The following specific aims will be addressed:
Aim 1: Determine the impacts of dementia on health and quality of life of persons with dementia (PWDs) and their caregivers. This aim will take advantage of the extensive health measures in HRS and NHATs to examine multiple dimensions of health and well-being. Aim 1a will examine trajectories of physical and mental functioning, disability, and frailty as well as onset of co-morbid conditions and transitions into care facilities among PWDs. Trajectories will also be examined both for community-dwelling PWDs and those living in care facilities. Aim 1b will examine trajectories of physical and mental functioning, disability, frailty, and disease onset, as well as life satisfaction, depression, and psychosocial well-being among caregivers.
Aim 2: Identify community-based supports and stressors that minimize or exacerbate the negative impacts of dementia on PWDs and their caregivers. This aim will leverage newly available data on the social, physical, and built environment, as well as underutilized data on community supportive services, to estimate the impact of community-level characteristics on the lives of PWDs and their caregivers. Aim 2a will create a national, longitudinal database of supportive services for older adults. Aim 2b will link community-level data with individual-level data and evaluate the contribution of community supports (e.g., meal delivery, home health care, amenities, walkability, social cohesion) and stressors (e.g., lack of safety, disorder, noise, traffic, food deserts, medically underserved areas) to the outcomes in Aim 1.
Aim 3: Characterize inequalities in the impact of dementia on PWDs and their caregivers and examine the role of community characteristics in generating and sustaining inequality. This aim will identify PWDs and their caregivers who are particularly vulnerable to the negative impacts of dementia and determine the mediating role of community characteristics. Dimensions of inequality that will be examined include gender, race/ethnicity, and socioeconomic status, as well as living alone and residence rural vs. urban areas and affluent vs. disadvantaged neighborhoods. Aim 3a will examine variability in outcomes of PWDs. Aim 3b will examine variability in outcomes of caregivers. Aim 3c will determine how much of the variation is due to differences in exposure to community supports and stressors and whether inequalities widen over time in certain communities.