Evaluating the Unmet Needs of Older Adults to Promote Functional Recovery after a Critical Illness (LANTERN)

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Nearly 2 million persons aged 65 years or older are admitted to an intensive care unit (ICU) each year; of those who survive, half will not achieve functional recovery over the subsequent months. To date, prior post-ICU in- terventions targeting functional outcomes have not been successful; moreover, no prior post-ICU interventions targeting functional recovery have focused on older adults, who are more vulnerable to poor functional out- comes than their younger counterparts. Our long-term goal is to develop interventions to improve functional outcomes among older ICU survivors. Our preliminary data suggest that unmet needs across four domains (home environment, skilled rehabilitation, hearing and vision, and informal and formal care) may adversely af- fect functional recovery among older adults who have returned home (either directly or after short-term rehab [STR]) after an ICU hospitalization. The overall objective of this application is to elucidate the unmet needs of older ICU survivors, evaluate the association of these unmet needs with disability, hospital readmissions, and mortality over the subsequent 6 months, and assess barriers and facilitators to addressing these unmet needs. The central hypothesis is that older ICU survivors have unmet needs in the aforementioned domains that rep- resent potential targets for intervention, and that these unmet needs are associated with disability burden, hos- pital readmissions, and mortality. The rationale for the proposed research is that this work will directly inform the development of an intervention to address unmet needs and facilitate functional recovery among older ICU survivors. The central hypothesis will be tested by enrolling a new cohort of older ICU survivors to achieve the following specific aims: 1) To identify unmet needs in multiple domains after return home from an ICU hospitali- zation, evaluate whether these unmet needs are associated with disability burden in the subsequent 6 months, and ascertain whether these associations are moderated by initial discharge destination (home or STR); the domains include: the home environment, skilled rehabilitation services, sensory needs (in hearing and vision), and informal (unpaid) care and formal (paid) home care services; 2) To evaluate the association of unmet needs in these multiple domains with hospital readmissions and mortality over the subsequent 6 months; and 3) Through qualitative interviews with a subset of older ICU survivors (and their caregivers, if applicable), to explore barriers to addressing unmet needs and to gather patient and caregiver input about facilitators in ad- dressing unmet needs to inform a future intervention. The proposed research is innovative because it will use a geriatrics lens to rigorously evaluate unmet needs across multiple domains, which in turn will directly inform the development of a future intervention to facilitate functional recovery among older ICU survivors by addressing these unmet needs. The research proposed in this application will provide a strong evidence base for actiona- ble targets to reduce disability, hospital readmissions, and mortality among older adults who have survived a critical illness, in line with NIA’s strategic priorities.