The Clinical Course and Outcomes of Older Stroke Patients with Feeding Tubes

使用饲管的老年中风患者的临床过程和结果

• 批准号: 9753101
• 负责人: Corey R Fehnel
• 金额: $ 12.25万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9753101
• 关键词: Acute; Address; Admission activity; Age; Aging; Body mass index; Caring; Certification; Cessation of life; Characteristics; Clinical; Cognitive; Creation of jejunostomy; Data; Data Reporting; Data Set; Databases; Deglutition; Deglutition Disorders; Delirium; Development Plans; Discipline of Nursing; Eating; Elderly; Enrollment; Enteral Feeding; Excision; Family; Future; Gastrostomy; Home environment; Hospitalization; Hospitals; Impaired cognition; Investigation; Ischemic Stroke; Length of Stay; Link; Long-Term Care; Measures; Medicare claim; Neurology; Nursing Homes; Operative Surgical Procedures; Oral cavity; Outcome; Palliative Care; Patient-Focused Outcomes; Patients; Performance Status; Provider; Recovery; Research; Research Personnel; Risk; Skilled Nursing Facilities; Speech Pathologist; Speech Therapist; Speech Therapy; Stroke; Stroke Volume; Subacute Care; Surveys; Survivors; Time; Tube; Variant; cognitive performance; cohort; cost; expectation; functional improvement; functional status; high risk; hospice environment; improved outcome; nursing home length of stay; nutrition; older patient; patient expectation; post stroke; primary outcome; stroke patient

! Project Summary/Abstract Demographic shifts will drive a doubling of stroke cases among older persons by 2050. For approximately 55% of ischemic stroke patients, dysphagia is a major barrier to recovery. Older stroke patients are at higher risk for severe and persistent dysphagia, prompting the surgical insertion of feeding tubes. Little is known about the clinical course of older patients with feeding tubes inserted during a hospitalization for stroke once they leave acute care. While it is generally assumed tube feeding is a temporary measure, the extent to which these patients ultimately regain the ability to eat by mouth remains largely unexamined. Similarly, while feeding tubes may be expected to contribute to functional improvements allowing patients to return home, their need for long- term care has never been well-explored. Most older stroke patients with feeding tubes are admitted to skilled nursing facilities (SNFs), which vary greatly in quality. No study has ever identified SNF features that influence whether these patients regain the ability to eat by mouth or return home. A more robust understanding of the clinical course of tube-fed older stroke patients will not only help inform realistic expectations for these patients and families, but also identify potentially modifiable factors that will promote positive long-term outcomes. The overriding objective of this proposal is to measure key long-term outcomes in the clinical course of older persons who had feeding tubes inserted post-stroke and identify patient and SNF-level factors associated with better outcomes. To conduct this research, we will leverage several linked nationwide databases from 2011- 2015, including: Medicare claims, the Minimum Data Set (MDS), and Certification and Survey Provider Enhanced Reporting (CASPER) data. In Aim 1, the clinical course of patients over 65 admitted to SNFs for post-acute care after hospitalization for acute ischemic stroke with feeding tube insertion will be examined for the following primary outcomes: 1) 90 day disposition, 2) feeding tube use at 90 days, 3) time to death or hospice enrollment. Patient characteristics upon admission to SNF associated with these outcomes will be identified. Among long-stay nursing home residents, MDS data will be used to examine feeding tube use, functional and cognitive status at 180 and 365-days post-admission to sub-acute care. Aim 2 will determine variation in outcomes across SNFs, and (after adjusting for patient and regional factors) identify SNF characteristics (e.g. stroke patient volume, speech pathologist staffing) associated with the primary outcomes. IMPACT: The proposed research will be the first rigorous, nationwide examination of the clinical course and determinants of outcomes among older patients with feeding tubes inserted post-stroke. As such, it has the potential to generate more realistic expectations of their future care needs and help identify addressable factors that could improve the outcomes of these patients (i.e., minimal volume and specialized staffing requirements for post-acute facilities). Finally, this research and professional development plan will help the PI evolve into one of the few independent investigators with expertise in aging, neurology and palliative care.

