Evaluating the Unmet Needs of Older Adults to Promote Functional Recovery after a Critical Illness (LANTERN)

评估老年人未满足的需求以促进危重疾病后的功能恢复（LANTERN）

• 批准号: 10735299
• 负责人: Lauren Ferrante
• 金额: $ 85.65万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10735299
• 关键词: Activities of Daily Living; Address; Admission activity; Affect; Age; American; Caregivers; Caring; Clinical; Communities; Critical Illness; Data; Dependence; Destinations; Development; Elderly; Enrollment; Evaluation; Evidence based intervention; Foundations; Frequencies; Future; Geriatrics; Goals; Health system; Hearing; Home; Home Care Services; Home environment; Hospitalization; Hospitals; Impairment; Intensive Care Units; Intervention; Interview; Left; Logistics; Mission; Modification; Nursing Homes; Outcome; Participant; Patients; Persons; Population; Public Health; Recovery; Recovery of Function; Rehabilitation therapy; Research; Sensory; Services; Severities; Societies; Structure; Survivors; Testing; United States National Institutes of Health; Vision; Work; aged; clinically relevant; cohort; disability; disability burden; evidence base; frailty; functional improvement; functional outcomes; health management; hospital readmission; improved; innovation; lens; mortality; rehabilitation service; skills; therapy development

Nearly 2 million persons aged 65 years or older are admitted to an intensive care unit (ICU) each year; of those who survive, half will not achieve functional recovery over the subsequent months. To date, prior post-ICU in- terventions targeting functional outcomes have not been successful; moreover, no prior post-ICU interventions targeting functional recovery have focused on older adults, who are more vulnerable to poor functional out- comes than their younger counterparts. Our long-term goal is to develop interventions to improve functional outcomes among older ICU survivors. Our preliminary data suggest that unmet needs across four domains (home environment, skilled rehabilitation, hearing and vision, and informal and formal care) may adversely af- fect functional recovery among older adults who have returned home (either directly or after short-term rehab [STR]) after an ICU hospitalization. The overall objective of this application is to elucidate the unmet needs of older ICU survivors, evaluate the association of these unmet needs with disability, hospital readmissions, and mortality over the subsequent 6 months, and assess barriers and facilitators to addressing these unmet needs. The central hypothesis is that older ICU survivors have unmet needs in the aforementioned domains that rep- resent potential targets for intervention, and that these unmet needs are associated with disability burden, hos- pital readmissions, and mortality. The rationale for the proposed research is that this work will directly inform the development of an intervention to address unmet needs and facilitate functional recovery among older ICU survivors. The central hypothesis will be tested by enrolling a new cohort of older ICU survivors to achieve the following specific aims: 1) To identify unmet needs in multiple domains after return home from an ICU hospitali- zation, evaluate whether these unmet needs are associated with disability burden in the subsequent 6 months, and ascertain whether these associations are moderated by initial discharge destination (home or STR); the domains include: the home environment, skilled rehabilitation services, sensory needs (in hearing and vision), and informal (unpaid) care and formal (paid) home care services; 2) To evaluate the association of unmet needs in these multiple domains with hospital readmissions and mortality over the subsequent 6 months; and 3) Through qualitative interviews with a subset of older ICU survivors (and their caregivers, if applicable), to explore barriers to addressing unmet needs and to gather patient and caregiver input about facilitators in ad- dressing unmet needs to inform a future intervention. The proposed research is innovative because it will use a geriatrics lens to rigorously evaluate unmet needs across multiple domains, which in turn will directly inform the development of a future intervention to facilitate functional recovery among older ICU survivors by addressing these unmet needs. The research proposed in this application will provide a strong evidence base for actiona- ble targets to reduce disability, hospital readmissions, and mortality among older adults who have survived a critical illness, in line with NIA’s strategic priorities.

每年有近200万人年龄在65岁以上的人被接受重症监护室（ICU）；那些 生存的人，一半将在随后的几个月内实现功能恢复。迄今为止，事先ICU 靶向功能结果的趋势尚未成功；此外，没有事先的ICU干预措施 靶向功能恢复的重点是老年人，他们更容易受到功能不良的影响。 比他们年轻的同行来了。我们的长期目标是制定干预措施以提高功能 较旧的ICU存活率的结果。我们的初步数据表明，四个领域的需求未满足 （家庭环境，熟练的康复，听力和视觉以及非正式和正式护理）可能会对 返回家园的老年人的功能恢复（直接或短期康复后 [str]）在ICU住院后。该应用的总体目的是阐明未满足的需求 较旧的ICU表面，评估这些未满足需求与残疾，医院再入院和 在随后的6个月内死亡率，并评估障碍和协助者以满足这些未满足的需求。 中心假设是，较旧的ICU存活物在代表的近似结构域中具有未满足的需求 令人讨厌的干预潜在目标，并且这些未满足的需求与残疾燃烧有关 PITAL RECHMISSIONS和死亡率。拟议的研究的理由是，这项工作将直接告知 开发干预措施，以满足未满足的需求并促进旧ICU的功能恢复 幸存者。中央假设将通过招募新的旧ICU存活群来测试中心假设以实现 以下具体目的：1）从ICU医院返回家乡后，确定多个领域的未满足需求 zaation，评估这些未满足的需求是否与随后6个月的残疾燃烧有关， 并确定这些关联是通过初始出院目的地（家还是str）调节的；这 领域包括：家庭环境，熟练的康复服务，感官需求（听力和视觉）， 以及非正式的（无薪）护理和正式（付费）家庭护理服务； 2）评估未安装的关联 随后6个月内，这些具有医院再入院和死亡率的多个领域的需求；和 3）通过与较旧的ICU幸存物（及其护理人员（如果适用））的定性访谈，以 探索满足未满足需求的障碍，并收集有关促进者的患者和照顾者的意见 穿衣服未满足，需要告知将来的干预措施。拟议的研究具有创新性，因为它将使用 老年医学镜头可以严格评估多个领域的未满足需求，这又将直接告知 开发未来的干预措施，以促进较旧的ICU表面的功能恢复 这些未满足的需求。本应用程序中提出的研究将为行动提供强大的证据基础 - 降低残疾，医院再入院和死亡率的目标，他们幸存于 重症疾病，符合NIA的战略重点。