Trajectories of Frailty and Cognitive Impairment in Older Adults

候选人：阿里·B·弗里德曼，医学博士，临床上担任急诊医生，并以健康经济学家的身份研究护理系统如何影响老年患者的生活。他热衷于改善他在急诊科(ED)看到的许多老年患者的护理和结果，方法是改进支撑这种护理的科学，特别是那些患有阿尔茨海默病和相关痴呆(ADRD)的患者。 目标：该GEMSSTAR的目的是获得必要的知识和技能，成为一名独立的调查者，专注于ED护理如何影响患者的身体虚弱和认知障碍，特别是阿尔茨海默病患者或有发展为阿尔茨海默病风险的患者。 研究背景：对65岁以上的老年人来说，去医院急诊室就诊是一个日益增长的护理来源，2017年总计就诊2240万人次。认知脆弱是认知障碍和身体脆弱的交集，被认为是多种生物系统失调的结果，并缩短了老年人的生活时间和质量。ED来访对认知脆弱轨迹的影响没有得到很好的描述。认知脆弱的不同定义包括阿尔茨海默病患者或排除阿尔茨海默病患者。 职业发展计划：弗里德曼博士寻求在身体虚弱和认知障碍、医疗保险数据分析、阿尔茨海默氏症和老年急救医学方面进行培训。该奖项将为弗里德曼博士提供受保护的时间和资源，使其能够通过包括课程作业、研究和有指导的独立研究在内的循序渐进、里程碑式的培训计划，获得获得独立资金所需的技能。 目的：这项建议的中心假设是，急诊室就诊导致认知缺陷患者出院代表着一个未被认识到的干预机会。他将利用这一GEMSSTAR资助的受保护时间来研究认知弱点如何预测老年人的ED就诊和随后的倾向，并评估ED出院与老年人随后结果之间的关系。他将探索认知脆弱的定义，其中包括阿尔茨海默病和排除阿尔茨海默病。 研究计划：这些目标将在两个数据集中实现，即国家健康和老龄化趋势研究和医疗保险索赔数据。这些数据库可以通过个人识别符进行链接，并提供年度测量，可用于计算经过验证的身体脆弱表型和认知障碍指数。这些数据库还提供社会人口和健康特征，包括急诊室就诊、阿尔茨海默病诊断和可能的痴呆症。多元回归将检验上述假设。 环境：资深研究人员拥有从早期职业生涯到独立和有影响力的工作指导学者的既定记录，他们致力于弗里德曼博士的成功。这个团队植根于一个大学环境，在卫生经济学、卫生服务研究、急救医学、阿尔茨海默氏症奖学金和老年学方面拥有合作的开创性学术记录。

Candidate: Ari B. Friedman, MD, PhD practices clinically as an emergency physician and conducts research as a health economist into how care systems affect older patients’ lives. He is passionate about improving the care and outcomes of the many older patients that he sees in the emergency department (ED) by improving the science underlying that care, especially those with Alzheimer’s Disease and Related Dementias (ADRD). Goal: The purpose of this GEMSSTAR is to gain knowledge and skills necessary to become an independent investigator focusing on how ED care affects physical frailty and cognitive impairment for patients, with a particular emphasis on patients with Alzheimer’s Disease or at risk of developing Alzheimer’s Disease. Research Context: Visits to hospital EDs are a growing source of care for older adults over 65, totaling 22.4 million visits in 2017. Cognitive frailty, the intersection of cognitive impairment and physical frailty, is hypothesized to result from dysregulation of multiple biological systems and curtails the length and quality of older adults’ lives. The impact of ED visits on trajectories of cognitive frailty is poorly characterized. Varying definitions of cognitive frailty include Alzheimer’s Disease patients or exclude Alzheimer’s Disease patients. Career Development Plan: Dr. Friedman seeks training in physical frailty and cognitive impairment, Medicare data analysis, Alzheimer’s Disease, and geriatric emergency medicine. This award will provide protected time and resources for Dr. Friedman to acquire the skills necessary to secure independent funding through a progressive, milestone-driven training plan that includes coursework, research, and guided independent study. Aims: The central hypothesis of this proposal is that ED visits resulting in discharge in patients with cognitive frailty represent an unrecognized opportunity for intervention. He will use the protected time funded by this GEMSSTAR to examine how cognitive frailty predicts ED visits and subsequent disposition for older adults, and to assess the relationship between ED discharges and subsequent outcomes in older adults. He will explore definitions of cognitive frailty which include Alzheimer’s Disease and exclude Alzheimer’s Disease. Research Plan: These Aims will be carried out in two datasets, the National Health and Aging Trends Study, and Medicare claims data. These databases can be linked by person identifiers, and provide annual measurements which can be used to calculate validated physical frailty phenotype and cognitive impairment indices. The databases also provide sociodemographic and health characteristics, including ED visits, Alzheimer’s Disease diagnoses and probable dementia. Multivariate regression will test the hypotheses above. Environment: Senior researchers with an established track record of mentoring scholars from their early career to independent and impactful work are committed to Dr. Friedman’s success. This team is embedded within a university environment with a track record of collaborative, pathbreaking scholarship in health economics, health services research, emergency medicine, Alzheimer’s Disease scholarship, and gerontology.