Health Care Use After Functional Disability: Opportunities to Improve the Care of Older Adults

PROJECT SUMMARY/ABSTRACT
Functional disability profoundly impacts the health and health care use of older adults, and yet functional status
is not consistently monitored by health systems, nor routinely collected by Medicare. Patients and their families
frequently struggle with inadequate support for these unrecognized needs. While specific diseases or
multimorbidity have traditionally been the focus of research investigating high and potentially burdensome
health care use, disability, defined as needing help performing activities of daily living (ADLs), may be a more
critical and universal factor. The relationship between disability and health care use is complex: medical
conditions may result in both disability and health care use, disability and unmet care needs can lead to health
care use, and hospitalization itself can cause disability. Variation in health system features and practice
patterns, such as the numbers of hospital beds and local levels of health care intensity, impact care patterns at
a regional level and may influence the relationship between disability and health care use. Nationally, the
Medicare Advantage (MA) program is rapidly expanding and offers increasing flexibility in supplemental
benefits that could better support older adults with disability. However, older adults with functional disability are
more likely leave MA plans and may receive care from lower quality skilled nursing facilities and home health
agencies in MA. It is unknown if MA plans are shifting care from facilities to the community and to unpaid
caregivers in order to reduce costs. The Paul Beeson Emerging Leaders Career Development Award in Aging
will support my effort to address this gap through research that will examine the relationship between disability
and health care use at three levels: the individual, health system, and health policy. In SA1, I will investigate
the individual-level heterogeneity of health care use after the first report of ADL disability using the Medicare
claims-linked National Health and Aging Trends Study (NHATS), which allows for identification of the month of
disability onset. In SA2, I will use the Health and Retirement Study and data capturing regional characteristics
to assess the influence of regional health system features on health care use after disability. In SA3, I will use
NHATS linked to Medicare data to examine differences in care setting (i.e., community vs. institutional care)
and caregiving (i.e., paid and unpaid caregiving) between older adults with functional disability in MA vs.
traditional Medicare. These scientific aims link closely with a comprehensive development plan through which I
will gain advanced methodological expertise in trajectory analysis and hierarchical modeling, clinical and
systems understanding in geriatric disability, health economics and policy insight, and the leadership skills to
translate my findings to policy change. This five-year project leverages my extensive experience conducting
survey-based research, the resources of my institution, and the expertise of my mentors to identify
opportunities to improve the care of older adults while catalyzing my development as an independent
researcher working to improve Medicare policy for older adults with functional disability.

Grant Number: 5K76AG064427-05
NIH Institute/Center: NIH
Principal Investigator: Claire Ankuda