Identifying contributing factors to burdensome ICU treatments in older adults with Alzheimer's disease and related dementias in the United States and United Kingdom

确定美国和英国患有阿尔茨海默病和相关痴呆症的老年人在 ICU 接受繁重治疗的影响因素

基本信息

批准号：
9751155
负责人：
Elizabeth Dzeng
金额：
$ 12.04万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2022-07-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY/ABSTRACT For the 5.3 million older Americans with Alzheimer’s disease and related dementias (ADRD), end-of life-care is increasingly marked by intensive medical treatments that are goal-discordant, confer no benefit, and likely causes harm. Compared to a decade ago, older adults with advanced dementia in the United States (US) are twice as likely to receive mechanical ventilation and be admitted to the ICU without substantial improvement in survival. There is a lack of research describing the systemic and cultural drivers of burdensome ICU care, which we define as ICU admission, ICU level treatments such as vasopressors or mechanical ventilation, and resuscitation amongst older adults with ADRD near the end of life. Comparisons between the US and the United Kingdom (UK), a country that has significantly lower rates of terminal ICU hospitalization than the US, are useful in determining modifiable drivers of burdensome ICU care. By identifying practices that are common or accepted in the UK, but not found in the US, we can bring a different perspective onto typical practices in the US and identify innovative practices that exist in the UK that could be introduced in the US context to modify the American culture of burdensome ICU care. The long-term goal is to design, pilot, and implement hospital systems-level interventions that successfully shift institutional culture to mitigate burdensome treatments for older adults with ADRD near the end of life. The objective of this project is to identify factors at the institutional level that contribute to burdensome ICU treatments in older adults with ADRD near the end of life. The first aim of this project is to identify institutional, clinician, patient, and family factors that contribute to burdensome ICU treatments in older adults with ADRD near the end of life in the US and United Kingdom (UK). This will be accomplished through a comparative ethnography (observations) at two hospitals in the US (UCSF and UCLA), and two in the UK (King’s College Hospital and Princess Royal University Hospital). The observations will focus on of the day-to-day activities and behaviors of individuals involved in the care of older adults with ADRD such as ward rounds, family meetings, and treatment discussions. The project’s second aim identifies promoter and inhibitors of burdensome ICU treatments in older adults with ADRD near the end of life through semi-structured in-depth interviews with key stakeholders at all levels of the healthcare system. The proposed research is innovative because it will be the first rigorously designed, in-depth qualitative study examining cultural and systemic factors related to burdensome ICU care between the US and UK. This study is significant because it will uncover previously uncharacterized cultural and systemic factors that contribute to burdensome ICU care, which can be used to develop targeted interventions to mitigate burdensome care in older adults with ADRD.

项目摘要/摘要对于患有阿尔茨海默氏病和相关痴呆症（ADRD）的530万年长的美国人，生命终结是越来越多地以目标治疗的强化医疗，会议没有好处，并且可能造成伤害。与十年前相比，美国患有晚期痴呆症的老年人（美国）接收机械通气并被接纳为ICU的可能性是ICU的两倍生存。缺乏描述朴素ICU护理的系统和文化驱动因素的研究，我们将其定义为ICU的入院，ICU水平处理（例如加压器或机械通气），以及在生命尽头，年轻人的复苏。美国与美国之间的比较英国（英国），这个国家的终端ICU住院率明显低于美国可用于确定可修改的BurnishSome ICU护理驱动因素。通过确定常见的做法或在英国接受，但在美国没有发现，我们可以对美国并确定在美国可以在美国背景中引入的创新实践以修改美国ICU护理的美国文化。长期目标是设计，试点和实施医院系统级干预措施成功地转移机构文化以减轻燃烧的治疗在生命的尽头接近ADRD的老年人。该项目的目的是确定机构的因素在生命末期的ADRD的老年人中导致燃烧的ICU治疗的水平。第一个目标该项目的内容是确定导致ICU的机构，临床，患者和家庭因素在美国和英国（英国）生命即将结束的老年人的治疗（英国）。这将是通过在美国两家医院的比较民族志（观察）完成（UCSF和加州大学洛杉矶分校（UCLA），两个在英国（国王学院医院和公主皇家大学医院）。观察将专注于参与老年人照顾的个人的日常活动和行为诸如病房，家庭会议和治疗讨论之类的事物。该项目的第二个目标确定在生命年代结束的老年人中，降生的ICU治疗的启动子和抑制剂通过在医疗保健系统各个级别的关键利益相关者的半结构化深入访谈。提议研究具有创新性，因为它将是第一个严格设计的，深入的定性研究与美国和英国之间的ICU护理有关的文化和系统因素。这项研究很重要因为它会发现以前未表征的文化和系统因素，这些因素有助于燃烧 ICU护理，可用于制定有针对性的干预措施，以减轻患有老年人的繁殖 adrd。