Earlier Introductions to Palliative Care in Older Adults Undergoing High-Risk Surgery

早期介绍接受高风险手术的老年人的姑息治疗

• 批准号: 9812080
• 负责人: Pasithorn Suwanabol
• 金额: $ 11.21万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9812080
• 关键词: Address; Adult; Aging; Attention; Bereavement; Caring; Cessation of life; Clinical; Cognitive; Communication; Comorbidity; Complication; Computers; Data; Decision Making; Decision Support Systems; Dementia; Development; Elderly; Family; Foundations; Funding; Future; Health Status; Health and Retirement Study; Healthcare; Hospitals; Impaired cognition; Impairment; Individual; Infrastructure; Inpatients; Intervention; Interview; K-Series Research Career Programs; Knowledge; Life; Light; Link; Longitudinal Surveys; Medicare; Medicare claim; Mentorship; Methods; Michigan; Operative Surgical Procedures; Outcome; Palliative Care; Patients; Pattern; Perioperative complication; Phase; Physical Function; Physiological; Population; Postoperative Complications; Quality of life; Recovery; Reporting; Research; Research Personnel; Services; Structure; Surgeon; Surgical complication; Surveys; System; Testing; Time; United States; Work; base; care systems; career; clinical decision-making; cognitive function; design; disability; economic outcome; experience; functional decline; health care service utilization; health data; high risk; improved; insight; meetings; mortality; mortality risk; novel strategies; operation; palliative; patient oriented; perioperative mortality; post-traumatic stress; preference; programs; research clinical testing; skills; sociodemographics; surgical risk; symptomatic improvement

ABSTRACT By 2030, adults older than 65 years will exceed 20% of the U.S. population. In parallel to this rapidly-changing demographic, rates of surgery in this population are expected to increase by as much as 30%. Although substantial efforts have been made to reduce perioperative complications and mortality, far less attention has been aimed at the long-term implications of surgery in older adults. In such patients, functional and cognitive decline are common, and may persist or progress to permanent disability or dementia and even death. An in-depth understanding of these long-term implications will shed light on how and when to introduce palliative care strategies to such patients. Capitalizing on rich and longitudinal data from the Health and Retirement Study (HRS) linked to Medicare data, we will conduct a mixed methods evaluation of the clinical, functional, cognitive, and economic outcomes in older adult patients who suffer a serious complication following high-risk elective surgery (Aim 1). More than 27,000 individuals have participated in HRS since its inception in 1992, which details specific information on sociodemographics, health status, spending and utilization, and functional and cognitive status. Through the unique and robust collaborative infrastructure of surgical programs in the State of Michigan, we will then perform a qualitative analysis of surgeon-perceived barriers to use of palliative care services directly informed by our findings from the HRS analysis (Aim 2). This study will have immediate impact on local and national initiatives by revealing how surgeons and hospitals can better anticipate and manage older adult patients' needs who may undergo high-risk surgical procedures. Furthermore, results from this study will allow for the design and implementation of a computer-based, empirically-driven alert to screen for and prompt palliative care referrals in older adult patients who may undergo high-risk surgery. This proposal is the ideal mechanism for me to transition my research career to a focus on palliative care and aging. Successful completion of this project will promote my application for externally-funded career development awards such as the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76) and a subsequent R01. The project, mentorship, and educational plan will prepare me to be an independent investigator and national leader in palliative care and aging among surgical populations.

摘要 到2030年，65岁以上的成年人将超过美国人口的20%。与这一快速变化的 从人口统计来看，这一人群的手术率预计将增加30%。虽然 在减少围手术期并发症和死亡率方面已经做出了很大努力，但关注的却少得多。 旨在研究手术对老年人的长期影响。在这类患者中，功能性和 认知能力下降很常见，可能会持续或进展为永久性残疾或痴呆症，甚至 死亡。深入了解这些长期影响将有助于阐明如何以及何时 向这类患者介绍姑息治疗策略。充分利用来自 健康和退休研究(HRS)链接到联邦医疗保险数据，我们将进行混合方法评估 严重脑梗塞老年患者的临床、功能、认知和经济结果 高危择期手术后并发症(目标1)。超过27,000人参与了 自1992年成立以来，详细介绍了关于社会人口、健康状况、 消费和利用，以及功能和认知状况。通过独特且强大的协作 密歇根州外科项目的基础设施，然后我们将对 外科医生-直接从HRS的调查结果中了解到的使用姑息治疗服务的感知障碍 分析(目标2)。这项研究将通过揭示以下方面对地方和国家倡议产生立竿见影的影响 外科医生和医院如何更好地预测和管理老年患者的需求 接受高风险的外科手术。此外，这项研究的结果将允许设计和 实施基于计算机、经验驱动的警报，以筛选和提示姑息治疗转诊 在可能接受高风险手术的老年患者中。这项建议是我的理想机制 将我的研究生涯转变为专注于姑息治疗和衰老。这个项目的成功完成将 促进我申请外部资助的职业发展奖，如保罗·B·比森奖 新兴领导者老年职业发展奖(K76)和随后的R01。项目，指导， 教育计划将使我成为一名独立调查员和姑息治疗领域的全国领导者 以及外科手术人群中的老龄化。