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

点击翻译按钮获取中文摘要

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.