呢 项目摘要/摘要 到2050年，人口变化将使老年人的中风案例增加一倍。大约55％ 在缺血性中风患者中，吞咽困难是恢复的主要障碍。老年人患者的风险更高 严重和持续的吞咽困难，促使手术插入进食管。关于 临床过程的临床病例在住院期间插入喂养管一旦离开后插入的喂养管 急性护理。虽然通常认为管喂食是临时措施，但这些措施的程度 最终，患者恢复了口腔进食的能力，在很大程度上没有审查。同样，喂食管 可能有望导致功能改善，使患者能够返回家园，他们需要长期 学期护理从未经过充分探索。大多数带有喂养管的中风患者都被接受 护理设施（SNF），质量差异很大。从来没有研究确定过影响的SNF功能 这些患者是恢复口腔进食还是返回家乡的能力。对 管子喂养的老年人患者的临床过程不仅可以帮助这些患者的现实期望 和家庭，但也确定了可能改变的因素，以促进长期的积极结果。这 该建议的重大目标是衡量临床年龄较大的临床过程中的关键长期结果 喂食管的人插入了冲程后，并识别与患者和SNF级因素相关的人 更好的结果。为了进行这项研究，我们将利用2011年的几个全国性数据库 - 2015年，包括：Medicare索赔，最低数据集（MDS）以及认证和调查提供商 增强报告（CASPER）数据。在AIM 1中，已接纳SNF的65岁以上患者的临床过程 住院后急性护理急性缺血性中风，插入喂食管的急性缺血性中风 以下主要结果：1）90天的处置，2）喂食管使用在90天，3）死亡时间或 临终关怀。与这些结果相关的SNF时，患者特征将是 确定。在长期疗养院居民中，MDS数据将用于检查使用管的使用， 亚急性护理后180和365天的功能和认知状况。 AIM 2将确定 跨SNF的结局变化，（调整了患者和区域因素后）确定SNF 与主要结果相关的特征（例如，中风患者数量，言语病理学家人员配备）。 影响：拟议的研究将是对临床课程的首次严格，全国范围的检查 老年患者的进食管插入后触摸后的预后决定因素。因此，它具有 产生对未来护理需求的更现实期望并帮助确定可寻址的潜力 可以改善这些患者结果的因素（即，数量最少和专业人才 急性后设施的要求）。最后，这项研究和专业发展计划将有助于PI 发展成为少数具有衰老，神经病学和姑息治疗专业知识的独立研究人员之一。

项目成果

Neurotoxicology Syndromes Associated with Drugs of Abuse.

• DOI: 10.1016/j.ncl.2020.08.005
• 发表时间: 2020-11
• 期刊: Neurologic clinics
• 影响因子: 2.4
• 作者: Caplan RA;Zuflacht JP;Barash JA;Fehnel CR
• 通讯作者: Fehnel CR

Delayed Cerebral Abscess Formation After Posterior Cerebral Artery Stroke in a Patient With Opioid Use Disorder.

• DOI: 10.1161/strokeaha.120.031081
• 发表时间: 2021-03
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Zuflacht JP;Fehnel CR
• 通讯作者: Fehnel CR

Sodium Variability and Probability of Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage.

• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106186
• 发表时间: 2022-01
• 期刊: JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
• 影响因子: 2.5
• 作者: Chua, Melissa M. J.;Enriquez-Marulanda, Alejandro;Gomez-Paz, Santiago;Akamatsu, Yosuke;Salem, Mohamed M.;Maragkos, Georgios A.;Ascanio, Luis C.;Hanafy, Khalid A.;Fehnel, Corey R.;Ogilvy, Christopher S.;Moore, Justin;Thomas, Ajith J.
• 通讯作者: Thomas, Ajith J.