Communication in the Hospital: Impact on Patients with Alzheimer's Disease and Other Causes of Cognitive Impairments and their Surrogate Decision Makers

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ABSTRACT Nearly half of hospitalized older adults are unable to make their own medical decisions and require a family member or other surrogate to make decisions for them. Many surrogates make decisions about life and death issues under conditions of high stress and often with poor support from clinicians. Surrogates rely on various sources of emotional support and sources of value to make medical decisions, including personal, religious and spiritual beliefs. However, both surrogates and clinicians report high levels of distress due to the emotional and communication challenges of making decisions for others. As the population ages and a greater number of older adults are at risk for cognitive impairment, the importance of surrogate decision making will only increase. The COVID-19 pandemic has added greater urgency due to the many cognitively impaired patients separated from their families during life threatening illness and hospitalization. Developing interventions to promote high quality decision making will allow us to best support family members and to provide the best possible care to older adults with Alzheimer’s disease and related disorders. Dr. Alexia Torke’s research has focused on the communication, ethical, religious and spiritual aspects of decision making for those patients who are incapacitated and require a family surrogate to make decisions for them. During her current period of funding from her K24 Midcareer Award in Patient Oriented Research, she achieved the research goals proposed in the award, obtained an R01 grant as PI, and mentored several successful junior faculty. This K24 renewal will continue to provide support for Dr. Torke’s program of research and will allow her additional protected time to pursue her passion for mentoring others. The specific aims of this proposal are to develop the national network for a multicenter trial of spiritual care delivered via telephone or video for surrogate decision makers of older adults in the ICU; conduct a pilot study of the effects of scheduled video and audio conferencing facilitated by clinical navigators on the experience of surrogate decision makers for hospitalized older adult patients who are incapacitated due to Alzheimer’s disease and other causes of cognitive impairment; and continue to provide mentorship to junior investigators conducting research on older adults who are vulnerable due to AD and other conditions. Indiana University provides an ideal location for this work. Dr. Torke’s primary appointment is in the IU Center for Aging Research. The Center has provided infrastructure, intramural funding and space for Dr. Torke’s research and for support of her mentees. Additional resources such as the Indiana Clinical and Translational Sciences Institute and the Clinical Investigation and Translational Education program enrich opportunities for mentees to obtain research training and funding support.