Optimal Prevention & Treatment In Medically Complex Alzheimer Patients (OPTIMAL)

描述(由申请人提供)：如RFA-HS-08-003所述，我们建议使用现有患者队列进行一项分析性流行病学研究，以探索在大型初级保健实践的“现实世界”环境中预防性干预的潜在益处和危害。与RFA的目标一致，我们选择了老年人中的认知障碍作为目标慢性疾病。我们将探索在认知障碍的老年人中进行预防性干预的潜在益处和危害，并检查另外两种疾病的健康状况，包括医学和精神健康状况：(A)晚年抑郁症和(B)心血管疾病。要研究的预防干预措施是癌症筛查(乳腺癌、前列腺癌和结肠癌)和流感疫苗接种。这项研究队列包括3954名60岁及以上的患者，作为早期研究的一部分，他们在1991-93年间就诊于初级保健医生的办公室期间完成了认知筛查。有关这些患者的全面随访信息可从Regenstrief医疗记录系统获得，包括提供预防性卫生措施、癌症发病率和生命状况的数据。 这项申请的具体目标是： 1)描述有认知障碍的老年人在有和没有抑郁症和心血管疾病的额外共病情况下的15年死亡轨迹； 2)描述在患有和不患有认知障碍、抑郁症和心血管疾病的老年人中，下列预防性卫生服务的发生率和结果： A)癌症筛查(乳腺癌、结肠癌和前列腺癌)； B)接种流感疫苗；以及 3)确定预防性保健服务利用增加的时间趋势在多大程度上延伸到这一研究人群。 这项工作旨在优化复杂初级保健患者中关于预防保健和痴呆症管理的决策。这些数据为未来的工作奠定了基础，以确定哪些治疗方法和治疗组合提供了最大的好处和最高质量的护理。

DESCRIPTION (provided by applicant): As specified in RFA-HS-08-003, we are proposing an analytic epidemiologic study using an existing patient cohort to explore the potential benefits and harms of preventive interventions in the "real world" setting of a large primary care practice. Consistent with the goals of the RFA, we have selected cognitive impairment among older adults as the targeted chronic condition. We will explore the potential benefits and harms of preventive interventions among older adults with cognitive impairment and also examine health status with regard to two other conditions including both a medical and mental health condition: (a) late life depression and (b) cardiovascular disease. The preventive interventions to be studied are cancer screening (breast, prostate, and colon) and influenza vaccination. The study cohort consists of 3,954 patients aged 60 and older who, as part of an earlier study, completed cognitive screening during office visits to their primary care physicians in 1991-93. Comprehensive follow-up information on these patients is available from the Regenstrief Medical Record System, including data on provision of preventive health measures, cancer incidence, and vital status. The specific aims for this application are to: 1) Describe the 15-year mortality trajectories for older adults with cognitive impairment, with and without the additional comorbid conditions of depression and cardiovascular disease; 2) Describe the incidence of and outcome for the following preventive health services among older adults with and without cognitive impairment, depression, and cardiovascular disease: a) cancer screening (breast, colon cancer, and prostate); b) influenza vaccination; and 3) Determine the extent to which temporal trends of increasing utilization of preventive health services extend to this study population. This work seeks to optimize decisions about preventive care and management of dementia among complex primary care patients. These data form the foundation for future work to determine which treatments and combinations of treatment offer the most benefit and the highest quality care.