Communication in the Hospital: Impact on Patients with Alzheimer's Disease and Other Causes of Cognitive Impairments and their Surrogate Decision Makers

医院沟通：对阿尔茨海默病和其他认知障碍原因患者及其替代决策者的影响

• 批准号: 10606575
• 负责人: Alexia Mary Torke
• 金额: $ 17.76万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10606575
• 关键词: Address; Admission activity; Advance Care Planning; Age; Aging; Alexia; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Amber; Anxiety; Appointment; Asian; Award; Belief; COVID-19; COVID-19 outbreak; COVID-19 pandemic; Caring; Cessation of life; Chaplain; Clinical; Clinical Sciences; Communication; Country; Critical Illness; Decision Making; Dementia; Distress; Doctor of Philosophy; Education; Effectiveness; Elderly; Emotional; Enrollment; Ethics; Ethnic Origin; Faculty; Family; Family member; Funding; Future; Goals; Grant; Health; Heart failure; Hispanic; Home; Hospitalization; Hospitals; Impaired cognition; Indiana; Infrastructure; Intervention; Intervention Studies; K-Series Research Career Programs; Latinx; Learning; Life; Location; Manuscripts; Medical; Medical center; Mental Depression; Mentors; Mentorship; Methods; Midwestern United States; Multicenter Trials; Outpatients; Palliative Care; Patient Care; Patients; Personal Satisfaction; Persons; Pilot Projects; Population; Pragmatic clinical trial; Preparation; Process; Publishing; Race; Randomized, Controlled Trials; Religion; Reporting; Research; Research Methodology; Research Personnel; Research Training; Resources; Risk; Schedule; Skilled Nursing Facilities; Source; Spiritual care; Spirituality; Stress; Stroke; Technology; Telephone; Testing; Time; Translational Research; Universities; Videoconferencing; Work; career; clinical investigation; clinical translation; early experience; experience; family support; future pandemic; improved; innovation; intervention delivery; new technology; pandemic disease; patient oriented research; post-traumatic symptoms; programs; research study; success; surrogate decision maker; surrogate decision making; symposium; telephone delivery; volunteer

ABSTRACT Nearly half of hospitalized older adults are unable to make their own medical decisions and require a family member or other surrogate to make decisions for them. Many surrogates make decisions about life and death issues under conditions of high stress and often with poor support from clinicians. Surrogates rely on various sources of emotional support and sources of value to make medical decisions, including personal, religious and spiritual beliefs. However, both surrogates and clinicians report high levels of distress due to the emotional and communication challenges of making decisions for others. As the population ages and a greater number of older adults are at risk for cognitive impairment, the importance of surrogate decision making will only increase. The COVID-19 pandemic has added greater urgency due to the many cognitively impaired patients separated from their families during life threatening illness and hospitalization. Developing interventions to promote high quality decision making will allow us to best support family members and to provide the best possible care to older adults with Alzheimer’s disease and related disorders. Dr. Alexia Torke’s research has focused on the communication, ethical, religious and spiritual aspects of decision making for those patients who are incapacitated and require a family surrogate to make decisions for them. During her current period of funding from her K24 Midcareer Award in Patient Oriented Research, she achieved the research goals proposed in the award, obtained an R01 grant as PI, and mentored several successful junior faculty. This K24 renewal will continue to provide support for Dr. Torke’s program of research and will allow her additional protected time to pursue her passion for mentoring others. The specific aims of this proposal are to develop the national network for a multicenter trial of spiritual care delivered via telephone or video for surrogate decision makers of older adults in the ICU; conduct a pilot study of the effects of scheduled video and audio conferencing facilitated by clinical navigators on the experience of surrogate decision makers for hospitalized older adult patients who are incapacitated due to Alzheimer’s disease and other causes of cognitive impairment; and continue to provide mentorship to junior investigators conducting research on older adults who are vulnerable due to AD and other conditions. Indiana University provides an ideal location for this work. Dr. Torke’s primary appointment is in the IU Center for Aging Research. The Center has provided infrastructure, intramural funding and space for Dr. Torke’s research and for support of her mentees. Additional resources such as the Indiana Clinical and Translational Sciences Institute and the Clinical Investigation and Translational Education program enrich opportunities for mentees to obtain research training and funding support.

抽象的 近一半的住院老年人无法做出自己的医疗决定，需要 家庭成员或其他代理人为他们做出决定。许多代理人就生活和 在高压力条件下的死亡问题，通常在临床医生的支持下差。代理人依靠 情感支持和价值来源的各种来源，以做出医疗决定，包括个人， 宗教和精神信仰。但是，代理人和临床医生都报告了由于 为他人做出决策的情感和沟通挑战。随着人口的年龄和更大的年龄 老年人的人数有认知障碍的风险，替代决策的重要性将 只会增加。由于许多认知障碍，共同19-19大流行使更紧迫 在威胁生命的疾病和住院期间，患者与家人分离。发展 促进高质量决策的干预措施将使我们能够为家庭成员提供最好的支持和 为患有阿尔茨海默氏病和相关疾病的老年人提供最好的护理。 Alexia Torke博士的研究集中于交流，道德，宗教和精神方面 为那些无能力的患者做出决策，要求家庭代理做决定 为他们。在她目前获得的K24中级护理奖的资金期间，以患者为导向的研究， 她实现了该奖项中提出的研究目标，获得了R01赠款作为PI，并修补了几项 成功的初级教师。此K24更新将继续为Torke博士的研究计划提供支持 并将让她额外的保护时间追求她对指导他人的热情。 该提案的具体目的是开发国家网络进行精神上的多中心试验 通过电话或视频为ICU老年人的替代决策者提供护理；进行飞行员 研究临床导航员准备的预定视频和音频会议的影响 为住院的老年人患者提供替代决策者的经验，这些患者因 阿尔茨海默氏病和其他认知障碍的原因；并继续为初中提供精神训练 研究人员对由于AD和其他条件而脆弱的老年人进行研究。 印第安纳大学为这项工作提供了理想的位置。 Torke博士的主要任命是在IU中 老化研究中心。该中心为博士提供了基础设施，壁内资金和空间。 托克的研究和支持她的梅内斯。其他资源，例如印第安纳州的临床和 翻译科学研究所以及临床调查和转化教育计划丰富 受训者获得研究培训和资金支持的机会。