Advanced-Stage Development of a Geriatric Palliative Care Research Infrastructure

项目摘要 社会正面临着其历史上最大的公共卫生挑战之一-人口的增长， 老年人和慢性重病导致的发病率增加。在接下来的几十年里，大多数医生 将照顾患有身体和心理症状困扰的重病老年人;渐进式 功能依赖和虚弱;高家庭支持需求;和不断升级的卫生保健资源使用。的确， 患有多种慢性疾病的老年人数量预计将增加三分之一以上 在2000年到2030年之间，痴呆症患者的人数将增加近一倍。大量证据表明， 对大多数人来说，疾病晚期的特点是身体痛苦得不到充分治疗; 护理系统;医生，患者和家庭之间的沟通不畅;家庭护理人员的压力。 由慈善机构资助的国家姑息治疗研究中心（NPCRC）一直是一个 自2006年以来，建立了促进跨学科老年姑息治疗研究的合作机制。NPCRC 成立的目的是促进和发展美国各地的姑息治疗研究。 医学科学院的建议，以支持“干部的专家，其人数和人才是 足以：a）为基于科学和实用的医学教育提供领导;以及B） 组织和进行临床，行为和健康服务的研究，为患者的严重和慢性 病”。NPCRC与NIA合作，确定了姑息治疗研究的优先事项， 它的证据基础，开发了新一代的研究人员在姑息治疗，并创建了一个国家 科学家社区。NPCRC资助了100名跨学科研究人员（54名从事老龄化研究）， 机构和21个国家沿着连续从初级到高级教师，并从事广泛的 致力于改善重病患者生活质量的研究。 我们新颖的研究平台现在构成了我们目前R33提案的基础，以扩展和增强这一点。 研究基础设施。我们会建立一个新的长者姑息治疗研究实习生网络， 在美国以姑息治疗为重点的博士后项目之间的合作。 研究人员，我们将领导一个研究技术援助计划，包括研讨会和网络研讨会， 先进的统计研究方法，资助写作（即，NIH K和R 01应用程序）技能研讨会，以及 赠款审查计划。我们将支持痴呆症和基于人口的研究和培训方面的新举措。 对于有经验的研究人员，我们将支持多地点协作老年医学的发展和开展。 通过支持网络和项目启动会议进行姑息治疗研究，从而开展多地点研究 专注于NIA在老年姑息治疗方面的研究重点。我们的提案将推进研究基础设施 成功地利用了NPCRC作为跨学科伙伴关系的合作工具， 老年姑息治疗研究的学员，初级，并在美国各地有经验的调查人员。

PROJECT SUMMARY Society is facing one of the largest public health challenges in its history - the growth of the population of older adults and increasing morbidity due to chronic serious illness. Over the next decades, most physicians will be caring for seriously ill older adults with physical and psychological symptom distress; progressive functional dependence and frailty; high family support needs; and escalating health care resource use. Indeed, the number of older adults with multiple chronic conditions is expected to increase by more than a third between 2000 and 2030 and those with dementia will nearly double. Abundant evidence suggests that the advanced stages of disease for most are characterized by inadequately treated physical distress; fragmented care systems; poor communication between doctors, patients, and families; and strains on family caregivers. The philanthropically funded National Palliative Care Research Center (NPCRC) has served as a collaborative mechanism for promoting interdisciplinary geriatric palliative care research since 2006. NPCRC was established to promote and develop palliative care research across the U.S. It addressed the National Academy of Medicine's recommendations to support a “cadre of experts whose numbers and talents are sufficient to: a) supply leadership for scientifically-based and practically useful medical education; and b) organize and conduct clinical, behavioral, and health services research for patients with serious and chronic illness.” The NPCRC, in collaboration with NIA, has established priorities for palliative care research, enhanced its evidence base, developed a new generation of researchers in palliative care, and created a national community of scientists. NPCRC has funded 100 interdisciplinary investigators (54 in aging research) from 46 institutions and 21 states along the continuum from junior to senior faculty and engaged in a broad spectrum of research dedicated to improving quality of life for persons living with serious illness. Our novel, research platform now forms the basis of our current R33 proposal to expand and enhance this research infrastructure. We will establish a new network of geriatric palliative care research trainees through collaboration across the palliative care focused post-doctoral programs in the U.S. For early-stage investigators, we will lead a research technical assistance program encompassing workshops and webinars on advanced statistical research methods, a grant writing (i.e., NIH K and R01 applications) skills workshop, and a grant review program. We will support new initiatives in dementia and population-based research and training. For experienced investigators, we will support the development and conduct of multisite collaborative geriatric palliative care research by supporting networking and project start-up meetings leading to multisite studies focusing on NIA research priorities in geriatric palliative care. Our proposal will advance research infrastructure that has successfully leveraged the NPCRC as the collaborative vehicle for interdisciplinary partnerships for geriatric palliative care research for trainees, junior, and experienced investigators across the U.S.