2021-2022 Projects
Measuring the supply and turnover of direct care workers in long-term services and supports (LTSS) in the care of adults with AD/ADRD
Janette Dill, Associate Professor, Health Policy and Management
The long-term goals of this project are to assess the supply of the LTSS direct care workforce needed to support the growing demand for AD/ADRD care and to measure the extent to which compensation and resource-related constraints contribute to high turnover and instability in the LTSS direct care workforce. This pilot study will conduct preliminary analyses toward these goals, leading to a rigorous study that will use robust, nationally-representative datasets to measure the supply of the LTSS direct care workforce relative to the AD/ADRD population in local labor markets, identifying areas with relative shortages of this critical workforce. This will be the first study to provide crucial national and regional rates of employer and industry turnover among LTSS direct care workers, including turnover rates across LTSS sectors.
LCC Themes: Later Life-Course Population Trends in Context and Life-Course Dynamics as Disparity Mechanisms
Racial and Ethnic Disparities in Risk for Cognitive Decline and Dementia among Veterans with PTSD
Wei Duan-Porter, Assistant Professor, School of Medicine
Our long-term goal is to address the negative effects of PTSD on cognitive functioning over the life-course, focusing on racial and ethnic minorities. We will meet this objective by building on our prior work with a national cohort of racially and ethnically diverse veterans in VA care who had PTSD and no diagnosis of dementia in 2009 (n=7645). The proposed pilot work will identify surviving respondents and evaluate potentially higher mortality among minority (vs. White) participants. We will update VA data on medical conditions, health care utilization, and participants’ addresses. To examine community-level markers of socioeconomic disadvantage, we will link publicly available Census data on several key measures (e.g., proportion unemployed and proportion of households below the poverty line) using participants’ home zip codes. We will also evaluate the feasibility of recruiting minority participants for cognitive assessments by telephone (using the modified Telephone Interview for Cognitive Status [TICS-M] and telephone-modified Mini-Mental Status Exam [T-3MS]).
LCC Theme: Life-Course Dynamics as Disparity Mechanisms
Primary Care Exam Length and Potentially Inappropriate Prescribing among Older Adults
Hannah Neprash, Assistant Professor, Health Policy and Management
This project will use a database of national electronic health record (EHR) data from athenahealth, Inc., a large health information technology company, to test for a relationship between exam length and PIP. This database contains detailed information on more than 40 million primary care visits for adults aged 65 and older, including exam length and medications ordered by the clinician during each visit. To quantify exam length, we will use methods developed and deployed by study team members. To define and quantify PIP, we will rely on the 2019 American Geriatric Society Beers Criteria for potentially inappropriate medication use in older adults. This proposed work will contribute much-needed evidence on possible age-related disparities in time use in the form of interaction times between older Americans and their physicians and how that relates to the quality of care that older adults receive. Time use studies typically focus on paid work or family relationships, not community relationships, and yet time spent in medical care is arguably key to healthy aging. We will also promote understanding about how race and gender in combination with being over 65 shape exam times and their health impacts.
LCC Theme: Interrelationships of Work, Family, Community Participation, and Health
Comparing the Utility of Subjective and Objective Measures of Older Adult Health and Physical Functioning to Predict Long-Term Driving Difficulty and Driving Cessation
Colleen Peterson, Postdoctoral Associate, Families and Long-Term Care Projects Team, University of Minnesota
The proposed exploratory study will identify the simplest and most predictive measures of driving difficulty and driving cessation by identifying relationships between several self-reported subjective and objective physical health measures and long-term incidence of driving difficulty and driving cessation. Limited research has evaluated both objective and subjective mental and physical health indicators to predict only older adult driving cessation over shorter follow-up periods. The more long-range prediction capacity a tool for driving cessation has, the more potential it has for reducing negative older adult health outcomes by linking them earlier to interventions that might delay driving cessation (e.g., rehabilitation to reduce physical difficulties) or support its successful transition (e.g., community-based transportation resources). The proposed study will identify simple, long-range predictors of both driving difficulty and driving cessation to inform evidence-based clinical practice and research.
LCC Theme: Later Life-Course Population Level Trends in Context
Intergenerational Health Socialization in Rural America
Tom VanHeuvelen, Assistant Professor, Sociology and Jane VanHeuvelen, Assistant Professor, Sociology
The goal of the proposed study is to investigate health socialization occurring within families that impacts health knowledge, beliefs, and behaviors throughout the life course. We focus on health socialization between retirement aged residents between 65 and 90 of rural areas and their adult children. We seek to identify key factors in the socialization process that influence adoption of health promoting behaviors among retirement-aged rural residents. Because health socialization is necessarily relational, we propose a data collection process that will capture the interconnected nature of health behavior and health socialization.
