The confluence of extreme heat cold on the health and longevity of an Aging Population with Alzheimers and related Dementia

极热寒冷对患有阿尔茨海默病和相关痴呆症的老年人口的健康和寿命的影响

• 批准号: 10448053
• 负责人: Francesca Dominici
• 金额: $ 238.55万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448053
• 关键词: Admission activity; Age-Years; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Antipsychotic Agents; Biological; Cardiovascular system; Cause of Death; Characteristics; Code; Cognitive; Computing Methodologies; Confidence Intervals; Confusion; Data; Dementia; Disease; Elderly; Emergency department visit; Epidemiology; Event; Exposure to; Frequencies; Future; Geographic Distribution; Goals; Health; High Performance Computing; Hospitalization; Image; Impaired cognition; Individual; Kidney Diseases; Link; Long-Term Effects; Longevity; Longitudinal cohort; Maps; Medicare; Memory Loss; Methods; Outcome; Pathway interactions; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Primary Health Care; Problem Solving; Psyche structure; Research; Resolution; Respiratory Disease; Risk; Risk Factors; Severities; Specialist; Temperature; Time; To specify; Visit; Visual; Vulnerable Populations; Weather; aging population; base; beneficiary; climate change; cohort; environmental change; extreme heat; extreme temperature; extreme weather; follow-up; health care service utilization; hospital readmission; human old age (65+); improved; interest; mortality; novel; patient population; phenotyping algorithm; resilience; response; spatiotemporal; stressor; tool; trend

Project Summary/Abstract About ten percent of Americans older than 65 (5.8 million) are estimated to live with Alzheimer’s dementia (AD) or related dementias (ADRD), constituting the 5th leading cause of death among 65 and older in the U.S. Yet, our estimates from the prevalence of AD/ADRD outdated and the vulnerabilities of the older adults living with AD/ADRD to extreme environmental change remain unknown. Understanding the vulnerabilities of these populations is critical due to two of the most prominent upcoming global challenges: a growing aging population and a changing climate. On the one hand, the number of Americans ages 65 and older is projected to nearly double, while those with AD/ADRD are projected to nearly triple by 2050. On the other hand, the severity and frequency of the extreme environmental changes, such as extreme heat and cold events, are expected to increase due to climate change. Extreme heat/cold events can increase mortality and healthcare utilization outcomes (e.g., hospitalization) among older adults. More frequent and intense extreme heat and cold events can pose disproportionate risks to the elderly population living with AD/ADRD through certain cognitive biologic pathways. However, we do not know about potential pathways through which exposure to extreme changes in ambient temperature may directly (or indirectly through other stressors) impact older AD/ADRD patients, whose responses to extreme environmental change may be disrupted/delayed due to memory loss, challenges in planning and solving problems, trouble in understanding visual images, and confusion with time and place. Our goal is to characterize the extent of the exacerbation of cause-specific healthcare utilization outcomes (i.e., hospitalizations, hospital readmissions within 30 days, primary care visits, and specialist visits) and mortality due to extreme heat/cold events, among the older adults living with AD/ADRD. Using a longitudinal cohort of over 63 million Medicare enrollees (≥65 years), we will apply comprehensive and well-validated computational approaches to study the immediate, short-, and long-term effects of extreme heat and cold events on healthcare utilization outcomes and mortality. In Aim 1, we will develop and validate computational methodologies to improve misclassification in AD/ADRD cohort identification, estimate and project the prevalence of the older adults living with dementia, build high-resolution spatio-temporal maps of extreme heat and cold events that can be integrated with administrative data (Aim 1c). In Aim 2, we will estimate the immediate and short-term effects of extreme heat and cold events on mortality and hospitalization (admission and emergency department visits) among the elderly population with AD/ADRD. Aim 3 will entail developing and deploying a high-performance computing pipeline to discover de novo and/or unanticipated causal links between long-term exposure to extreme temperature events and cause-specific healthcare utilization outcomes among older adults living with Alzheimer’s or related dementias.

项目总结/摘要 据估计，65岁以上的美国人中约有10%（580万）患有阿尔茨海默氏痴呆症（AD）。 或相关痴呆症（ADRD），构成了美国65岁及以上人群的第五大死亡原因。然而， 我们对AD/ADRD患病率的估计已经过时， AD/ADRD对极端环境变化的影响仍然未知。了解这些漏洞 人口问题至关重要，因为即将到来的两个最突出的全球挑战是：日益老龄化 人口和气候变化。一方面，预计65岁及以上的美国人的数量 到2050年，AD/ADRD患者预计将增加近两倍。另一方面 极端环境变化的严重性和频率，如极端高温和低温事件， 由于气候变化，预计将增加。极端高温/低温事件会增加死亡率和医疗保健 利用结果（例如，老年人（老年人）。更频繁和强烈的极端高温， 寒冷事件可通过某些途径对AD/ADRD老年人群造成不成比例的风险， 认知生物学途径然而，我们不知道通过哪些潜在途径暴露于 环境温度的极端变化可能直接（或通过其他压力源间接）影响老年人 AD/ADRD患者，其对极端环境变化的反应可能因以下原因而中断/延迟 记忆丧失，计划和解决问题的挑战，理解视觉图像的困难，以及 时间和地点的混淆。我们的目标是描述特定原因的恶化程度 保健利用结果（即，住院治疗，30天内再次入院，初级保健就诊， 和专家访问）和死亡率由于极端热/冷事件，在老年人生活在 AD/ADRD。使用超过6300万Medicare登记者（≥65岁）的纵向队列，我们将申请 全面和有效的计算方法来研究即时，短期和长期 极端高温和低温事件对医疗保健利用结果和死亡率的影响。在目标1中，我们 开发并验证计算方法，以改善AD/ADRD队列的错误分类 识别、估计和预测老年痴呆症患者的患病率，建立高分辨率的 可与行政数据相结合的极端高温和低温事件的时空图（目标1c）。 在目标2中，我们将估计极端高温和低温事件对死亡率的即时和短期影响 和住院治疗（入院和急诊）的老年人群与AD/ADRD。 目标3将需要开发和部署一个高性能计算管道，以发现新的和/或 长期暴露于极端温度事件和特定原因之间的意外因果关系 老年痴呆症或相关痴呆症患者的医疗保健利用结果。