University of Southern California
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2021. Bryan Tysinger, Research Assistant Professor, USC. Dynamic Microsimulation Projections of ADRD in Ireland and the United States .
Projecting the future burden of Alzheimer’s Disease and Related Diseases (ADRD) is of critical importance to understand implications for individuals, families, health systems, and government planning. Previously, the applicants have developed dynamic microsimulation models in longitudinal panel data to estimate statistical models of aging and predict future outcomes. This pilot has five Aims: 1. Extend and validate the TILDA-based microsimulation to model new outcomes: cognitive function, depressive behavior, functional limitations and time spent in residential care; 2. Extend and validate the HRS-based microsimulation to model the depressive behavioral domain of ADRD; 3. Produce population and subpopulation (gender, education, and race) projections, and compare these projections within and between countries; 4. Recommend best practices for projecting cognition, depressive behavior, functional status, and ADRD to guide other researchers using panel studies similar to HRS and TILDA. Scope the potential for novel inclusion of biomarkers and laboratory measures in projections; 5. Use the results as a basis for large-scale international study proposal to project future needs, estimate future health and social care costs, and evaluate the effect of different systems and payment models on care, health and economic outcomes. We anticipate three outcomes associated with the pilot aims: (a) Projections of ADRD prevalence, associated depressive symptoms and functional limitations, and associated residential care use in the United States and Ireland, for the population and for subgroups of interest (Aims 1-3); (b) Lessons learned in validating the domains of ADRD will be documented to inform other modelers undertaking similar work, including assessment of how biomarkers and lab data may improve prediction (Aim 4); (c) An R01 proposal for modeling future ADRD prevalence and associated costs in different countries covered by the g2aging family of longitudinal studies (Aim 5).
Priority Research Areas: Population, Economic and Health Forecasting
2021. Karen Fingerman, Professor, University of Texas at Austin. Young Adult Caregivers of Aging Family Members.
More than 40 million adults in the U.S. provide caregiving to older adults and 1 in 4 of these caregivers are young adults aged 18 to 34. Research and interventions for Alzheimer’s Disease caregiving have focused on middle aged and older caregivers. Young adults may have distinct experiences in caregiving and providing care for older family members may be detrimental to future goals (e.g., education) with lasting repercussions on well-being throughout the life course. This pilot study will develop survey instruments and research methodologies to examine this under-researched group. Aim 1 Develop research battery to assess young adults’ caregiving experiences. We will assess the frequency and types of tasks young adult caregivers perform, their role in the family caregiving system and cultural beliefs about caregiving. Aim 2 Develop of assessments of young adults’ caregiving burdens and well-being We will assess implications of caregiving (positive and negative), including burden, loss of goal-directed statuses (e.g., educational pursuits) and subjective perceptions of control. Aim 3 Generate methodologies of daily sampling of caregiving. Intensive data collection will provide insights into caregiving close to the time these tasks occur. Across all aims, we will consider race/ethnicity, gender, relationship to care recipient and intergenerational coresidence. We will recruit a sample of 80 Hispanic, African American or Asian young adults (aged 18 to 34) who identify as caregivers for an older relative with ADRD (i.e., aged 65+). They will complete a 30 minute baseline survey to adapt existing measures and develop new ones to assess young adults’ caregiving experiences. Then, participants will complete brief surveys every week for 5 weeks. Our research team has extensive experience analyzing data intensive assessments. The proposed study may fundamentally shift the paradigm for understanding how family caregiving occurs, embedded in cultural and socioeconomic contexts.
Priority Research Areas: Caregiving
2021. Leah Richmond-Rakerd, Assistant Professor, University of Michigan. Do Mental Disorders Forecast ADRD in Nationwide Administrative Registers?.
Neurodegenerative conditions, including Alzheimer’s disease and related dementias (ADRD), have an outsized impact on disability and loss of independence in older adults. As such, there is a growing need to identify modifiable factors that drive variation in ADRD risk at the population level. We propose to investigate mental disorders as a potential preventable risk factor for later-life ADRD. Using three decades of nationwide health-register data on 1.7 million New Zealand citizens aged 21-60 at baseline, we will test whether mental disorders forecast the development of ADRD in the subsequent 30 years. We will test whether these associations hold across sex and age, across different types of mental disorders, within pairs of siblings matched on family-level risk factors, and after controlling for pre-existing physical-health conditions. Through this project, we will (1) quantify the degree to which preventing mental-health problems in young people might reduce the health and social burden of neurodegenerative diseases, and (2) create exportable tools, including a new linked-sibling data resource and a method for ascertaining ADRD across multiple health registers, that can be used by other ADRD researchers employing linked administrative data in their work. If results of the proposed project indicate that mental disorders forecast neurodegenerative diseases, this would also suggest novel hypotheses about mechanisms that underlie the development of ADRD and that may drive variation in ADRD risk across populations (e.g., inflammation, low education, poor health behaviors, social isolation, or psychiatric medications), to be tested in future basic-science and administrative-register studies.
