The Effects of the COVID-19 Pandemic on Long-Term Care for High-Need Older Adults with and without Alzheimer’s Disease and Related Dementias

项目总结 近2000万65岁及以上的成年人(38%)在一项或多项自我照顾活动方面有局限性(例如， 穿衣、起床)，十分之一的老年人患有阿尔茨海默氏症和相关疾病 痴呆(ADRD)。这两组重叠的“高需求”老年人通常依赖于 各种长期护理(LTC)来源，以协助日常活动，包括家庭和无偿护理，有偿 居家护理、居家护理、辅助生活和养老院护理等。护理不足可能会导致 日常自我护理的不良后果和可避免的卫生保健利用。冠状病毒的突然发作- 19大流行可能对长期TC的获取和使用产生深远影响，并导致进一步的不利影响 对高需求老年人的影响，特别是对那些患有ADRD的人。这项工程将借鉴 两项互补的纵向、具有全国代表性的老年人调查--健康和退休 研究(HRS)和国家健康和老龄化趋势研究(NHATS)-与地理数据和 医疗保险索赔。使用统计方法加强我们得出因果推理的能力，我们将：1) 评估新冠肺炎大流行对长期TC使用类型和数量的短期影响(2018年至2020年)， 比较患有ADRD和不患有ADRD的高需求老年人，确定更有可能更稳定的安排 改变的风险更低。2)确定护理轨迹在开始后是否中断 大流行，比较2016年至2024/2025年期间患有和不患有ADRD的高需求老年人。3)考核 新冠肺炎对高危老年人护理缺口相关不良后果的影响 而且没有ADRD。我们将评估新冠肺炎大流行对未满足需求的自我报告的影响(使用 NHATS)和基于索赔的可避免住院和急诊科就诊措施(使用 小时)适用于患有和不患有ADRD的人。详细的地理数据将使我们能够考虑到当地 在确定更多的“脆弱”护理安排的同时，有更高的不良后果风险。 该项目的结果将使人们全面了解新冠肺炎大流行对 LTC在短期和长期的结果。这项研究与NIA了解社区的优先事项一致 对痴呆症护理的支持，特别是可获得性、长期TC、长期TC利用率的决定因素以及如何影响 社区层面的因素，包括基础设施和风险环境。

PROJECT SUMMARY Nearly 20 million adults (38%) aged 65 and older have limitations with one or more self-care activities (e.g., dressing, getting out of bed) and one in ten older adults are living with Alzheimer’s Disease and Related Dementias (ADRD). Together these two overlapping groups of “high-need” older adults typically rely on a variety of long-term care (LTC) sources to assist with daily activities, including family and unpaid care, paid care in the home, residential care such as assisted living and nursing home care. Inadequate care may lead to adverse consequences in daily self-care and avoidable health care utilization. The sudden onset of the COVID- 19 pandemic may have profoundly affected access to and use of LTC and contributed to further adverse consequences for high-need older adults, particularly for those living with ADRD. This project will draw upon two complementary longitudinal, nationally representative surveys of older adults–the Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS)–linked to geographic data and Medicare claims. Using statistical approaches that strengthen our ability to draw causal inferences, we will: 1) Evaluate the short-term impact (2018-2020) of the COVID-19 pandemic on the type and amount of LTC use, comparing high-need older adults with and without ADRD and identify arrangements more likely to be “stable” with lower risks of change. 2) Determine whether care trajectories were disrupted after the start of the pandemic, comparing high-need older adults with and without ADRD from 2016 through 2024/2025. 3) Assess the impact of COVID-19 on adverse consequences related to care gaps among high-need older adults with and without ADRD. We will estimate the effect of the COVID-19 pandemic on self-reports of unmet need (using NHATS) and claims-based measures of avoidable hospitalizations and emergency department visits (using HRS) for those with and without ADRD. Detailed geographic data will allow us to take into account local conditions while identifying more “vulnerable” care arrangements with higher risks of adverse consequences. The results of this project will provide a comprehensive understanding of the COVID-19 pandemic’s impact on LTC outcomes in the short and longer term. This study aligns with NIA’s priority to understand community support for dementia care, in particular the determinants of availability LTC, LTC utilization and how the effects of community level factors including infrastructure and risk environment.