The impact of COVID-19 pandemic on community-dwelling older adults with ADRD

项目摘要。ADRD患者在冠状病毒疾病大流行下面临重大挑战 2019年（COVID-19）。首先，ADRD患者患COVID-19的风险很高，因为他们通常年龄较大 患有合并症的成人。此外，ADRD患者可能难以理解疾病， 遵守安全程序，从而使他们更容易感染COVID-19。请秘书长向大会第六十五 大流行引起的后果可能影响ADRD患者接受的常规医疗护理。 患有ADRD的人通常有认知障碍，并且很可能发展破坏性行为。所以他们 可能需要常规的医疗和/或精神病服务来管理他们的慢性病并解决他们的 心理健康问题他们更有可能从亲自就医中受益，这已经大大提高了他们的健康水平。 在大流行期间中断。尽管CMS扩大了远程医疗的福利， 可能会发现电信作为接受医疗保健的手段是困难的。最后，大多数人 ADRD生活在社区，他们可能需要面对面的长期服务和支持（LTSS）来帮助 他们的日常生活和心理或情感护理需要。大流行可能减少了 这些支持和服务。此外，照顾者（不住在同一个家庭）可能必须穿 提供服务的个人防护设备，造成混乱和不安，引发行为问题 在病人中。这些护理变化可能使ADRD患者更难维持 社区生活，并可能加速机构化的可能性。COVID疫情对香港的影响 患有ADRD的黑人可能特别显著。研究表明，患有ADRD的黑人倾向于 比他们的白色同龄人有更高程度的认知障碍。与此同时，据透露， 黑人感染COVID-19和死亡的风险非常高。这些种族差异很可能 由社会经济决定因素引发。例如，黑人往往聚集在弱势群体中， 资源和支持较少、COVID-19感染率较高的社区。到目前为止，还不清楚 这种流行病如何影响ADRD患者，包括COVID-19的风险和严重程度， 以及他们对常规医疗护理和LTSS（与COVID-19无直接关系）的需求，以及 这种影响如何因种族而异。这项研究有两个目的：1）检查 COVID-19和社区居住老年人的疾病严重程度（住院，ICU，死亡） ADRD，以及这种情况如何因种族而异; 2）研究这种大流行对非COVID的影响 该人群中的相关医疗保健利用（例如住院、ER访视、疗养院安置）， 以及这在不同种族之间的差异。拟议的研究是重要的，因为研究结果将提供有价值的， 及时了解这一公共卫生危机如何影响患有ADRD的脆弱老年人， 为今后的努力提供信息，以减少这一本已脆弱的人口在健康方面的种族差异。

Project Summary. Persons with ADRD face significant challenges under the pandemic of coronavirus disease 2019 (COVID-19). First, persons with ADRD are at a high risk for COVID-19 because they are generally older adults with comorbidities. In addition, persons with ADRD may have difficulty understanding the disease and following the safety procedures, thus making them more susceptible to COVID-19. Furthermore, the general ramifications stemming from the pandemic may affect the usual medical care received by persons with ADRD. Persons with ADRD often have cognitive impairment and are likely to develop disruptive behaviors. Thus, they may need routine medical and/or psychiatric services to manage their chronic conditions and to address their mental health issues. They are more likely to benefit from in-person medical visits, which has been greatly interrupted during the pandemic. Although the CMS has expanded telemedicine benefits, persons with ADRD may find telecommunication as the means of receiving healthcare, difficult. Lastly, the majority of persons with ADRD live in community, and they may need in-person long-term services and supports (LTSS) to assist with their daily living and psychological or emotional care needs. The pandemic may have reduced the availability of these supports and services. In addition, caregivers (not residing in the same household) may have to wear personal protective equipment to deliver services, causing confusion and upset that trigger behavioral issues among patients. These changes in care may have made it more difficult for persons with ADRD to maintain community living and may accelerate the likelihood of institutionalization. The impact of COVID pandemic on blacks with ADRD could be particularly significant. It has been shown that blacks with ADRD tend to have higher levels of cognitive impairment than their white counterparts. At the same time, it has been revealed that blacks are at disproportionally high risks for COVID-19 infection and death. These racial differences are likely triggered by socioeconomic determinants. For example, blacks tend to aggregate in disadvantaged communities with fewer resources and supports and higher rates of COVID-19 infection. To date, it is unclear how this pandemic affects persons with ADRD, both regarding the risk of and severity of COVID-19, as well as their needs for usual medical care and LTSS (that are not directly related to COVID-19), and how such impacts vary by individual's race. This proposed study has two Aims: 1) to examine the risk of COVID-19 and the severity of illness (hospitalization, ICU, death) among community dwelling older adults with ADRD, and how that varies by individual's race; 2) to examine the impact of this pandemic on non-COVID related health care utilization (e.g. hospitalization, ER visits, nursing home placement) among this population, and how that varies by race. The proposed research is significant as the findings will provide valuable and timely information on how this public health crisis affects the vulnerable older population with ADRD, and inform future efforts aimed at reducing racial disparities in health among this already vulnerable population.