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.

项目概要/摘要对于 530 万患有阿尔茨海默病和相关痴呆症 (ADRD) 的美国老年人来说，临终关怀是越来越多的特点是强化医疗治疗与目标不一致、没有任何益处，并且可能与十年前相比，美国患有晚期痴呆症的老年人正在遭受伤害。接受机械通气并入住 ICU 且病情没有实质性改善的可能性增加一倍缺乏描述繁重的 ICU 护理的系统和文化驱动因素的研究，我们将其定义为 ICU 入住、ICU 级别的治疗（例如血管加压药或机械通气），以及美国和美国临终 ADRD 老年人的复苏情况。英国 (UK) 是一个 ICU 晚期住院率明显低于美国的国家，通过识别常见的做法，有助于确定繁重的 ICU 护理的可改变驱动因素。或者在英国被接受，但在美国却没有，我们可以从不同的角度来看待典型的做法美国并确定英国现有的创新做法，可以在美国的背景下进行修改美国繁重的 ICU 护理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转变机构文化，减轻治疗负担该项目的目标是确定机构中患有 ADRD 的老年人。导致临终 ADRD 的老年人承受繁重的 ICU 治疗的水平。该项目的目的是确定造成 ICU 负担的机构、临床医生、患者和家庭因素在美国和英国，对临终 ADRD 的老年人进行治疗。通过对美国两家医院（加州大学旧金山分校和加州大学旧金山分校）进行比较人种学（观察）来完成加州大学洛杉矶分校），英国有两家（国王学院医院和皇家公主大学医院）。将重点关注参与护理老年人的个人的日常活动和行为 ADRD，例如查房、家庭会议和治疗讨论该项目的第二个目标是确定。对于临近生命末期的 ADRD 老年人来说，繁重的 ICU 治疗的促进者和抑制剂对医疗保健系统各级关键利益相关者进行半结构化深入访谈。该研究具有创新性，因为它将是第一个经过严格设计、深入的定性研究与美国和英国繁重的 ICU 护理相关的文化和系统因素这项研究意义重大。因为它将揭示以前未表征的文化和系统因素，这些因素导致了繁重的负担 ICU 护理，可用于制定有针对性的干预措施，以减轻患有老年痴呆症的老年人的繁重护理 ADRD。