Longevity and Medical Treatment in Old Age

长寿与晚年医疗

• 批准号: 7803562
• 负责人: SHARON R KAUFMAN
• 金额: $ 47.93万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7803562
• 关键词: Address; Advocacy; Affect; Age; Aging; American; Anthropology; Area; Attention; Attitude; Bypass; Cadaver; Cardiac; Caring; Case-Control Studies; Cessation of life; Chronic Care; Clinic; Clinical; Clinical Medicine; Clinical Trials; Code; Communities; Cultural Anthropology; Data; Data Analyses; Data Collection; Decision Making; Defibrillators; Development; Disease; Elderly; Eligibility Determination; Ethics; Ethnography; Explosion; Face; Family; Family Physicians; Family health status; Family member; Frequencies; Geriatrics; Gerontology; Goals; Health; Health Knowledge, Attitudes, Practice; Health Professional; Healthcare; Hepatitis B; Home environment; Individual; Intervention; Interview; Investigation; Kidney Transplantation; Knowledge; Learning; Life; Life Cycle Stages; Life Extension; Life Support Care; Liver diseases; Living Donor Liver Transplantation; Living Donors; Longevity; Love; Maintenance; Malignant Neoplasms; Malignant neoplasm of prostate; Mediation; Medical; Medicare; Medicine; Methods; Nature; Operative Surgical Procedures; Organ Donor; Organ Transplantation; Palliative Care; Participant; Patients; Persons; Pharmaceutical Preparations; Physicians; Pilot Projects; Principal Investigator; Procedures; Process; Prostate; Renal dialysis; Research; Research Personnel; Role; Sampling; Shapes; Social Obligations; Societies; Staging; Stents; Techniques; Time; Treatment outcome; Work; Writing; base; cancer therapy; caregiving; clinical practice; end of life; end of life care; ethnographic method; expectation; experience; federal policy; health care cost/financing; implantation; innovation; intervention effect; liver transplantation; medical specialties; normal aging; older patient; programs; response; senescence; standard care; success; treatment effect

DESCRIPTION (provided by applicant): The goal of this 5-year qualitative anthropological study is to describe and examine the specific ways in which 3 types of life-extending medical interventions for the elderly are affecting growing numbers of aging Americans, the physicians who treat them, their families, and the delivery of medical care in an aging society. The three types of intervention, never before studied for their effects on clinical and family obligation and end of life planning and care are: the automatic implantable cardiac defibrillator; living donor kidney transplant and living or cadaver donor liver transplant; and prostate and gynecological cancer treatments. These specific interventions have been selected for study for the following 2 reasons. They are affecting increasing numbers of elderly persons and are emblematic of the rising age for medical interventions of all kinds; and they exemplify both the successes of life-extension for those who are already elderly and the burdens and dilemmas of medical choice about aggressive treatments and chronic care for health practitioners, older persons, and their families. The long-term goal is to learn, in as much detail as possible, how life extension practices and the socio-medical developments surrounding them are impacting geriatric medicine, the health care older Americans receive, and the experience of elderly persons. The specific aims of this empirical, ethnographic study are: 1) to discover and describe the criteria and rationale by which older patients, their families, and physicians decide to move forward, or not, with the 3 types of interventions; 2) to learn how patients and families understand and live with treatments; 3) to learn the effects of treatments on end of life planning; 4) to explore what constitutes ethical and practical dilemmas and challenges surrounding life extension; 5) to investigate clinical and family responsibilities regarding these treatments; and 6) to investigate ways in which recently expanded Medicare eligibility criteria affect physician, patient and family understandings of standard care and 'normal' old age. The traditional anthropological methods of participant-observation (in medical clinics) and in-depth interviews with small samples will be used to collect data from physicians, patients, and their family members. Well-known coding based qualitative data analysis techniques will be used to fully examine the study aims: cross-sectional comparison, case studies, thematic analysis, and frequencies of response. Relevance: This project will document the ways in which the proliferation of life-extending interventions for the elderly influences patients age 70 and over, families, the field of geriatric medicine and medical practice with older individuals generally. This study will provide data about physician decision-making and patient responses to both aggressive and palliative treatments that will be important for health consumers, health professionals in a variety of fields, academic geriatrics, and health care planning for an aging society.

这项为期5年的定性人类学研究的目标是描述和研究3种类型的延长老年人寿命的医疗干预措施正在影响越来越多的美国老年人，治疗他们的医生，他们的家庭以及老龄化社会中的医疗服务的具体方式。三种类型的干预，从来没有研究过他们的临床和家庭义务和生命规划和护理结束的影响：自动植入心脏除颤器;活体供肾移植和活体或尸体供肝移植;前列腺和妇科癌症治疗。选择这些特定干预措施进行研究的原因有以下两个。它们影响到越来越多的老年人，并象征着接受各种医疗干预的年龄越来越大;它们既反映了延长老年人寿命的成功，也反映了保健从业人员、老年人及其家人在积极治疗和长期护理方面的医疗选择的负担和困境。长期目标是尽可能详细地了解延长寿命的做法及其周围的社会医学发展如何影响老年医学，美国老年人获得的医疗保健以及老年人的经验。本研究的具体目的是：1）发现和描述老年患者、其家属和医生决定是否继续进行3种干预的标准和理由; 2）了解患者和家属如何理解和接受治疗; 3）了解治疗对生命结束计划的影响; 4）探讨什么构成了伦理和实际的困境和挑战周围的生命延长; 5）调查临床和家庭责任有关这些治疗;和6）调查的方式，最近扩大医疗保险资格标准影响医生，病人和家庭的理解标准护理和“正常”老年。传统的人类学方法参与观察（在医疗诊所）和小样本的深入访谈将被用来收集医生，病人和他们的家庭成员的数据。著名的编码为基础的定性数据分析技术将被用来充分检查研究的目的：横截面比较，案例研究，专题分析，和响应的频率。相关性：该项目将记录老年人延长寿命干预措施的扩散对70岁及以上患者、家庭、老年医学领域和老年人医疗实践的影响。这项研究将提供有关医生决策和患者对积极和姑息治疗的反应的数据，这些数据对健康消费者，各个领域的健康专业人员，学术老年医学和老龄化社会的医疗保健规划都很重要。