Care Arrangements Research Articles

IMMIGRANT EXPERIENCES AND CARE ARRANGEMENTS LATER IN LIFE: EVIDENCE FROM THE MARIEL BOATLIFT

Abstract The role of public policy in older immigrants’ use of and access to services has mainly been regarded with respect to its legal framework. However, the way public policies are framed and societies’ perceptions of immigrant groups can additionally influence immigrants’ experiences, with long-lasting effects on needs and services use later in life. Still, the importance of these mechanisms has rarely been analyzed. This study uses the Mariel boatlift in 1980 as a case study to assess the relationship between circumstances that surround an immigrants’ cohort and their care arrangement later in life. Cuban immigrants from the Mariel boatlift were perceived in a different way by the federal government and the general population than Cuban immigrants who arrived previously. Based on data from the American Community Survey (2008-2021), care arrangements of older Cubans who arrived in 1980, who are limited in daily activities, and who reside in the Miami area are compared to care arrangements of Cubans that immigrated before. Regression models are estimated and individual characteristics are accounted for. Compared to Cubans who arrived before 1980, Cubans of the Mariel boatlift are more likely to live in the community than in an institutional setting. However, among those living in the community, Cubans of the Mariel boatlift reveal a higher risk of living alone. The results suggest that Cubans of the Mariel boatlift are at higher risk for unmet needs. It is discussed how circumstances that surround immigrants’ cohort of arrival shape immigrants’ services needs and use.

WHO’S UP NEXT? EXTENDED FAMILY CAREGIVERS OF PERSONS LIVING WITH DEMENTIA: CURRENT AND FUTURE CARE

Abstract Various societal trends and expanded family boundaries have led to a broad array of family members involved in caring for persons living with dementia (PLwD). We examined how extended family caregivers (FCG) manage their care responsibilities and how the care arrangement impacts the provision of future care for PLwD. Mixed-method data from 48 extended FCG and 56 nuclear FCG (71% White, 68% female, 63% co-reside with PLwD) revealed that 70% of extended FCG rely on informal helpers to care for PLwD. Spouses and daughters were more often sole caregivers while most sons relied on informal helpers. If no longer able to help, sisters, granddaughters, and nieces more likely foresaw moving PLwD to a care facility, whereas brothers, grandsons, and nephews anticipated another informal helper would assume their care. Extended FCG often expressed dissatisfaction with one or more informal helpers for failing to meet care responsibilities, potentially leading to unmet needs and increased risk for early nursing home placement for the PLwD. The discussion will focus on the attributes of informal helpers of extended FCG that contribute to stable or inconsistent care arrangements for PLwD, which can ultimately affect the well-being of PLwD and FCG.

BEST PRACTICES FOR STUDYING OLDER MIGRANTS IN CONTEXT

Abstract Understanding health outcomes of the older migrant (ages 60+) requires insight into the perceptions of the older person and considering the impact of the environment in which the older person lives. The four papers on this panel address these issues, each using a different methodology. Bilecen’s study, using qualitative methods, examines the impact of the wording of questions on the ways in which older Turkish migrants in the Netherlands discuss loneliness. The paper helps us understand both perceptions of older migrants and the influence of methodology used on the types of responses collected. Diederich’s paper on Cuban migrants to the United States uses census data to investigate the impact of changes in the environment of arrival at different points in time on care arrangements later in life. She demonstrates the value and limitations of using this type of data. Torres uses a survey of the scientific literature to ask questions about the impact of bigotry on the well-being of older immigrants and whether lack of attention to this topic means there is an important missing piece in our understanding of the experience of the older migrant. Glicksman et. al. use clinical data to describe interactions with the formal health and social service systems by persons of limited English proficiency, an opportunity to understand both actual service use and the benefits and limitations of using clinical data for this purpose. Schrauf’s response will discuss both the findings and the relation of methods to goals in the study of older migrants. This is an International Aging and Migration Interest Group Sponsored Symposium.

