The impact of COVID-19 pandemic on community-dwelling older adults with ADRD

COVID-19 大流行对社区居住的患有 ADRD 的老年人的影响

基本信息

批准号：
10202236
负责人：
Shubing Cai
金额：
$ 38.5万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-15 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10202236
关键词：
Activities of Daily Living Address Affect Alzheimer&apos s disease related dementia Behavior Behavioral COVID-19 COVID-19 pandemic Caregivers Caring Cessation of life Chronic Communities Confusion Contracts Data Disadvantaged Disease Elderly Emergency department visit Emotional Equipment Face Family member Federal Government Friends Future Handwashing Health Services Accessibility Healthcare Home environment Hospitalization Household Impaired cognition Individual Infection Institutionalization Intensive Care Units Interruption Knowledge Masks Medicaid Medical Mental Health Nursing Homes Older Population Patients Pattern Persons Population Prevalence Public Health Race Research Resources Risk Risk Factors Services Severities Severity of illness System Telemedicine Time Visit Vulnerable Populations community based service community living comorbidity coronavirus disease health care delivery health care service utilization health difference high risk home based service improved multiple chronic conditions pandemic disease parent grant payment procedure safety psychologic racial difference racial disparity racial health disparity racial minority residence routine care social norm socioeconomics stem

项目摘要

Project Summary. Persons with ADRD face significant challenges under the pandemic of coronavirus disease 2019 (COVID-19). First, persons with ADRD are at a high risk for COVID-19 because they are generally older adults with comorbidities. In addition, persons with ADRD may have difficulty understanding the disease and following the safety procedures, thus making them more susceptible to COVID-19. Furthermore, the general ramifications stemming from the pandemic may affect the usual medical care received by persons with ADRD. Persons with ADRD often have cognitive impairment and are likely to develop disruptive behaviors. Thus, they may need routine medical and/or psychiatric services to manage their chronic conditions and to address their mental health issues. They are more likely to benefit from in-person medical visits, which has been greatly interrupted during the pandemic. Although the CMS has expanded telemedicine benefits, persons with ADRD may find telecommunication as the means of receiving healthcare, difficult. Lastly, the majority of persons with ADRD live in community, and they may need in-person long-term services and supports (LTSS) to assist with their daily living and psychological or emotional care needs. The pandemic may have reduced the availability of these supports and services. In addition, caregivers (not residing in the same household) may have to wear personal protective equipment to deliver services, causing confusion and upset that trigger behavioral issues among patients. These changes in care may have made it more difficult for persons with ADRD to maintain community living and may accelerate the likelihood of institutionalization. The impact of COVID pandemic on blacks with ADRD could be particularly significant. It has been shown that blacks with ADRD tend to have higher levels of cognitive impairment than their white counterparts. At the same time, it has been revealed that blacks are at disproportionally high risks for COVID-19 infection and death. These racial differences are likely triggered by socioeconomic determinants. For example, blacks tend to aggregate in disadvantaged communities with fewer resources and supports and higher rates of COVID-19 infection. To date, it is unclear how this pandemic affects persons with ADRD, both regarding the risk of and severity of COVID-19, as well as their needs for usual medical care and LTSS (that are not directly related to COVID-19), and how such impacts vary by individual's race. This proposed study has two Aims: 1) to examine the risk of COVID-19 and the severity of illness (hospitalization, ICU, death) among community dwelling older adults with ADRD, and how that varies by individual's race; 2) to examine the impact of this pandemic on non-COVID related health care utilization (e.g. hospitalization, ER visits, nursing home placement) among this population, and how that varies by race. The proposed research is significant as the findings will provide valuable and timely information on how this public health crisis affects the vulnerable older population with ADRD, and inform future efforts aimed at reducing racial disparities in health among this already vulnerable population.

项目摘要。在冠状病毒大流行下，ADRD的人面临重大挑战 2019（Covid-19）。首先，ADRD的人患Covid-19的风险很高，因为他们通常年龄较大合并症的成年人。此外，ADRD的人可能难以理解该疾病，并且遵循安全程序，从而使它们更容易受到19号的影响。此外，将军由于大流行而产生的后果可能会影响ADRD患者接受的通常的医疗服务。患有ADRD的人通常会有认知障碍，并且可能会发展出破坏性行为。因此，他们可能需要常规的医疗和/或精神病服务来管理其慢性状况并解决他们的心理健康问题。他们更有可能从面对面的医疗访问中受益，这是极大的大流行期间中断。尽管CMS扩大了远程医疗福利，但ADRD的人可能会发现电信是接受医疗保健的手段。最后，大多数人 Adrd居住在社区中，他们可能需要面对面的长期服务和支持（LTSS）来协助他们的日常生活以及心理或情感护理需要。大流行可能降低了可用性这些支持和服务。此外，护理人员（不居住在同一家庭）可能必须穿个人保护设备以提供服务，引起混乱和烦恼，触发行为问题在患者中。这些护理的变化可能使ADRD的人更加困难维护社区生活，并可能加速制度化的可能性。共同大流行对患有ADRD的黑人可能特别重要。已经表明，有Adrd的黑人倾向于与白人同行相比，认知障碍的水平更高。同时，已经揭示了黑人患有19009年感染和死亡的黑人风险不成比例。这些种族差异可能是由社会经济决定因素触发。例如，黑人倾向于在不利的地方聚集资源和支持较少的社区和COVID-19感染率更高。迄今为止，还不清楚这次大流行如何影响ADRD的人，无论是关于Covid-19的风险和严重性的风险，以及他们对常规医疗和LTSS的需求（与COVID-19无直接相关），以及这种影响如何因个人的种族而异。这项拟议的研究有两个目的：1）检查 COVID-19和疾病严重程度（住院，ICU，死亡） ADRD，以及这如何随着个人的种族而变化； 2）检查该大流行对非循环的影响该人群中相关的医疗保健利用（例如住院，急诊就诊，疗养院安置），以及这种情况因种族而变化。拟议的研究很重要，因为这些发现将提供有价值的和及时有关这种公共卫生危机如何影响ADRD的脆弱老年人口的信息，以及告知未来旨在减少这种已经脆弱人群中健康种族差异的努力。