Trajectories of Frailty and Cognitive Impairment in Older Adults

老年人虚弱和认知障碍的轨迹

基本信息

批准号：
10518585
负责人：
Ari B Friedman
金额：
$ 16.25万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10518585
关键词：
Accident and Emergency department Acute Address Admission activity Affect Aging Algorithms Alzheimer&apos s Disease Alzheimer&apos s disease diagnosis Alzheimer&apos s disease patient Alzheimer&apos s disease related dementia Award Caregivers Caring Characteristics Chronic Cognitive Cognitive aging Data Data Analyses Data Set Databases Dementia Development Plans Doctor of Philosophy Elderly Emergency Care Emergency Department Physician Emergency Medicine Emergency department visit Environment Event Family member Feasibility Studies Funding Future Gerontology Goals Health Health Services Research Health system Home Hospitalization Hospitals Iatrogenesis Impaired cognition Impairment Infarction Infection Intervention Knowledge Length Link Literature Measurement Medicare Medicare claim Mentors Mentorship Modeling Morbidity - disease rate Nursing Homes Outcome Outpatients Patient-Focused Outcomes Patients Persons Phenotype Population Probability Publishing Reporting Research Research Personnel Residencies Resources Risk Scholarship Science Secure Sentinel Shock Source Testing Time Training Training Support Universities Variant Visit Vulnerable Populations Work base biological sex biological systems care coordination care outcomes care systems career career development clinical practice cognitive performance conditioning cost data resource disability disability risk experience falls frailty health economics improved indexing longitudinal database mild cognitive impairment mortality multiple chronic conditions older patient programs skills smart home social sociodemographics success trend

项目摘要

Candidate: Ari B. Friedman, MD, PhD practices clinically as an emergency physician and conducts research as a health economist into how care systems affect older patients’ lives. He is passionate about improving the care and outcomes of the many older patients that he sees in the emergency department (ED) by improving the science underlying that care, especially those with Alzheimer’s Disease and Related Dementias (ADRD). Goal: The purpose of this GEMSSTAR is to gain knowledge and skills necessary to become an independent investigator focusing on how ED care affects physical frailty and cognitive impairment for patients, with a particular emphasis on patients with Alzheimer’s Disease or at risk of developing Alzheimer’s Disease. Research Context: Visits to hospital EDs are a growing source of care for older adults over 65, totaling 22.4 million visits in 2017. Cognitive frailty, the intersection of cognitive impairment and physical frailty, is hypothesized to result from dysregulation of multiple biological systems and curtails the length and quality of older adults’ lives. The impact of ED visits on trajectories of cognitive frailty is poorly characterized. Varying definitions of cognitive frailty include Alzheimer’s Disease patients or exclude Alzheimer’s Disease patients. Career Development Plan: Dr. Friedman seeks training in physical frailty and cognitive impairment, Medicare data analysis, Alzheimer’s Disease, and geriatric emergency medicine. This award will provide protected time and resources for Dr. Friedman to acquire the skills necessary to secure independent funding through a progressive, milestone-driven training plan that includes coursework, research, and guided independent study. Aims: The central hypothesis of this proposal is that ED visits resulting in discharge in patients with cognitive frailty represent an unrecognized opportunity for intervention. He will use the protected time funded by this GEMSSTAR to examine how cognitive frailty predicts ED visits and subsequent disposition for older adults, and to assess the relationship between ED discharges and subsequent outcomes in older adults. He will explore definitions of cognitive frailty which include Alzheimer’s Disease and exclude Alzheimer’s Disease. Research Plan: These Aims will be carried out in two datasets, the National Health and Aging Trends Study, and Medicare claims data. These databases can be linked by person identifiers, and provide annual measurements which can be used to calculate validated physical frailty phenotype and cognitive impairment indices. The databases also provide sociodemographic and health characteristics, including ED visits, Alzheimer’s Disease diagnoses and probable dementia. Multivariate regression will test the hypotheses above. Environment: Senior researchers with an established track record of mentoring scholars from their early career to independent and impactful work are committed to Dr. Friedman’s success. This team is embedded within a university environment with a track record of collaborative, pathbreaking scholarship in health economics, health services research, emergency medicine, Alzheimer’s Disease scholarship, and gerontology.

候选人：阿里·B·弗里德曼 (Ari B. Friedman)，医学博士、博士，作为一名急诊医生进行临床实践，并作为一名健康经济学家进行护理系统如何影响老年患者生活的研究。他热衷于改善他所看到的许多老年患者的护理和结果。通过改进护理基础科学，特别是那些患有阿尔茨海默氏病和相关痴呆症 (ADRD) 的急诊科 (ED) 患者。目标：本次 GEMSSTAR 的目的是获得成为一名独立研究者所需的知识和技能，重点关注 ED 护理如何影响患者的身体虚弱和认知障碍，特别关注患有阿尔茨海默病或有患阿尔茨海默病风险的患者。研究背景：去医院急诊室就诊已成为 65 岁以上老年人日益增长的护理来源，2017 年就诊次数总计 2,240 万人次。认知衰弱（认知障碍和身体虚弱的交集）被重新定义为多个生物系统失调和限制的结果。认知脆弱的不同定义包括：阿尔茨海默病患者或排除阿尔茨海默病患者。职业发展计划：弗里德曼博士寻求身体虚弱和认知障碍、医疗保险数据分析、阿尔茨海默病和老年急诊医学方面的培训。该奖项将为弗里德曼博士提供受保护的时间和资源，以获取通过获得独立资助所需的技能。渐进的、里程碑驱动的培训计划，包括课程作业、研究和指导性独立学习。目的：该提案的中心假设是，认知衰弱患者因急诊就诊而出院是一个未被认识到的干预机会。他将利用 GEMSSTAR 资助的受保护时间来研究认知衰弱如何预测老年患者的急诊就诊和后续处置。他将探讨认知衰弱的定义，其中包括阿尔茨海默病和排除阿尔茨海默病。研究计划：这些目标将在两个数据集中进行，即国家健康和老龄化趋势研究和医疗保险索赔数据，这些数据库可以通过个人标识符链接，并提供年度测量结果，可用于计算经过验证的身体虚弱表型和健康状况。数据库还提供社会人口统计学和健康特征，包括急诊室就诊、阿尔茨海默病诊断和可能的痴呆症，将检验上述假设。环境：资深研究人员在指导学者从早期职业生涯到独立和有影响力的工作方面有着良好的记录，他们致力于弗里德曼博士的成功。卫生服务研究、急诊医学、阿尔茨海默病奖学金和老年学。