The Impact of Alzheimer's Disease and Related Dementias on Older Adults' Medicare Coverage Choices, Financial Well-being, and Health

阿尔茨海默病和相关痴呆症对老年人医疗保险覆盖选择、财务状况和健康的影响

• 批准号: 10507004
• 负责人: Brian McGarry
• 金额: $ 12.57万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10507004
• 关键词: Address; Adverse effects; Affect; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Award; Budgets; Caregiver support; Caregivers; Clinical; Cognitive aging; Cognitive deficits; Complex; Data; Decision Making; Dementia; Diagnosis; Disease; Drug Prescriptions; Elderly; Ensure; Family Caregiver; Foundations; Future; Health; Health Services; Health Services Accessibility; Health Services Needs; Health Services Research; Health Services for the Aged; Health Status; Health and Retirement Study; Household; Impaired cognition; Impairment; Individual; Interdisciplinary Study; Intervention; Interview; K-Series Research Career Programs; Lead; Leadership; Link; Measurement; Medicare; Medicare Part C; Medicare claim; Medicine; Mentors; Mentorship; Methods; Outcome; Personal Satisfaction; Policies; Policy Maker; Population; Psychologist; Qualitative Research; Quasi-experiment; Research; Research Methodology; Research Personnel; Resources; Risk; Role; Security; Surveys; Testing; Time; Training; Universities; Vulnerable Populations; beneficiary; career development; caregiving research; clinical care; cognitive ability; cognitive capacity; cognitive change; cognitive disability; coping; cost; decision-making capacity; design; experience; family caregiving; health care availability; health inequalities; mild cognitive impairment; multidisciplinary; professor; programs; response; social; socioeconomics

1. PROJECT SUMMARY/ABSTRACT This NIA career development award will establish Dr. McGarry, an Assistant Professor in the Department of Medicine at the University of Rochester (UR), as an independent investigator with expertise in the areas of cognitive aging, including Alzheimer’s Disease and related dementias (ADRD), and consumer choice in the Medicare program. With support from the award, Dr. McGarry will undertake a training plan that focuses on: 1) the clinical trajectory of ADRD, 2) ADRD family caregiving and research, 3) qualitative research methods, and 4) leadership of a multidisciplinary research team. This training will enable Dr. McGarry to conduct multidisciplinary, mixed-methods research examining the impact of ADRD on Medicare choices and resultant outcomes. It builds off his current areas of expertise, including Medicare policy and benefit design and quantitative health services research. Dr. McGarry has leveraged the considerable resources available at UR to assemble a multidisciplinary team of nationally-recognized experts. Dr. Kathi Heffner, the primary career development mentor, is a social psychologist with expertise in cognitive aging and the study of caregivers with ADRD. Dr. Helena Temkin-Greener, the primary methods mentor, is a health services researcher with expertise in the delivery and quality of health services for older adults and mixed methods research. Together they will lead a mentorship team with additional expertise in qualitative research methods, the measurement of functional cognitive abilities, the diagnosis and clinical care of individuals with ADRD, and the use of national survey data linked with Medicare claims to study health outcomes in older adults. The Medicare program depends on consumer choice, yet little is known about the ability of older adults with ADRD to navigate this complexity. Available evidence suggests this population is at increased risk of suboptimal coverage choices, yet little is known about how these risks evolve over the disease course and their health and financial effects. This mixed-methods study will examine the Medicare coverage choices of individuals with ADRD throughout the disease course (Aim 1). The Health and Retirement Study (HRS) linked with Medicare claims will be used to describe the Medicare coverage, and propensity to make changes, of individuals with ADRD at various stages of cognitive decline. Analyses will also examine whether the impacts of cognitive declines are moderated by the availability of family caregivers and socioeconomic resources. Qualitative interviews with caregivers of individuals with ADRD will add depth and support the interpretation of the quantitative results. Using the same HRS data, the effects of impaired household Medicare decision making due to ADRD on health and financial outcomes will be estimated using a quasi-experimental design (Aim 2). Study results will provide critical information to policy makers about the effects of Medicare program design on the well-being of individuals with ADRD. In combination with mentored training, this research will form the basis of an R01 proposal that will evaluate the effects of potential policy reforms designed to support Medicare choices in households with ADRD and the acceptability of such reforms to this population.

1。项目摘要/摘要 NIA职业发展奖将建立麦克加里博士，该系的助理教授 罗切斯特大学（University of Rochester）（UR）的医学，是一名独立研究者，在认知领域的专家 衰老，包括阿尔茨海默氏病和相关痴呆症（ADRD）以及Medicare计划中的消费者选择。 在该奖项的支持下，麦加里博士将执行一项培训计划，重点是：1） ADRD，2）ADRD家庭护理和研究，3）定性研究方法，以及4）领导 多学科研究团队。这项培训将使麦加里博士能够进行多学科的混合方法 研究研究ADRD对Medicare选择和结果结果的影响。它建立了他目前的领域 专业知识，包括医疗保险政策和福利设计和定量卫生服务研究。麦加里博士有 利用UR可用的大量资源来组建一个全国认可的多学科团队 专家。主要职业发展的Kathi Heffner博士是一位社会心理学家，具有认知专家 衰老和对ADRD的护理人员的研究。主要方法指导者海伦娜·特姆金·格林（Helena Temkin-Greener）博士是健康 服务研究人员具有专业知识在为老年人提供保健服务和混合方法的卫生服务的专业知识 研究。他们将共同领导一个具有定性研究方法的其他专业知识的心态团队， 测量功能认知能力，ADRD患者的诊断和临床护理以及使用 国家调查数据与Medicare有关研究老年人健康成果的主张有关。 Medicare计划取决于消费者的选择，但对老年人的能力知之甚少 ADRD浏览这种复杂性。可用证据表明，该人群的次优风险增加 覆盖范围的选择，但对于这些风险如何在疾病过程中发展及其健康以及其健康以及 财务影响。这项混合方法研究将检查ADRD个人的Medicare覆盖范围选择 在整个疾病过程中（目标1）。与Medicare索赔相关的健康和退休研究（HRS）将是 用于描述Medicare覆盖范围，并承诺在各个阶段对ADRD的个人进行更改 认知能力下降。分析还将检查认知下降的影响是否由 家庭护理人员和社会经济资源的可用性。与个人的照顾者进行定性访谈 ADRD将增加深度并支持定量结果的解释。使用相同的HRS数据，效果 估计，由于健康和财务成果而导致的家庭医疗保险决策受损 使用准实验设计（AIM 2）。研究结果将向政策制定者提供关键信息 Medicare计划设计对ADRD个人福祉的影响。结合指导培训， 这项研究将构成R01提案的基础，该提案将评估旨在的潜在政策改革的影响 支持ADRD家庭中的Medicare选择，并对此类改革对这一人群的可接受性。