“Examining Health and Well-Being Among Community-Dwelling Older Adults with Serious Illness and Their Family Caregivers”

Dissertation Committee

Howard Degenholtz, PhD, Professor, Department of Health Policy and Management, School of Public Health (Committee Chair)
Coleman Drake, PhD, Associate Professor, Department of Health Policy and Management, School of Public Health
Heidi Donovan, PhD, RN, Professor, Department of Health and Community Systems, School of Nursing
Janel Hanmer, MD, PhD, Associate Professor, Department of General Internal Medicine, School of Medicine

Abstract

This dissertation explores the intersection of serious illness and health-related quality of life among community-dwelling older adults and their family caregivers. Using nationally representative data from the National Health and Aging Trends Study (NHATS), the National Study of Caregiving (NSOC), and linked Medicare and Medicaid claims, this study investigates how “Healthy Days at Home” (HDAH)—a population-level measure of time spent alive and out of institutional care—and the receipt of personal assistive services (PAS) relates to physical, mental, and social well-being, as well as the risk of hospitalization.
 
Aim 1 examines whether HDAH is associated with self-reported health, depression, anxiety, and activity limitations among older adults with serious illness. These findings show that while more HDAH is linked to better self-rated health and fewer depressive symptoms, it is not associated with anxiety. Aim 2 extends this analysis to caregivers, assessing how care recipients’ HDAH affects caregiver outcomes. Although HDAH alone was not consistently associated with caregiver well-being, caregiving intensity—measured by time and task complexity—was strongly linked to poorer outcomes. Aim 3 evaluates the role of PAS in reducing hospitalization risk among seriously ill older adults, highlighting the importance of supportive services in maintaining community residence.
 
This work underscores the need for outcome measures that reflect both individual health experiences and the broader caregiving context. By integrating insights from older adults and their family caregivers with claims data, this dissertation contributes to the growing literature on the development of person- and family-centered care models and outcome measures at the intersection of aging, serious illness, and family caregiving.