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

• 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
• 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

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）： 理由：65 岁及以上的美国人占所有重症监护病房 (ICU) 入院人数的一半以上。随着技术进步，许多危重老年人现在摆脱了以前致命的疾病，但出院后前 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对患者进行风险分层并确定最适合在 ICU 后护理期间（包括 ICU 后急性护理、急性后机构护理或出院后家庭护理）进行姑息、康复和/或治疗干预的患者。释放）。候选人：作为一名肺部重症监护医师和哥伦比亚大学医学助理教授，PI 发表了原始研究，表明虚弱是一种无法测量的表型，可能有助于风险分层 ICU 老年幸存者进行 ICU 后干预。 PI 的长期职业目标是成为一名独立的临床研究者，将重症监护和老年病学领域整合到一个新颖的职业领域，致力于改善老年 ICU 幸存者在护理过渡期间的生活质量和生存率。职业发展：PI的短期目标是获得老年病和姑息治疗评估方面的正式培训，学习先进的统计模型和流行病学方法，并获得临床试验实施方面的专业知识，同时接受老年学、姑息治疗领域领导者的多学科指导。护理和肺部重症护理。环境：哥伦比亚大学投入了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所，以及最近为 PI 颁发的 KL2 培训奖。研究：我们的目标是通过两种方式推进老年人 ICU 后医学的新兴领域。首先（目标 1），我们将对老年 ICU 呼吸衰竭幸存者进行一项前瞻性单中心队列研究，以 (1A) 确定出院前一周测量的虚弱是否与 1 和 6 个月死亡率和残疾独立相关。 6 个月，并 (1B) 衡量出院前一周内的姑息治疗需求。目标 1 将产生新的基于虚弱的风险分层模型，该模型可能有助于识别老年 ICU 幸存者以进行 ICU 后干预，并将产生有关老年 ICU 幸存者的姑息治疗需求的新知识，从而为研究人员、临床医生和患者提供信息政策制定者了解姑息治疗的哪些方面需要更好地纳入 ICU 后的急性护理中。其次（目标 2），我们将在预计出院前一周在 ICU 呼吸衰竭的年老幸存者及其代理人中试行 ICU 后姑息治疗咨询干预。目标 2 将提供可行性数据和效应大小估计，为未来 R01 提案的设计提供信息，该提案针对老年 ICU 幸存者进行 ICU 后姑息治疗干预试验。通过开展这些研究，PI 将满足老年 ICU 幸存者的各种需求，同时获得成为独立研究者所需的专业知识，领导临床研究和试验，旨在提高这一快速增长的人群的生活质量和生存率体弱多病的老年人。