Durham Veterans Affairs (VA) Medical Center, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA.
Department of Population Health Sciences, Duke School of Medicine, Durham, NC, USA.
J Appl Gerontol. 2021 Jun;40(6):648-660. doi: 10.1177/0733464820903908. Epub 2020 Feb 6.
Consideration of place of care is the first step in long-term care (LTC) planning and is critical for patients diagnosed with Alzheimer's disease; yet, drivers of consideration of place of care are unknown. We apply machine learning algorithms to cross-sectional data from the CARE-IDEAS (Caregivers' Reactions and Experience: Imaging Dementia-Evidence for Amyloid Scanning) study ( = 869 dyads) to identify drivers of patient consideration of institutional, in-home paid, and family care. Although decisions about LTC are complex, important drivers included whether patients consulted with a financial planner about LTC, patient demographics, loneliness, and geographical proximity of family members. Findings about consulting with a financial planner match literature showing that perceived financial constraints limit the range of choices in LTC planning. Well-documented drivers of institutionalization, such as care partner burden, were not identified as important variables. By understanding which factors drive patients to consider each type of care, clinicians can guide patients and their families in LTC planning.
考虑护理地点是长期护理 (LTC) 规划的第一步，对于被诊断患有阿尔茨海默病的患者至关重要；然而，考虑护理地点的驱动因素尚不清楚。我们将机器学习算法应用于 CARE-IDEAS（护理人员的反应和体验：对淀粉样蛋白扫描的证据）研究（= 869 对）的横截面数据，以确定患者对机构、家庭付费和家庭护理的考虑因素。尽管 LTC 决策很复杂，但重要的驱动因素包括患者是否就 LTC 咨询过财务规划师、患者人口统计学特征、孤独感以及家庭成员的地理位置。关于咨询财务规划师的发现与表明认知财务限制限制了 LTC 规划中选择范围的文献相吻合。像照顾者负担这样与机构入住相关的有据可查的驱动因素并未被确定为重要变量。通过了解哪些因素促使患者考虑每种类型的护理，临床医生可以指导患者及其家属进行 LTC 规划。