2021. Sarah Mawhorter, Assistant Professor, University of Gronigen. Housing Transitions Associated with Cognitive Decline.
While existing research addresses the suitability of various housing alternatives for persons with dementia (PWD), little is known about PWDs’ housing transitions over the course of cognitive decline. This study investigates PWDs’ housing transitions using Health and Retirement study data from 2002 through 2016. We find that over half (56%) of PWD move in the years around dementia onset: 28% move once, and 28% move twice or more. Examining various types of moves, we see that slightly over a third of respondents move to another home at some point during cognitive decline, just under a third move into nursing homes, and around ten percent move in with relatives, with overlap between these categories since some PWD move more than once. We find strong patterns by educational attainment and race/ethnicity: Black and Hispanic PWD and those with lower education levels are less likely to move to another home or enter a nursing home than White and college-educated PWD. This suggests the importance of providing support for PWD and their families to transition into different living arrangements as their housing needs change.
2020. Alice Chen, Associate Professor, USC. ADRD Care in New Delivery and Payment Methods.
This study estimates the impact of new payment and delivery models—including accountable care organization models, patient-centered medical care homes, value-based payment modifiers, and merit-based incentive payments – on the health care and drug use and cost for ADRD patients. Results from this research will identify which delivery and payment models are most effective in improving dementia care. They will also inform an R01 proposals that seek to uncover mechanisms for observed improvements in dementia care, such as the restructuring of ADRD care teams, care coordination, and the placement of higher-risk ADRD patients into care management programs.
Priority Research Areas: Care for Persons Living with Dementia
2020. Bryan Tysinger, Research Assistant Professor, USC; Rebeca Wong, Professor, UT Medical Branch. Harmonized Cognitive Measures for International Microsimulation Modeling of ADRD.
This project will extend two existing microsimulation models, the United States Future Elderly Model (US-FEM, based on the HRS) and the FEM-Mexico (based on the MHAS) to incorporate measures from the HCAP supplement and produce population and subpopulation estimates of dementia today and in the future. It will inform an R01 proposal for modeling ADRD that will extend the analysis to potentially include microsimulation models for England, India, and China.
2020. Chandra Muller, Professor, University of Texas, Austin. National Longitudinal Study, 1972 (NLS-72) Record Matching to Centers for Medicare and Medicaid Services (CMS) Records.
This study addresses the social or skill aspects of education that shape cognitive functioning. The study will create new data for analysis of education and early cognition effects on economic security among older people. The matching and analyses will lay the foundation for an R01 proposal to follow-up the NLS-72 cohort to study cognitive aging and AD.
Priority Research Areas: Determinants of Health, Well-Being and Longevity
2020. Karen Eggleston, Senior Fellow; Jay Bhattacharya, Professor, Stanford. Trends and Projections of ADRD in Asia.
This project will extend the current Japanese Future Elderly Model (JFEM) microsimulation model to include cognitive function and dementia. It will use this expanded JFEM to study the social and economic burden of ADRD in Japan, and compare to other FEM for North America and Europe. Existing Asia microsimulation models include those for South Korea and Singapore, with a model under development for Taiwan, and in the planning stages for Hong Kong, the rest of China, and India. The study will project the health and cost implications of cognitive decline and ADRD and implications of long-term care insurance (LTCI) programs in Japan and South Korea.
Priority Research Areas: Population, Economic and Health Forecasting
2020. Mireille Jacobson, Associate Professor; Jason Doctor, Professor; Julie Zissimopoulos, Associate Professor, USC. The Impact of Cognitive Screening on Early ADRD Diagnosis, Treatment and Spending.
This study examines how Medicare plan type affects the likelihood of an early ADRD diagnosis combining both Traditional Medicare Fee-for-service claims and MA plan encounter files. The study will also fill a gap in our understanding of the impact of ADRD diagnosis on differences in health care utilization and spending in MA and Traditional Medicare. It will inform an R01 proposal to improve screening, diagnosis and care for person living with dementia.
Priority Research Areas: Cognitive Aging and the Demography of Dementia
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