Connecting housing insecurity, health, and aging in place among older adults with cancer

Project Summary and Abstract This award will support Dr. Jensen-Battaglia’s appointment as a postdoctoral fellow at Yale University’s Cancer Outcomes and Public Policy Effectiveness Research group (COPPER) and progress toward her long-term goal of developing the expertise and skills needed to become an independent cancer-focused investigator. By 2040, 73% of people in the United States (U.S.) living with cancer will be over age 65. The majority of older adults prefer to remain in their current homes as they age (‘age in place’), which is associated with health benefits. At the same time, living in deprived areas is associated with negative cancer-related outcomes ranging from delayed diagnosis and treatment to mortality, and the effects of this deprivation are intensified for those with fewer individual level resources. Housing insecurity (e.g., inadequate, unaffordable, or unstable housing) is an under-studied aspect of living environment with impacts along the cancer care continuum. Residential relocation, one sequalae of housing insecurity, has been linked to both increased utilization and disruption of healthcare. Yet there is a lack of contemporary, nationally representative data on residential relocation and its impacts among older adults with cancer. In addition, whether negative outcomes associated with relocation are related to relocation itself or deprivation of the surrounding area remains unclear. Although programs exist which support aging in place for under resourced older adults, little is known about their utilization among older adults with cancer. Identifying trends and disparities for use of programs providing long term care services in the home like Medicaid’s 1915(c) home and community-based service waivers is critical to inform future policy interventions tailored for older adults with cancer. This K00 project will address these gaps by studying adults •DJH IURP: A nationally representative dataset of U.S. older adults (Health and Retirement Study, HRS), and the Surveillance, Epidemiology and End Results program (SEER) with linked Centers for Medicare and Medicaid (CMS) claims. Using HRS data for community-dwelling older adults Dr. Jensen-Battaglia will: 1) Describe residential relocation by cancer status, 2) Compare adjusted rates of residential relocation for those with and without cancer, 3) Estimate associations between housing insecurity in the surrounding area and negative health outcomes, and 4) Explore whether these associations are stronger among those who have recently relocated. SEER data linked with Medicaid claims will allow Dr. Jensen-Battaglia to describe utilization (by state, county, and cancer characteristics) of the 1915 (c) waiver program among older adults with cancer dually eligible for Medicare and Medicaid. Dr. Jensen-Battaglia has worked closely with her mentors to develop a training plan which includes gaining expertise in the use of area-based measures and geospatial analysis, developing health policy analysis skills, and preparation to apply for future funding and a competitive, cancer- focused faculty position.