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

摘要 近一半的住院老年人无法做出自己的医疗决定， 家庭成员或其他代理人为他们做决定。许多代理人对生活做出决定， 高压力条件下的死亡问题，往往与临床医生的支持不足。代孕妈妈依赖于 各种情感支持来源和做出医疗决定的价值来源，包括个人， 宗教和精神信仰。然而，代理人和临床医生都报告说， 为他人做决定的情感和沟通挑战。随着人口的老龄化和更大的 许多老年人有认知障碍的风险，替代决策的重要性将 只是增加。COVID-19大流行增加了更大的紧迫性，因为许多认知受损的人 在危及生命的疾病和住院期间与家人分离的患者。发展中 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， 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博士的研究集中在沟通，道德，宗教和精神方面 对于那些没有行为能力，需要家庭代理人做出决定的患者， 为他们在她目前的资金从她的K24中期职业生涯奖在病人为导向的研究， 她实现了奖项中提出的研究目标，获得了PI的R 01补助金，并指导了几个 成功的青年教师K24的更新将继续为Torke博士的研究计划提供支持。 并将允许她额外的保护时间去追求她对指导他人的热情。 这项建议的具体目标是发展国家网络，以进行多中心的精神审判。 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 临床导航员促进的预定视频和音频会议对 代理决策者对因以下原因而丧失能力的住院老年患者的经验 老年痴呆症和其他认知障碍的原因;并继续为初级 研究人员对易受AD和其他疾病影响的老年人进行研究。 印第安纳州大学为这项工作提供了一个理想的地点。Torke医生的主要预约是在IU 老龄化研究中心。该中心提供了基础设施，校内资金和空间博士。 托克的研究和对她的学员的支持。其他资源，如印第安纳州临床和 转化科学研究所和临床研究和转化教育计划丰富了 学员获得研究培训和资助的机会。

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.