Title: The Role of Informal Care in Cognitive Outcome and Healthcare Utilization Among Older Adults with Dementia Show Chinese title

Title: 老年人痴呆症患者非正式护理在认知结果和医疗资源使用中的作用

Abstract: This paper examines the relationship between informal caregiving and both cognitive functioning and healthcare utilization among older adults with dementia. Using data from the RAND version of the Health and Retirement Study (HRS), a nationally representative longitudinal panel of U.S. adults over age 50, covering the years 2010 to 2022, I estimate Ordinary Least Squares (OLS) and Instrumental Variables (IV) models to address potential endogeneity in caregiving decisions. The number of children is employed as an instrument for informal care intensity. While OLS estimates suggest a negative association between informal caregiving and cognition, IV estimates show no significant causal effect after controlling for demographic, socioeconomic, and lagged cognition variables. In contrast, IV results indicate that informal care significantly reduces the likelihood of nursing home use, the number of institutional nights, and the probability of institutionalization. No robust causal effects are found for hospital use, doctor visits, or outpatient surgery, although there is some suggestive evidence of a complementary relationship between informal care and home health services. These findings highlight the role of informal caregiving in substituting for institutional care and underscore its importance in long-term care policy for dementia patients. Keywords: Informal Caregiving; Cognitive Decline; Instrumental Variables; Healthcare Utilization: Dementia Patients. Show Chinese abstract

Abstract: 本文探讨了痴呆老年人中非正式照护与认知功能及医疗保健使用之间的关系。 使用RAND版本的健康与退休研究（HRS）数据，这是一个全国代表性纵向面板，涵盖50岁以上美国成年人，时间范围为2010年至2022年，我估计普通最小二乘法（OLS）和工具变量（IV）模型，以解决照护决策中的潜在内生性问题。 子女数量被用作非正式照护强度的工具变量。 虽然OLS估计表明非正式照护与认知之间存在负相关关系，但控制人口统计学、社会经济和滞后认知变量后，IV估计显示没有显著的因果效应。 相反，IV结果表明非正式照护显著降低了入住养老院的可能性、机构住宿天数以及机构化的概率。 对于医院使用、医生就诊或门诊手术，没有发现稳健的因果效应，尽管有一些证据表明非正式照护与家庭健康服务之间存在互补关系。 这些发现突显了非正式照护在替代机构护理中的作用，并强调了其在痴呆患者长期护理政策中的重要性。 关键词：非正式照护；认知衰退；工具变量；医疗保健使用；痴呆患者。