Migration and outcomes among older adults with and without ADRD from Puerto Rico

项目总结 最近的社会经济和自然灾害，包括飓风玛丽亚，加剧了移民的外逃。 波多黎各居民移民到美国本土，并导致了“历史性的净移民损失”。更糟糕的生活 条件、没有资格获得低收入补贴、高贫困率和获得保健服务的机会有限可能 成为老年人从波多黎各移民到美国本土的重要驱动力，特别是在 患有慢性病和复杂的医疗保健需求。阿尔茨海默病及相关痴呆症患者 (ADRD)医疗保健支出高、结果差，往往需要长期服务和支持。这个 波多黎各的医疗补助计划不包括长期护理，这可能会迫使患有ADRD的老年人 在波多黎各以外的地方寻求长期护理。然而，人们对移民的驱动因素和结果知之甚少 跟踪患有和不患有ADRD的波多黎各老年人的移徙情况。因此，迫切需要 了解老年人一生中的老龄化经历、迁移模式和结果 从波多黎各来的。使用针对65岁及以上(自2010年以来)的联邦医疗保险患者的数据，具有丰富的临床和 使我们能够跟踪移徙模式、死亡率、长期服务利用情况的社会经济变量 我们的具体目标如下：目标1)估计移民率并确定移民的驱动因素 在波多黎各医疗保险受益人中，无论是否被诊断为ADRD。我们的工作假说 在被诊断为ADRD的老年人中，外迁率比那些 如果没有ADRD诊断(H1)；飓风玛丽亚将加剧先前存在的ADRD的迁出 患者相对于灾前时期(H2)；移民的人将更有可能是黑人，有 收入更低，社会支持更多，卫生保健利用率更高 没有迁移，这些因素对既往有ADRD诊断的移民的影响更大 (H3)；和AIM2)审查移民是否缓和了ADRD对死亡率、发病率和 波多黎各受益人的住院情况。我们的工作假设是，移民将 缓和ADRD对健康下降、死亡率和住院的影响，这些下降将是 在有ADRD诊断的人中较高(H1)；患有ADRD的移民将有较高的 与既往ADRD患者相比，双重资格、医疗费用和使用率 没有迁移的人(H2)。这项建议是对FOA(PAR-21-080)的直接回应 关于移民人口的健康差距和健康优势的研究。这项研究的结果可能 指导干预措施1)帮助居住在波多黎各的老年人，他们可能想要在家里继续老龄化， 因此他们不必迁移；2)针对患有ADRD和/或新移民在提供服务方面的任何差距 抵达美国后可能面临的复杂慢性疾病；以及3)重组联邦医疗保险和医疗补助 在波多黎各提供福利和资金；以及4)提供奖励，以增加波多黎各的专门护理。

PROJECT SUMMARY Recent socio-economic and natural disasters, including Hurricane Maria, have exacerbated the exodus of Puerto Rican residents to the US mainland and has led to a “historic net migration loss.” Worse living conditions, ineligibility to low-income subsidies, high poverty rates and limited access to health services may be important drivers for older adults to migrate from Puerto Rico to the US mainland, particularly among those with chronic illness, and complex health care needs. People with Alzheimer’s Disease and Related Dementias (ADRD) have high health care spending, poor outcomes, often require long-term services and supports. The Medicaid program in Puerto Rico does not cover long-term care, which may compel older adults with ADRD to seek long-term care outside of Puerto Rico. However, little is known about drivers of migration and outcomes following migration among Puerto Rican older adults with and without ADRD. Thus, there is a crucial need to understand the aging experience across the life-course, migration patterns and outcomes among older adults from Puerto Rico. Using data for Medicare patients ages 65 and older (since 2010) with rich clinical and socioeconomic variables that allow us to track migration patterns, mortality, utilization of long-term services and supports, our specific aims are as follows: AIM 1) Estimate migration rates and identify drivers of migration among Puerto Rican Medicare beneficiaries with and without a diagnosis of ADRD. Our working hypotheses are that out-migration rates will be higher among older adults following an ADRD diagnosis compared to those without an ADRD diagnosis (H1); Hurricane Maria will have exacerbated out-migration of preexisting ADRD patients relative to the pre-disaster period (H2); People who migrated will be more likely to be black, have lower income, greater social support and higher rates of health care utilization compared to persons who do not migrate, and the effect of these factors will be greater among migrants with preexisting ADRD diagnosis (H3); and AIM2) Examine whether migration moderates the effect of ADRD on mortality, morbidity and hospitalizations among beneficiaries from Puerto Rico. Our working hypotheses are that migration will moderate the effect of ADRD on health decline, mortality and hospitalizations and that these declines will be higher among people with preexisting ADRD diagnosis (H1); migrants with preexisting ADRD will have higher rates of dual eligibility, healthcare expenditures and utilization compared to persons with preexisting ADRD who did not migrate (H2). This proposal is a direct response to the FOA (PAR-21-080) “Addressing the Etiology of Health Disparities and Health Advantages Among Immigrant Populations.” Results from this research could guide interventions 1) to assist older adults residing in Puerto Rico who may want to continue aging at home, so they do not have to migrate; 2) to target any gaps in service delivery that new migrants with ADRD and/or complex chronic conditions may face after arriving to the US; and 3) to restructure Medicare and Medicaid benefits and funding in Puerto Rico; and 4) to provide incentives to increase specialized care in Puerto Rico.