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

本研究的目的是为了更好地了解老年痴呆患者的认知变化、功能丧失、社会影响和环境因素如何影响老年人的原地老龄化决策和实施。对许多老年人来说，住在自己家里是头等大事。决策和规划对于确保成功的就地老龄化至关重要，特别是当老年人被诊断患有阿尔茨海默病时。许多成年人面临的最重要的决定是如何平衡逐渐恶化的认知能力（见于阿尔茨海默病）和越来越多的残疾与他们的支持需求之间的关系。尽管很多老年人需要帮助，但先前的研究表明，许多人可能会完全忽视他们家庭支持需求的计划（例如，我计划在我需要帮助之前在睡梦中死去）。大多数老年人不想离开他们的家，但很少有人计划他们的家庭为基础的需求，他们将需要安全的老在原地，因为他们的认知和功能恶化。通过我们之前pcori资助的研究，我们开发了一种工具，plananyourlifespan (PYL)，它有助于制定决策和计划，特别是老年痴呆症。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，并与亲人分享他们未来的需求。PYL在一项对385名居住在社区的老年人进行了3个月随访的多地点随机对照试验中进行了测试，发现PYL在改善老年人对原地老龄化选择的决策行为方面显着有效。由于随访时间较短，我们在确定老年人的这些决策计划如何转化为对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原地老龄化决策的影响存在差距。这些计划如何转化为及时的收养，以及所爱的人对目标一致性的影响也未被探索。通过本研究，我们的目标是：目标1。确定老年人的认知变化（如患有阿尔茨海默病）、功能变化、多种慢性疾病、社会影响（如成年子女、配偶）和环境（如农村/城市、家庭类型）如何影响就地养老的决策和规划。目标2。检查老年人认知、功能、社会影响和环境在原地老龄化选择决策中的中介/调节相互作用。目标3。评估老年人和他们的代理/照顾者决策者的就地老龄化决策和规划是否转化为及时收养和目标一致性。为了实现这些目标，我们将利用nia资助的队列（LitCog, n=700）进行广泛的认知测试和pcori资助的干预：planyourlifespan。我们将对LitCog队列中的老年人进行为期42个月的纵向研究，这些老年人将在第1天接受PYL干预。将每6个月进行一次调查，同时开展积极的LitCog研究，收集认知、社会、功能和健康素养数据。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.