Longitudinal study of cognition, health literacy, and self-care in COPD patients

COPD患者认知、健康素养和自我护理的纵向研究

• 批准号: 8490418
• 负责人: Alex D Federman
• 金额: $ 77.04万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-18 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8490418
• 关键词: Acute; Acute Disease; Address; Adherence; Adult; Affect; Attention; Behavior; Caregivers; Caring; Chicago; Chronic; Chronic Disease; Chronic Obstructive Airway Disease; Chronically Ill; Cognition; Cognitive; Communication; Data; Disease; Disease Management; Disease Progression; Elements; Functional disorder; Health; High Prevalence; Home environment; Hospitalization; Hospitals; Hypoxemia; Impaired cognition; Individual; Information Services; Inhalators; Instruction; Intervention; Interview; Longitudinal Studies; New York City; Outcome; Patients; Physicians; Play; Policies; Primary Health Care; Process; Research; Resources; Role; Science; Self Care; Self Management; Severity of illness; Short-Term Memory; Social support; Symptoms; Techniques; Time; Vulnerable Populations; base; cognitive function; disorder control; executive function; health literacy; improved; inner city; innovation; insight; loved ones; medication compliance; processing speed; skills; socioeconomics; therapy design

PROJECT SUMMARY The overall objective of this study is to investigate longitudinal associations between cognition, health literacy (HL), and self-care in patients with chronic obstructive pulmonary disease (COPD), and determine whether social support from informal caregivers mitigates these associations. Cognitive function, a major component of HL, declines progressively in many COPD patients. HL might change over time as well, progressively altering COPD patients' ability to understand and use health information. However, longitudinal data on HL are not available. It is also unknown whether acute COPD exacerbations temporarily worsen cognition and HL, as might be expected owing to hypoxemia. Informal caregivers frequently help COPD patients manage their health at home, but little is known about the extent to which social support compensates for the HL and cognitive limitations of these patients, and whether caregivers' own problems of HL limit their ability to help others manage their chronic disease. Elucidating these issues could provide important data for developing interventions aimed at both patients and caregivers to overcome HL and cognition barriers to successful COPD management, and perhaps to other chronic diseases as well. Accordingly, the Specific Aims of this study are to (1) Examine longitudinally the trajectory of HL among patients with COPD, both as the disease progresses over time and following acute exacerbations; (2) Assess the association between HL, and it subcomponents, and specific self-management behaviors in patients with COPD, such as medication adherence and inhaler technique; (3) Evaluate the mitigating role of support from informal caregivers and caregivers' HL on the relationship between patients' HL and COPD self-management. We will address these aims by conducting a study of 400 English and Spanish-speaking adults with COPD from two socioeconomically and racially diverse inner-city primary care practices in New York City, NY and Chicago, IL. Patients will be followed for 2 years to collect data on HL, cognitive function, COPD symptoms and self-management behaviors. These data will also be assessed at the time of a hospital discharge for COPD exacerbation and one week later. Additionally, 100 informal caregivers of a subset of patients with COPD will be interviewed to determine their HL. This study is innovative in its longitudinal examination of the effects of HL and cognitive function and the potential mitigating role of caregiver support and caregiver HL. It will expand our understanding of the mechanisms through which HL and cognition influence COPD self-management, offering us an opportunity to design interventions to improve outcomes in a highly vulnerable population.

项目概要 本研究的总体目标是调查认知、健康素养之间的纵向关联 (HL) 和慢性阻塞性肺疾病 (COPD) 患者的自我护理，并确定是否 来自非正式照顾者的社会支持减轻了这些关联。认知功能的重要组成部分 许多 COPD 患者的 HL 逐渐下降。 HL 也可能随着时间的推移而改变，逐渐改变 慢性阻塞性肺病患者理解和使用健康信息的能力。然而，HL 的纵向数据并不 可用的。目前尚不清楚慢性阻塞性肺病急性加重是否会暂时恶化认知和 HL，因为 可能是由于低氧血症所致。非正式护理人员经常帮助慢性阻塞性肺病患者管理他们的生活 家庭健康状况，但人们对社会支持在多大程度上补偿 HL 和 这些患者的认知局限性，以及护理人员自身的 HL 问题是否限制了他们提供帮助的能力 其他人则控制自己的慢性病。阐明这些问题可以为开发提供重要数据 针对患者和护理人员的干预措施，以克服 HL 和认知障碍，成功实现慢性阻塞性肺病 管理，也许还有其他慢性病。因此，本研究的具体目标是 (1) 纵向检查 COPD 患者随着疾病进展的 HL 轨迹 随着时间的推移和急性加重后； (2) 评估 HL 及其子组件之间的关联， 慢性阻塞性肺病患者的具体自我管理行为，例如药物依从性和吸入器 技术; (3) 评估非正式照顾者和照顾者 HL 的支持对 患者HL与COPD自我管理的关系。我们将通过开展一项 对来自两个社会经济和种族不同的 400 名患有慢性阻塞性肺病的讲英语和西班牙语的成年人进行的研究 纽约州纽约市和伊利诺伊州芝加哥市的市中心初级保健实践。患者将接受为期 2 年的随访 收集有关 HL、认知功能、COPD 症状和自我管理行为的数据。这些数据也将 在因 COPD 恶化出院时和一周后进行评估。另外，100 将采访一部分 COPD 患者的非正式护理人员以确定他们的 HL。这项研究是 在对 HL 和认知功能的影响以及潜在缓解作用的纵向检查方面具有创新性 照顾者支持和照顾者 HL 的作用。它将扩大我们对机制的理解 HL 和认知影响 COPD 自我管理，为我们提供了设计干预措施的机会 改善高度脆弱人群的结果。