Tube-feeding in Elderly: Decision-making and Outcomes

老年人的管饲：决策和结果

• 批准号: 6619654
• 负责人: SUSAN L MITCHELL
• 金额: $ 10.8万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-30 至 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6619654
• 关键词: audiotape; books; clinical trials; counseling; decision making; dementia; extended care; frail elderly; functional ability; geriatrics; health care cost /financing; health care service evaluation; health services research tag; human mortality; human subject; interview; nursing homes; nutrition of aging; nutrition related tag; outcomes research; patient oriented research; postdoctoral investigator; quality of life; restraint; skin ulcer; tube feeding

DESCRIPTION (provided by applicant): The goal of the proposed development program is to prepare the applicant, Susan L. Mitchell MD for a career as an independent investigator and leader in the field of aging. The award will provide five years of supervised geriatrics health services research with the following specific objectives: 1. to develop expertise in innovative approaches to decision-making for older persons at the end-of-life, 2. to become an expert in outcomes research and resource utilization related to the use medical technologies in frail nursing home patients, and 3. to utilize this expertise in decision-making, health outcomes, and resource utilization to improve the end-of-life care in older persons by influencing clinical management and health care policy. The candidate will achieve these goals through mentored research, coursework, directed readings and educational activities. Dr. Lewis A. Lipsitz, an international leader in geriatrics, Professor of Medicine at Harvard Medical School, Chief of Geriatrics at the Beth Israel Deaconess Medical Center (BIDMC) and Co-Director of the Hebrew Rehabilitation Center for Aged (HRCA) Research and Training Institute will serve as sponsor. Dr. Lipsitz will ensure that Dr. Mitchell will have full advantage of the rich environment of the HRCA, a reknowned center dedicated to gerontological care and research, as well as the Harvard Division on Aging, BIDMC and Harvard School of Public Health. The proposed research is a randomized trial of a feeding tube decision aid for nursing home residents with advanced dementia with a one year follow-up of clinical outcomes and costs. The specific aims of the project are to determine: 1. whether a decision-aid (vs. usual care) improves the decision-making process for long-term tube-feeding, 2. the impact of a decision aid on the substitute decision-makers preferences for tube-feeding, 3. the impact of long-term tube-feeding (vs. no tube-feeding) on clinical outcomes and resource utilization in nursing home residents with advanced dementia. In addition to the proposed project, Dr. Mitchell will achieve her career goals by regularly scheduled meeting with Dr. Lipsitz, as well as members of her advisory panel including; 1. Drs. A. O Connor and A. Mulley - decision-making, health policy, 2. Dr. J. Buchanan - economic evaluation, 3. Dr. M. Gillick - bioethics, 4. J. Weinberg ScD - advanced statitstical methods and 5. Dr. M. Slaven - end-of-life care. Her research activities will be complimented by focussed clinical, educational and administrative activities including the associate directorship of the Harvard Geriatrics Fellowship Program. By the end of the award period the applicant will have the skills, experience and research track record necessary to become an independent investigator and leader in academic geriatrics.

描述（由申请人提供）：拟议开发的目标 计划的目的是帮助申请人苏珊·L·米切尔 (Susan L. Mitchell MD) 为成为一名 老龄化领域的独立研究者和领导者。 该奖项将 提供五年的老年病学健康服务监督研究 具体目标如下： 1. 发展创新方面的专业知识 2. 临终老年人的决策方法 成为与相关成果研究和资源利用方面的专家 对体弱的疗养院患者使用医疗技术，以及 3. 利用 决策、健康结果和资源利用方面的专业知识 通过影响临床改善老年人的临终关怀 管理和医疗保健政策。 候选人将实现这些目标 通过指导研究、课程作业、定向阅读和教育 活动。 Lewis A. Lipsitz 博士是老年病学领域的国际领军人物， 哈佛医学院医学教授、老年病学主任 贝斯以色列女执事医疗中心 (BIDMC) 和希伯来语联合主任 老年康复中心（HRCA）研究和培训机构将 担任赞助商。 利普西茨博士将确保米切尔博士充分了解 充分利用 HRCA 丰富的环境，这是一个致力于 老年学护理和研究，以及哈佛大学老龄化部， BIDMC 和哈佛大学公共卫生学院。 拟议的研究是一项饲管决策辅助的随机试验 患有晚期痴呆症的疗养院居民，经过一年的随访 临床结果和费用。 该项目的具体目标是 确定： 1. 决策辅助（相对于常规护理）是否可以改善 长期管饲的决策过程，2. 关于替代决策者对管饲偏好的决策援助， 3. 长期管饲（与不管饲）对临床的影响 高级疗养院居民的结果和资源利用 失智。 除了拟议的项目外，米切尔博士还将实现她的职业生涯 通过定期与 Lipsitz 博士以及成员进行会议来实现目标 她的顾问小组包括： 1. 博士。 A. O Connor 和 A. Mulley - 决策、卫生政策，2。J. Buchanan 博士 - 经济评估，3。 M. Gillick 博士 - 生物伦理学，4. J. Weinberg ScD - 高级统计方法 5. M. Slaven 博士 - 临终关怀。她的研究活动将是 辅之以集中的临床、教育和行政活动 包括哈佛老年病学奖学金副主任 程序。 奖励期结束时，申请人将具备技能、经验 以及成为独立调查员所需的研究记录 老年医学学术界的领导者。

项目成果

A framework for meaningful Medicare reform.

有意义的医疗保险改革框架。

• DOI: 10.1300/j031v16n03_01
• 发表时间: 2004
• 期刊: Journal of aging & social policy.
• 作者: Gillick,MurielR;Mitchell,Susan
• 通讯作者: Mitchell,Susan

Occurrence and treatment of suspected pneumonia in long-term care residents dying with advanced dementia.

死于晚期痴呆的长期护理居民中疑似肺炎的发生和治疗。

• DOI: 10.1111/j.1532-5415.2005.00524.x
• 发表时间: 2006
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Chen,Jen-Hau;Lamberg,JenniferL;Chen,Yen-Ching;Kiely,DanK;Page,JohnH;Person,CarmelJ;Mitchell,SusanL
• 通讯作者: Mitchell,SusanL

Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison.

患有晚期痴呆症的疗养院居民的管饲与手工喂养：成本比较。

• DOI: 10.1097/01.jam.0000043421.46230.0e
• 发表时间: 2003
• 期刊: Journal of the American Medical Directors Association
• 影响因子: 7.6
• 作者: Mitchell,SusanL;Buchanan,JoanL;Littlehale,Steven;Hamel,MaryBeth
• 通讯作者: Hamel,MaryBeth