Aging in Place: A Cross-Sector Partnership of Housing and Health Care

就地养老：住房和医疗保健的跨部门合作

• 批准号: 10829158
• 负责人: Lesli Elizabeth Skolarus
• 金额: $ 23.34万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-15 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10829158
• 关键词: Academic support; Administrator; Adoption; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Behavior Therapy; Black American; Black Populations; Black race; Blood Pressure; Caring; Clinic; Clinic Visits; Cognitive; Communities; Community Health Aides; Elderly; Electronic Health Record; Equilibrium; Evaluation; Federally Qualified Health Center; Geriatrics; Health Services Research; Health behavior; Healthcare; High Prevalence; Home; Home visitation; Household; Housing; Impairment; Interview; Low income; Measures; Medical; Methods; Michigan; Modeling; Modification; Penetration; Physical Function; Physical environment; Poverty; Proctor framework; Provider; Research; Resources; Risk Factors; Safety; Site; Social Environment; Social isolation; Social support; Structure; Testing; U.S. Department of Housing and Urban Development; Visit; Vulnerable Populations; Work; aging in place; blood pressure reduction; cognitive function; community engagement; design; disability; disability risk; experience; high risk; implementation evaluation; implementation outcomes; implementation science; improved; safety net; social engagement; social interventions

Abstract/Project Summary Many older adults prefer to remain in their homes as they age. The ability to age in place is a balance between the amount of cognitive and physical function, the physical environment, and the social environment available to stay in their homes. Black older adults and the poor experience greater physical impairment and a higher prevalence of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRDs) than their counterparts resulting in greater challenges to aging in place. Bold ideas to facilitate aging in place, particularly among vulnerable populations, are needed. To promote aging in place, we present the Unite care model, a community-initiated, academic supported, dual- sector initiative that combines two sectors: housing and health care. The Unite care model co-locates a Federally Qualified Health Center (FQHC) clinic on an older adult affordable housing campus, home to over 700 predominately Black older adults in Flint, Michigan. The Unite care model will promote aging in place by optimizing: 1) medical care including onsite clinic and home visits; 2) the physical environment through referrals for home safety evaluations and facilitating environmental modifications and; 3) the social environment by community health worker led health behavior and social interventions. Overall, the Unite care model will flip the paradigm that asks the most vulnerable older adults to seek out the medical safety net. Instead, the Unite care model will bring the safety net to older adults to support aging in place. The objective of this proposal is to assess how well the Unite care model is implemented, identify which older adults utilize it, with particular emphasis on older adults with activity limitations or AD/ADRD, and whether the model promotes aging in place. In aim 1, through a concurrent exploratory mixed methods design guided by the Proctor implementation outcomes framework, we seek to determine how much and for whom (i.e., penetration) and how well (i.e., adoption and acceptability) the Unite care model is implemented. In aim 2, we will determine which older adults utilize the Unite care model and assess whether the Unite care model promotes aging in place through blood pressure reduction, a measure of medical care and an important predictor of disability, and changes to the physical and social environment. We have worked in partnership with the Flint community for over a decade and have specifically worked on this project with our housing and healthcare partners for two years. This proposal will inform other communities contemplating new models of care to promote aging in place among older adults living in poverty and older Black Americans and suggest whether larger-scale testing of this model of care is warranted. .

摘要/项目摘要 许多老年人更喜欢随着年龄的增长留在家里。实现老化的能力是在 认知和身体功能，身体环境以及可用的社会环境的数量 留在家中。黑人老年人和贫穷的人经历了更大的身体障碍，更高 阿尔茨海默氏病和阿尔茨海默氏病与疾病相关的痴呆（AD/ADRD）的患病率要比其患病率 同行对衰老面临更大的挑战。大胆的想法促进衰老，特别是 在脆弱的人群中。 为了促进衰老，我们提出了Unite Care模型，这是一个社区发起的，学术支持的，双重的 结合了两个部门的部门倡议：住房和医疗保健。 Unite Care模型共同关联A 在一个老年人负担得起的住房校园的联邦合格健康中心（FQHC）诊所，住所 密歇根州弗林特市的700名主要黑人老年人。 Unite Care模型将通过 优化：1）医疗服务，包括现场诊所和家庭就诊； 2）通过 转介家庭安全评估和支持环境修改； 3）社会 社区卫生工作者的环境领导了健康行为和社会干预措施。总体而言，联合护理 模型将翻转要求最脆弱的老年人寻找医疗安全网的范式。 取而代之的是，Unite Care模型将把安全网带给老年人，以支持衰老。 该建议的目的是评估Unite Care模型的实施程度，确定哪个较旧的 成年人利用它，特别强调具有活动限制或AD/ADRD的老年人，以及是否是 模型促进衰老。在AIM 1中，通过并发的探索性混合方法设计。 普罗克特实施结果框架，我们试图确定多少和为谁（即 渗透）以及（即适应性和可接受性）的实现（即适应和可接受性）。在AIM 2中，我们 将确定哪个老年人使用Unite Care模型，并评估Unite Care模型是否 通过降压，医疗护理的度量和重要的 我们已经与残疾的预测指标以及对身体和社会环境的变化合作。 弗林特社区已经十多年了，并与我们的住房和 医疗保健伙伴两年。该提案将告知其他社区，即考虑新的模型 谨此促进生活在贫困和年龄较大的黑人美国人的老年人中的衰老，并建议 是否有必要对这种护理模型进行大规模测试。 。