Perioperative Cognitive Anesthesia Network Extension for Socially Vulnerable Older Adults

摘要 美国医疗保健系统照顾越来越多的老年人，包括阿尔茨海默氏症患者 疾病和相关痴呆症，需要在麻醉下手术。衡量的地区社会不平等 通过空间指数，如面积剥夺和社会脆弱性指数，独立地贡献 围手术期和神经退行性变结果的差异。数据也支持显著的关联性 社区水平区域剥夺指数与阿尔茨海默病神经病理学之间的关系。尽管 新出现的证据表明，健康的社会决定因素与老年人术后结果的差异有关 对于成年人来说，这些领域的调查越来越需要不同主题的专门知识，包括 临床围手术期实践，老年病学，神经心理学，健康的社会决定因素，地理空间分析， 甚至是人工智能。K07申请者是美国国立卫生研究院(NIH)资助的独立人士 研究人员和训练有素的麻醉师，具有区域麻醉和整形外科方面的专业知识， 以及在机器学习、地理空间差异以及围手术期疼痛和认知方面的研究经验。 这项建议的目的是促进机构和社区对社会脆弱性的认识 影响老年人的围手术期结果，包括阿尔茨海默病和相关痴呆症患者， 尤其是那些与术后疼痛和认知相关的结果。这项提议的总体战略 是发展跨学科研究基础设施以及跨学科培训计划，以 交叉组建研究团队。这一结构将通过围手术期认知麻醉进行组织 网络-社会脆弱性(PeCANSV)构建的三个目标：目标1：召集一个多学科的PeCANSV 咨询组将在1)地理空间基础设施中建立三个补充核心；2)社会决定因素 健康；3)人工智能。目标2：通过跨学科研究途径加速研究发现 通过正式确定补充PeCANSV核心和UF资源与现有地理空间之间的新联系， UF Health和整个佛罗里达州的环境、认知和临床围手术期数据库。目标3： 培养一支由临床和基础科学研究人员组成的跨学科队伍，以领导跨学科团队 解决老年手术患者的社会脆弱性问题。里程碑包括定期分析 优势、机会、抱负和结果、跨学科提案提交，以及学员的证据 在包括阿尔茨海默病患者在内的老年人的社会差异方面的围手术期研究取得成功 以及相关的痴呆症。

ABSTRACT The U.S. healthcare system cares for increasing numbers of older adults, including those with Alzheimer’s disease and related dementias, who require surgery with anesthesia. Regional social inequities, as measured by spatial indices such as area deprivation and social vulnerability indices, independently contribute to differences in perioperative and neurodegenerative outcomes. Data also support a significant association between neighborhood-level area deprivation indices with Alzheimer’s disease neuropathology. Despite emerging evidence linking social determinants of health with disparities in postoperative outcomes in older adults, investigations in these areas increasingly require expertise with disparate subject matters, including clinical perioperative practice, geriatrics, neuropsychology, social determinants of health, geospatial analyses, and even artificial intelligence. The K07 applicant is a National Institutes of Health (NIH)-funded independent investigator and fellowship-trained anesthesiologist with expertise in regional anesthesia and orthopedic surgery, as well as research experience in machine learning, geospatial disparities, and perioperative pain and cognition. The purpose of this proposal is to promote institutional and community awareness of how social vulnerabilities impact perioperative outcomes in older adults, including those with Alzheimer’s disease and related dementias, and particularly those outcomes related to postoperative pain and cognition. The overall strategy of this proposal is to develop interdisciplinary research infrastructure along with transdisciplinary training programs to crosspollinate research teams. This structure will be organized via the Perioperative Cognitive Anesthesia Network-Social Vulnerability (PeCANSV) construct in three aims: Aim 1: Convene a PeCANSV multidisciplinary advisory team to establish three supplemental cores in 1) geospatial infrastructure; 2) social determinants of health; 3) artificial intelligence. Aim 2: Accelerate research discovery through interdisciplinary research pathways by formalizing nascent linkages between supplemental PeCANSV cores and UF resources and extant geospatial, environmental, cognitive, and clinical perioperative databases at UF Health and throughout Florida. Aim 3: Develop a transdisciplinary workforce of clinical and basic science researchers to lead interdisciplinary teams addressing the social vulnerability of older adult surgical patients. Milestones include regular analysis of strengths, opportunities, aspirations, and results, interdisciplinary proposal submissions, and evidence of trainee success in perioperative research in social disparities of older adults, including those with Alzheimer’s disease and related dementias.