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

项目摘要/摘要 据估计，65岁以上的美国人中约有10%(580万)患有阿尔茨海默氏症(AD) 或相关痴呆症(ADRD)，在美国65岁及以上人群中占第五大死因。 我们根据AD/ADRD的流行率和老年人的脆弱性进行的估计已经过时 AD/ADRD对极端环境变化的影响仍然未知。了解这些服务器的漏洞 人口是至关重要的，因为即将到来的两个最突出的全球挑战：日益老龄化 人口和不断变化的气候。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程度和频率，如极端高温和寒冷事件，是 由于气候变化，预计会增加。极端高温/寒冷事件会增加死亡率和医疗保健 老年人的利用结果(例如，住院)。更加频繁和强烈的极端高温和 寒冷事件可能通过某些方式对患有AD/ADRD的老年人群构成不成比例的风险 认知生物学途径。然而，我们不知道可能通过哪些途径接触到 环境温度的极端变化可能直接(或通过其他应激源间接)影响老年人 AD/ADRD患者，他们对极端环境变化的反应可能会因以下原因而中断/延迟 记忆力丧失，计划和解决问题的挑战，理解视觉图像的困难，以及 对时间和地点的困惑。我们的目标是描述特定原因的疾病恶化的程度 医疗保健利用结果(即住院、30天内再次住院、初级保健就诊、 和专家就诊)和因极端高温/寒冷事件造成的死亡率 AD/ADRD。使用6300多万联邦医疗保险参保人(≥65岁)的纵向队列，我们将 全面且经过充分验证的计算方法，用于研究近期、短期和长期 极端高温和寒冷事件对医疗保健利用结果和死亡率的影响。在目标1中，我们将 开发和验证计算方法以改善AD/ADRD队列中的错误分类 识别、评估和预测患有痴呆症的老年人的患病率，建立高分辨率 可与行政数据整合的极端高温和寒冷事件的时空图(目标1c)。 在目标2中，我们将估计极端高温和寒冷事件对死亡率的直接和短期影响。 AD/ADRD老年人口的住院(入院和急诊科就诊)。 目标3将需要开发和部署高性能计算管道，以发现从头开始和/或 长期暴露于极端温度事件和特定原因之间的意外因果联系 患有阿尔茨海默氏症或相关痴呆症的老年人的医疗保健利用结果。

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the 5th leading cause of death among 65 and older in the U.S. Yet, our estimates from the prevalence of AD/ADRD outdated and the vulnerabilities of the older adults living with AD/ADRD to extreme environmental change remain unknown.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.