Palliative needs of cognitively impaired patients during health care transactions

认知障碍患者在医疗保健交易过程中的姑息需求

• 批准号: 8165628
• 负责人: KAREN B HIRSCHMAN
• 金额: $ 6.56万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8165628
• 关键词: Acute; Advanced Practice Nurse; Age; Aging; Alzheimer' s Disease; Back; Behavioral; Caregiver Burden; Caregivers; Caring; Characteristics; Cognitive; Communication; Communities; Comorbidity; Computerized Medical Record; Data; Data Analyses; Data Collection; Data Set; Delirium; Dementia; Development; Discipline of Nursing; Disease; Documentation; Elderly; Electronic Health Record; Family Caregiver; Future; Gender; Goals; Health; Healthcare; Home environment; Hospitals; Impaired cognition; Intervention; Intervention Studies; Intervention Trial; Language; Life; Linear Models; Logistics; Modeling; NIH Program Announcements; National Institute on Aging; Nurses; Nursing Models; Outcome; Palliative Care; Participant; Patient Self-Report; Patients; Persons; Population; Populations at Risk; Public Health; Quality of life; Rehabilitation Centers; Reporting; Research; Signs and Symptoms; Skilled Nursing Facilities; Source; Staging; Supportive care; Symptoms; System; Testing; United States National Institutes of Health; base; care episode; design; evidence base; experience; improved; instrument; meetings; nursing intervention; palliative; patient population; psychologic; response; social; statistics; symptom management

DESCRIPTION (provided by applicant): Older adults with cognitive impairment (CI) and multiple health conditions often need some degree of supportive care in addition to treatment for their diseases. One type of supportive care is palliative care. Palliative care is an individualized approach to care designed to meet the needs of people at all stages of progressive, life-limiting illness with the goals to improve quality of life and minimize caregiver burden. The emphasis of palliative care is on communication symptom management (both physical and psychological), and coordination of care. Understanding the palliative care needs of older adults with cognitive impairment (CI) at various stages along the disease trajectory is critical to understanding how to provide care for this population through acute care episodes. Although palliative care for persons with CI has been the focus of recent studies, little is known about the care of older persons with CI who experience an episode of acute illness. One possible option is the Transitional Care Model (TCM), an evidence-based, nurse-led model of care for older adults. The proposed study aims to describe the effect of palliative care needs and interventions, quality of life and caregiver burden among community dwelling older adults with CI and their family caregivers through an episode of acute illness. This proposed study will utilize data from the "Hospital to Home: Cognitively Impaired Elders/Caregivers" (R01AG023116-05; primary data collection completed July 2010). An expert panel will examine the electronic medical records of study participants that received the TCM intervention to determine specific palliative care interventions associated with palliative care needs. Data analyses will involve descriptive statistics, unadjusted bivariate analyses and adjusted multivariable analysis (logistic and generalized linear modeling). Secondary analysis of these data offers a value opportunity to better understand care coordination and palliative care for this population and to improve future care. The findings from this study will generate a profile of palliative care interventions to support the development of a competitive NIH R01 application to test a modified palliative care focused Transitional Care Model. Findings from this study have the potential to change existing palliative care practice for this priority population of at risk older adults with CI and their family caregivers. PUBLIC HEALTH RELEVANCE: Care of older adults with cognitive impairment will be one the most serious public health challenges in the coming decades. Palliative care is essential for older adults with cognitive and serious or life limiting illnesses and can support their family caregivers through an acute episode of care. Secondary analysis of available NIA data offers a value opportunity to better understand care coordination and palliative care for this population and to improve future care.

描述（由申请人提供）：认知障碍（CI）和多种健康状况的老年人除了治疗疾病外，还需要一定程度的支持性护理。一种支持护理的一种类型是姑息治疗。姑息治疗是一种个性化的护理方法，旨在满足人们在进步的，限制生命的疾病各个阶段的需求，其目标是改善生活质量并最大程度地减少照料者负担。姑息治疗的重点是沟通症状管理（身体和心理）以及护理协调。了解沿疾病轨迹的各个阶段的老年人的姑息治疗需求对于如何通过急性护理发作为该人群提供护理至关重要。尽管对患有CI患者的姑息治疗一直是最近研究的重点，但对患有急性疾病的CI的老年人的护理知之甚少。一种可能的选择是Transitional Care模型（TCM），这是一种基于循证的，由护士主导的老年人护理模型。拟议的研究旨在通过急性疾病的情节来描述姑息治疗需求和干预，生活质量以及护理人员负担的影响。这项拟议的研究将利用“医院到家的数据：认知受损的长者/照顾者”（R01AG023116-05； 2010年7月完成的主要数据收集）。专家小组将检查接受TCM干预措施的研究参与者的电子医疗记录，以确定与姑息治疗需求相关的特定姑息治疗干预措施。数据分析将涉及描述性统计，未经调整的双变量分析和调整后的多变量分析（逻辑和广义线性建模）。对这些数据的次要分析为该人群更好地了解护理协调和姑息治疗提供了有价值的机会，并改善了未来的护理。这项研究的发现将产生姑息治疗干预措施的概况，以支持竞争性NIH R01应用程序的开发，以测试以姑息治疗为重点的过渡性过渡护理模型。这项研究的发现有可能改变患有CI及其家庭护理人员的正处于风险的老年人的优先人群。 公共卫生相关性：对认知障碍的老年人的护理将是未来几十年中最严重的公共卫生挑战之一。姑息治疗对于认知，严重或限制生命疾病的老年人至关重要，可以通过急性护理来支持其家庭护理人员。对可用NIA数据的次要分析提供了一个有价值的机会，可以更好地了解该人群的护理协调和姑息治疗，并改善未来的护理。