The Effects of the COVID-19 Pandemic on Long-Term Care for High-Need Older Adults with and without Alzheimer’s Disease and Related Dementias

COVID-19 大流行对患有或不患有阿尔茨海默病和相关痴呆症的高需求老年人的长期护理的影响

• 批准号: 10589386
• 负责人: Yulya Truskinovsky
• 金额: $ 60.49万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589386
• 关键词: Address; Adult; Affect; Aging; Alzheimer' s disease related dementia; Area; Assisted Living Facilities; Beds; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Caregivers; Caring; Cessation of life; Communities; Data; Dementia; Elderly; Emergency department visit; Environment; Family; Family Caregiver; Generations; Geography; Health; Health and Retirement Study; Healthcare; Home; Home Nursing Care; Hospitalization; Impaired cognition; Infrastructure; Link; Long-Term Care; Marketing; Measures; Medicare claim; Nursing Homes; Patient Self-Report; Persons; Public Health; Reporting; Research; Residential Treatment; Risk; Self Care; Services; Signal Transduction; Soil; Source; Sterile coverings; Surveys; Techniques; Time; Training; Variant; Virus; Work; adverse outcome; aging population; care outcomes; community-level factor; dementia care; geographic difference; health care availability; health care service utilization; health data; high risk; human old age (65+); improved; mortality; mortality risk; neglect; pandemic disease; pandemic impact; pandemic potential; patient home care; programs; resilience; school closure; trend

PROJECT SUMMARY Nearly 20 million adults (38%) aged 65 and older have limitations with one or more self-care activities (e.g., dressing, getting out of bed) and one in ten older adults are living with Alzheimer’s Disease and Related Dementias (ADRD). Together these two overlapping groups of “high-need” older adults typically rely on a variety of long-term care (LTC) sources to assist with daily activities, including family and unpaid care, paid care in the home, residential care such as assisted living and nursing home care. Inadequate care may lead to adverse consequences in daily self-care and avoidable health care utilization. The sudden onset of the COVID- 19 pandemic may have profoundly affected access to and use of LTC and contributed to further adverse consequences for high-need older adults, particularly for those living with ADRD. This project will draw upon two complementary longitudinal, nationally representative surveys of older adults–the Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS)–linked to geographic data and Medicare claims. Using statistical approaches that strengthen our ability to draw causal inferences, we will: 1) Evaluate the short-term impact (2018-2020) of the COVID-19 pandemic on the type and amount of LTC use, comparing high-need older adults with and without ADRD and identify arrangements more likely to be “stable” with lower risks of change. 2) Determine whether care trajectories were disrupted after the start of the pandemic, comparing high-need older adults with and without ADRD from 2016 through 2024/2025. 3) Assess the impact of COVID-19 on adverse consequences related to care gaps among high-need older adults with and without ADRD. We will estimate the effect of the COVID-19 pandemic on self-reports of unmet need (using NHATS) and claims-based measures of avoidable hospitalizations and emergency department visits (using HRS) for those with and without ADRD. Detailed geographic data will allow us to take into account local conditions while identifying more “vulnerable” care arrangements with higher risks of adverse consequences. The results of this project will provide a comprehensive understanding of the COVID-19 pandemic’s impact on LTC outcomes in the short and longer term. This study aligns with NIA’s priority to understand community support for dementia care, in particular the determinants of availability LTC, LTC utilization and how the effects of community level factors including infrastructure and risk environment.

项目概要 近 2000 万 65 岁及以上的成年人 (38%) 在一项或多项自我护理活动方面存在限制（例如， 穿衣、起床），十分之一的老年人患有阿尔茨海默病及相关疾病 痴呆症（ADRD）这两个重叠的“高需求”老年人群体通常依赖于痴呆症（ADRD）。 协助日常活动的各种长期护理 (LTC) 来源，包括家庭和无偿护理、有偿护理 家庭护理、辅助生活和疗养院护理等住宿护理可能会导致护理不足。 新冠病毒的突然发作对日常自我护理和可避免的医疗保健利用产生不利后果。 19 大流行可能深刻影响了 LTC 的获取和使用，并导致进一步的不利影响 对高需求老年人，特别是 ADRD 患者的影响 该项目将利用这一点。 两项互补的纵向、全国代表性的老年人调查——健康和退休 研究 (HRS) 和国家健康与老龄化趋势研究 (NHATS)——与地理数据和 医疗保险索赔。使用统计方法来增强我们得出因果推论的能力，我们将：1) 评估 COVID-19 大流行对 LTC 使用类型和数量的短期影响（2018-2020 年）， 比较患有和不患有 ADRD 的高需求老年人，并确定更有可能“稳定”的安排 2) 确定护理轨迹在开始后是否被打乱。 流行病，比较 2016 年至 2024/2025 年患有和不患有 ADRD 的高需求老年人 3) 评估。 COVID-19 对高需求老年人护理缺口相关不良后果的影响 在没有 ADRD 的情况下，我们将估计 COVID-19 大流行对未满足需求的自我报告的影响（使用 NHATS）以及基于索赔的可避免住院和急诊就诊措施（使用 HRS）适用于有或没有 ADRD 的人 详细的地理数据将使我们能够考虑当地情况。 同时确定更“脆弱”的护理安排，这些安排具有更高的不良后果风险。 该项目的结果将帮助人们全面了解 COVID-19 大流行对 LTC 的短期和长期成果与 NIA 了解社区的优先事项相一致。 对痴呆症护理的支持，特别是 LTC 可用性的决定因素、LTC 的利用以及效果如何 包括基础设施和风险环境在内的社区层面因素。