Predicting and Identifying Risk Factors for Short Time at Home in Older Adults after Hospitalization

预测和识别老年人住院后短时间在家的危险因素

• 批准号: 10517817
• 负责人: Sandra Shi
• 金额: $ 16万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10517817
• 关键词: Accounting; Acute; Admission activity; Adult; Age; Aging; Award; Career Choice; Cessation of life; Characteristics; Cognitive; Communities; Complex; Data; Data Analyses; Data Set; Delirium; Development; Disease; Elderly; Environment; Evaluation; Fellowship; Foundations; Frail Elderly; Future; Geriatrics; Goals; Health; Home; Hospitalization; Hospitals; Impairment; Individual; Institutionalization; Intervention; Knowledge; Lead; Link; Literature; Logistic Regressions; Long-Term Care; Measures; Medical; Medicare; Medicare claim; Mental Depression; Mentors; Modeling; Nursing Homes; Operative Surgical Procedures; Outcome; Outpatients; Patient-Centered Care; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Phenotype; Physical Medicine; Physiological; Pilot Projects; Principal Investigator; Property; Public Health; Quality of life; Race; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Proposals; Research Training; Risk; Risk Factors; Self Care; Sensitivity and Specificity; Skilled Nursing Facilities; Surveys; Testing; Time; United States National Institutes of Health; Validation; Work; acute care; base; beneficiary; career development; clinical care; cohort; design; efficacious intervention; experience; falls; frailty; functional restoration; health science research; high risk; hospital readmission; improved; improved functioning; improved outcome; indexing; insight; modifiable risk; mortality; multidisciplinary; older patient; patient oriented; prospective; rehabilitation science; rehabilitation strategy; research and development; risk stratification; sex; skills; social; statistics; success; therapy design; tool; trend; walking program

ABSTRACT The time after hospitalization is a critical window for older adults recovering from acute medical problems. Roughly 1 in 5 Medicare beneficiaries are discharged from hospital to skilled nursing facilities (SNFs) for post- acute care and rehabilitation, accounting for over 2 million stays annually. Although SNF stays are intended to restore independence and function, many patients cycle between re-hospitalizations and SNF in a downward spiral. Time at home quantifies this phenomenon of being ‘rehabbed to death’ by counting the number of days spent alive in the community, out of the hospital or SNF. However, tools that assess risk for short time at home have not been developed in the SNF setting, and identifying these can inform the design of interventions. Frailty is a common state of vulnerability known to increase risks of hospitalizations and mortality among older adults. Although rehabilitation interventions improve function and outcomes among non-frail adults in outpatient settings, frail compared to more robust older adults do not benefit from the same rehabilitation approaches. Moreover, whether modifiable risk factors such as delirium, depression, and potentially inappropriate medications (PIMs), independently impact short time at home in the setting of frailty is unclear. Thus, frailty measures have the potential to risk-stratify rehabilitation patients for short time at home while informing targeting of meaningful and efficacious interventions. This proposal aims to elucidate predictors of short time at home after SNF discharge among well- established frailty measures and modifiable risk factors. This research will leverage an existing dataset of a nationally representative cohort of Medicare beneficiaries, the National Health and Aging Trends Study (NHATS) linked to Medicare claims. The specific aims are to: 1) Assess and compare the ability of two measures of pre-hospitalization frailty to predict short time at home after post-acute SNF rehabilitation, in a nationally representative cohort of Medicare beneficiaries, and 2) Identify modifiable risk factors (delirium, depression, PIMs, rehabilitation characteristics) that are independently associated with short time at home after post-acute SNF rehabilitation. IMPACT: This award will support the principal investigator’s (PI’s) early career development and pathway to becoming a national leader in geriatric post-acute SNF rehabilitation. As a geriatrician with experience in aging research, Dr. Shi will acquire new insight and perspective from rehabilitation medicine and develop the skills to design and lead multidisciplinary SNF rehabilitation interventions. This proposal is supported by a collaborative team of highly experienced mentors and a rich research environment. The research and training will provide the PI with foundational knowledge in longitudinal data analysis, risk stratification, and modifiable risk factors for short time at home after SNF rehabilitation. In doing so, it will lead to the next logical step: designing and evaluating a tailored intervention guided by the frailty status of older patients, maximizing their time at home.

抽象的 住院后的时间是老年人从急性医疗物品中恢复的关键窗口。 大约有五分之一的医疗保险受益人从医院到熟练的护理设施（SNFS），以供职业 急性护理和康复，占一年一度的超过200万人。 恢复独立性和功能，许多患者在重新住院和SNF之间循环 螺旋的时间。 在社区中，在医院或SNF中还活着。 尚未在SNF环境中开发，并且要进行IND促进这些可以告知Design formnterventintions。 脆弱是已知住院和死亡率增加的脆弱状态 在老年人中。 在门诊环境中的成年人，与更多到更多的成年人相比，香气不足。 此外，康复方法是否可修改 可能不适当的药物（PIMS），独立的LEY在周围环境中在家中撞击短暂的时间为 因此，不清楚。 同时告知有意义有效的干预措施。 该建议旨在阐明SNF在井中出院后在家中短时间时间的预测指标 建立了脆弱的措施和可修改的风险因素。 全国代表性的Medicare福利队员，国家健康和年龄趋势研究 （NHAT）与Medicare主张相关的特定目的是：1）评估和比较两个 在急性SNF康复后的宿舍前送礼前，可以预测在家中短暂的时间 全国代表性的Medicare利益队列，2）确定可修改的风险因素（ir妄， 深度，pim，康复特征），与在家中短时间独立相关 急性后SNF康复。 影响：该奖项将支持首席调查员（PI）的早期职业发展和通往的途径 成为老年急性后SNF康复的国家领导者。 研究，什（Shi 设计和Lead LeadIdeDioldary SNF康复干预措施。 经验丰富的导师团队和丰富的研究环境。 PI具有纵向数据分析，风险分层和控制性的基础知识 在SNF康复后的短时间内，这将导致下一个逻辑步骤：设计和设计 评估患者脆弱的状态量身定制的干预剂，从而最大程度地利用在家中。