Determinants of End-of-Life Care Experiences among Assisted Living Residents with Alzheimer's Disease and Related Dementia

项目总结 越来越多患有阿尔茨海默病和相关痴呆(ADRD)的老年人正在接受治疗 和在辅助生活(AL)中死亡。到2015年，在收费医疗保险中，18.4%的社区死亡 接受临终关怀的受益人发生在AL。最近的一些研究提出了对 AL提供的临终关怀质量。例如，接受临终关怀的AL居民不太可能收到 阿片类药物治疗疼痛的人比家庭临终关怀的人更多。此外，鉴于对临终关怀索赔数据的依赖 到目前为止，为了研究AL的临终关怀，我们对没有临终关怀而死亡的AL居民的了解有限 服务。如果我们要为促进AL更高质量的临终关怀的政策和实践提供信息，有一个 迫切需要在全国范围内检查AL患者ADRD死亡经历的决定因素。使用 由我们团队开发的方法，用于确定居住在大型AL社区的联邦医疗保险受益人 (25张以上床位)，我们建议确定死者是否在AL住院，并检查他们的临终关怀 经历。此应用程序的总体目标是确定更好的临终关怀的决定因素 通过行政索赔数据、对AL管理人员的调查和对 AL死者的近亲。我们计划通过追求一种混合的- 方法探讨以下具体目标：1)检查生命最后一个月中在AL中度过的时间和 潜在的繁重护理(即生命最后三天的过渡和反复住院) ADRD AL死亡队列，并确定有和没有支持性结束的州之间是否存在差异 临终关怀法规，2)使用AL全国调查数据记录临终关怀流程 管理员，并检查这些流程、州法规和AL花费的时间之间的关联 在生命的最后一个月和ADRD死亡队列的繁重过渡中，3)探索感知 通过深入的定性访谈，了解ADRD AL遗属接受临终关怀的质量 近亲，来自有目的的ALS样本，各州的临终关怀程序更多，而不是更少 无论有没有支持性的报废法规。这项提议的预期结果包括更好的 了解国家法规和护理流程，以改善对ADRD死亡患者的护理 艾尔拟议的研究最终将指导政策和实践决策，以确保AL居民 接受高质量的临终关怀。

PROJECT SUMMARY A growing number of older adults with Alzheimer’s Disease and Related Dementias (ADRD) are receiving care and dying in assisted living (AL). By 2015, 18.4% of community deaths among fee-for-service Medicare beneficiaries receiving hospice took place in AL. A number of recent studies have raised concerns about the quality of end-of-life care delivered in AL. For example, AL residents on hospice were less likely to receive opioids for pain than were individuals with home hospice. Moreover, given the reliance on hospice claims data to study end-of-life care in AL to date, we have limited knowledge about AL residents who die without hospice services. If we are to inform policies and practices that promote better quality end-of-life care in AL, there is a critical need to examine the determinants of dying experiences for AL residents with ADRD, nationally. Using a methodology developed by our team to identify Medicare beneficiaries who resided in large AL communities (25+ beds), we propose to identify decedents with a stay in AL, and to examine their end-of-life care experiences. The overall objective of this application is to identify the determinants of better end-of-life care experiences in AL through administrative claims data, a survey of AL administrators, and interviews with the next of kin of AL decedents. We plan to accomplish the overall research objective by pursuing a mixed- methods approach to the following specific aims: 1) examine time spent in AL during the last month of life and potentially burdensome care (i.e. transitions in last three days of life and repeated hospitalizations) for an ADRD AL decedent cohort and determine if differences exist between states with and without supportive end- of-life regulations, 2) document end-of-life care processes using data from a national survey of AL administrators, and examine the association between these processes, state regulations, and time spent in AL in the last month of life and burdensome transitions for an ADRD decedent cohort, and 3) explore perceptions of the quality of end-of-life care received by ADRD AL decedents through in-depth qualitative interviews with next of kin, from a purposeful sample of ALs with more vs. less established end-of-life care processes in states with and without supportive end-of-life regulations. The expected outcomes from this proposal include a better understanding of state regulations and processes of care that will improve care of persons with ADRD dying in AL. The proposed research will ultimately guide policy and practice decisions to ensure that AL residents receive high quality end-of-life care.