TY - JOUR
T1 - The Role of Neighborhood Socioeconomic Status in Institutionalization of Home Health Care Patients With and Without Alzheimer's Disease and Related Dementias
AU - Jung, Daniel
AU - Jarrín, Olga F.
AU - Choi, Jeong Ha (Steph)
AU - Knox, Sara
AU - Emerson, Kerstin Gerst
AU - Chen, Zhuo
N1 - Publisher Copyright:
© 2024
PY - 2024/9
Y1 - 2024/9
N2 - Objectives: To assess whether neighborhood socioeconomic status (SES) moderates the association between Alzheimer's disease and related dementias (ADRD) and successful discharge to the community. In addition, to explore whether the role of neighborhood SES on successful discharge for patients with ADRD varies by the severity of ADRD. Design: This is a retrospective cohort study. Setting and Participants: Medicare Fee-for-service beneficiaries, aged 65 or older, who received home health care in 2019. Methods: We used linear probability regression models with successful discharge to the community as the main outcome, and neighborhood SES and ADRD as independent variables. Also, we modified the Functional Assessment Staging Tool (FAST) to measure ADRD severity. Results: Our study results show ADRD and residing in neighborhoods with lower socioeconomic conditions were independently associated with lower probabilities of successful discharge to the community. We also found that the differences in probabilities of remaining at home between patients with and without ADRD were larger among those in neighborhoods with lower SES (ADRD∗less disadvantaged neighborhood, coeff: −0.01, P < .001; ADRD∗more disadvantaged neighborhood, coeff: −0.02, P < .001; ADRD∗most disadvantaged neighborhood, coeff: 0.032, P < .001). Among patients with ADRD, patients with the most advanced ADRD were less likely to remain in their homes and community when living in neighborhoods with lower SES. Conclusions and Implications: Our study results show that when patients with ADRD receiving home health care live in neighborhoods with lower SES, they face further challenges to remaining in their homes and community. Public health officials and community planners should consider using area-level interventions to improve care and health outcomes for patients with ADRD. Also, further research aimed at identifying the specific factors and resources influencing lower care quality and poorer health outcomes in socioeconomically disadvantaged neighborhoods, particularly for patients with ADRD, can provide valuable insights for the development and implementation of targeted interventions.
AB - Objectives: To assess whether neighborhood socioeconomic status (SES) moderates the association between Alzheimer's disease and related dementias (ADRD) and successful discharge to the community. In addition, to explore whether the role of neighborhood SES on successful discharge for patients with ADRD varies by the severity of ADRD. Design: This is a retrospective cohort study. Setting and Participants: Medicare Fee-for-service beneficiaries, aged 65 or older, who received home health care in 2019. Methods: We used linear probability regression models with successful discharge to the community as the main outcome, and neighborhood SES and ADRD as independent variables. Also, we modified the Functional Assessment Staging Tool (FAST) to measure ADRD severity. Results: Our study results show ADRD and residing in neighborhoods with lower socioeconomic conditions were independently associated with lower probabilities of successful discharge to the community. We also found that the differences in probabilities of remaining at home between patients with and without ADRD were larger among those in neighborhoods with lower SES (ADRD∗less disadvantaged neighborhood, coeff: −0.01, P < .001; ADRD∗more disadvantaged neighborhood, coeff: −0.02, P < .001; ADRD∗most disadvantaged neighborhood, coeff: 0.032, P < .001). Among patients with ADRD, patients with the most advanced ADRD were less likely to remain in their homes and community when living in neighborhoods with lower SES. Conclusions and Implications: Our study results show that when patients with ADRD receiving home health care live in neighborhoods with lower SES, they face further challenges to remaining in their homes and community. Public health officials and community planners should consider using area-level interventions to improve care and health outcomes for patients with ADRD. Also, further research aimed at identifying the specific factors and resources influencing lower care quality and poorer health outcomes in socioeconomically disadvantaged neighborhoods, particularly for patients with ADRD, can provide valuable insights for the development and implementation of targeted interventions.
KW - Alzheimer's disease
KW - Health disparities
KW - dementia
KW - home health care
KW - quality of care
KW - socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85200143955&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2024.105170
DO - 10.1016/j.jamda.2024.105170
M3 - Article
C2 - 39067862
AN - SCOPUS:85200143955
SN - 1525-8610
VL - 25
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 9
M1 - 105170
ER -