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Identifying contributing factors to burdensome ICU treatments in older adults with Alzheimer's disease and related dementias in the United States and United Kingdom

确定美国和英国患有阿尔茨海默病和相关痴呆症的老年人在 ICU 接受繁重治疗的影响因素

基本信息

批准号：
9751155
负责人：
Elizabeth Dzeng
金额：
$ 12.04万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2022-07-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY/ABSTRACT For the 5.3 million older Americans with Alzheimer’s disease and related dementias (ADRD), end-of life-care is increasingly marked by intensive medical treatments that are goal-discordant, confer no benefit, and likely causes harm. Compared to a decade ago, older adults with advanced dementia in the United States (US) are twice as likely to receive mechanical ventilation and be admitted to the ICU without substantial improvement in survival. There is a lack of research describing the systemic and cultural drivers of burdensome ICU care, which we define as ICU admission, ICU level treatments such as vasopressors or mechanical ventilation, and resuscitation amongst older adults with ADRD near the end of life. Comparisons between the US and the United Kingdom (UK), a country that has significantly lower rates of terminal ICU hospitalization than the US, are useful in determining modifiable drivers of burdensome ICU care. By identifying practices that are common or accepted in the UK, but not found in the US, we can bring a different perspective onto typical practices in the US and identify innovative practices that exist in the UK that could be introduced in the US context to modify the American culture of burdensome ICU care. The long-term goal is to design, pilot, and implement hospital systems-level interventions that successfully shift institutional culture to mitigate burdensome treatments for older adults with ADRD near the end of life. The objective of this project is to identify factors at the institutional level that contribute to burdensome ICU treatments in older adults with ADRD near the end of life. The first aim of this project is to identify institutional, clinician, patient, and family factors that contribute to burdensome ICU treatments in older adults with ADRD near the end of life in the US and United Kingdom (UK). This will be accomplished through a comparative ethnography (observations) at two hospitals in the US (UCSF and UCLA), and two in the UK (King’s College Hospital and Princess Royal University Hospital). The observations will focus on of the day-to-day activities and behaviors of individuals involved in the care of older adults with ADRD such as ward rounds, family meetings, and treatment discussions. The project’s second aim identifies promoter and inhibitors of burdensome ICU treatments in older adults with ADRD near the end of life through semi-structured in-depth interviews with key stakeholders at all levels of the healthcare system. The proposed research is innovative because it will be the first rigorously designed, in-depth qualitative study examining cultural and systemic factors related to burdensome ICU care between the US and UK. This study is significant because it will uncover previously uncharacterized cultural and systemic factors that contribute to burdensome ICU care, which can be used to develop targeted interventions to mitigate burdensome care in older adults with ADRD.

项目总结/摘要对于530万患有阿尔茨海默病和相关痴呆症（ADRD）的美国老年人来说，越来越多地以目标不一致的强化医学治疗为特征，造成伤害。与十年前相比，美国（US）患有晚期痴呆症的老年人接受机械通气并被送入ICU的可能性是接受机械通气并没有实质性改善的可能性的两倍。生存缺乏描述ICU护理负担的系统和文化驱动因素的研究，我们将其定义为ICU入院，ICU级别的治疗，如血管加压药或机械通气，在接近生命尽头的ADRD老年人中进行复苏。美国与英国（UK）是一个晚期ICU住院率明显低于美国的国家，有助于确定ICU护理负担的可修改驱动因素。通过确定常见的做法，或者在英国被接受，但在美国没有发现，我们可以从不同的角度来看待美国的典型做法，美国，并确定英国存在的创新做法，这些做法可以在美国引入，以修改重症监护室护理的美国文化长期目标是设计、试点和实施医院系统层面的干预措施，成功地改变了机构文化，以减轻负担的治疗，接近生命尽头的老年ADRD患者。该项目的目标是确定体制方面的因素，导致ADRD老年人在接近生命尽头时进行繁重的ICU治疗。第一个目标该项目的目的是确定导致ICU负担过重的机构、临床医生、患者和家庭因素在美国和英国（UK），ADRD老年人接近生命末期的治疗。这将是通过在美国两家医院（UCSF和加州大学洛杉矶分校），以及两个在英国（国王学院医院和公主皇家大学医院）。的意见将重点关注参与老年人护理的个人的日常活动和行为， ADRD，如查房、家庭会议和治疗讨论。该项目的第二个目标是确定在接近生命尽头的ADRD老年人中进行繁重的ICU治疗的促进剂和抑制剂，与医疗保健系统各级关键利益相关者进行半结构化深入访谈。拟议研究是创新的，因为它将是第一个严格设计的，深入的定性研究，与美国和英国之间繁重的ICU护理相关的文化和系统因素。这项研究意义重大因为它将揭示以前没有特征的文化和系统因素，这些因素导致了沉重的负担， ICU护理，可用于制定有针对性的干预措施，以减轻老年人的护理负担， ADRD。