Medical Illness & Cognitive Impairment in Older Adults: Heart Failure as a Model

描述（由申请人提供）：本职业发展奖申请的主要目标是使申请人能够发展成为独立调查员所需的技能和专业知识，重点关注认知功能在老年人医疗疾病过程中的重要作用。认知障碍（CI）通常发生在老年人常见的慢性疾病背景下，可能通过自我护理受损影响这些高风险患者的临床和生活质量结局。心力衰竭（HF）是研究CI对疾病自我护理和长期结局影响的理想条件。本研究的具体目标是：（1）前瞻性地检查年龄65岁的HF患者从住院到出院后3个月的认知功能;（2）前瞻性地检查从住院到出院后3个月的自我护理活动的表现;（3）在HF出院后的选定时间间隔检查认知功能与自我护理活动表现之间的关系;（4）开发和试点测试一种干预措施，以增强针对患者认知状态定制的HF幸存者的自我护理实践。一个强大的培训计划将补充这一研究计划，并为申请人提供必要的工具，成功地作为一个独立的研究者;它将包括课程和重点指导临床老年病学，心血管流行病学，纵向研究方法，临床试验设计和实施领域。在获奖期间进行的工作的结果将有可能为制定针对患者认知状态的自我护理干预措施提供信息，并改善患有慢性疾病的认知受损患者的健康状况。 公共卫生相关性：有证据表明，认知功能受损的老年患者的健康状况不佳，包括生活质量下降，重复住院和死亡率增加，但这种情况发生的途径尚不清楚。了解认知障碍在患者自我护理中的作用，对自我护理干预措施的设计和改善慢性疾病老年人的护理具有重要意义。

DESCRIPTION (provided by applicant): The primary objective of this Career Development Award application is to enable the applicant to develop the skills and expertise necessary to become an independent investigator focusing on the important role cognitive function plays in the course of medical illness in older adults. Cognitive impairment (CI) often occurs in the context of chronic medical conditions that are common in older adults and likely influences clinical and quality of life outcomes in these high- risk patients, potentially through impaired self-care. Heart failure (HF) is an ideal condition through which to study the impact of CI on disease self-care and long-term outcomes. The specific aims of my research program are to: (1) prospectively examine cognitive function in patients aged e65 years from the time of hospitalization for HF through 3-months after hospital discharge; (2) prospectively examine the performance of self-care activities from the time of hospitalization for HF through 3-months after hospital discharge; (3) examine the relation between cognitive function and performance of self-care activities at selected time intervals following hospital discharge for HF; (4) develop and pilot test an intervention to enhance self- care practices for HF survivors that is tailored to a patient's cognitive status. A robust training plan will complement this research program and provide the applicant with the tools necessary to be successful as an independent investigator; it will include coursework and focused mentoring in the areas of clinical geriatrics, cardiovascular epidemiology, longitudinal research methodologies, and clinical trial design and implementation. The findings of the work conducted during the award period will have the potential to inform the development of self-care interventions that are tailored to the patient's cognitive status and to improve the health of cognitively impaired patients with chronic medical conditions. PUBLIC HEALTH RELEVANCE: Evidence suggests that cognitively impaired older patients have poor health outcomes including reduced quality of life, repeat hospitalizations, and increased mortality, yet the pathways by which this occurs are not well understood. Understanding the role cognitive impairment plays in patient self-care has significant implications for the design of self-care interventions and for improving the care of older adults with chronic medical conditions.