Profiling Psychosocial Dementia Caregiving Networks: The Impact of Dementia Care Networks on Care Outcomes of Medicare Enrollee Persons Living with Dementia

分析心理社会痴呆症护理网络：痴呆症护理网络对医疗保险参保者痴呆症患者护理结果的影响

• 批准号: 10523325
• 负责人: Amanda Noel Leggett
• 金额: $ 53.04万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10523325
• 关键词: Accounting; Address; Adult; Affect; Age; Aging; Alzheimer' s disease related dementia; Anxiety; Attention; Behavior Therapy; Caregivers; Caring; Characteristics; Communities; Complex; Conflict (Psychology); Data; Dementia; Dementia caregivers; Emergency department visit; Family; Family Caregiver; Family dynamics; Family member; Friends; Future; Growth; Health; Healthcare; Hospitalization; Individual; Infrastructure; Institutionalization; Intervention; Interview; Link; Long-Term Care; Measures; Medicare; Medicare claim; Mental Depression; Mental Health; Meta-Analysis; Modeling; Monitor; Nature; Network-based; Outcome; Participant; Patients; Pattern; Personal Satisfaction; Persons; Population; Population Heterogeneity; Process; Psychosocial Assessment and Care; Public Health; Reporting; Research; Respondent; Risk; Role; Sampling; Self Care; Services; Stress; Symptoms; Techniques; Time; Work; anxiety symptoms; base; beneficiary; care giving burden; care outcomes; care recipients; caregiver functioning; caregiver stress; caregiving; caregiving research; coping; dementia care; dementia caregiving; depressive symptoms; experience; health care service utilization; human old age (65+); improved; member; neglect; primary caregiver; psychosocial; psychosocial stressors; research and development; response; sleep quality; statistics; stressor; systems research; theories; therapy development; treatment adherence; trend

ABSTRACT Caregivers of persons living with dementia (PLwD) do not act in isolation and are typically involved in broader networks of family and friends who also assist with care, and yet this expanded caregiver network is largely neglected in research. Theories of mutual influence and empirical work suggest that caregivers’ stress and mental health have a negative impact on both caregivers and PLwD, yet recent reports and meta-analyses suggest disappointingly small effects of care-related behavioral interventions. Given that PLwD typically have broad networks involved in care, an exclusive focus on a primary caregiver may be missing the mark. This study aims to fill this immense gap by 1) Classifying dementia caregiver networks into profiles based on compositional and psychosocial facets of the care network, 2) Examining the association between dementia caregiver network profiles on PLwD’s well-being and important healthcare utilization, and 3) Identify the association between changing care needs of PLwD and how dementia caregiver networks change over time. We will first identify a sample of PLwD in the nationally representative National Health and Aging Trends Study (NHATS), which conducts annual interviews with age-eligible Medicare beneficiaries by pooling unique data from the 2011, 2015, and 2017 waves with additional waves forthcoming (2021 and moving forward annually). To characterize care network profiles, we will use information about caregivers from NHATS and additional rich detail from the associated National Study of Caregiving (NSOC), which interviews up to 5 caregivers per eligible NHATS participant. Latent class analysis models will be used to characterize and cluster networks based on similar patterns of compositional and psychosocial characteristics. Measures of between and within- network variability (e.g., average care stress in network, variability of stress within network) will be included. We will then explore the association of care network profiles, and individual components of network profiles, with key health outcomes for PLwD including sleep quality, depression and anxiety symptoms, and important health care utilization (potentially preventable hospitalization, Emergency Department visits, and long-term care stay) through linked NHATS respondent-level Medicare claims. Finally, taking advantage of the longitudinal nature of NHATS and NSOC, we will follow care networks over time to examine the association of network changes with change in PLwD’s self-care needs. This work is significant as results will substantially improve understanding of these caregiver networks and how they may increase risks for negative outcomes for PLwD such that future interventions may target those networks with potential for adverse influence. In line with NIA priorities to improve assessment of caregiving processes and understand connections between family dynamics and patient health and well-being, this understanding of care networks can fundamentally shift the paradigm of caregiving research by establishing the importance of considering family and network systems for research and intervention development, moving beyond the standard focus on a sole, primary caregiver.

抽象的 患有痴呆症（PLWD）的人的护理人员不孤立地行动，通常参与更广泛的参与 家人和朋友的网络也可以协助照顾，但是这个扩展的护理人员网络在很大程度上是 在研究中被忽略。相互影响和经验工作的理论表明，护理人员的压力和 心理健康对看护人和PLWD都有负面影响，但最近的报告和荟萃分析 暗示与护理相关的行为干预措施的小小作。鉴于PLWD通常有 涉及护理的广泛网络，对主要护理人员的独家关注可能会缺少标记。 研究旨在通过1）将痴呆症护理人员网络分类为基于个人资料的巨大空白。 护理网络的组成和社会心理方面，2）检查痴呆症之间的关联 PLWD福祉和重要医疗保健利用的护理人员网络概况，3）确定 不断变化的PLWD护理需求与痴呆症护理人员网络如何随时间变化之间的关联。 我们将首先在全国代表性的国家健康和衰老趋势研究中确定PLWD样本 （NHAT），通过汇总独特数据，对符合年龄的Medicare受益人进行年度访谈 从2011年，2015年和2017年浪潮，即将推出的额外浪潮（2021年，每年向前移动）。 为了表征护理网络概况，我们将使用有关NHAT的护理人员的信息和其他富人 相关的国家护理研究（NSOC）的细节，该研究最多可容纳5名护理人员 合格的NHATS参与者。潜在类分析模型将用于表征和聚类网络 基于组成和社会心理特征的类似模式。之间的衡量标准和 网络可变性（例如，网络中的平均护理应力，网络内压力的变异性）将包括在内。 然后，我们将探索护理网络配置文件的关联以及网络配置文件的各个组成部分， PLWD的关键健康结果包括睡眠质量，抑郁和动画症状以及重要 医疗保健利用（潜在可预防的住院，急诊就诊和长期 通过链接的NHATS响应级Medicare主张来保健住宿）。最后，利用 NHAT和NSOC的纵向性质，我们将随着时间的推移遵循护理网络，以检查 网络随着PLWD自我保健需求的变化而变化。这项工作很重要，因为结果将大大 提高对这些护理人员网络的理解以及它们如何增加负面结果的风险 PLWD使得未来的干预措施可能针对那些具有不利影响的网络。与 NIA的优先事项以改善对护理过程的评估并了解家庭之间的联系 动态，患者健康和福祉，对护理网络的这种理解可以从根本上改变 护理研究范式通过确定考虑家庭和网络系统的重要性 研究和干预开发超越了对唯一的主要护理人员的标准关注。