THE INFLUENCE OF STATIC AND DYNAMIC FACTORS ON LONGITUDINAL PATTERNS OF CAREGIVER NETWORK

Abstract Care networks are defined as the collection of individuals who provide support for older adults with health challenges. Although many older adults receive care from multiple caregivers, with varying intensities of caregiving, little is known about the structure of their care networks and whether or to what extent it changes over time. This study aims to examine the stability of care networks and the predictive effects of static and dynamic factors on patterns of caregiving networks. Using data from the National Health Aging Trends (NHAT) and National Study of Caregiving (NSOC), we examine the static and dynamic intrapersonal structures of care arrangements with regard to systematic continuity across 7 years. We utilize both Latent Profile Analysis and Latent Transition Analysis to identify different types of caregiving arrangements and patterns of transitions over time. Moreover, we use logistic regressions to examine how individual and time-varying factors affect those arrangements and transitions. The results show three groups of caregiving arrangements: 1) intense care with one caregiver, 2) moderate-level care with multiple caregivers, and 3) low-level care with multiple caregivers. Among the groups, moderate-level care with multiple caregivers is the most stable group. Moreover, static factors, such as gender and race, and dynamic factors, such as psychological resilience of care recipients, significantly impacts the probability of transitioning from low-level care to intense care over time. The findings highlight the utility of Latent Transition Analysis in caregiving networks, suggesting that patterns of caregiving outcomes should be understood as process as well as a condition.

ALZHEIMER’S DISEASE AND RELATED DEMENTIAS IN A FAMILY CONTEXT

Abstract This symposium considers the ways in which the presence of Alzheimer’s Disease and Related Dementias (ADRD) shapes functional and affective relationships between family members, and raises questions about the future public health implications of ADRD family caregiving. In the first paper, Huo and Kim use dyadic data collected from husbands and wives in which one partner lives with mild-to-moderate cognitive AD to explore the role of relationship quality in caregiver stress. Next, Suitor and colleagues use mixed-methods data from the Within-Family Differences Study to examine how mothers’ cognitive impairment moderates the impact of maternal favoritism/disfavoritism on the psychological well-being of adult sons and daughters. Third, Gilligan, Suitor and Ogle investigate the role of adult children’s care provision in the association between parents’ cognitive impairment and adult sibling tension, also using mixed-methods data from the WFDS. Next, Savla and Roberto use mixed-methods data to explore how extended family caregivers manage their care responsibilities and how care arrangements impact the provision of future care for persons living with ADRD. Finally, Gaugler considers the public health ramifications of family caregiving, summarizing the scientific literature on estimating the future supply of family caregivers, and presenting a research agenda to address the potential family care gap. Taken together, this diverse set of papers highlights the complex ways in which the presence of ADRD shapes patterns of care, relationship quality, and well-being of members of later-life families. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias and Family Caregiving Interest Groups.

FAMILY CAREGIVING DURING THE COVID-19 PANDEMIC FOR OLDER ADULTS WITH DEMENTIA

Abstract Family caregiving plays a crucial role in meeting the care needs of older adults, especially those living with Alzheimer’s disease and related dementias (ADRD). The COVID-19 disrupted an already fragile care landscape by reducing the desirability of nursing home care and the availability of paid caregivers in the home and by destabilizing family caregiving arrangements. Older adult living with ADRD may be at higher risk for destabilized care and more vulnerable to adverse effects from the COVID-19 pandemic’s disruption to the long-term care landscape. This symposium draws on five papers providing qualitative and quantitative evidence of how care arrangements shifted during the COVID-19 pandemic among older adults with ADRD. Patterson and colleagues set the stage for understanding the impacts of the pandemic on family caregiving for older adults with dementia by providing estimates of how many families and households include someone with dementia. Choi and colleagues use a mixed-methods approach to show that family members provided more care during than before the pandemic, especially coresident family members. Lin and colleagues use quantitative evidence to examine how pandemic-specific needs and help from nonresident adult children varied by older adults’ cognitive functioning. Leggett and Tsuker examine the consequences of the pandemic for caregiver stress across different ADRD caregiver relationship types. Finally, Wiemers and colleagues extend the focus on unpaid family caregivers to include paid care and show how tradeoffs between paid and unpaid care for older adults with ADRD were affected by pandemic severity.

