Access and use of long-term services and supports for older adults living alone with Alzheimer's disease and related dementias from four racial/ethnic groups

为来自四个种族/族裔群体的患有阿尔茨海默病和相关痴呆症的独居老年人提供和使用长期服务和支持

• 批准号: 10256715
• 负责人: Elena Portacolone
• 金额: $ 80.72万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10256715
• 关键词: Address; Administrator; Adult Children; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Asians; Child; Cognition; Communities; Consultations; Data; Dementia; Development; Distress; Education; Elderly; Ensure; Ethnic Origin; Ethnic group; Family; Family member; Fire - disasters; Friends; Future; Health; Health Services Accessibility; Health and Retirement Study; Heterogeneity; Home Health Aides; Hospitalization; Impaired cognition; Individual; Institutionalization; Interview; Knowledge; Latino; Link; Living Arrangement; Malnutrition; Medicaid; Medical; Methods; Modeling; Older Population; Outcome; Participant; Performance; Personal Satisfaction; Persons; Pharmaceutical Preparations; Policies; Population; Positioning Attribute; Provider; Public Health; Race; Recommendation; Reporting; Research; Rural; Services; Social Workers; Spouses; Structure; Transportation; United States; Vulnerable Populations; cohort; cost; design; development policy; ethnic minority population; experience; falls; family support; health disparity; high risk; informant; meetings; racial and ethnic; self-neglect; urban residence

One-third of older adults with Alzheimer's disease and related dementias (ADRD) in the United States (US) live alone. Previous studies have shown that older adults with ADRD who live alone have high risk for health threats. Because they lack cohabitants, who typically provide most of informal unpaid LTSS, older adults with ADRD living alone often have limited access to LTSS, which increases their distress. This also increases costs for unnecessary hospitalizations and institutionalizations. Therefore, the large population of older adults with ADRD living alone likely has large-scale underserved needs that constitute an urgent public health problem, but little is known about their access to, and use of, essential LTSS. Moreover, strategies for increasing access to LTSS are largely lacking and unknown. These knowledge gaps impede development, and thus implementation, of policies to ensure access to essential LTSS to older adults with ADRD living alone, especially with respect to racial/ethnic minorities who have increased risk of ADRD vs. Whites, often live alone and often have worse access to services. This project's objective is thus to elucidate specific barriers and facilitators to access to and use of LTSS among older adults with ADRD living alone vs those with ADRD living with others, and to compare how these barriers and facilitators may differ among racial/ethnic groups. We will then apply this knowledge to develop policy recommendations to increase access to and use of LTSS, emphasizing racial/ethnic minorities and older adults living alone. Building on the Goldberg-Huxley model, we will leverage our preliminary studies to conduct a longitudinal mixed-method study with convergent and independent quantitative (Aim 1) and qualitative aims (Aim 2) in Years 1-3, followed by a policy aim (Aim 3) in Years 4-5. The design and promise of this project were endorsed by our Community Advisory Board. Our interdisciplinary team's expertise in aging alone, LTSS, ADRD, health disparities, and policy positions us well to achieve the aims. The Specific Aims are: 1) To quantify multi-level barriers and facilitators of LTSS use among older adults with ADRDs and the extent to which these predictors of LTSS use vary by living arrangement (living alone vs. living with others) and race/ethnicity. 2) To elucidate in depth the barriers and facilitators to accessing and using LTSS via semi-structured interviews with older adults with ADRD, informants, and LTSS providers and administrators. 3) To develop policy recommendations to increase access to and use of LTSS among older adults with ADRD, emphasizing racial/ethnic minorities and older adults living alone. Our findings will inform development of policies to enhance the performance of LTSS in the US. Findings will support policies to increase access, affordability, acceptance, and use of essential LTSS for older adults with ADRD, especially those living alone and racial/ethnic minorities. Thus, the proposed project will likely reduce health disparities. Furthermore, this project will likely reduce unnecessary hospitalizations and institutionalizations, which will enhance the wellbeing of older adults with ADRD and reduce costs.

在美国，三分之一患有阿尔茨海默病和相关痴呆症 (ADRD) 的老年人生活在 独自的。先前的研究表明，独居的 ADRD 老年人的健康风险较高 威胁。由于老年人缺乏同居者（通常提供大部分非正式无薪 LTSS）， 独居 ADRD 获得 LTSS 的机会往往有限，这增加了他们的痛苦。这也增加了成本 不必要的住院和住院治疗。因此，大量老年人口 独居的 ADRD 可能有大规模的未得到满足的需求，构成了紧迫的公共卫生问题， 但人们对他们获取和使用基本 LTSS 的情况知之甚少。此外，增加访问的策略 LTSS 的相关知识很大程度上是缺乏和未知的。这些知识差距阻碍了发展，因此 实施政策，确保患有 ADRD 的独居老年人获得基本的 LTSS， 尤其是少数种族/族裔，他们患 ADRD 的风险比白人高，经常独居 而且获得服务的机会往往更差。因此，该项目的目标是阐明具体的障碍和 独居 ADRD 老年人与 ADRD 居住老年人获取和使用 LTSS 的促进者 与其他人进行比较，并比较这些障碍和促进因素在不同种族/族裔群体中可能有何不同。我们将 然后应用这些知识来制定政策建议，以增加 LTSS 的获取和使用， 强调种族/族裔少数群体和独居老年人。基于戈德堡-赫胥黎模型，我们 将利用我们的初步研究进行纵向混合方法研究 第 1-3 年的独立定量（目标 1）和定性目标（目标 2），随后是第 1-3 年的政策目标（目标 3） 4-5 年级。该项目的设计和承诺得到了我们的社区咨询委员会的认可。我们的 跨学科团队在老龄化、LTSS、ADRD、健康差异和政策方面的专业知识使我们处于有利地位 以实现目标。具体目标是： 1) 量化 LTSS 使用的多层次障碍和促进因素 在患有 ADRD 的老年人中，以及这些 LTSS 使用的预测因素因居住方式而异的程度 安排（独居与与他人同住）和种族/民族。 2）深入阐明障碍和障碍 通过对患有 ADRD 的老年人进行半结构化访谈，促进访问和使用 LTSS， 线人、LTSS 提供者和管理员。 3) 制定政策建议以增加准入 患有 ADRD 的老年人中使用 LTSS，强调种族/族裔少数群体和老年人 独自的。我们的研究结果将为制定政策提供信息，以提高美国 LTSS 的绩效。 研究结果将支持旨在增加老年人基本 LTSS 的获取、负担能力、接受度和使用的政策 患有 ADRD 的成年人，尤其是独居者和少数种族/族裔。因此，拟议的项目将 可能会减少健康差距。此外，该项目可能会减少不必要的住院治疗和 机构化，这将提高患有 ADRD 的老年人的福祉并降低成本。