Prognostic Significance of Family Caregiver Factors for Older Adult Health Events

家庭照顾者因素对老年人健康事件的预后意义

• 批准号: 9545107
• 负责人: Jennifer L. Wolff
• 金额: $ 18.67万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9545107
• 关键词: Adverse event; Affect; Age; Aging; American; Bathing; Budgets; Calibration; Clinical; Cognitive; Communities; Complement; Computer software; Computerized Medical Record; Consequentialism; Data Collection; Data Set; Demographic Aging; Diffusion; Disabled Persons; Discrimination; Eating; Economics; Elderly; Event; Family Caregiver; Family Characteristics; Future; Gender; Health; Health Status; Healthcare; Home environment; Hospitalization; Individual; Inpatients; Intervention; Knowledge; Light; Link; Long-Term Care; Measures; Medicare claim; Medicare/Medicaid; Nursing Homes; Outcome; Performance; Play; Policies; Policy Developments; Population; Predictive Factor; Predictive Value; Preventive service; Public Health; Public Health Practice; Reporting; Rewards; Risk; Risk Factors; Role; Self Care; Services; Sterile coverings; Surveys; Time; Translating; Vital Statistics; Work; base; care delivery; caregiving; clinical decision-making; clinical practice; disability; economic value; electronic data; experience; high risk population; improved; indexing; insight; mortality; novel; nursing home length of stay; payment; population based; predictive modeling; prognostic; prognostic significance; programs; social; targeted treatment; tool; trend

 DESCRIPTION (provided by applicant): Growing numbers of disabled older adults with extensive health needs and persistent concerns about the sustainability of health care entitlement programs make efficient targeting of services to those who will most benefit a high priority. Most disabled older adults live at home and receive assistance from family caregivers. There is strong evidence that family caregivers play an instrumental role to disabled older adults' risk for a range of adverse health events. Although specific characteristics of family caregivers are likely to affect the extent to which adverse events among disabled older adults are experienced, robust evidence is lacking. Because disabled older adults have exceedingly high rates of adverse health events, such evidence could illuminate a potentially powerful but under-recognized domain of risk for a high-risk population. Risk prediction tools ("prognostic models") are widely used to identify individuals who are at risk for adverse health events, and in turn, to guide clinical decision-making and targeting of therapeutic and preventive services. Existing tools incorporate extensive measures of biomedical risk but do not include information reported by family caregivers. In this study, we will draw on national surveys of disabled older adult-family caregiver dyads to comprehensively and systematically elucidate the potential significance of family caregiver factors to disabled older adults' risk for diverse and consequential adverse health events that are of both fiscal and public health importance. In Aim 1, we determine whether and which family caregiver factors predict disabled older adults' future risk of all-cause hospitalization, long-stay nursing home entry, and mortality, controlling for disabled older adult risk factors. In Aim 2, we identify a reduced set of measures that could be efficiently used for risk prediction. We develop two prognostic models for each outcome that include: (1) disabled older adult factors only, and (2) disabled older adult and family caregiver factors. By comparing performance of the two prognostic indices, we will identify the predictive benefit of incorporating information from family caregivers to complement traditional assessments of disabled older adults. To accomplish this work we will construct a unique population-based dataset with information on social, economic, cognitive, health, and interpersonal domains of risk reported by 3,023 disabled older adult-family caregiver dyads who responded to linked nationally representative disability and family caregiver surveys (the 1999 and 2004 National Long-Term Care Surveys, and 2011 National Health and Aging Trends Study). All three survey waves will be linked to Medicare claims, Minimum Data Set assessments, and mortality/vital statistics files, which will contribute longitudinal information o older adults' health events. Together, these study aims will fill provide new knowledge regarding the relevance of family caregiver factors to diverse and consequential events among disabled older adults, as well as develop practical tools to translate this knowledge into clinical practice

 描述（由申请人提供）：越来越多的残疾老年人有广泛的健康需求，并且对医疗保健权利计划的可持续性持续关注，这使得向最受益者提供有效的服务成为重中之重。大多数残疾老年人住在家里。并接受家庭照顾者的帮助 有强有力的证据表明，家庭照顾者在降低残疾老年人发生一系列不良健康事件的风险方面发挥着重要作用，尽管家庭照顾者的具体特征可能会影响残疾人发生不良事件的程度。老年人经验丰富，证据有力由于残疾老年人发生不良健康事件的比例极高，因此此类证据可以阐明高风险人群潜在的强大但未被充分认识的风险领域（“预后模型”）。识别有不良健康事件风险的个人，进而指导临床决策和治疗和预防服务的目标。现有工具纳入了广泛的生物医学风险衡量标准，但不包括家庭护理人员报告的信息。 ，我们将利用全国调查残疾老年人与家庭照顾者二人组，全面系统地阐明家庭照顾者因素对残疾老年人发生具有财政和公共卫生重要性的各种后果性不良健康事件的风险的潜在重要性。家庭照顾者因素可预测残疾老年人未来因各种原因住院、长期入住疗养院和死亡的风险，并控制残疾老年人的风险因素。在目标 2 中，我们确定了一套可以有效减少的措施。用于风险我们为每种结果开发了两种预后模型，包括：（1）仅残疾老年人因素，以及（2）残疾老年人和家庭照顾者因素通过比较两个预后指数的表现，我们将确定预测益处。整合家庭护理人员的信息来补充残疾老年人的传统信息 为了完成这项工作，我们将构建一个独特的基于人口的数据集，其中包含 3,023 名残疾老年人报告的社会、经济、认知、健康和人际领域的风险评估信息。回复链接的家庭看护者二人组全国代表性的残疾和家庭护理人员调查（1999 年和 2004 年全国长期护理调查以及 2011 年全国健康和老龄化趋势研究）所有三轮调查都将与医疗保险索赔、最低数据集评估和死亡率/生命统计相关联。这些文件将提供有关老年人健康事件的纵向信息，这些研究的目的将提供有关家庭照顾者因素与残疾老年人中各种后果性事件的相关性的新知识，并开发实用的知识。将这些知识转化为临床实践的工具