The Impact of Disruptive Events Among Community-Dwelling Persons with Dementia

破坏性事件对社区痴呆症患者的影响

基本信息

批准号：
10689052
负责人：
R. Sean Morrison
金额：
$ 15.79万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-30 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10689052
关键词：
Admission activity Adult Children Alzheimer&apos s disease related dementia Antibiotics Attention Caregivers Caring Cessation of life Clinical Communities Data Decision Making Dementia Disease Elderly Emergency department visit Emotional Event Family Health Health Care Costs Health and Retirement Study Health system Healthcare Systems Heterogeneity Hip Fractures Home Hospitalization Hour Incidence Intervention Knowledge Link Measures Medical Medicare Medicare claim Modeling Nursing Homes Occupational activity of managing finances Operative Surgical Procedures Outcome Patients Persons Physical Function Physiological Pneumonia Policies Policy Maker Population Prevalence Prognosis Research Self Care Serious Adverse Event Spouses System Traumatic injury Uncertainty Work advanced dementia adverse outcome care systems cognitive function comorbidity cost design end of life experience functional decline health care service utilization high risk hospital readmission improved population based prevent prognostic repaired social sociodemographics therapy design

项目摘要

RP2 PROJECT SUMMARY Traditional models of the experience of persons with Alzheimer’s disease and related dementias have largely focused on the inexorable dwindling of physical and cognitive function. Recent research by our group, others, and clinical experience suggest that persons with Alzheimer’s disease and related dementias experience sudden serious adverse events that markedly alter disease trajectory. Such “disruptive events” can include traumatic injuries such as hip fracture, medical events like pneumonia, or social or emotional upheavals such as the death of a spouse. There is a critical need to understand the impact of disruptive events on persons with Alzheimer’s disease and related dementias and families, including functional decline, survival, and need for increased personal care, as well as their impact on the healthcare system, including healthcare costs and service use. We will use the longitudinal, nationally representative Health and Retirement Study linked to Medicare claims to characterize the incidence and impact of disruptive events on community-dwelling persons with Alzheimer’s disease and related dementias. We will focus on three examples of disruptive events that prior work suggests may differentially impact persons with Alzheimer’s disease and related dementias: (1) hip fracture (i.e. surgical crisis); (2) hospitalization for pneumonia (i.e. medical crisis); or (3) death of a spouse (i.e. social crisis). We will examine the impact of these events on outcomes that are meaningful to patients, families, and health systems by a) comparing trajectories and outcomes for persons without dementia who experience disruptive events and b) comparing trajectories and outcomes for persons with Alzheimer’s disease and related dementias experiencing or not experiencing disruptive events. Our specific aims are: (1) To determine the incidence of the disruptive events among persons with Alzheimer’s disease and related dementias; (2) To compare the impact of disruptive events in persons with and without Alzheimer’s disease and related dementias; and (3) To examine persons with Alzheimer’s disease and related dementias who do and do not experience disruptive events. The knowledge gained from this proposal will guide community- dwelling persons with Alzheimer’s disease and related dementias, caregivers, and clinicians in decision making and planning for outcomes following disruptive events, inform the design of interventions to prevent or delay negative outcomes following a disruptive event, and lead to policy changes that prepare our health and social systems for the rising prevalence of dementia.

RP2 项目摘要阿尔茨海默病和相关痴呆症患者经历的传统模型我们小组最近的研究主要集中在身体和认知功能的不可避免的衰退上。其他人以及临床经验表明，患有阿尔茨海默病和相关痴呆症的人经历突然的严重不良事件会显着改变疾病轨迹。包括髋部骨折等外伤、肺炎等医疗事件或社交或情感因素配偶去世等剧变非常需要了解破坏性事件的影响。对阿尔茨海默病和相关痴呆症患者及其家庭的影响，包括功能衰退、生存、和增加个人护理的需求，以及它们对医疗保健系统的影响，包括医疗保健我们将使用具有全国代表性的纵向健康和退休研究。与医疗保险索赔相关联，以描述破坏性事件对社区住宅的发生率和影响我们将重点关注三个破坏性事件的例子。先前的研究表明可能会对阿尔茨海默病和相关痴呆症患者产生不同的影响：(1) 髋部骨折（即手术危机）；（2）因肺炎住院（即医疗危机）或（3）配偶死亡；（即社会危机）。我们将研究这些事件对患者有意义的结果的影响，家庭和卫生系统，a) 比较没有痴呆症的人的轨迹和结果经历破坏性事件 b) 比较阿尔茨海默病患者的轨迹和结果以及正在经历或未经历破坏性事件的相关痴呆症患者。我们的具体目标是：(1) 确定阿尔茨海默病及相关疾病患者中破坏性事件的发生率 (2) 比较破坏性事件对阿尔茨海默病患者和非阿尔茨海默病患者的影响和相关痴呆症；以及 (3) 检查患有阿尔茨海默病和相关痴呆症的人并且不经历破坏性事件从该提案中获得的知识将指导社区 - 患有阿尔茨海默病和相关痴呆症的居民、护理人员和新移民参与决策并规划破坏性事件后的结果，为预防或延迟干预措施的设计提供信息破坏性事件后产生负面结果，并导致政策变化，为我们的健康和社会做好准备痴呆症患病率上升的系统。