Palliative needs of cognitively impaired patients during health care transactions

描述(由申请人提供)：患有认知障碍(CI)和多种健康状况的老年人除了治疗他们的疾病外，通常还需要某种程度的支持性护理。一种支持性护理是姑息护理。姑息治疗是一种个性化的护理方法，旨在满足进展性、限制生命的疾病所有阶段的人们的需求，目标是提高生活质量并将照顾者的负担降至最低。姑息治疗的重点是沟通、症状管理(包括身体和心理)以及护理的协调。了解认知障碍(CI)老年人在疾病发展轨迹的不同阶段的姑息治疗需求，对于理解如何通过急性护理事件为这一人群提供护理至关重要。尽管对CI患者的姑息治疗一直是最近研究的重点，但对经历急性疾病发作的CI老年患者的护理知之甚少。一种可能的选择是过渡性护理模式(Medice)，这是一种以证据为基础的、护士主导的老年人护理模式。这项拟议的研究旨在描述社区老年CI患者及其家庭照顾者在急性疾病发作期间的姑息护理需求和干预、生活质量和照顾者负担的影响。这项拟议的研究将利用“医院到家庭：认知受损的老年人/照顾者”(R01AG023116-05；主要数据收集已于2010年7月完成)中的数据。一个专家小组将检查接受中医药干预的研究参与者的电子医疗记录，以确定与姑息治疗需求相关的特定姑息治疗干预措施。数据分析将涉及描述性统计、未调整的双变量分析和调整后的多变量分析(逻辑和广义线性建模)。对这些数据的二次分析提供了一个宝贵的机会，可以更好地了解这些人群的护理协调和姑息护理，并改善未来的护理。这项研究的结果将产生姑息治疗干预的概况，以支持开发竞争性的NIH R01应用程序，以测试修改后的以姑息治疗为重点的过渡性护理模式。这项研究的发现有可能改变这一优先群体的现有姑息治疗做法，这一群体是患有CI的高危老年人及其家庭照顾者。

DESCRIPTION (provided by applicant): Older adults with cognitive impairment (CI) and multiple health conditions often need some degree of supportive care in addition to treatment for their diseases. One type of supportive care is palliative care. Palliative care is an individualized approach to care designed to meet the needs of people at all stages of progressive, life-limiting illness with the goals to improve quality of life and minimize caregiver burden. The emphasis of palliative care is on communication symptom management (both physical and psychological), and coordination of care. Understanding the palliative care needs of older adults with cognitive impairment (CI) at various stages along the disease trajectory is critical to understanding how to provide care for this population through acute care episodes. Although palliative care for persons with CI has been the focus of recent studies, little is known about the care of older persons with CI who experience an episode of acute illness. One possible option is the Transitional Care Model (TCM), an evidence-based, nurse-led model of care for older adults. The proposed study aims to describe the effect of palliative care needs and interventions, quality of life and caregiver burden among community dwelling older adults with CI and their family caregivers through an episode of acute illness. This proposed study will utilize data from the "Hospital to Home: Cognitively Impaired Elders/Caregivers" (R01AG023116-05; primary data collection completed July 2010). An expert panel will examine the electronic medical records of study participants that received the TCM intervention to determine specific palliative care interventions associated with palliative care needs. Data analyses will involve descriptive statistics, unadjusted bivariate analyses and adjusted multivariable analysis (logistic and generalized linear modeling). Secondary analysis of these data offers a value opportunity to better understand care coordination and palliative care for this population and to improve future care. The findings from this study will generate a profile of palliative care interventions to support the development of a competitive NIH R01 application to test a modified palliative care focused Transitional Care Model. Findings from this study have the potential to change existing palliative care practice for this priority population of at risk older adults with CI and their family caregivers.