The ADEPT Study: Estimating Prognosis in Advanced Dementia

ADEPT 研究：评估晚期痴呆症的预后

• 批准号: 7637346
• 负责人: SUSAN L MITCHELL
• 金额: $ 29.4万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7637346
• 关键词: Address; Alzheimer' s Disease; American; Caring; Cessation of life; Clinical; Clinical Research; Data; Data Set; Databases; Decision Making; Dementia; Elderly; Eligibility Determination; Enrollment; Evaluation; Foundations; Goals; Guidelines; Hospice Care; Letters; Life Expectancy; Life Experience; Long-Term Care Nursing; Measures; Medicare; Methods; Nursing Homes; Palliative Care; Patients; Persons; Policies; Population; Principal Investigator; Provider; Research Personnel; Research Priority; Risk; Services; Validation; Work; advanced dementia; base; cohort; end of life; end of life care; end-of-life decision making; high risk; hospice environment; improved; instrument; mortality; outcome forecast; prognostic; programs; prospective; success; tool

DESCRIPTION (provided by applicant): Advanced dementia is a common, morbid and costly condition. The current standard of palliative care provided to the growing number of Americans dying with dementia is sub-optimal. The challenge of accurately estimating the life expectancy in advanced dementia is a major barrier to providing this care. Prognostication is needed to inform clinical decision-making and to access the Medicare hospice benefit. Hospice grossly under-serves persons with dementia largely due to difficulties predicting six-month survival. Current hospice eligibility guidelines for dementia are not based on empircally derived prognostic measures, and therefore completely fail to accurately estimate survival. Thus, the over-riding goal of the ADEPT study is to create a valid and practical risk score, the Advanced DEmentia Prognostic Tool, which will identify persons with advanced dementia at a high risk of death. To accomplish this goal, and building on the success of earlier work by the PI, we will develop the risk score using secondary data from a nationwide nursing home (NH) database, and then prospectively validate the score at the bedside. Our aims are: 1 To derive and validate a mortality risk score in a nationwide population of 237,783 NH residents with advanced dementia using 2002 Minimum Data Set (MDS) assessments; 2. To compare the accuracy of the risk score to predict six-month survival with current hospice eligibility criteria for dementia using 2002 MDS assessments; 3. To establish a cohort of 400 NH residents with advanced dementia and conduct a second, prospective validation of the mortality risk score to demonstrate that the tool is practical and effective at the bedside; and 4. To conduct a second, prospective comparison of the accuracy of the ADEPT risk score with hospice eligibility criteria for dementia. Implications: The proposed work to create a valid and practical instrument to estimate survival in advanced dementia, represents an opportunity to improve end-of-life decision-making and promote access to hospice services for the over 4.5 million Americans with dementia. The ADEPT instrument will also provide palliative care researchers with a method to identify subjects with advanced dementia at high mortality risk. Thus, the information derived from this study has the potential to make important clinical, research and policy-relevant contributions to the care of older persons with dementia at the end-of-life.

描述（由申请人提供）：晚期痴呆症是一种常见，病态且昂贵的状况。当前为日益增长的痴呆症的美国人提供的姑息治疗标准是最佳的。准确估计晚期痴呆症预期寿命的挑战是提供此护理的主要障碍。需要预后才能为临床决策提供信息，并获得Medicare临终关怀的福利。临终关怀的痴呆症患者的临终关怀不足，这主要是由于难以预测六个月生存的困难。痴呆症的当前临终关怀准则不是基于额外的预后措施，因此完全无法准确估计生存率。因此，熟练研究的过度目标是创建一个有效且实用的风险评分，即先进的痴呆预后工具，该工具将确定患有高级痴呆症患者的死亡风险高。为了实现这一目标，并基于PI的早期工作的成功，我们将使用来自全国范围内疗养院（NH）数据库的辅助数据来开发风险评分，然后前瞻性地验证床边的分数。我们的目标是：1使用2002最低数据集（MDS）评估，在237,783 NH居民的全国人口中得出和验证死亡率风险评分； 2。要比较风险评分的准确性，以预测六个月的生存与当前使用2002 MDS评估的痴呆症临终关怀标准相比； 3。建立一个患有晚期痴呆症的400名NH居民的队列，并进行第二次对死亡率风险评分的前瞻性验证，以证明该工具在床边是实际且有效的；和4。进行第二次前瞻性比较，将熟练的风险评分与痴呆症的临终关怀标准进行预期。含义：拟议的工作旨在创建一种有效且实用的工具来估计高级痴呆症生存，这是一个改善寿命终止决策并促进450万美国痴呆症的美国人的临终关怀服务的机会。熟练的工具还将为姑息治疗研究人员提供一种方法，以识别患有高死亡率风险的高级痴呆症受试者。因此，从这项研究中得出的信息有可能对在终止生命的痴呆症的老年人的护理中做出重要的临床，研究和政策贡献。