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
Most disabled older adults live in the community and receive assistance from family caregivers. This project examines the significance of family caregiver factors to disabled older adults' risk for three diverse and consequential health events of public health importance. By providing new information regarding a potentially important but poorly understood domain of risk for a particularly vulnerable subpopulation this project will provide knowledge of practical relevance to clinical practice and of fiscal importance to health care and long- term care delivery reform.
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