THE NEED FOR FAMILY-CENTERED HOME CARE IN HOME-BASED DEMENTIA CARE

Abstract Family caregivers, paid caregivers, and geriatricians frequently work together to care for people with dementia living at home, yet little is known about the paid caregiver role in home-based dementia care. We conducted repeated, one-on-one, semi-structured interviews with the care team (i.e., family caregiver, paid caregiver, geriatrician) of 9 people living at home with dementia over 6 months to explore multiple perspectives on paid caregivers’ role in care over time. In all, 29 unique respondents participated in 75 interviews that were analyzed using the framework method of analysis. Results revealed nuanced and highly individual care arrangements where paid caregiver roles in care varied significantly, though changes to this role over time were minimal. Families were the key players in defining the paid caregivers’ role regardless of home care agency involvement or source of paid caregiver payment (i.e., Medicaid-funded vs. privately paid) and geriatricians frequently deferred to family caregivers to determine how they should engage with paid caregivers. While paid caregivers often described their emotional connection to their clients, family caregivers and geriatricians rarely described this as an important aspect of paid care. To meet the nuanced care needs of people with dementia, home care needs to be centered around the unique needs of both people with dementia and their family caregivers. Rather than provide prescriptive standards for home care, family-centered home care should facilitate improved communication and clear expectation setting to be sure that care best meets the unique care needs of people with dementia living at home.

SOCIAL ISOLATION AND DELAYED DEMENTIA DIAGNOSIS AMONG US OLDER ADULTS

Abstract Delayed dementia diagnosis may exacerbate dementia symptoms and reduce opportunities for care arrangements, further harming older adults’ health and well-being. Social isolation may increase the risk of delayed dementia diagnosis via a lack of support that prevents seeking help and accessing primary and specialty care for diagnosis. We investigated the association between social isolation and missed/delayed dementia diagnosis using the Health and Retirement Study (2004-2018) linked with the Medicare Claims record. We defined social isolation as having 3 or more affirmative responses to 6 questions about living arrangements, family/friend contact, and social participation. We defined missed/delayed diagnosis as having no clinical diagnosis documented in Medicare in the presence of an algorithm-defined dementia diagnosis in the survey; or having dementia diagnosed more than 3 years after meeting the survey-based algorithmic criterion for dementia. We fitted logistic regression models, adjusting for sociodemographic and health characteristics. Among 2,417 people in our sample (mean age 82.4(SD 5.85); 60% women), 54.7% of older adults experienced social isolation at the time of survey-based dementia onset, 41.5% had missed/delayed diagnosis, and 22.1% died with no dementia diagnosis in their Medicare record. Preliminary results indicate that social isolation was not associated with increased odds of missed/delayed diagnosis (OR 1.09 95% CI 0.90, 1.32). Our findings suggest that social isolation may not be a major driver of healthcare access and system factors pertinent to clinical documentation of dementia. To corroborate findings, we plan to refine our models (e.g., accounting for attrition and selection).