LCC Themes: Life-Course Dynamics as Disparity Mechanisms and Later-Life Course Population Trends in Context
2020 - 2021 Projects
Rural-Urban Differences in 5-Year Mortality among Older Adults in the United States: The Role of Socio-Demographic and Health Characteristics, Living Arrangements, and Spousal Mortality
Carrie Henning-Smith, Assistant Professor, Health Policy and Management, and Julia Drew, Research Scientist, IPUMS
This project will investigate rural-urban differences in five-year mortality among older adults and variation in mortality risk by individual socio-demographic and health characteristics, living arrangements, and spousal mortality. This demographic research will produce new knowledge about the large number of older adults living in rural areas and deepen our understanding of mortality risks in urban versus rural areas.
The Budgetary Impact of Assisted Living Availability on State Medicaid Spending on LTSS
Lynn Blewett, Professor of Health Policy and Management
This project will document and evaluate Medicaid financing of assisted living services in Minnesota. We have three aims: (1) conduct a preliminary scan of state Medicaid financial support for care in Assisted Facilities; (2) operationalize an assisted living support variable to include in our Minnesota LTSS Projection Model; and (3) provide baseline data on Medicaid coverage of home care services in assisted living facilities. We will develop an initial financial projection model that assesses the impact of the availability of Assisted Living facilities on use and costs of Medicaid spending on LTSS. The model will include both supply information on number and type of Assisted Living, Nursing Facilities, and waivered services as well as demand based on current projections of Minnesota’s aging population and need for LTSS currently available in Minnesota’s LTSS Projection Model.
Do Grandparents Moderate the Association Between Early Life Conditions and Health at Older Ages?
Evan Roberts, Assistant Professor of Sociology, and Anna Prizment, Associate Professor of Medicine, Division of Hematology, Oncology and Transplantation
Grandparents can be a crucial source of material and social assistance to families and make a significant difference to early-life environments. Because early-life social environments and experiences have an important impact on the life course and aging trajectories, the availability and role of grandparents potentially shapes the aging pattern of subsequent generations. We will expand understanding of how grandparents influence the aging and mortality of their grandchildren by creating a dataset of women observed in childhood in the 1920s, for whom we can objectively measure the presence, proximity, and socio-economic status of grandparents and track health and mortality in recent years. Using these data, we will examine whether the proximity and resources of grandparents during childhood moderates the association between early-life social and economic conditions, and health outcomes at older ages.
The Impacts of Extreme Weather on Older Adults’ Time Use
Sarah Flood, Research Scientist, IPUMS; Jesse Berman, Assistant Professor of Environmental Health Science; Kathryn Grace, Associate Professor of Geography; and David Van Riper, Director of Spatial Analysis, ISRDI.
This project seeks to understand how older adults’ daily lives are affected by extreme weather and to explore demographic variation in the impact of such events. This project promises to advance our understanding of the effects of different types of extreme weather on daily lived experiences and well-being and speaks directly to NIA’s current “heightened interest in research to understand how extreme weather and disaster events impact older adults” (NIH PAR-19-250). Using novel data linkage, the research team will provide a population-based understanding of older adults’ time allocation and well-being on days when they experience extreme weather events.
The Paradox Of Racial Disparities In Alzheimer’s Disease
Rachel Hardeman, Associate Professor of Health Policy and Management, and Samuel L. Myers, Jr., Professor of Public Policy.
This research seeks to resolve a paradox that drives misunderstandings of the impact of Alzheimer’s on African American and white populations. Although research on the diagnosis of Alzheimer’s and other forms of dementia indicates a much higher incidence among African Americans than whites, mortality rates indicate the opposite. The proposed pilot study tests two competing hypotheses for the divergence in the racial gaps in the recorded diagnoses of Alzheimer’s disease and related disorders vs official mortality statistics. The first hypothesis is that there is a pattern of misdiagnosis of African American patients with cognitive deficits possibly due to lower quality medical care or lack of access to expensive modern screening technologies that minimize misdiagnoses. The second hypothesis is that there is a statistical anomaly arising from the fact that relatively few deaths result in autopsies, the definitive assessment of the presence of Alzheimer’s disease.