Decision Making and Implementation of Aging-in-Place/Long Term Care Plans among Older Adults

这项研究的目标是更好地了解阿尔茨海默病、功能丧失、社会影响和环境因素等认知变化对老年人就地老龄化决策和实施的影响。对许多老年人来说，留在自己的家里是优先考虑的事情。决策和规划对于确保成功的就地老龄化至关重要，尤其是在老年人被诊断为阿尔茨海默病的情况下。许多成年人面临的最重要的决定是如何在阿尔茨海默氏症中逐渐恶化的认知和日益增长的残疾与他们的支持需求之间取得平衡。尽管许多老年人需要支持，但先前的研究表明，许多人可能会直接放弃对家庭支持需求的计划(例如，我计划在需要帮助之前在睡梦中死去)。大多数老年人不想离开家，但很少有人计划满足他们在家中的需求，随着他们的认知和功能恶化，他们将需要安全地在适当的地方变老。通过我们之前由PCORI资助的研究，我们开发了一种工具，PlanYourLifesspan(PYL)，它有助于做出决策和计划就地老龄化，特别是阿尔茨海默病。通过关于未来健康和家庭需求的教育以及获得这些资源，老年人可以做出选择，并为他们未来的需求与所爱的人分享。PEL在一项对385名居住在社区的老年人进行的多点随机对照试验中进行了测试，并进行了3个月的随访，结果发现，PEL在改善老年人对就地老龄化选择的决策行为方面非常有效。在短期的随访中，我们在确定这些老年人的决策计划如何转化为与就地老龄化的目标一致性方面受到限制。老年人在认知、功能丧失、社会因素和环境方面的变化对就地老龄化决策的影响存在差距。这些计划如何转化为及时采用，以及亲人对目标一致性的影响也没有得到探索。通过这项研究，我们的目标是：1.确定老年人的认知变化(如阿尔茨海默病)、功能变化、多慢性病、社会影响(如成年子女、配偶)和环境(如农村/城市、居家类型)对就地老龄化决策和规划的影响。目的2.考察老年人认知、功能、社会影响和环境对就地老龄化决策的中介/调节作用。目的3.评估针对就地老龄化的决策和规划是否转化为老年人及其代理人/照顾者决策者及时采用和目标一致。为了实现这些目标，我们将利用NIA资助的具有广泛认知测试的队列(LitCog，n=700)和PCORI资助的干预：PlanYourLifespan.org。我们将对LitCog队列中将在第一天接受PYL干预的老年人进行为期42个月的纵向研究。调查将每6个月与积极的LitCog研究一起进行，收集认知、社交、功能和健康素养的数据。此外，还将收集有关决策变更、资源使用、计划实施时间和目标一致性的数据。

The goal of this research is to better understand how older adult aging-in-place decision making and implementation is impacted by cognitive changes seen with Alzheimer’s disease, functional loss, social influences, and environmental factors. Remaining in one’s own home is a priority for many older adults. Decision making and planning is critical to ensure successful aging-in-place, especially when older adults are diagnosed with Alzheimer’s disease. The most important decision that many adults navigate is how to balance progressively worsening cognition, seen in Alzheimer’s disease, and increasing disability with their support needs. Although a great number of older adults will need support, prior research has shown that many may dismiss planning for their home support needs outright (e.g. I plan to die in my sleep before I ever need help). Most older adults do not want to leave their home and yet very few people plan for their home-based needs that they will require to age-in-place safely, as their cognition and function worsens. Through our previously PCORI-funded research, we developed a tool, PlanYourLifespan (PYL), which facilitates making decisions and planning to age-in-place, specifically with Alzheimer’s disease. Through education about future health and home-based needs as well as access to these resources, older adults can make choices and share them with loved ones for their future needs. PYL was tested in a multi-site randomized controlled trial of 385 community-dwelling older adults with 3 month follow-up and found to be significantly efficacious in improving decision making behaviors towards aging-in-place options among older adults. With the short follow-up, we were limited in determining how these decision making plans of older adults translated into goal concordance towards aging-in-place. A gap exists in how decision making for aging-in-place is impacted by older adults’ changes in cognition, functional loss, social factors, and environments. How these plans translate into timely adoption as well as the impact that loved ones have on goal concordance have also been unexplored. Through this research, we aim to: Aim 1. Determine how decision making and planning for aging-in-place is impacted by older adults’ cognition changes (e.g. as experienced with Alzheimer’s disease), functional changes, multi-chronic conditions, social influences (e.g. adult offspring, spouses), and environments (e.g. rural/urban, home type). Aim 2. Examine the mediating/ moderating interactions between older adult cognition, function, social influences, and environments in decision making for aging-in-place choices. Aim 3. Assess whether decision making and planning for aging-in-place translates into timely adoption and goal concordance for older adults and their surrogate/caregiver decision makers. To achieve these aims, we will leverage both an NIA-funded cohort (LitCog, n=700) with extensive cognitive testing and a PCORI-funded intervention: PlanYourLifespan.org. We will conduct a 42 month longitudinal study of older adults from the LitCog cohort who will receive the PYL intervention on Day 1. Surveys will be conducted every 6 months in conjunction with the active LitCog research, where cognitive, social, functional, health literacy data is being collected. Additionally, data will be collected on decision changes, resource use, timing of plan implementation, and goal concordance.