CHANGES IN LONG-TERM CARE ARRANGEMENTS AMONG OLDER ADULTS WITH ADRD DURING THE FIRST YEAR OF THE COVID-19 PANDEMIC

Abstract This study will examine how COVID-19 affected care needs and immediate long-term care (LTC) outcomes including paid and family care, coresidence with adult children, and nursing home use for older adults living with ADRD. For this study we use the 2018 and 2020 waves of the Health and Retirement Study (HRS), a longitudinal, nationally representative survey of individuals aged 51 and older in the U.S. To assess how long-term care arrangements changed among older adults with dementia during the first year of the COVID-19 pandemic, we first describe the needs and LTC outcomes of older adults living with dementia and examine changes between 2018 and 2020 comparing them to changes among older adults with care needs but no dementia. Then, to identify changes associated with COVID-19 (rather than secular trends due to disease progression) we compare the 2020 LTC outcomes of HRS respondents with care needs who had differential exposure to the severity of the pandemic. We proxy pandemic severity with county level COVID-19 deaths. To understand whether changes in LTC outcomes among older adults with dementia were different from the broader population of high-need older adults, we interact local COVID-19 severity with the presence of dementia in 2018. Preliminary findings indicate a retreat from paid care and increases in coresidence with adult children and receiving unpaid help but no significant differences in LTC outcomes among high need older adults with and without dementia.

RISKS AND HEALTH OUTCOMES OF NEW ONSET OF UNMET NEEDS FOR HELP WITH ACTIVITIES OF DAILY LIVING

Abstract Twenty percent of community-living older adults who have difficulty completing mobility and self-care daily activities have unmet need for help with one or more daily activities. Prior research described correlates of existing unmet needs but did not consider which health characteristics and events increase risks for new onset of unmet needs. Data are from the 2011-2019 annual interviews of the National Health and Aging Trends Study. Onset of unmet need was calculated as having more unmet needs in the subsequent year compared to the prior year. Linear Mixed models were computed to assess which health characteristics and events increased risk for new onset of unmet need across 15,334 observations from persons who needed help with mobility tasks and 12,895 observations from persons who needed help with self-care tasks. Characteristics associated with new onset of mobility unmet needs were: age 80+, minority race, female sex, 2+ mobility limitations, 2+ chronic conditions, and dementia. Hospitalization during the yearly interval increased risk for new onset of unmet need for those with dementia (OR=3.01, 95%CI=2.62-3.44) and for those without dementia (OR=2.27, 95%CI=2.03-2.53). New onset of unmet need increased risk for nursing home or residential care placement (OR=1.63, 95%CI=1.31-2.03) and mortality (OR=2.10 95% CI =1.84-2.39) in the year following new onset of mobility unmet need. Results were similar for self-care daily activities. The findings inform the need for regularly assessing care needs, particularly after hospital discharge, with the goal of addressing new care needs to prevent new onset of unmet needs and its health consequences.

The 4C model of healthy sleep for childhood interpersonal trauma

Restorative sleep is foundational for growth and development but remains a largely neglected area of health in the context of childhood trauma. This healthcare gap is especially great among child victims of interpersonal trauma who experience sleep disturbances at high rates. A trauma-informed framework is imperative both for understanding and addressing sleep-wake dysregulation in this vulnerable population. This article introduces the 4C Model of Healthy Sleep for Childhood Interpersonal Trauma as a resource and tool for professionals who provide services and support for these children in various settings (e.g., pediatricians, social workers, prevention specialists). Model components were developed and derived from evidence-based pediatric sleep practices, principles of attachment theory, reciprocal relationships between trauma and sleep disruption, and sleep intervention research among children with a history of foster care placement. Developed for use with infants and children up to 10 years of age, the trauma-informed model aims to educate and empower caregivers with behavioral tools for reducing sleep-related problems among child victims of interpersonal trauma including attachment disruptions. Although not intended to address complex sleep problems and disorders, the relevance and conciseness of the 4C model provides a needed resource for both research and practice.

Spells of subsidized childcare arrangements and subsidy non-use

Programs supported by the Child Care and Development Fund (CCDF) help families with low incomes and in vulnerable circumstances obtain high-quality childcare at a reduced cost. Stable childcare arrangements are an important aspect of quality, but stability depends on families maintaining eligibility, using their subsidies, and staying with a provider. This study uses records from Georgia’s CCDF-supported Childcare and Parent Services program to investigate children’s spells of receiving subsidized childcare from the same provider and of holding subsidies but not using them. It finds that subsidized care arrangements are relatively stable but frequently interrupted by non-use. Only 37% of children are ever observed to change providers, and the median length of spells of continuously receiving care from the same provider is 16 weeks. However, 17% of subsidies go unused each week, and 66% of children have spells of not using their subsidies. The median length of spells of having an available subsidy but not using it is three weeks. Many spells of care arrangements end on annual eligibility renewal dates. Children in smaller settings, before-/after-school care, Quality-Rated care, and settings close to home have more stable care arrangements than other children.

