CAPRA - Year 2 Pilot Awardees
Sue Anne Bell, PhD, FNP-BC
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Healthcare utilization among older adults with ADRD after large-scale hurricanesRecent disasters have devastated parts of the United States. These events are expected to occur with increasing frequency and severity as the impacts of climate change advance. For individuals living with dementia, the disruption in patterns of daily living caused by a disaster can be highly disorienting and lead to acute changes in health and well-being. We hypothesize that older Americans with Alzheimer’s disease and related dementias (ADRD) are at particular risk for poor health outcomes that result from the disruption of a disaster, leading to an increased use of healthcare during these times. Using Medicare claims data, we will estimate the effect of a disaster on the frequency of types of healthcare utilization for individuals with ADRD. The proposed study will fill critical gaps in knowledge about the health effects of disasters on older adults living with ADRD.
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Lianlian Lei, PhD
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Medicare Advantage plan choice among older adults living with dementiaAbout one-third Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, which are designed to provide care more efficiently than traditional fee-for-service Medicare through better care coordination and additional preventive and nonmedical services. However, the proliferation of MA plans might overwhelm older adults with impaired decision-making capabilities, and particularly those living with dementia. This study will use the nationally representative Health and Retirement Study linked with Medicare claims data and publicly available MA plan data to examine the characteristics of MA plans in which older adults with dementia are enrolled, as well as factors associated with their enrollment and disenrollment of MA plans. This study might have critical policy applications in improving health insurance plan choices and health care delivery for older adults with dementia.
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Neil Mehta, PhD
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Leveraging the HRS to Understand Disparities in Dementia by Education LevelEducational attainment is the largest non-biological risk factor for dementia. Short of medical innovation, reducing risk and improving management among those with low education will lead to the greatest reduction in the population dementia burden. The reasons why dementia risk varies so strongly by educational attainment remain poorly understood. This gap in knowledge limits our understanding of what practical interventions would be most effective in reducing disparities in dementia risk across education groups. In this project, I will apply rigorous counterfactual statistical approaches on existing national-level data to identify the major pathways through which disparities in dementia by educational attainment arise. I do so by leveraging recent enhancements to the NIA-funded Health and Retirement Study (HRS) including the collection of genetic information, clinical assessments, life-course histories, and improved cognitive evaluations. These enhancements remain an under-used resource in dementia research. The value of this project is to provide a first rigorous treatment of the multiple life-course pathways that produce dementia disparities by educational attainment at a national level with the goal of identifying practical intervention points
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Lauren Wallner, PhD, MPH
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Cancer Treatment Decision Making in Older Adults with Mild Cognitive ImpairmentMany patients with mild cognitive impairment (MCI) will not progress to dementia, and will live years with good quality of life, making cancer one of the greatest risks to their health and wellbeing. Yet, whether patients with MCI receive suboptimal cancer treatment remains unknown. We will compare the receipt of effective cancer treatments among older adults with MCI and cognitively normal adults, and explore how physician recommendations for cancer treatment and caregiver involvement influence the receipt of effective treatments in the context of MCI. We will utilize the Health and Retirement Survey linked with Medicare claims and pilot a physician survey to ascertain whether physician recommendations for cancer treatments differ by the patient’s cognitive status. This study will provide the preliminary data necessary to support an R01 to investigate how physician recommendations, caregiver support and patient preferences influence the receipt of effective cancer treatments among patients with cognitive impairment.
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