Longevity and Medical Treatment in Old Age

长寿与晚年医疗

• 批准号: 7595112
• 负责人: SHARON R KAUFMAN
• 金额: $ 47.03万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7595112
• 关键词: Address; Advocacy; Affect; Age; Aging; American; Anthropology; Area; Attention; Attitude; Bypass; Cadaver; Cardiac; Caring; Case-Control Studies; Cessation of life; Chronic Care; Clinic; Clinical; Clinical Medicine; Clinical Trials; Code; Communities; Cultural Anthropology; Data; Data Analyses; Data Collection; Decision Making; Defibrillators; Development; Disease; Elderly; Eligibility Determination; Ethics; Ethnography; Explosion; Face; Family; Family Physicians; Family health status; Family member; Frequencies; Geriatrics; Gerontology; Goals; Health; Health Knowledge, Attitudes, Practice; Health Professional; Healthcare; Hepatitis B; Home environment; Individual; Intervention; Interview; Investigation; Kidney Transplantation; Knowledge; Learning; Life; Life Cycle Stages; Life Extension; Life Support Care; Liver diseases; Living Donor Liver Transplantation; Living Donors; Longevity; Love; Maintenance; Malignant Neoplasms; Malignant neoplasm of prostate; Mediation; Medical; Medicare; Medicine; Methods; Nature; Operative Surgical Procedures; Organ Donor; Organ Transplantation; Palliative Care; Participant; Patients; Persons; Pharmaceutical Preparations; Physicians; Pilot Projects; Principal Investigator; Procedures; Process; Prostate; Renal dialysis; Research; Research Personnel; Role; Sampling; Shapes; Social Obligations; Societies; Staging; Stents; Techniques; Time; Treatment outcome; Work; Writing; base; cancer therapy; caregiving; clinical practice; end of life; end of life care; ethnographic method; expectation; experience; federal policy; health care cost/financing; implantation; innovation; intervention effect; liver transplantation; medical specialties; normal aging; older patient; programs; response; senescence; standard care; success; treatment effect

DESCRIPTION (provided by applicant): The goal of this 5-year qualitative anthropological study is to describe and examine the specific ways in which 3 types of life-extending medical interventions for the elderly are affecting growing numbers of aging Americans, the physicians who treat them, their families, and the delivery of medical care in an aging society. The three types of intervention, never before studied for their effects on clinical and family obligation and end of life planning and care are: the automatic implantable cardiac defibrillator; living donor kidney transplant and living or cadaver donor liver transplant; and prostate and gynecological cancer treatments. These specific interventions have been selected for study for the following 2 reasons. They are affecting increasing numbers of elderly persons and are emblematic of the rising age for medical interventions of all kinds; and they exemplify both the successes of life-extension for those who are already elderly and the burdens and dilemmas of medical choice about aggressive treatments and chronic care for health practitioners, older persons, and their families. The long-term goal is to learn, in as much detail as possible, how life extension practices and the socio-medical developments surrounding them are impacting geriatric medicine, the health care older Americans receive, and the experience of elderly persons. The specific aims of this empirical, ethnographic study are: 1) to discover and describe the criteria and rationale by which older patients, their families, and physicians decide to move forward, or not, with the 3 types of interventions; 2) to learn how patients and families understand and live with treatments; 3) to learn the effects of treatments on end of life planning; 4) to explore what constitutes ethical and practical dilemmas and challenges surrounding life extension; 5) to investigate clinical and family responsibilities regarding these treatments; and 6) to investigate ways in which recently expanded Medicare eligibility criteria affect physician, patient and family understandings of standard care and 'normal' old age. The traditional anthropological methods of participant-observation (in medical clinics) and in-depth interviews with small samples will be used to collect data from physicians, patients, and their family members. Well-known coding based qualitative data analysis techniques will be used to fully examine the study aims: cross-sectional comparison, case studies, thematic analysis, and frequencies of response. Relevance: This project will document the ways in which the proliferation of life-extending interventions for the elderly influences patients age 70 and over, families, the field of geriatric medicine and medical practice with older individuals generally. This study will provide data about physician decision-making and patient responses to both aggressive and palliative treatments that will be important for health consumers, health professionals in a variety of fields, academic geriatrics, and health care planning for an aging society.

描述（由申请人提供）：这项为期5年的定性人类学研究的目标是描述和检查针对老年人的三种延长生命的医疗干预措施对越来越多的美国老年人、治疗他们的医生、他们的家人以及老龄化社会中医疗保健的提供的具体方式。以前从未研究过的三种干预措施对临床和家庭义务以及临终计划和护理的影响是：自动植入式心脏除颤器；活体供肾移植和活体或尸体供肝移植；前列腺癌和妇科癌症的治疗。选择这些具体的干预措施进行研究有以下两个原因。它们影响到越来越多的老年人，标志着接受各种医疗干预的年龄越来越大；他们既证明了延长老年人寿命的成功，也说明了医疗从业者、老年人及其家人在积极治疗和慢性护理方面的医疗选择的负担和困境。长期目标是尽可能详细地了解延长寿命的做法和围绕它们的社会医学发展如何影响老年医学、美国老年人接受的卫生保健和老年人的经验。这项实证的民族志研究的具体目的是：1)发现和描述老年患者、他们的家人和医生决定是否采用这三种干预措施的标准和理由；2)了解患者和家属如何理解和接受治疗；3)了解治疗对临终计划的影响；4)探索围绕生命延长的伦理和实践困境和挑战；5)调查临床和家庭在这些治疗方面的责任；6)调查最近扩大的医疗保险资格标准如何影响医生、患者和家庭对标准护理和“正常”老年的理解。将采用传统的人类学方法，即参与者观察（在医疗诊所）和小样本深度访谈，从医生、患者及其家庭成员那里收集数据。众所周知的基于编码的定性数据分析技术将用于全面检查研究目标：横断面比较，案例研究，主题分析和响应频率。相关性：本项目将记录老年人延长生命干预措施的激增对70岁及以上的患者、家庭、老年医学领域和一般老年人医疗实践的影响。本研究将提供关于医生决策和患者对积极治疗和姑息治疗的反应的数据，这对健康消费者、各种领域的卫生专业人员、学术老年病学和老龄化社会的卫生保健计划都很重要。