The rare diseases and orphan medications: Placement in health care of the Russian Federation

The rare diseases are characterized both by relatively small prevalence in population and complexity of medical care support of patients. In this particular case, the legal regulation of medical care takes its particular placement in health care. The uniqueness of rare diseases requires development of special normative legal acts, definitions and treating approaches. One of such approaches are orphan drugs that also are unique, complicated in development and require special legislative regulation. The article presents corresponding legislative terminology in modern Russian health care, actual listings of rare diseases and orphan drugs. The directions to improve current terminology and normative legal regulation are proposed.

The quality of family relationships in dementia: Mixed methods to unravel mixed feelings.

Objective: Close relationships influence health and quality of life outcomes for people with dementia and their families. Yet, we know little on the role of different relationship domains with quantitative methods having proved to have limitations in this research field. We aimed to study these relationship domains over time, contrasting the views of people with dementia and their family carers, making use of both quantitative and qualitative approaches.Methods: A convergent mixed methods design was adopted, analysing longitudinal data (four time points over three years) from 66 dyads of Portuguese community-dwelling people with dementia and their primary carers, from the EU-Actifcare project sample. Quantitative assessments used sociodemographic and clinical variables, and Positive Affect Index scores, with descriptive and inferential analyses. Qualitative data, collected through individual and joint semi-structured interviews, were explored using thematic analysis.Results: Both quantitative and qualitative findings demonstrated that some domains of relationship quality are affected in different ways, with changes occurring at different stages. Some (e.g., 'communication') may even improve after initial decline. 'Closeness' was consistently altered over time, from carers' perspectives, and played an important protective role regarding institutionalisation. Overall, changes in the relationship quality were perceived differently by people with dementia and their carers, and these divergent perspectives often led to tension. Qualitative data revealed that 'mixed feelings' (ambivalence) involve complex experiences, arguably more difficult to manage than negative feelings alone. Furthermore, perceived informal support, particularly from the extended family, and receiving formal services' assistance, seemed to facilitate positive (re)appraisals of the relationship.Conclusions: A deeper understanding of relationship quality and its domains as dementia progresses may help tailoring interventions to tackle modifiable aspects of relationships, meeting the needs and cherishing the resources of dyads and families. Timely assessments could identify relationships at risk and need for support, including for alternative caring arrangements.

“They're scared that somebody's gonna judge them”: Female African American youth in foster care's perspectives on sexual and reproductive health communication with caregivers

BackgroundObtaining accurate information is critical for youth's sexual and reproductive health (SRH). Youth not in foster care often learn about SRH from their biological parents. Separated from their biological parents, youth in care depend on healthcare providers and caregivers for SRH information. However, they often receive insufficient information and feel unsupported in meeting their needs for SRH information. PurposeThis study explored female African American adolescents in foster care's perspectives on effective SRH communication with caregivers to help them avoid sexual risks. MethodsA qualitative study was conducted using semi-structured interviews. We used purposive sampling to recruit 16 adolescents aged 18 to 20 years old with a history of foster care placement. The transcribed interviews underwent inductive thematic analysis. The Positive Youth Development theory underpinned this research. ResultsTwo prominent themes emerged: establishing a relationship and preferred communication approach. Youth reported that for caregivers to engage in effective SRH communication, they must first establish a relationship by being aware of the youth's childhood trauma, building trust, having patience, and being vulnerable. Youth also appreciated caregivers who ensured comfortability and were honest and straightforward. DiscussionCaregivers should be trained on adverse childhood experiences, trauma-informed approaches, SRH knowledge, and communication. Implications to practiceHealthcare providers should make use of the time spent with youth and discuss SRH topics during clinical encounters. This time spent with youth may be their only chance to obtain accurate SRH information. Youth's perspectives regarding communication about SRH should be implemented in future SRH communication interventions.

