Home- and Community-Based Service Use and Preferences Among Post-9/11 Veterans at High Risk of Alzheimer s Disease and Related Dementia and Their Caregivers
Abstract
Background: Veterans are at heightened risk of developing Alzheimer’s disease and related dementias (AD/ADRD) because of military exposures like traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Family members often provide care for people with AD/ADRD, which makes it possible for them to live at home in their community. A broad set of services and supports is available outside of healthcare settings to enable community living; these services are known as home- and community-based services (HCBS). These HCBS may be used by Veterans to provide specific, short-term assistance or for ongoing support, and some HCBS support family caregivers. We know very little about what HCBS Post-9/11 Veterans with early-onset AD/ADRD are using and what they and their family caregivers need to be sure they stay healthy and can remain at home. We know even less about what types of HCBS Post-9/11 Veterans with early-onset AD/ADRD and their caregivers would like to have. Most HCBS are designed for and used by older adults, so these younger Veterans may have different needs. In order to design and deliver effective HCBS that promote health and well-being among Veterans and their caregivers, we must understand the current needs and preferences for HCBS among Post-9/11 Veterans with early-onset AD/ADRD and their caregivers. The goal of this study is to fill the gaps in knowledge so that tailored and effective HCBS can be tested and delivered in the future. Hypotheses: Based on the existing information, we expect that Post-9/11 Veterans with early-onset AD/ADRD and their caregivers use HCBS more often than their peers with high risk for early-onset AD/ADRD but no AD/ADRD diagnosis. We further expect that Post-9/11 Veterans with early-onset AD/ADRD and their caregivers will report barriers to and preferences for using HCBS that do not match with HCBS currently available to them. Finally, we expect that we can use feedback from Veterans and their caregivers to identify new HCBS strategies to meet the needs of Post-9/11 Veterans with early-onset AD/ADRD and their caregivers and to prioritize HCBS that would work well for them. Specific Aims: Aim 1: Measure HCBS use by Post-9/11 Veterans with early-onset AD/ADRD using data from Department of Veterans Affairs (VA) and Department of Defense (DOD) and compare it to Post-9/11 Veterans with high risk for early-onset AD/ADRD but no AD/ADRD diagnosis. Aim 2: Identify HCBS-specific facilitators, barriers, and preferences among Post-9/11 Veterans with early-onset AD/ADRD and their caregivers. Aim 3: Develop and prioritize specific HCBS interventions with input from Post-9/11 Veterans with early-onset AD/ADRD and caregivers. Research Strategy: We will use data from a previous set of studies about the health and well-being of Post-9/11 Veterans to classify Veterans with early-onset AD/ADRD and those at risk for early-onset AD/ADRD without a diagnosis, and measure their use of HCBS. We will measure HCBS use overall and among Veterans by sex, race/ethnicity, and rural/urban areas to see if there are differences across these groups. Next, we will conduct interviews with a diverse sample of Veterans with early-onset AD/ADRD and their caregivers. These interviews will ask about HCBS use, including what makes it easier or harder to access HCBS and what needs these Veterans and caregivers have that are not being met by current HCBS. Finally, we will combine information from these two data sources and input from our Service Member, Veteran, and Caregiver Stakeholder Group to complete a rating process, called a modified Delphi process, with a diverse group of Post-9/11 Veterans with early-onset AD/ADRD and their caregivers. This process will allow Veterans and caregivers to suggest new ideas and to rate the list of ideas that came from interviews and the Stakeholder Group. We will use their ratings to rank the importance of the different HCBS-related ideas and identify types of HCBS-rela
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210291
Entities
People
- Erin Bouldin
Organizations
- United States Army
- VA Salt Lake City Healthcare System