Function Before and After the Institutionalization of Persons with Alzheimer's Disease and Related Dementias
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PROJECT ABSTRACT Alzheimer’s Disease and Related Dementias (ADRD) produce progressive impairments that lead older persons and their caregivers to consider moving into an institution. Given the significance of institutionalization in a person’s life and increasing fears about the harms of institutional settings,1–4 we need objective descriptions of outcomes before and after institutionalization to guide persons with ADRD and caregivers through this major event. The major reason why persons with ADRD seek institutional care is to meet functional needs. We therefore propose epidemiologic studies of function before and after institutionalization in persons with ADRD, examining (1) which activities tend to be impaired prior to institutionalization and (2) the average extent to which moving to a facility leads to functional needs being met. For each aim, we will make comparisons to those without ADRD who seek institutional care. The UCSF Older Americans Independence Center (OAIC) studies the prevention of disability in older persons and its amelioration when irreversible. Institutionalization is a major way through which disabled older Americans seek support when their functional needs become too great. This administrative supplement advances the mission of the OAIC by constructing a cohort of persons being institutionalized and examining an important outcome in this cohort: function. We will leverage the expertise of the OAIC Data Analysis Core and our experience working with the National Health and Aging Trends Study (NHATS), a nationally representative study containing an unprecedented amount of detail on function in older persons before and after they are institutionalized. Our proposal will determine how function changes with institutionalization for persons with and without ADRD. In Aim 1, we will describe the prevalence of functional impairments and unmet functional needs in persons with and without ADRD the year prior to institutionalization. In Aim 2, we will describe how the unmet functional needs change with institutionalization in persons with and without ADRD. Clinicians can use our results to help persons with ADRD considering institutionalization know what to expect. Our results will provide the first nationally representative data about functional impairment before institutionalization in persons with ADRD, whether patients and caregivers believe those needs were met after placement, and how this compares in persons without ADRD. Critically, we will also construct a cohort that can be used for future K76 proposals examining other measures available in NHATS affected by institutionalization, such as caregiver hours. This research aligns with the “NIA Strategic Directions for Research, 2020-2025” to improve our understanding of ADRD (Goal D) and to better understand the effects of societal factors on aging, including the mechanisms through which these factors exert their effects (Goal B).
