Aging in Place: A Cross-Sector Partnership of Housing and Health Care

摘要/项目摘要 随着年龄的增长，许多老年人更愿意呆在家里。就地老化的能力是在以下方面取得平衡 可利用的认知和身体功能、物理环境和社会环境的数量 留在他们的家里。黑人老年人和穷人经历了更大的身体损伤和更高的 阿尔茨海默病和阿尔茨海默病相关痴呆(AD/ADRD)的患病率比他们的 这给当地的老龄化带来了更大的挑战。促进就地老龄化的大胆想法，特别是 在易受伤害的人群中，这一点是必要的。 为了促进老龄化，我们提出了Unite关怀模式，这是一种社区发起的、学术支持的、双重的- 将住房和医疗保健两个部门结合在一起的部门倡议。Unite关怀模式将一个 联邦合格健康中心(FQHC)诊所位于老年人经济适用房园区，有超过 密歇根州弗林特的700名以黑人为主的老年人。Unite护理模式将通过以下方式促进老龄化 优化：1)医疗保健，包括现场诊所和家访；2)通过 为家庭安全评估和促进环境改造提供转介；3)社会 环境由社区卫生工作者主导的健康行为和社会干预。总体而言，Unite关怀 该模型将颠覆要求最脆弱的老年人寻找医疗安全网的范式。 取而代之的是，Unite护理模式将为老年人带来安全网，以支持适当的老龄化。 该提案的目标是评估Unite护理模式的实施情况，确定哪些老年人 成年人使用它，特别强调有运动限制或AD/ADRD的老年人，以及 模特在原地促进衰老。在目标1中，通过并行探索性混合方法进行设计，由 根据普罗科特执行成果框架，我们寻求确定多少资金和为谁提供资金(即， 渗透率)以及Unite关怀模式的实施情况(即采用率和可接受性)。在目标2中，我们 将确定哪些老年人使用Unite护理模式，并评估Unite护理模式 通过降低血压来促进衰老，这是一种医疗保健措施，也是一种重要的 残疾的预测因素，以及物质和社会环境的变化。我们一直与 弗林特社区已经有十多年的历史了，他们专门致力于这个项目，我们的住房和 医疗保健合作伙伴两年。这项提议将通知其他正在考虑新模式的社区 关注在生活贫困的老年人和老年美国黑人中促进老龄化，并建议 是否有必要对这种护理模式进行更大规模的测试。 。

Abstract/Project Summary Many older adults prefer to remain in their homes as they age. The ability to age in place is a balance between the amount of cognitive and physical function, the physical environment, and the social environment available to stay in their homes. Black older adults and the poor experience greater physical impairment and a higher prevalence of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRDs) than their counterparts resulting in greater challenges to aging in place. Bold ideas to facilitate aging in place, particularly among vulnerable populations, are needed. To promote aging in place, we present the Unite care model, a community-initiated, academic supported, dual- sector initiative that combines two sectors: housing and health care. The Unite care model co-locates a Federally Qualified Health Center (FQHC) clinic on an older adult affordable housing campus, home to over 700 predominately Black older adults in Flint, Michigan. The Unite care model will promote aging in place by optimizing: 1) medical care including onsite clinic and home visits; 2) the physical environment through referrals for home safety evaluations and facilitating environmental modifications and; 3) the social environment by community health worker led health behavior and social interventions. Overall, the Unite care model will flip the paradigm that asks the most vulnerable older adults to seek out the medical safety net. Instead, the Unite care model will bring the safety net to older adults to support aging in place. The objective of this proposal is to assess how well the Unite care model is implemented, identify which older adults utilize it, with particular emphasis on older adults with activity limitations or AD/ADRD, and whether the model promotes aging in place. In aim 1, through a concurrent exploratory mixed methods design guided by the Proctor implementation outcomes framework, we seek to determine how much and for whom (i.e., penetration) and how well (i.e., adoption and acceptability) the Unite care model is implemented. In aim 2, we will determine which older adults utilize the Unite care model and assess whether the Unite care model promotes aging in place through blood pressure reduction, a measure of medical care and an important predictor of disability, and changes to the physical and social environment. We have worked in partnership with the Flint community for over a decade and have specifically worked on this project with our housing and healthcare partners for two years. This proposal will inform other communities contemplating new models of care to promote aging in place among older adults living in poverty and older Black Americans and suggest whether larger-scale testing of this model of care is warranted. .