Earlier Introductions to Palliative Care in Older Adults Undergoing High-Risk Surgery

早期介绍接受高风险手术的老年人的姑息治疗

• 批准号: 9812080
• 负责人: Pasithorn Suwanabol
• 金额: $ 11.21万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9812080
• 关键词: Address; Adult; Aging; Attention; Bereavement; Caring; Cessation of life; Clinical; Cognitive; Communication; Comorbidity; Complication; Computers; Data; Decision Making; Decision Support Systems; Dementia; Development; Elderly; Family; Foundations; Funding; Future; Health Status; Health and Retirement Study; Healthcare; Hospitals; Impaired cognition; Impairment; Individual; Infrastructure; Inpatients; Intervention; Interview; K-Series Research Career Programs; Knowledge; Life; Light; Link; Longitudinal Surveys; Medicare; Medicare claim; Mentorship; Methods; Michigan; Operative Surgical Procedures; Outcome; Palliative Care; Patients; Pattern; Perioperative complication; Phase; Physical Function; Physiological; Population; Postoperative Complications; Quality of life; Recovery; Reporting; Research; Research Personnel; Services; Structure; Surgeon; Surgical complication; Surveys; System; Testing; Time; United States; Work; base; care systems; career; clinical decision-making; cognitive function; design; disability; economic outcome; experience; functional decline; health care service utilization; health data; high risk; improved; insight; meetings; mortality; mortality risk; novel strategies; operation; palliative; patient oriented; perioperative mortality; post-traumatic stress; preference; programs; research clinical testing; skills; sociodemographics; surgical risk; symptomatic improvement

ABSTRACT By 2030, adults older than 65 years will exceed 20% of the U.S. population. In parallel to this rapidly-changing demographic, rates of surgery in this population are expected to increase by as much as 30%. Although substantial efforts have been made to reduce perioperative complications and mortality, far less attention has been aimed at the long-term implications of surgery in older adults. In such patients, functional and cognitive decline are common, and may persist or progress to permanent disability or dementia and even death. An in-depth understanding of these long-term implications will shed light on how and when to introduce palliative care strategies to such patients. Capitalizing on rich and longitudinal data from the Health and Retirement Study (HRS) linked to Medicare data, we will conduct a mixed methods evaluation of the clinical, functional, cognitive, and economic outcomes in older adult patients who suffer a serious complication following high-risk elective surgery (Aim 1). More than 27,000 individuals have participated in HRS since its inception in 1992, which details specific information on sociodemographics, health status, spending and utilization, and functional and cognitive status. Through the unique and robust collaborative infrastructure of surgical programs in the State of Michigan, we will then perform a qualitative analysis of surgeon-perceived barriers to use of palliative care services directly informed by our findings from the HRS analysis (Aim 2). This study will have immediate impact on local and national initiatives by revealing how surgeons and hospitals can better anticipate and manage older adult patients' needs who may undergo high-risk surgical procedures. Furthermore, results from this study will allow for the design and implementation of a computer-based, empirically-driven alert to screen for and prompt palliative care referrals in older adult patients who may undergo high-risk surgery. This proposal is the ideal mechanism for me to transition my research career to a focus on palliative care and aging. Successful completion of this project will promote my application for externally-funded career development awards such as the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76) and a subsequent R01. The project, mentorship, and educational plan will prepare me to be an independent investigator and national leader in palliative care and aging among surgical populations.

抽象的 到2030年，65岁以上的成年人将超过美国人口的20％。与这种快速变化的平行 人口统计学，该人群的手术率预计将增加30％。虽然 为了减少围手术期并发症和死亡率而做出了巨大的努力，注意力少得多 针对老年人手术的长期影响。在这样的患者中，功能和 认知能力下降很普遍，可能会持续或发展为永久性残疾或痴呆症，甚至 死亡。对这些长期影响的深入了解将阐明如何以及何时 向此类患者介绍姑息治疗策略。利用从 与Medicare数据相关的健康和退休研究（HRS），我们将对 遭受严重严重的老年患者的临床，功能，认知和经济成果 高危选修手术后的并发症（AIM 1）。超过27,000个人参加了 HR自1992年成立以来，详细介绍了有关社会人口统计学，健康状况， 支出和利用以及功能和认知状况。通过独特而强大的合作 然后，我们将在密歇根州进行手术计划的基础设施，然后我们将对 我们发现的HRS的发现直接告知外科医生的使用障碍物使用姑息治疗服务 分析（目标2）。这项研究将通过揭示当地和国家倡议立即影响 外科医生和医院如何更好地预测和管理老年人的患者需求 接受高危手术程序。此外，这项研究的结果将允许设计和 实施基于计算机的，经验驱动的警报，以筛选并提示姑息治疗推荐 在可能接受高风险手术的老年人中。这个建议是我的理想机制 将我的研究生涯转变为姑息治疗和衰老。成功完成该项目将 促进我申请外部资助的职业发展奖，例如Paul B. Beeson 新兴领导者衰老职业发展奖（K76）和随后的R01。项目，指导， 教育计划将使我成为姑息治疗的独立调查员和国家领导者 和手术人群之间的老化。