Perioperative Cognitive Anesthesia Network Extension for Socially Vulnerable Older Adults

摘要

ABSTRACT The U.S. healthcare system cares for increasing numbers of older adults, including those with Alzheimer’s disease and related dementias, who require surgery with anesthesia. Regional social inequities, as measured by spatial indices such as area deprivation and social vulnerability indices, independently contribute to differences in perioperative and neurodegenerative outcomes. Data also support a significant association between neighborhood-level area deprivation indices with Alzheimer’s disease neuropathology. Despite emerging evidence linking social determinants of health with disparities in postoperative outcomes in older adults, investigations in these areas increasingly require expertise with disparate subject matters, including clinical perioperative practice, geriatrics, neuropsychology, social determinants of health, geospatial analyses, and even artificial intelligence. The K07 applicant is a National Institutes of Health (NIH)-funded independent investigator and fellowship-trained anesthesiologist with expertise in regional anesthesia and orthopedic surgery, as well as research experience in machine learning, geospatial disparities, and perioperative pain and cognition. The purpose of this proposal is to promote institutional and community awareness of how social vulnerabilities impact perioperative outcomes in older adults, including those with Alzheimer’s disease and related dementias, and particularly those outcomes related to postoperative pain and cognition. The overall strategy of this proposal is to develop interdisciplinary research infrastructure along with transdisciplinary training programs to crosspollinate research teams. This structure will be organized via the Perioperative Cognitive Anesthesia Network-Social Vulnerability (PeCANSV) construct in three aims: Aim 1: Convene a PeCANSV multidisciplinary advisory team to establish three supplemental cores in 1) geospatial infrastructure; 2) social determinants of health; 3) artificial intelligence. Aim 2: Accelerate research discovery through interdisciplinary research pathways by formalizing nascent linkages between supplemental PeCANSV cores and UF resources and extant geospatial, environmental, cognitive, and clinical perioperative databases at UF Health and throughout Florida. Aim 3: Develop a transdisciplinary workforce of clinical and basic science researchers to lead interdisciplinary teams addressing the social vulnerability of older adult surgical patients. Milestones include regular analysis of strengths, opportunities, aspirations, and results, interdisciplinary proposal submissions, and evidence of trainee success in perioperative research in social disparities of older adults, including those with Alzheimer’s disease and related dementias.