Effects of Informal Care for persons with Alzheimer's Disease and related dementias

非正式护理对阿尔茨海默病和相关痴呆症患者的影响

基本信息

批准号：
9756265
负责人：
Norma B Coe
金额：
$ 62.36万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-30 至 2021-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9756265
关键词：
Address Advocate Age Alzheimer&apos s disease related dementia American Area Assisted Living Facilities Budgets Care given by nurses Caregivers Caring Clinical Communities Cost of Illness Country Data Data Set Databases Dedications Direct Costs Disease Economics Effectiveness Elderly Emergency department visit Emotional Evaluation Experimental Designs Facilities and Administrative Costs Family Financial Hardship Formal caregiver Friends Goals Government Financing Health Health Resources Health and Retirement Study Healthcare Home Nursing Care Home environment Hospitalization Independent Living Individual Industry Intuition Long-Term Care Longevity Measures Medicaid Medicare Medicare/Medicaid Memory Mental Health Methods Nature Nursing Homes Outcome Patient Self-Report Patients Persons Play Policies Population Prevalence Privatization Psyche structure Research Residential Treatment Resources Retirement Role Sampling Science Severity of illness Source Techniques Training Work aged care costs care outcomes care providers care recipients cost disability experience functional disability health care availability health care service utilization informal care informal caregiver informal support instrument patient oriented person centered physical conditioning psychologic social trend

项目摘要

Effects of Informal Care for persons with Alzheimer's Disease and Related Dementias The current debate about how best to meet the growing demand for patient-centered, high-quality long- term care for persons with ADRD in the least restrictive setting possible has centered almost solely on the direct and indirect costs of each type of care. A crucial missing piece is a comparison of the benefits. While receiving informal care may seem intuitively appealing, we currently know surprisingly little about the implications of this choice for outcomes of the individuals receiving the care. Our study would be the first to measure the causal impact of receiving informal versus formal long-term care on key and multi-faceted outcomes for the care recipient, primarily using the Health and Retirement Study, a nationally-representative dataset of Americans age 50+. Our analysis would include all individuals receiving long-term care, as well as a sub-sample of individuals living with ADRD, since informal care costs account for approximately half the total costs of the disease. Our health outcomes include a rich set of self-reported physical, mental, emotional, and social health measures, as well as self-reported and administrative health care utilization measures. In order to estimate the causal impact of formal and informal care, we employ instrumental variable techniques and a set of instruments that have been successfully used to predict informal care receipt in previous work using the same dataset. In addition, we propose new and promising instruments, including the supply of formal care available in the market. Finally, our study is the first to take a comprehensive look at all forms of formal care, including the plethora of private-pay residential care options. To do so, this research brings together the Area Health Resource Files (AHRF) and the NIC-MAP database, the industry's premiere dataset concerning the long-term care market. Using this approach, our study proposes to address the following specific aims: to describe comprehensively an expanded profile of the supply of publicly and privately financed formal care in local markets and its correlation with informal care, and to quantify the difference in care recipient outcomes caused by receiving informal versus formal care. This proposal will inform the policy tradeoffs between supporting informal care providers and expanding publicly financed formal care options.

非正式护理对阿尔茨海默病和相关痴呆症患者的影响当前关于如何最好地满足以患者为中心的高质量长期医疗服务日益增长的需求的争论在尽可能限制最少的环境中为 ADRD 患者提供的长期护理几乎完全集中于直接护理以及每种护理的间接成本。一个关键的缺失部分是利益的比较。接收时非正式护理似乎直观上很有吸引力，但我们目前对此的影响知之甚少接受护理的个人的结果的选择。我们的研究将是第一个衡量接受非正式与正式长期教育的因果影响的研究。主要利用健康与退休研究，对被护理者的关键和多方面结果进行护理， 50 岁以上美国人的全国代表性数据集。我们的分析将包括所有接受治疗的个人长期护理以及 ADRD 患者的子样本，因为非正式护理费用占大约占该疾病总费用的一半。我们的健康结果包括一系列丰富的自我报告的身体、精神、情感和社会健康措施，以及自我报告和行政医疗保健利用措施。为了估计正式和非正式护理的因果影响，我们采用工具变量过去已成功用于预测非正式护理接受情况的技术和一套工具使用相同的数据集进行工作。此外，我们还提出了新的、有前景的工具，包括提供市场上提供正规护理。最后，我们的研究首次全面审视了所有形式的正规护理，包括大量的私人付费住宿护理选择。为此，这项研究汇集了区域健康资源文件 (AHRF) 和 NIC-MAP 数据库，这是业界首屈一指的数据集，涉及长期护理市场。使用这种方法，我们的研究建议解决以下具体目标：全面扩大当地市场公共和私人资助的正规护理的供应范围及其与非正式护理的相关性，并量化由以下原因引起的护理接受者结果的差异接受非正式与正式护理。该提案将告知支持非正规经济之间的政策权衡护理提供者和扩大公共资助的正规护理选择。