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: 10214974
• 负责人: Alexia Mary Torke
• 金额: $ 18.1万
• 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/10214974
• 关键词: Address; Advance Care Planning; Age; Aging; Alexia; Alzheimer' s Disease; Alzheimer' s disease related dementia; Amber; Anxiety; Appointment; Asians; Award; Belief; COVID-19; COVID-19 outbreak; COVID-19 pandemic; Caring; Cessation of life; Clinical; Clinical Sciences; Communication; Country; Critical Illness; Decision Making; Dementia; Disease; Distress; Doctor of Philosophy; Education; Effectiveness; Elderly; Emotional; Enrollment; Ethics; Ethnic Origin; Faculty; Family; Family member; Funding; Future; Goals; Grant; Health; Heart failure; Hispanics; Home; Hospitalization; Hospitals; Impaired cognition; Indiana; Infrastructure; Institutes; Intervention; Intervention Studies; K-Series Research Career Programs; Latinx; Lead; 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; Religion and Spirituality; Reporting; Research; Research Methodology; Research Personnel; Research Support; Research Training; Resources; Risk; Schedule; Skilled Nursing Facilities; Source; Stress; Stroke; Technology; Telephone; Testing; Time; Translational Research; Universities; Videoconferencing; Work; clinical investigation; early experience; experience; family support; improved; innovation; new technology; pandemic disease; patient oriented research; post-traumatic symptoms; programs; research study; success; surrogate decision maker; surrogate decision making; symposium; 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自己做出医疗决定，需要医生的帮助 家庭成员或其他代理人为他们做出决定 许多代理人做出有关生活和生活的决定。 死亡问题是在高压力的情况下进行的，而且往往得不到选民的支持。 做出医疗决定的各种情感支持和价值来源，包括个人、 然而，代孕妈妈和代孕妈妈都表示，由于宗教和精神信仰，他们感到非常痛苦。 随着人口老龄化和更大程度的增加，为他人做决定的情感和沟通方面的挑战。 由于许多老年人面临认知障碍的风险，代理决策的重要性将 由于许多人患有认知障碍，COVID-19 大流行加剧了紧迫性。 患者在危及生命的疾病和住院期间与家人分离。 促进高质量决策的干预措施将使我们能够最好地支持家庭成员并 为患有阿尔茨海默病和相关疾病的老年人提供最好的护理。 Alexia Torke 博士的研究重点是沟通、伦理、宗教和精神方面 为那些无行为能力并需要家庭代理人做出决定的患者提供决策支持 在她目前获得 K24 Midcareer Award 的以患者为导向的研究资助期间， 她实现了该奖项中提出的研究目标，作为 PI 获得了 R01 资助，并指导了几位 此次 K24 续聘将继续为 Torke 博士的研究项目提供支持。 并将让她有更多受保护的时间来追求指导他人的热情。 该提案的具体目标是发展全国网络进行多中心灵性审判 通过电话或视频为 ICU 中老年人的代理决策者提供护理进行试点； 研究由临床导航员促成的预定视频和音频会议对患者的影响 代理决策者为因以下原因而丧失行为能力的住院老年患者提供的经验： 阿尔茨海默病和其他导致认知障碍的原因；并继续为青少年提供指导； 研究人员对因 AD 和其他疾病而易受伤害的老年人进行研究。 印第安纳大学为托克博士的这项工作提供了理想的地点。 老龄化研究中心 该中心为博士提供了基础设施、校内资金和空间。 托克的研究以及对她的学员的支持，例如印第安纳临床和 转化科学研究所以及临床研究和转化教育项目丰富 受训者获得研究培训和资金支持的机会。