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Trajectories of Frailty and Cognitive Impairment in Older Adults

老年人虚弱和认知障碍的轨迹

基本信息

批准号：
10518585
负责人：
Ari B Friedman
金额：
$ 16.25万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10518585
关键词：
Accident and Emergency department Acute Address Admission activity Affect Aging Algorithms Alzheimer&apos s Disease Alzheimer&apos s disease diagnosis Alzheimer&apos s disease patient Alzheimer&apos s disease related dementia Award Caregivers Caring Characteristics Chronic Cognitive Cognitive aging Data Data Analyses Data Set Databases Dementia Development Plans Doctor of Philosophy Elderly Emergency Care Emergency Department Physician Emergency Medicine Emergency department visit Environment Event Family member Feasibility Studies Funding Future Gerontology Goals Health Health Services Research Health system Home Hospitalization Hospitals Iatrogenesis Impaired cognition Impairment Infarction Infection Intervention Knowledge Length Link Literature Measurement Medicare Medicare claim Mentors Mentorship Modeling Morbidity - disease rate Nursing Homes Outcome Outpatients Patient-Focused Outcomes Patients Persons Phenotype Population Probability Publishing Reporting Research Research Personnel Residencies Resources Risk Scholarship Science Secure Sentinel Shock Source Testing Time Training Training Support Universities Variant Visit Vulnerable Populations Work base biological sex biological systems care coordination care outcomes care systems career career development clinical practice cognitive performance conditioning cost data resource disability disability risk experience falls frailty health economics improved indexing longitudinal database mild cognitive impairment mortality multiple chronic conditions older patient programs skills smart home social sociodemographics success trend

项目摘要

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.

候选人：阿里B。弗里德曼，医学博士，博士临床实践作为一个急诊医生，并进行研究作为一个健康经济学家如何护理系统影响老年患者的生活。他热衷于通过改善护理的科学基础来改善他在急诊科（艾德）看到的许多老年患者的护理和结果，特别是那些患有阿尔茨海默病和相关痴呆症（ADRD）的患者。目标：本GEMSSTAR的目的是获得必要的知识和技能，成为一个独立的研究者，专注于艾德护理如何影响身体虚弱和认知障碍的患者，特别强调阿尔茨海默病患者或有发展阿尔茨海默病的风险。访问医院急诊室是65岁以上老年人越来越多的护理来源，2017年总计2240万次访问。认知脆弱是认知障碍和身体脆弱的交叉点，被假设是由多种生物系统的失调引起的，并缩短了老年人生活的长度和质量。艾德访视对认知脆弱轨迹的影响特征不明显。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，阿尔茨海默病和老年急救医学的培训。该奖项将为弗里德曼博士提供受保护的时间和资源，以获得必要的技能，通过渐进的，里程碑式的培训计划，包括课程，研究和指导独立研究，以确保独立的资金。目的：该建议的中心假设是，认知功能障碍患者出院后的艾德访视代表了一个未被认识到的干预机会。他将利用GEMSSTAR资助的受保护时间来研究认知脆弱如何预测老年人的艾德就诊和随后的处置，并评估老年人的艾德放电和随后结果之间的关系。他将探讨认知脆弱的定义，其中包括阿尔茨海默氏症和排除阿尔茨海默氏症。研究计划：这些目标将在两个数据集中进行，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标识符链接，并提供年度测量结果，可用于计算经验证的身体虚弱表型和认知障碍指数。数据库还提供社会人口和健康特征，包括艾德就诊、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。工作环境：资深研究人员在指导学者从早期职业生涯到独立和有影响力的工作方面有着良好的记录，他们致力于弗里德曼博士的成功。该团队融入大学环境，在卫生经济学、卫生服务研究、急诊医学、阿尔茨海默病奖学金和老年学领域拥有协作性、开创性的奖学金记录。