Frailty, Palliative Care Needs, and Outcomes in Older Survivors of Critical Illne

危重疾病老年幸存者的虚弱、姑息治疗需求和结果

基本信息

批准号：
8767509
负责人：
Matthew R Baldwin
金额：
$ 13.23万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-08-15 至 2019-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8767509
关键词：
Accounting Acute Address Adherence Admission activity Age American Anxiety Award Caring Characteristics Clinical Investigator Clinical Research Clinical Trials Cohort Studies Collaborations Commit Comorbidity Complement Conduct Clinical Trials Consultations Critical Care Critical Illness Data Development Plans Dyspnea Elderly Enrollment Environment Epidemiologic Methods Funding Future Geriatric Assessment Geriatrics Gerontology Goals High Prevalence Hospitalization Hospitals Institutes Intensive Care Intensive Care Units Intervention Intervention Trial Investigation Knowledge Lead Learning Lung Measures Mechanical ventilation Medicine Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Metric Modeling Morbidity - disease rate Needs Assessment Outcome Pain Palliative Care Patients Phase Phenotype Physician Assistants Population Prevalence Protocols documentation Publishing Quality of life Randomized Recruitment Activity Rehabilitation therapy Research Research Personnel Resources Respiratory Failure Risk Severities Social Characteristics Statistical Models Stratification Survivors Symptoms Syndrome Therapeutic Intervention Training United States United States National Institutes of Health Universities Work base career career development design disability experience frailty high risk hospice environment improved indexing innovation mortality multidisciplinary novel palliative patient home care predictive modeling preference professor prospective public health relevance skills success tool treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Rationale: Americans age 65 and older comprise more than half of all intensive care unit (ICU) admissions. With technological advances, many critically ill older adults now survive what were previously fatal illnesses, but disability and mortality in the first 6-months after hospital discharge remain high. We need to understand better how to risk-stratify and identify patients most suitable for palliative, rehabilitative, andor therapeutic interventions in the post-ICU care period (which includes post-ICU acute care, post-acute facility care, or home care after hospital discharge). Candidate: As a pulmonary-critical care physician and Assistant Professor of Medicine at Columbia University, the PI has published original investigations that suggest frailty is an unmeasured phenotype that may help risk-stratify older ICU survivors for post-ICU interventions. The PI's long- term career goal is to become an independent clinical investigator who integrates the fields of critical care and geriatrics into a novel career niche dedicated to improving the quality-of-life and survival of older ICU survivors across care transitions. Career Development: The PI's short term objectives are to obtain formal training in geriatric and palliative care assessments, to learn advanced statistical modeling and epidemiological methods, and to gain expertise in clinical trial conduct while receiving multidisciplinary mentorship from leaders in the fields of gerontology, palliative care, and pulmonary-critical care. Environment: Columbia University has committed abundant resources to support this proposal including use of the NIH-CTSA funded Irving Institute for Clinical Research, and the recent KL2 training award for the PI. Research: We aim to advance the burgeoning field of post-ICU medicine for older adults in two ways. First (Aim 1), we will perform a prospective single-center cohort study of older ICU survivors of respiratory failure to (1A) determine whether frailty measured during the week before hospital discharge is associated independently with 6-month mortality and disability at 1 and 6 months, and to (1B) measure their palliative care needs during the week before hospital discharge. Aim 1 will lead to novel frailty-based risk-stratification models that may help identify older ICU survivors for post-ICU interventions, and will generate new knowledge about the palliative care needs of older ICU survivors that in turn will inform investigators, clinicians, and policymakers about what aspects of palliative care need to be better incorporated into post-ICU acute care. Second (Aim 2), we will pilot a post-ICU palliative care consultation intervention among frail older ICU survivors of respiratory failure and their surrogates during the week prior to anticipated hospital discharge. Aim 2 will provide feasibility data and effect size estimates that will inform the design of a futue R01 proposal for a post-ICU palliative care intervention trial in older ICU survivors. By pursuing these studies, the PI will address the spectrum of needs of older ICU survivors while garnering the expertise needed to emerge as an independent investigator who leads clinical studies and trials aimed at improving the quality-of-life and survival of this rapidly growing population of debilitated older adults.

描述（由申请人提供）：基本原理：65岁及以上的美国人占所有重症监护室（ICU）的一半以上。随着技术进步，许多重病的老年人现在幸存下来，以前是致命的疾病，但是住院后的前6个月的残疾和死亡率仍然很高。我们需要更好地了解如何在ICU后护理期间（包括ICU后急性护理，急性后设施护理或住院后的住院后护理，包括ICU后的急诊护理，包括ICU后的急诊护理，包括ICU后的急性护理，包括ICU后的康复，Andor治疗干预措施），以更好地风险分层和确定最适合姑息治疗的Andor治疗干预措施的患者。候选人：作为哥伦比亚大学肺部关键护理医生和医学助理教授，PI发表了原始调查，认为Flifailty是一种未衡量的表型，可能有助于风险分层 ICU后ICU干预措施的较旧的ICU幸存者。 PI的长期职业目标是成为一名独立的临床研究者，将重症监护和老年医学家的领域融入了一个新颖的职业生涯，致力于改善跨护理过渡的年长ICU幸存者的生活质量和生存。职业发展：PI的短期目标是获得老年医学和姑息治疗评估的正式培训，学习先进的统计建模和流行病学方法，并获得临床试验行为方面的专业知识，同时从老年医学学领域获得多学科的指导，姑息治疗，姑息治疗，姑息治疗，palliative Care和肺部关键护理。环境：哥伦比亚大学已投入大量资源来支持该提案，包括使用NIH-CTSA资助的欧文临床研究研究所，以及最近获得PI的KL2培训奖。研究：我们旨在通过两种方式推进老年人后ICU医学的新兴领域。首先（AIM 1），我们将对（1A）的呼吸失效的较老的ICU幸存者进行前瞻性单中心队列研究，以确定在住院前一周中测量的脆弱性是否与1和6个月的6个月死亡率和残疾独立相关，并且（1B）在住院前一周衡量其palliative Care的需求。 Aim 1 will lead to novel frailty-based risk-stratification models that may help identify older ICU survivors for post-ICU interventions, and will generate new knowledge about the palliative care needs of older ICU survivors that in turn will inform investigators, clinicians, and policymakers about what aspects of palliative care need to be better incorporated into post-ICU acute care.第二（AIM 2），我们将在预计住院预期出院前一周中，在年龄较大的ICU呼吸道衰竭及其代理人中，ICU后ICU后的姑息治疗咨询干预措施。 AIM 2将提供可行性数据和效果大小的估计值，该估计值将为您在ICU较老的ICU幸存者中进行ICU后姑息治疗干预试验的期货R01提案的设计提供信息。通过进行这些研究，PI将满足年长的ICU幸存者需求的范围，同时获得作为一名独立研究者所需的专业知识，该研究人员领导临床研究和试验，旨在改善这一迅速增长的衰减老年人的生活质量和生存。