例如，住院、急诊）。 在目标2中，使用与目标1相同的样本，我们将灾难发生后6个月死亡的人限制为 确定一个死者队列，然后评估在最后一个生命周期内家庭健康使用对临终服务的影响。 六个月的生命差异的方法。独特的功能和创新：检查使用 家庭卫生保健在灾害期间是一个创新的方法，开始了解的方式， 哪些灾害会影响ADRD患者，并在未来为这一弱势群体提供更好的支持 灾害和其他社区紧急情况。仅检查家庭医疗保健用户的结果， 灾难可能是一个问题，因为用户由于其需要家庭护理的性质，可能需要更多地使用 与那些不使用家庭医疗保健的人相比。通过ADRD人群研究这一点 死者是创新的，因为它公平竞争。预期影响：拟议研究将填补 对家庭医疗保健和医疗保健使用之间关系的认识存在直接和关键的差距 灾害发生后，并提供证据，证明使用家庭医疗保健作为一种战略，以支持个人与 ADRD和他们的照顾者在灾难期间继续在原地老化。