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

摘要 近一半住院的老年人无法做出自己的医疗决定，需要 家庭成员或其他代孕母亲为他们做决定。许多代孕者对生活和生活做出决定 高压力条件下的死亡问题，而且往往得不到临床医生的支持。代理依赖于 做出医疗决定的各种情感支持和价值来源，包括个人， 宗教和精神信仰。然而，代孕者和临床医生都报告了由于 为他人做决定的情感和沟通挑战。随着人口老龄化和更大的 许多老年人面临认知障碍的风险，代孕决策的重要性将 只会增加。由于许多认知受损，新冠肺炎大流行增加了更大的紧迫性 在危及生命的疾病和住院期间，患者与家人分离。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并 为患有阿尔茨海默氏症和相关疾病的老年人提供尽可能好的护理。 Alexia Torke博士的研究主要集中在沟通、伦理、宗教和精神方面 为那些无行为能力并需要家庭代孕的患者做出决定 对他们来说。在她目前获得的以患者为导向的K24中期研究奖的资助期间， 她实现了奖项中提出的研究目标，以PI的身份获得了R01拨款，并指导了几个 成功的初级教员。这次K24更新将继续为Torke博士的研究计划提供支持 并将让她有更多受保护的时间来追求她对指导他人的热情。 这项提议的具体目标是发展多中心精神审判的全国网络。 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 临床导航员安排视听会议对患者心理健康影响的研究 老年住院患者因以下原因致残的替代决策体会 阿尔茨海默氏症和其他导致认知障碍的原因；并继续为青少年提供指导 研究人员对因阿尔茨海默病和其他疾病而易受伤害的老年人进行研究。 印第安纳大学为这项工作提供了一个理想的地点。托克医生的主要预约是在重症监护室 老龄化研究中心。该中心已经为Dr。 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 翻译科学研究所和临床研究和翻译教育计划丰富 为学员提供获得研究、培训和资金支持的机会。

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.