Healthcare use among older adults with dementia after large-scale disasters

大规模灾难后患有痴呆症的老年人的医疗保健使用情况

• 批准号: 10591812
• 负责人: Susan Anne Bell
• 金额: $ 15.6万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10591812
• 关键词: Activities of Daily Living; Acute; Affect; Aftercare; Alzheimer' s disease related dementia; American; Area; Care given by nurses; Caregivers; Caring; Chronic; Communities; Data; Data Set; Dementia; Dependence; Disasters; Disorientation; Distress; Elderly; Emergency Situation; Emergency department visit; Emotional Disturbance; Environment; Event; Evolution; Exhibits; Exposure to; Funding; Future; Goals; Health; Health Services; Healthcare; Home; Home Care Services; Hospitalization; Hospitals; Individual; Knowledge; Lead; Life; Long-Term Care; Measures; Medicare; Medicare claim; Methods; Nature; Office Visits; Outcome; Pathway interactions; Pattern; Personal Satisfaction; Persons; Play; Population; Quality of Care; Rehabilitation therapy; Research; Resources; Risk; Role; Sampling; Services; Visit; Vulnerable Populations; aging in place; climate change; cohort; end of life; end of life care; health care service; health care service utilization; health service use; healthy aging; hospice environment; innovation; medication administration; nursing skill; patient home care; poor health outcome; programs; protective factors

PROJECT ABSTRACT Background: There is a critical need to understand how disaster events affect individuals with Alzheimer’s disease and related dementias (ADRD), particularly around aging in place. Home health care is a critical mechanism to support aging in place for individuals with ADRD, where these services allow older adults to remain in their own homes for as long as possible. For people living with ADRD, the disruption in normal patterns of daily living caused by a disaster can be highly disorienting and lead to acute changes in health and well-being, leading to increased healthcare use. Our overall goal in conducting this project is to develop strategies to support older adults with ADRD, and their caregivers, to age in place after a disaster—staying out of the hospital and long-term care— through the use of home health care. We hypothesize that older Americans with ADRD are at particular risk for poor health outcomes that result from the disruption of a disaster, requiring increased healthcare resources at the end of life. Specific Aims: Aim 1 will determine whether home health care use reduces reliance on conventional healthcare services following a disruption in care (i.e., exposure to a disaster) among older adults with ADRD. Aim 2 will determine the extent to which home health care use is associated with additional healthcare use at the end of life and the quality of care among ADRD decedents, after a large-scale disaster. Project Methods: Using Medicare claims data, Aim 1 will identify older adults living with ADRD who use home health care, compared to those who do not using a propensity score matching approach, then use difference-in-difference methods to assess the effects of home health use in healthcare use (e.g., hospitalizations, emergency department visits) before and after a disaster. In Aim 2, using the same sample as in Aim 1 we will limit to those who died 6 months after the disaster to identify a decedent cohort, then assess the effects of home health use for end-of-life services during the last six months of life by difference-in-difference methods. Unique Features and Innovation: Examining the use of home health care in the intra-disaster period is an innovative method to begin to understand the ways in which disasters affect individuals with ADRD, and can lead to better supports for this vulnerable group in future disasters and other community emergencies. Examining outcomes of home health care users alone after disaster can be problematic in that users by their nature of needing home care may require more use of healthcare than those who do not use home health care. Studying this through a population of ADRD decedents is innovative in that it levels this playing field. Anticipated Impact: The proposed study will fill immediate and critical gaps in knowledge about the relationship between home health care and healthcare use after disasters, and provide evidence for the use home health care as a strategy to support individuals with ADRD and their caregivers to continue aging in place during a disaster.

项目摘要 背景：迫切需要了解灾难事件如何影响阿尔茨海默病患者 疾病和相关痴呆症（ADRD），尤其是居家养老至关重要。 为 ADRD 患者提供支持老龄化的机制，这些服务使老年人能够 对于患有 ADRD 的人来说，尽可能长时间地呆在自己的家中，这会扰乱正常的生活。 灾难造成的日常生活模式可能会让人非常迷失方向，并导致健康和健康发生急剧变化。 福祉，从而增加医疗保健的使用，我们开展该项目的总体目标是发展。 支持患有 ADRD 的老年人及其护理人员在灾难发生后原地安老的策略——留在外面 医院和长期护理——通过使用家庭保健。 患有 ADRD 的美国人尤其面临因生活秩序受到破坏而导致健康状况不佳的风险。 灾难，需要在生命结束时增加医疗资源。 具体目标：目标 1 将确定。 家庭医疗保健的使用是否会减少对传统医疗保健服务的依赖 目标 2 将决定患有 ADRD 的老年人的护理（即遭受灾难）。 家庭医疗保健的使用与临终时的额外医疗保健使用和护理质量相关 项目方法：使用医疗保险索赔数据，目标 1。 与不使用家庭医疗保健的老年人相比，将识别出患有 ADRD 的老年人使用家庭医疗保健 倾向得分匹配方法，然后使用双重差分法来评估家庭的影响 灾难前后医疗保健用途（例如住院、急诊科就诊）中的健康用途。 在目标 2 中，使用与目标 1 相同的样本，我们将仅限于灾难后 6 个月内死亡的人 确定下降的队列，然后评估过去一段时间家庭保健对临终服务的影响 通过双重差异法观察六个月的生命：检查使用情况。 灾难期间的家庭医疗保健是一种创新方法，可以帮助您了解灾区的方法 哪些灾害会影响 ADRD 患者，并且可以在未来为这一弱势群体提供更好的支持 单独检查家庭医疗保健使用者的结果。 灾难可能会产生问题，因为用户本质上需要家庭护理，可能需要更多地使用 通过 ADRD 人群进行研究。 《Decedents》的创新之处在于它创造了公平的竞争环境。 预期影响：拟议的研究将填补这一空白。 关于家庭医疗保健和医疗保健使用之间关系的知识存在直接和关键的差距 灾后，并提供使用家庭医疗保健作为支持个人的策略的证据 ADRD 及其照顾者在灾难期间继续就地养老。