Day care availability and awareness of gendered economic risks: How they shape work and care norms

Family policies not only provide money, time and infrastructure to families, but also convey normative assumptions about what is considered desirable or acceptable in paid work and family care. This study conceptualises and empirically investigates how priming respondents with brief media report-like information on existing day care policy entitlements and economic consequences of maternal employment interruptions may change personal normative judgements about parental work–care arrangements. Furthermore, we analyse whether these effects differ between groups of respondents assumed to vary in their degree of affectedness by the information as well as previous knowledge. The theoretical framework builds on the concept of normative policy feedback effects combined with social norm theory and human cognition theories. The study is based on a fully randomized survey experiment combined with a vignette experiment in Wave 12 of the German Family Panel (pairfam). It applies linear and ordinal logistic regressions with cluster-robust standard errors to a sample of 5,783 respondents. Our results suggest that priming respondents with information on day care policy and long-term economic risks of maternal employment interruptions increases acceptance of intensive day care use across the full sample and especially for mothers with children below school entry age. It further increases support for longer maternal hours spent in paid work among childless women and mothers with school-aged children. Norms regarding paternal working hours are largely unaffected by the information given in this survey experiment.

Child care access for families raising children with disabilities

Access to affordable, quality child care is a crucial employment support for families and may be particularly salient for families with young children with disabilities. Without access to quality care, parents may not be able to find and maintain employment, increasing the likelihood of economic precarity. We use data from the ECLS-B to examine whether child care arrangements differ by child’s disability status. We find that having an identified disability in childhood, and particularly IEP receipt, is associated with increased likelihood of attending center-based and part-time care as well as lower child care costs. To investigate the extent to which child care access may be impacting maternal employment, we employ a difference-in-difference framework to examine changes in maternal employment rates at kindergarten enrollment by disability status. We find no difference, or possibly a smaller increase, in maternal employment at kindergarten enrollment for mothers of children with disabilities compared to mothers of typically-developing peers. Findings emphasize the importance of understanding the overall policy environment for children with disabilities and their families.

Allied health students' experiences of older adults in residential aged care placements: A scoping review.

To explore the attitudes and experiences of allied health students working with older adults on residential aged care placements. A systematic literature search was conducted to identify studies of any design describing allied health student experience of residential aged care placements. Online databases searched to identify potentially relevant documents included Scopus, Web of Science, PubMed, CINAHL Complete (EBSCOhost) and Health and Medicine (ProQuest). Studies were excluded if residential aged care facilities or allied health professional students could not be extracted from the data. No restrictions were applied to methodological design, language, geographical location or year of publication. The Mixed Methods Appraisal Tool was used to assess methodological quality. Extracted studies were analysed to identify the study design, participant and placement characteristics, study methodology and student experience measures. Data from the included studies were analysed thematically using meta-synthesis. Six studies (total number of participants, n = 308) met inclusion criteria, with four papers scoring a 5/5 on the Mixed Methods Appraisal Tool. Studies included undergraduate and master's students from physiotherapy (n = 3), speech language pathology (n = 2), dietetics (n = 1) and audiology (n = 1). Placement length varied from two to 15 h, between one and six residential aged care visits. Three themes were identified; (1) Opportunity to improve skills and gain confidence, (2) Development of empathy and shift in attitudes towards older adults and (3) Recognised challenges associated with older adults and residential aged care settings. While the size of the evidence-base is limited, the studies were largely consistent in demonstrating an increase in positive attitudes towards older adults following residential aged care placements. Future research, innovations and planning around workforce size, preparation and motivation must be prioritised to ensure older adults receive the care they need and deserve.

