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：Ari B. Friedman，医学博士，博士在临床上作为急诊医师进行练习，并作为健康经济进行研究，以研究护理系统如何影响老年患者的生活。他热衷于改善他在急诊科（ED）中看到的许多老年患者的护理和结果，通过改善该护理的基础科学，尤其是患有阿尔茨海默氏病和相关痴呆症（ADRD）的科学。目标：该GEMSSTAR的目的是获得必要的知识和技能，成为一名独立研究者，专注于ED护理如何影响患者的身体脆弱和认知障碍，并特别着重于患有阿尔茨海默氏病的患者或有患阿尔茨海默氏病的风险。研究背景：访问医院EDS是对65岁以上的老年人的越来越多的护理来源，2017年总共有2240万次访问。认知脆弱，认知障碍和身体脆弱的交汇处是由多个生物学系统和老年人生活的长度和质量降低的失调而导致的。 ED访问对认知脆弱轨迹的影响的特征很差。认知脆弱的不同定义包括阿尔茨海默氏病患者或排除阿尔茨海默氏病患者。职业发展计划：弗里德曼博士寻求培训身体虚弱和认知障碍，医疗保险数据分析，阿尔茨海默氏病和老年急诊医学。该奖项将为弗里德曼博士提供受保护的时间和资源，以通过进步的里程碑式驱动的培训计划获得独立资金所需的技能，其中包括课程，研究和指导性独立研究。目的：该提案的中心假设是，ED访问导致认知脆弱患者出院代表了干预的机会。他将使用该GEMSSTAR资助的受保护时间来研究认知脆弱的时间如何预测ED访问和随后对老年人的倾向，并评估ED出院之间的关系与老年人的后续结果之间的关系。他将探索包括阿尔茨海默氏病在内的认知脆弱的定义，排除了阿尔茨海默氏病。研究计划：这些目标将在两个数据集（国家健康和衰老趋势研究以及Medicare索赔数据）中进行。这些数据库可以通过人员标识符链接，并提供年度测量值，可用于计算经过验证的身体脆弱表型和认知障碍指数。数据库还提供社会人口统计学和健康特征，包括ED访问，阿尔茨海默氏病的诊断和可能的痴呆症。多元回归将测试上述假设。环境：具有从早期职业生涯到独立和有影响力的工作的学者的既定记录的高级研究人员致力于弗里德曼博士的成功。该团队嵌入了大学环境中，并具有协作，开创性科学在健康经济学，卫生服务研究，急诊医学，阿尔茨海默氏病科学和老年内科学方面的记录。