Substance Use and Access to Care among Older Adults

老年人的药物使用和获得护理的机会

• 批准号: 10260529
• 负责人: Jonathan Cantor
• 金额: $ 24.31万
• 依托单位: RAND CORPORATION
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10260529
• 关键词: Address; Adult; Affect; Age; American; Caring; Centers of Research Excellence; Chronic Disease; Code; County; Data; Data Linkages; Data Set; Death Rate; Disadvantaged; Disease; Drug usage; Elderly; Equipment and supply inventories; Future; Geography; Goals; Health; Health Care Costs; Health Expenditures; Health Insurance; Health Services Accessibility; Health and Retirement Study; Improve Access; Individual; Information Centers; Insurance Coverage; Life Expectancy; Link; Long-Term Effects; Measures; Medicare; Mental Health; Metabolism; Methadone; Modality; Modeling; Neighborhoods; Opioid; Outcome; Overdose; Pharmaceutical Preparations; Policies; Population; Prevalence; Prevention; Substance Abuse Treatment Centers; Substance abuse problem; Surveys; Treatment Cost; United States; Variant; Work; addiction; aged; base; beneficiary; cost; effectiveness measure; evidence base; experience; human old age (65+); innovation; medical specialties; medication-assisted treatment; novel; opioid epidemic; opioid misuse; opioid mortality; opioid overdose; opioid policy; opioid treatment program; opioid use disorder; overdose death; overdose risk; payment; prescription opioid; repository; rural area; substance abuse treatment; substance use; tool; treatment center; treatment disparity; treatment services; young adult

Project Summary The rate of drug overdose deaths has increased so rapidly due to increases in opioid-poisonings that the average life expectancy in the United States has declined. Although older Americans are less likely to misuse opioids, rates of drug overdose have increased the most among those aged 55 to 64 since 1999 and 45% of all opioid deaths are among individuals age 45 and older. In 2018, 80% of Americans with opioid use disorders (OUD) received no treatment. Older adults are particularly disadvantaged. In 2017, only 35 percent of treatment facilities accepted Medicare as payment and Medicare itself does not cover methadone, a drug often used in the evidence-based medication assisted treatment (MAT). Additionally, lack of geographic access to specialty treatment is a broad problem with 85 percent of counties in the U.S. lacking a treatment center with an opioid treatment program. For older adults, access challenges may be exacerbated as approximately 25 percent of Americans older than age 65 live in a small town or other rural area; a rate that is higher than for younger adults. Rural areas also tend to have fewer substance abuse treatment (SAT) centers and higher rates of overdose. The data typically used to track the supply of licensed SAT centers – the National Survey of SAT Services (N-SSATS) – do not allow lack facility identifiers that are necessary to distinguish between centers opening and closing and survey non-response. This distinction is important because survey non-response does not mean the actual number of facilities nearby (or access) has changed whereas openings and closings do. The overall objective of this R21 is to increase understanding of geographic access to SAT facilities and to health insurance coverage of treatment, whether it is related to disparities in treatment and how policies to improve access will affect long-term health outcomes and costs among older adults. Our specific aims are to: Aim 1. Track and characterize geographic access to SAT centers for older adults age 50+ using the novel Mental health and Addiction Treatment Tracking Repository (MATTR) linked to the Health and Retirement Study and the National Survey of Drug Use and Health. Aim 2. Determine the extent to which disparities for older adults exist in the availability of SAT based on urban-rural location and state-level opioid policies. Aim 3. Project long-term effects of disparities in access to treatment on health trajectory and healthcare costs using a microsimulation approach, the Future Elderly Model. The proposed R21 is a necessary first step to creating data linkages between the novel licensed SAT center repository with other nationally representative survey datasets and to applying microsimulation modeling to policy efforts to address OUD in later life.

项目摘要 由于阿片类药物的增加，药物过量死亡的速率迅速增加，以至于 美国的平均预期寿命下降。虽然年长的美国人不太可能错过 opioids，在1999年以来55至64岁的药物过量发生率最高，而所有的人中有45％ Oopioid死亡是45岁以上的个体中的死亡。在2018年，有80％的美国人使用使用障碍 （OUD）没有得到治疗。老年人特别处于不利地位。 2017年，只有35％ 治疗设施接受医疗保险作为付款和医疗保险本身不涵盖美沙酮，这是一种经常的药物 用于基于证据的药物辅助治疗（MAT）。此外，缺乏地理访问 专业治疗是一个广泛的问题，美国85％的县缺乏一个治疗中心 阿片类药物治疗计划。对于老年人，访问挑战可能会加剧约25 65岁以下的美国人中，有百分比居住在一个小镇或其他农村地区；比率高于 年轻人。农村地区也倾向于更少的药物滥用治疗（SAT）中心和较高的比率 用药过量。通常用于跟踪许可的SAT中心供应的数据 - SAT的全国调查 服务（N-SSAT） - 不允许缺乏区分中心所需的设施标识符 开放和关闭和调查无响应。这种区别很重要，因为调查无响应确实 并不意味着附近（或访问）的实际设施数量已更改，而开口和关闭也是如此。 R21的总体目的是提高对对SAT设施和健康的地理访问的了解 治疗的保险范围，是否与治疗方面的差异以及如何改善政策有关 访问将影响老年人的长期健康成果和成本。我们的具体目的是： AIM 1。使用小说跟踪和表征地理访问50岁以上的老年人的SAT中心 与健康和退休相关的心理健康和成瘾治疗追踪存储库（MATTR） 研究和全国药物使用和健康调查。 AIM 2。确定在SAT可用性中存在的年轻人分布的程度 城市农村地点和州级阿片类药物政策。 目标3。项目分配对获得治疗的长期影响对健康轨迹和医疗保健费用 使用微仿真方法，未来的老年模型。 提出的R21是在新颖的许可SAT中心之间建立数据链接的必要第一步 与其他全国代表性调查数据集的存储库，并将微仿真建模应用于 政策努力解决以后的生活。