Prazosin for Agitation in Alzheimer’s Disease: PEACE‐AD

AbstractBackgroundDisruptive agitation is a major source of distress to patients/caregivers and is a common precipitant of long‐term care placement. High CNS noradrenergic signaling at the alpha‐1 adrenoreceptor (AR) in AD appears contributes to disruptive agitation. Prazosin, a CNS active alpha‐1 AR antagonist, was effective for reducing disruptive agitation and was well tolerated in our previous pilot study. The objective of this study was to evaluate efficacy and safety of prazosin for disruptive agitation in AD participants residing at home or in long‐term care in a multicenter RCT conducted by the NIA‐funded Alzheimer’s Disease Cooperative Study.MethodIn this multi‐site RCT recruitment was substantially handicapped by COVID‐19. Participants were randomized to prazosin or placebo 2:1 for 12 weeks. Prazosin was titrated over 4 weeks to a maximum possible dose of 4 mg mid‐morning and 6 mg at bedtime based on tolerability and persistent agitation. Adverse events and orthostatic blood pressure and heart rate were monitored. Primary outcome: ADCS‐Clinical Global Impression of Change‐Agitation (CGIC‐A) targeting disruptive agitation. Secondary outcomes: 17‐item Neuropsychiatric Inventory (NPI), Cohen Mansfield Agitation Inventory (CMAI), and total # study days completed. An exploratory outcome was the NPI 5‐item subscale reflecting agitation. Methods were adapted to allow for remote consent, participant screening, and outcome and safety assessments.Result35 participants were randomized. MMRM analysis revealed: no significant differences in CGIC‐A or total NPI scores; 7 of 18 prazosin participants were moderately‐markedly improved on the CGIC‐A compared to 1 of 4 placebo participants (NS); change from BL in the CMAI significantly favored prazosin (p = 0.04) and the 5‐item NPI Agitation subscale numerically favored prazosin (NS); 63% of prazosin participants completing compared to 38% of placebo participants (NS). Adverse events were as anticipated for prazosin. Remote consent and assessments allowed continuation of the study without the necessity of in‐person clinic visits.ConclusionAssessments were limited by the small # of participants. There was some benefit with prazosin with the expected safety profile. Feasibility of performing an RCT for disruptive agitation in AD using remote technology was demonstrated. A larger study of prazosin for moderate‐severe disruptive agitation in AD is necessary.

Is Dementia Related to a Longer Wait Time to be Assigned a New Primary Care Provider? An Analysis of the Nova Scotia Need a Family Practice Registry Derived from the PUPPY-Study.

Access to Primary Care Providers (PCPs) is limited for many Canadians. "Unattached patients" are persons who do not have a PCP. Older adults living with dementia may face greater challenges seeking attachment. This study investigated whether older adults living with dementia experience differential wait times for PCPs compared to those without a diagnosis of dementia. This was an observational descriptive study of the centralized wait-list data from the Nova Scotia (NS) Need a Family Practice Registry (NaFPR). Time on provider wait-list by dementia diagnosis and age were compared. Number of days on the registry across these measures was estimated. Multivariable proportional hazards regression was used to compare hazards of remaining on the registry over time. Unattached older adults living with dementia were on the NaFPR for less time compared to those without dementia (381.4 vs. 428.8 days, respectively). After adjusting for age, self-reported gender, comorbidity, rurality, income quintiles, and overall deprivation, older adults with dementia had a 1.13-fold (95% CI: 1.04-1.24) increase in the likelihood of leaving the NaFPR. Potential contributors to this small difference could be placement in Long Term Care (LTC) and subsequent facility PCP attachment. Analysis of the NaFPR exhibited similarly time to PCP attachment despite a diagnosis of dementia. This represented an effective equality model of health care utilized in NS. Future studies should investigate whether an equity model with priority attachment for vulnerable patients would reduce hospitalization and LTC institutionalization.