The confluence of extreme heat cold on the health and longevity of an Aging Population with Alzheimers and related Dementia

极热寒冷对患有阿尔茨海默病和相关痴呆症的老年人口的健康和寿命的影响

• 批准号: 10448053
• 负责人: Francesca Dominici
• 金额: $ 238.55万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448053
• 关键词: Admission activity; Age-Years; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Antipsychotic Agents; Biological; Cardiovascular system; Cause of Death; Characteristics; Code; Cognitive; Computing Methodologies; Confidence Intervals; Confusion; Data; Dementia; Disease; Elderly; Emergency department visit; Epidemiology; Event; Exposure to; Frequencies; Future; Geographic Distribution; Goals; Health; High Performance Computing; Hospitalization; Image; Impaired cognition; Individual; Kidney Diseases; Link; Long-Term Effects; Longevity; Longitudinal cohort; Maps; Medicare; Memory Loss; Methods; Outcome; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Primary Health Care; Problem Solving; Psyche structure; Research; Resolution; Respiratory Disease; Risk; Risk Factors; Severities; Specialist; Temperature; Time; To specify; Visit; Visual; Vulnerable Populations; Weather; aging population; base; beneficiary; climate change; cohort; environmental change; extreme heat; extreme temperature; extreme weather; follow-up; health care service utilization; hospital readmission; human old age (65+); improved; interest; mortality; novel; patient population; phenotyping algorithm; resilience; response; spatiotemporal; stressor; tool; trend

Project Summary/Abstract About ten percent of Americans older than 65 (5.8 million) are estimated to live with Alzheimer’s dementia (AD) or related dementias (ADRD), constituting the 5th leading cause of death among 65 and older in the U.S. Yet, our estimates from the prevalence of AD/ADRD outdated and the vulnerabilities of the older adults living with AD/ADRD to extreme environmental change remain unknown. Understanding the vulnerabilities of these populations is critical due to two of the most prominent upcoming global challenges: a growing aging population and a changing climate. On the one hand, the number of Americans ages 65 and older is projected to nearly double, while those with AD/ADRD are projected to nearly triple by 2050. On the other hand, the severity and frequency of the extreme environmental changes, such as extreme heat and cold events, are expected to increase due to climate change. Extreme heat/cold events can increase mortality and healthcare utilization outcomes (e.g., hospitalization) among older adults. More frequent and intense extreme heat and cold events can pose disproportionate risks to the elderly population living with AD/ADRD through certain cognitive biologic pathways. However, we do not know about potential pathways through which exposure to extreme changes in ambient temperature may directly (or indirectly through other stressors) impact older AD/ADRD patients, whose responses to extreme environmental change may be disrupted/delayed due to memory loss, challenges in planning and solving problems, trouble in understanding visual images, and confusion with time and place. Our goal is to characterize the extent of the exacerbation of cause-specific healthcare utilization outcomes (i.e., hospitalizations, hospital readmissions within 30 days, primary care visits, and specialist visits) and mortality due to extreme heat/cold events, among the older adults living with AD/ADRD. Using a longitudinal cohort of over 63 million Medicare enrollees (≥65 years), we will apply comprehensive and well-validated computational approaches to study the immediate, short-, and long-term effects of extreme heat and cold events on healthcare utilization outcomes and mortality. In Aim 1, we will develop and validate computational methodologies to improve misclassification in AD/ADRD cohort identification, estimate and project the prevalence of the older adults living with dementia, build high-resolution spatio-temporal maps of extreme heat and cold events that can be integrated with administrative data (Aim 1c). In Aim 2, we will estimate the immediate and short-term effects of extreme heat and cold events on mortality and hospitalization (admission and emergency department visits) among the elderly population with AD/ADRD. Aim 3 will entail developing and deploying a high-performance computing pipeline to discover de novo and/or unanticipated causal links between long-term exposure to extreme temperature events and cause-specific healthcare utilization outcomes among older adults living with Alzheimer’s or related dementias.

项目概要/摘要 据估计，65 岁以上的美国人中约有 10%（580 万）患有阿茨海默氏痴呆症 (AD) 或相关痴呆症 (ADRD)，是美国 65 岁及以上老年人的第五大死因。 我们对 AD/ADRD 患病率以及患有 AD/ADRD 的老年人的脆弱性的估计已经过时 AD/ADRD 对极端环境变化的脆弱性仍然未知。 由于即将到来的两个最突出的全球挑战，人口至关重要：日益老龄化 一方面，预计 65 岁及以上的美国人数量。 到 2050 年，患有 AD/ADRD 的患者预计将增加近三倍。 极端环境变化（例如极热和极冷事件）的严重程度和频率 由于气候变化，预计会增加死亡率和医疗保健。 老年人的使用结果（例如住院）更加频繁和强烈的极端炎热和严重。 寒冷事件可能通过某些方式对患有 AD/ADRD 的老年人造成不成比例的风险 然而，我们不知道接触的潜在途径。 环境温度的极端变化可能会直接（或通过其他压力源间接）影响老年人 AD/ADRD 患者，其对极端环境变化的反应可能因以下原因而受到干扰/延迟： 记忆丧失、计划和解决问题的挑战、理解视觉图像的困难，以及 我们的目标是描述特定原因的恶化程度。 医疗保健利用结果（即住院、30 天内再次入院、初级保健就诊、 和专家就诊）以及因极端炎热/寒冷事件而导致的老年人中的死亡率 AD/ADRD。我们将使用超过 6300 万医疗保险参保者（≥65 岁）的纵向队列来申请。 全面且经过充分验证的计算方法来研究近期、短期和长期 极端炎热和寒冷事件对医疗保健利用结果和死亡率的影响在目标 1 中，我们将。 开发和验证计算方法以改善 AD/ADRD 队列中的错误分类 识别、估计和预测老年人痴呆症的患病率，建立高分辨率 可与行政数据整合的极热和极冷事件的时空地图（目标 1c）。 在目标 2 中，我们将估计极端炎热和寒冷事件对死亡率的直接和短期影响 患有 AD/ADRD 的老年人群中的住院治疗（入院和急诊科就诊）。 目标 3 将需要开发和部署高性能计算管道来发现从头和/或 长期暴露于极端温度事件与特定原因之间的意外因果关系 患有阿尔茨海默氏症或相关痴呆症的老年人的医疗保健利用结果。