Predicting and Identifying Risk Factors for Short Time at Home in Older Adults after Hospitalization

预测和识别老年人住院后短时间在家的危险因素

• 批准号: 10517817
• 负责人: Sandra Shi
• 金额: $ 16万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10517817
• 关键词: Accounting; Acute; Admission activity; Adult; Age; Aging; Award; Career Choice; Cessation of life; Characteristics; Cognitive; Communities; Complex; Data; Data Analyses; Data Set; Delirium; Development; Disease; Elderly; Environment; Evaluation; Fellowship; Foundations; Frail Elderly; Future; Geriatrics; Goals; Health; Home; Hospitalization; Hospitals; Impairment; Individual; Institutionalization; Intervention; Knowledge; Lead; Link; Literature; Logistic Regressions; Long-Term Care; Measures; Medical; Medicare; Medicare claim; Mental Depression; Mentors; Modeling; Nursing Homes; Operative Surgical Procedures; Outcome; Outpatients; Patient-Centered Care; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Phenotype; Physical Medicine; Physiological; Pilot Projects; Principal Investigator; Property; Public Health; Quality of life; Race; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Proposals; Research Training; Risk; Risk Factors; Self Care; Sensitivity and Specificity; Skilled Nursing Facilities; Surveys; Testing; Time; United States National Institutes of Health; Validation; Work; acute care; base; beneficiary; career development; clinical care; cohort; design; efficacious intervention; experience; falls; frailty; functional restoration; health science research; high risk; hospital readmission; improved; improved functioning; improved outcome; indexing; insight; modifiable risk; mortality; multidisciplinary; older patient; patient oriented; prospective; rehabilitation science; rehabilitation strategy; research and development; risk stratification; sex; skills; social; statistics; success; therapy design; tool; trend; walking program

ABSTRACT The time after hospitalization is a critical window for older adults recovering from acute medical problems. Roughly 1 in 5 Medicare beneficiaries are discharged from hospital to skilled nursing facilities (SNFs) for post- acute care and rehabilitation, accounting for over 2 million stays annually. Although SNF stays are intended to restore independence and function, many patients cycle between re-hospitalizations and SNF in a downward spiral. Time at home quantifies this phenomenon of being ‘rehabbed to death’ by counting the number of days spent alive in the community, out of the hospital or SNF. However, tools that assess risk for short time at home have not been developed in the SNF setting, and identifying these can inform the design of interventions. Frailty is a common state of vulnerability known to increase risks of hospitalizations and mortality among older adults. Although rehabilitation interventions improve function and outcomes among non-frail adults in outpatient settings, frail compared to more robust older adults do not benefit from the same rehabilitation approaches. Moreover, whether modifiable risk factors such as delirium, depression, and potentially inappropriate medications (PIMs), independently impact short time at home in the setting of frailty is unclear. Thus, frailty measures have the potential to risk-stratify rehabilitation patients for short time at home while informing targeting of meaningful and efficacious interventions. This proposal aims to elucidate predictors of short time at home after SNF discharge among well- established frailty measures and modifiable risk factors. This research will leverage an existing dataset of a nationally representative cohort of Medicare beneficiaries, the National Health and Aging Trends Study (NHATS) linked to Medicare claims. The specific aims are to: 1) Assess and compare the ability of two measures of pre-hospitalization frailty to predict short time at home after post-acute SNF rehabilitation, in a nationally representative cohort of Medicare beneficiaries, and 2) Identify modifiable risk factors (delirium, depression, PIMs, rehabilitation characteristics) that are independently associated with short time at home after post-acute SNF rehabilitation. IMPACT: This award will support the principal investigator’s (PI’s) early career development and pathway to becoming a national leader in geriatric post-acute SNF rehabilitation. As a geriatrician with experience in aging research, Dr. Shi will acquire new insight and perspective from rehabilitation medicine and develop the skills to design and lead multidisciplinary SNF rehabilitation interventions. This proposal is supported by a collaborative team of highly experienced mentors and a rich research environment. The research and training will provide the PI with foundational knowledge in longitudinal data analysis, risk stratification, and modifiable risk factors for short time at home after SNF rehabilitation. In doing so, it will lead to the next logical step: designing and evaluating a tailored intervention guided by the frailty status of older patients, maximizing their time at home.

抽象的 住院后的时间是老年人从急性医疗问题中康复的关键窗口。 大约有五分之一的医疗保险受益人从医院到熟练的护士设施（SNF）出院 急诊和康复，每年占200万以上。虽然SNF停留旨在 恢复独立性和功能，许多患者在重新住院和SNF之间循环 螺旋。在家的时间量化了这种“康复为死”的现象 在社区，在医院或SNF外面度过。但是，在家中评估风险的工具 尚未在SNF设置中开发，并且确定这些可以告知干预措施的设计。 脆弱是已知增加住院风险和死亡率的常见脆弱状态 在老年人中。尽管康复干预措施改善了非怪异的功能和结果 与更健壮的老年人相比，门诊环境中的成年人没有受益 康复方法。此外，是否可以改变危险因素，例如ir妄，抑郁和 潜在的不当药物（PIMS），在脆弱的情况下独立影响在家中的短时间 不清楚。这是脆弱的措施有可能在家中短时间冒险将康复患者施加风险 同时了解有意义有效的干预措施的目标。 该提案旨在阐明SNF出院后在家中短时间的预测指标 建立的脆弱措施和可修改的风险因素。这项研究将利用现有的数据集 全国代表性的医疗保险受益人，国家健康和衰老趋势研究 （NHAT）与Medicare主张有关。具体目的是：1）评估和比较两个的能力 急性SNF康复后的院前脆弱措施预测在家中短暂的时间 全国代表性的医疗保险受益人群体，2）确定可修改的危险因素（ir妄， 抑郁症，PIM，康复特征），与在家之后短时间独立相关 急性后SNF康复。 影响：该奖项将支持首席调查员（PI）的早期职业发展和通往 成为老年急性后SNF康复的国家领导者。作为具有衰老经验的老年医生 研究，Shi博士将从康复医学中获得新的见解和观点，并发展技能 设计和领导多学科的SNF康复干预措施。该建议得到了协作的支持 由经验丰富的导师组成的团队和丰富的研究环境。研究和培训将提供 PI具有纵向数据分析，风险分层和可修改风险因素的基础知识的PI SNF康复后短时间在家。这样，它将导致下一个逻辑步骤：设计和 评估受老年患者脆弱状态的量身定制干预措施，从而最大程度地利用他们在家的时间。