Older Adults Living with Dementia and Their Informal Caregivers: Reciprocal Impacts of Caregiving and Serious Illness on Health Care Outcomes

项目总结 阿尔茨海默氏症和其他痴呆症是一个日益严重的公共卫生问题，目前影响着近8人 美国有100万老年人和1600万非正式照顾者。非正式照看--家庭无偿照看 会员或朋友-对于痴呆症患者(PLWD)是独特的要求，有大量的经济 和情感的影响。随着人口继续老龄化，以及需要援助的可持续发展的人数 随着人数的增长，潜在的非正式照顾者的人数也在减少，这给维持 护理人员和为其提供护理的可持续发展妇女的健康和福祉。有迫切的需要 了解非正式护理如何影响PLWD和照顾者的医疗保健使用，以及影响有多严重 PLWD或照顾者的疾病会影响二元体其他成员的医疗保健使用，以告知未来 护理者干预和政策。这个K99/R00独立之路奖的目标是为博士做好准备。 雷连连作为一名成功的独立卫生服务调查员，专注于理清 非正式护理与PLWD及其照顾者如何参与和与卫生保健互动之间的联系 系统。雷博士在卫生服务研究、政策和经济学方面的背景和培训为她提供了 为拟议的工作奠定了坚实的基础，但为了过渡到独立，她需要额外的 通过研究、指导和教学的协调计划获得的技能和经验 在获奖期的K99阶段。这将包括以下方面的培训和经验：(1)临床接触 PLWD的护理人员；(2)分析复杂的、具有全国代表性的调查数据的技能；(3)高级 使用计量经济学模型进行因果推断的方法；以及(4)过渡到 独立性，包括与研究相关的领导力和勇气。在她之前研究的基础上 和培训检查PLWD的医疗保健使用和成本，雷博士的研究将使用来自全国的数据 代表性调查，包括国家健康和老龄化趋势研究以及健康和退休 这两项研究都与联邦医疗保险索赔数据相关联，以确定非正式护理对医疗保健使用的影响 PLWD(目标1.1)和照顾者(目标1.2)，比较辅助变量(例如，女儿的数量， 正式护理的市场供给)模型和面板数据固定效应模型。AIM 2将进一步应用该小组 HRS挂钩医疗保险中的数据固定效应模型声称检查照顾者严重疾病对 PLWD医疗保健使用，而AIM 3将检查PLWD严重疾病对照顾者保健的影响 使用。在成功完成这项研究后，研究结果将产生关于非正式照料和 严重疾病，以便更好地识别高危PLWD和照顾者，并将通知未来的目标 促进可持续发展妇女和照顾者的健康和福祉的干预措施。这些结果将提供 为未来针对严重疾病后的高危PLWD和照顾者的R01赠款申请奠定基础。

PROJECT SUMMARY Alzheimer’s disease and other dementias are a growing public health concern, currently affecting nearly 8 million older adults and 16 million informal caregivers in the U.S. Informal caregiving—unpaid care by family members or friends—for persons living with dementia (PLWD) is uniquely demanding, with significant financial and emotional impacts. While the population continues to age and the number of PLWD requiring assistance grows, the pool of potential informal caregivers is also contracting, creating intense pressure to maintain the health and wellbeing of both caregivers and the PLWD for whom they provide care. There is an urgent need to understand how informal caregiving impacts both PLWD and caregiver health care use, and how serious illness for a PLWD or caregiver impacts the health care use of the other member of the dyad, to inform future caregiver interventions and policy. The goal of this K99/R00 Pathway to Independence Award is to prepare Dr. Lianlian Lei for a career as a successful independent health services investigator focused on disentangling the links between informal caregiving and how PLWD and their caregivers engage and interact with the health care system. Dr. Lei’s background and training in health services research, policy, and economics provide her with a solid foundation for the proposed work, but in order to transition to independence she requires additional skills and experience that will be gained through a coordinated program of research, mentorship, and didactics during the K99 phase of the award period. This will include training and experiences in: (1) clinical exposure to caregivers of PLWD; (2) skills to analyze complex, nationally representative survey data; (3) advanced methods of causal inference using econometric models; and (4) career skills needed to transition to independence, including research-related leadership and grantsmanship. Building on her previous research and training examining health care use and costs for PLWD, Dr. Lei’s research will use data from nationally representative surveys, including the National Health and Aging Trends Study and the Health and Retirement Study, both linked with Medicare claims data to identify the impact of informal caregiving on health care use of both PLWD (Aim 1.1) and caregivers (Aim 1.2), comparing instrumental variable (e.g., number of daughters, market supply of formal care) models and panel data fixed effects models. Aim 2 will further apply the panel data fixed effects models in HRS-linked Medicare claims to examine the impact of caregiver serious illness on PLWD health care use, while Aim 3 will examine the impact of PLWD serious illness on caregiver health care use. Upon successful completion of the study, findings will yield key knowledge of informal caregiving and serious illness to enable better identification of high-risk PLWD and caregivers, and will inform future targeted interventions to promote the health and wellbeing of both PLWD and caregivers. These results will provide the basis for a future R01 grant application targeting high-risk PLWD and caregivers following serious illness.