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

描述(由申请人提供)：非正式照顾者是医疗保健系统的重要组成部分，他们的重要性将随着美国人口老龄化而增加。研究发现，年长的照顾者死亡的风险要高得多，他们报告说，照顾者的情绪紧张。然而，导致死亡风险增加的途径尚不清楚。研究表明，护理与临床前和临床疾病之间存在联系，但关于护理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在照顾者中都受到了损害，特别是那些经历情绪压力的人，导致医疗管理更差，护理的连续性更差，照顾者的可治疗条件进展更快，如卫生服务使用模式所示。目前关于这一假设的现有证据有限，结果相互矛盾。大多数研究：1)将看护视为一个静态结构，而不是一个生命周期结构(包括看护前、看护中和看护后)，2)使用可能不能代表所有照顾者的临床或志愿者样本，3)难以确定可靠的可比较的非照顾者，以及4)通过自我报告追溯确定卫生保健服务，这限制了信息的精确度和细节。我们建议通过对599名65岁或以上的双族人群样本在护理生命周期中卫生保健服务使用的差异进行调查，来检验护理对健康的影响。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联邦医疗保险账单数据，在此期间确定护理阶段和其他相关特征。因为已经可以从对照顾者的纵向、基于人群的研究中获得数据，所以可以以很小的成本检验这些假设。我们假设，在护理期间，与非护理人员或以前的护理人员相比，人们预防性和常规的医生就诊次数更少，护理的连续性更低，医生就诊的护理强度更高。在护理期间和护理后，人们将比非护理人员有更多的急诊科(ED)就诊，更紧急和紧急的急诊科就诊，更多的住院治疗，以及更多的因非护理敏感条件(ACSC)住院。我们进一步假设，对于非西班牙裔黑人和白人来说，这些关系将是相似的，在照顾者中，服务使用将受到情绪压力水平的影响。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，它可能会指出减少与照看相关的过度死亡率的方法。大多数干预措施都集中在护理接受者的需求上；这项工作可能会建议如何帮助照顾者照顾自己的健康。

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.