Use of Health Services by Caregivers in an Older biracial Population Sample

描述（由申请人提供）：非正式护理人员是医疗保健系统的重要组成部分，其重要性将随着美国人口老龄化而增长。研究发现，老年照顾者因情绪紧张而死亡的风险明显更高。然而，这种死亡风险增加的途径尚不清楚。研究表明，肥胖与临床前和临床疾病之间存在关联，但关于肥胖对发病率和死亡率的影响，科学知识存在很大差距。我们的一般假设是，自我护理和正式护理是妥协的照顾者，特别是那些经历情绪紧张，导致较差的医疗管理，护理的连续性较低，和更大的进展照顾者的可治疗的条件，如所示的模式的卫生服务使用。目前关于这一假设的证据是有限的，结果是矛盾的。大多数研究：1）将护理视为静态结构，而不是生命周期结构（具有护理前、护理中和护理后阶段），2）使用的临床或志愿者样本可能不能代表所有护理者，3）难以可靠地识别可比较的非护理者，以及4）通过自我报告回顾性地识别医疗保健服务，这限制了信息的精确性和细节。我们建议在599名65岁或以上的混血人群样本中调查整个护理生命周期中医疗保健服务使用的差异，以检查护理对健康的影响。为了统一评估医疗服务利用率，我们将使用特定时间间隔内的医疗保险账单数据，在此期间确定了医疗服务阶段和其他相关特征。由于数据已经从一个纵向的，以人口为基础的研究照顾者，可以在小成本测试的假设。我们假设，在护理期间，人们将有更少的预防和常规医生访问，更少的护理连续性，和医生访问的护理强度比非照顾者或前照顾者更高。在护理期间和之后，与非护理者相比，人们将有更多的急诊科（艾德）就诊，更多的紧急和急诊艾德就诊，更多的住院治疗，以及更多的门诊护理敏感性疾病（ACSC）住院治疗。我们进一步假设，这些关系将是类似的非西班牙裔黑人和白人，照顾者之间，服务的使用将被修改的情绪紧张的水平。 公共卫生相关性：如果这项工作的结果表明照顾者忽视了自己的健康，那么它可能会指出减少与生育相关的过度死亡率的方法。大多数干预措施侧重于照顾者的需要;这项工作可能会建议如何照顾者应协助照顾自己的健康。

DESCRIPTION (provided by applicant): Informal caregivers are a vital part of the health care system and their importance will grow with the aging of the U.S. population. Research has found a significantly higher risk of death among older caregivers who reported emotional strain due to caregiving. However, the pathway to this increased mortality risk is not clear. Studies have shown an association between caregiving and preclinical and clinical disease, but there is a large gap in scientific knowledge about the effect of caregiving on morbidity and mortality. Our general hypothesis is that both self-care and formal care is compromised among caregivers, especially those experiencing emotional strain, resulting in poorer medical management, less continuity of care, and greater progression of the caregiver's treatable conditions, as shown by patterns of health service use. Currently available evidence concerning this hypothesis is limited and results are contradictory. Most studies: 1) treated caregiving as a static construct, rather than a life- cycle construct (with before, during and after caregiving stages), 2) used clinical or volunteer samples which may not be representative of all caregivers and 3) which have difficulty identifying reliably comparable non-caregivers, and 4) identified health care service retrospectively by self-report which limits precision and detail of information. We propose to examine the effect of caregiving on health by investigating differences in health care service use across the caregiving life cycle in a biracial population-based sample of 599 people age 65 or older. To uniformly assess health service utilization, we will use Medicare billing data over the specific interval during which caregiving stage and other relevant characteristics were identified. Because data are already available from a longitudinal, population-based study of caregivers, the hypotheses can be tested at small cost. We hypothesize that during caregiving, people will have fewer preventive and routine physician visits, less continuity of care, and physician visits with higher intensity of care than non-caregivers or former caregivers. During and after caregiving people will have more emergency department (ED) visits, more urgent and emergent ED visits, more hospitalizations, and more hospitalizations for ambulatory care sensitive conditions (ACSC) than non-caregivers. We further hypothesize that these relationships will be similar for non-Hispanic blacks and whites and that among caregivers, service use will be modified by level of emotional strain. PUBLIC HEALTH RELEVANCE: If results of this work suggest caregivers neglect their own health it could point to ways of reducing the excess mortality associated with caregiving. Most interventions focus on the needs of the care recipient; this work may suggest ways caregivers should be assisted to care for their own health.