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

项目摘要 背景：迫切需要了解灾难事件如何影响阿尔茨海默氏症患者 疾病和相关痴呆症(ADRD)，特别是在当地的老龄化方面。家庭保健是一个至关重要的问题 为患有ADRD的个人提供支持老龄化的机制，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，正常生活的中断 灾难造成的日常生活模式可能会非常令人迷失方向，并导致健康和 幸福感，导致医疗保健使用量增加。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发生后就地养老的战略--远离灾难 医院的长期护理--通过使用家庭保健。我们假设年龄较大的 患有ADRD的美国人尤其有可能因 灾难，需要在生命末期增加医疗保健资源。具体目标：目标1将决定 家庭保健使用是否在#年中断后减少了对传统保健服务的依赖 对患有ADRD的老年人的护理(即，暴露在灾难中)。目标2将决定在何种程度上 家庭保健使用与生命末期的额外保健使用和护理质量相关 在ADRD的死者中，在一场大规模灾难之后。项目方法：使用联邦医疗保险索赔数据，目标1 将识别患有ADRD的老年人，他们使用家庭医疗保健，而不使用 采用倾向性评分匹配法，然后使用差异法对家庭效果进行评估 灾难前后医疗保健使用中的健康使用情况(例如住院、急诊科就诊)。 在目标2中，使用与目标1相同的样本，我们将限制在灾难发生6个月后死亡的人 确定一个死亡队列，然后评估在过去的一年中家庭健康使用临终服务的影响 六个月的生命通过差异法。独特的功能和创新：检查使用 是一种创新的方法，可以开始了解 哪些灾难会影响患有ADRD的个人，并在未来为这一弱势群体提供更好的支持 灾害和其他社区突发事件。检查家庭卫生保健用户在治疗后单独使用的结果 灾难可能会带来问题，因为用户需要家庭护理的性质可能需要更多地使用 医疗保健比那些不使用家庭保健的人更多。通过ADRD的人群研究这一点 《遗赠者》的创新之处在于它使这一竞争环境变得公平。预期影响：拟议的研究将填补 关于家庭保健和保健使用之间的关系的知识存在直接和严重的差距 灾难发生后，并提供证据证明将家庭卫生保健作为一种战略来支持个人 ADRD和他们的照顾者在灾难期间继续在原地老化。

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.