Mid-Career Mentoring Award in Palliative Care, Aging, and Cognitive Impairment

项目总结 姑息治疗的重点是提高严重疾病患者及其家庭照顾者的生活质量 疾病的任何阶段，并使医疗与一个人的价值观和目标相一致。老年人患有 严重的疾病，如心力衰竭(HF)或慢性阻塞性肺疾病(COPD)，有许多 姑息治疗的需要。然而，临终关怀通常是由临终关怀专家在疾病晚期提供的。 地老天荒。此外，姑息治疗是一种有限的资源，许多患有 心力衰竭或慢性阻塞性肺病及其家庭照顾者，特别是在城市贫困和农村环境中。此外，更年长的人 患有心力衰竭或慢性阻塞性肺病的成年人患有认知障碍和痴呆，这与病情恶化有关 结果。在之前的工作中，我测试了早期姑息护理干预对患有心力衰竭或慢性阻塞性肺疾病的成年人的效果。在……里面 在这项应用中，我建议进行新的研究，以确定如何将早期姑息治疗适应和实施到 有认知障碍或阿尔茨海默病的心力衰竭或慢性阻塞性肺病患者的初级保健环境 相关痴呆症。该提案的总体目标是：(1)培训学员(通过增加辅导 时间)增加成功的以患者为导向的研究人员队伍，他们将改善对 有严重疾病和认知障碍的老年人，以及(2)扩大我的研究技能和经验 初级保健中重病老年人的认知障碍和实施科学研究。这就做 通过额外的培训、研究经验和来自以下领域专家的指导来实现这些目标 认知障碍、实施科学和指导。在K24期间，我将与学员密切合作 制定个人职业生涯规划并进行研究，以促进其独立发展 姑息治疗、衰老和认知障碍方面的研究人员。本申请中提出的研究将： (1)确定认知障碍如何影响参与早期姑息治疗和姑息治疗 结果：我们将分析我的两项多点临床试验(一项)的认知功能和生活质量数据 已完成的，一个活跃的)患有心力衰竭或慢性阻塞性肺病的老年人，以及(2)动员初级保健利益相关者(临床医生， 领导、工作人员、患者和照顾者)，以确定在初级保健中实施哪些姑息护理干预措施 关心以及如何实施这些原则。拟议的研究，以实施科学的方式进行 合作者和被辅导者将提供关于如何适应和实施早期姑息治疗的新知识 为患有心力衰竭或慢性阻塞性肺病以及包括阿尔茨海默病在内的认知障碍的老年人提供初级保健 以及相关的痴呆症。我很高兴能培训下一代以患者为导向的姑息性研究人员 护理、衰老和认知障碍。以我在研究和指导方面的成功记录和资源 从K24和科罗拉多大学，我可以提供一个出色的训练环境。

PROJECT SUMMARY Palliative care focuses on improving quality of life for people with serious illness and their family caregivers at any stage of illness and aligning medical treatments with a persons' values and goals. Older adults with serious illnesses such as heart failure (HF) or chronic obstructive pulmonary disease (COPD) have numerous palliative care needs. However, palliative care is often provided late in illness by palliative care specialists, near the end of life. In addition, palliative care is a limited resource that is not available to many of the patients with HF or COPD and their family caregivers, especially in urban poor and rural settings. Furthermore, many older adults with HF or COPD have comorbid cognitive impairment and dementia which are associated with worse outcomes. In prior work, I tested the effect of early palliative care interventions for adults with HF or COPD. In this application, I propose new research to determine how to adapt and implement early palliative care into the primary care setting for patients with HF or COPD who have cognitive impairment or Alzheimer's disease and related dementias. The overall goals of this proposal are to (1) train mentees (through increased mentoring time) to increase the cadre of successful patient-oriented researchers who will improve care and outcomes for older adults with serious illness and cognitive impairment, and (2) expand my research skills and experience in cognitive impairment and implementation science research for seriously ill older adults in primary care. I will accomplish these goals through additional training, research experience, and mentorship from experts in cognitive impairment, implementation science, and mentoring. During the K24, I will work closely with mentees to develop individual career plans and conduct research to further their development as independent investigators in palliative care, aging, and cognitive impairment. The research proposed in this application will: (1) determine how cognitive impairment influences participation in early palliative care and palliative care outcomes; we will analyze cognitive function and quality of life data from two of my multisite clinical trials (one completed, one active) of older adults with HF or COPD, and (2) engage primary care stakeholders (clinicians, leaders, staff, patients, and caregivers) to identify which palliative care interventions to implement in primary care and how to implement them. The proposed research, conducted with implementation science collaborators and mentees, will provide new knowledge on how to adapt and implement early palliative care into primary care for older adults with HF or COPD and cognitive impairment, including Alzheimer's disease and related dementias. I am thrilled to train the next generation of patient-oriented researchers in palliative care, aging, and cognitive impairment. With my record of research and mentoring success and the resources from the K24 and the University of Colorado, I can provide an outstanding training environment.