Critical Illness, Disability, and Vulnerability in Older Persons

 描述(申请人提供)：在美国，每年有近140万老年人在一次危重疾病发作中幸存下来。这一数字预计将随着人口老龄化和重症监护医学的进步而增长，从而提高ICU存活率。在独立生活所必需的活动中，残疾经常见于上了年纪的印第安纳大学幸存者。这一发现具有重要的临床和公共卫生意义，因为残疾 与死亡率增加、制度化以及更多地使用正式和非正式家庭服务有关。为了促进旨在改善功能结果的循证干预措施的发展，全面了解患有危重疾病的老年人的残疾流行病学是至关重要的。这项评估必须考虑到先前存在的虚弱和认知障碍的影响，这两个脆弱性因素已知会增加没有危重疾病的老年人的不良后果。目前，关于先前存在的虚弱和认知障碍对危重疾病老年幸存者的残疾类型和负担的影响，人们知之甚少。此外，虽然住院相关的残疾已经有了很好的描述，但与其他住院后观察到的残疾负担相比，危重疾病后的残疾负担以前还没有评估过。这项建议的总体目标是评估危重疾病老年幸存者的残疾类型和负担，特别注意先前存在的脆弱因素的作用，并量化危重疾病后残疾与其他住院后残疾的相对程度。我们将通过以下三个目标来实现这一目标：(1)在患有危重疾病的老年人中，评估与没有虚弱的危重老年人相比，先前存在的脆弱对ICU后新的或恶化的残疾(基本、工具和活动)以及长期入住疗养院的影响；(2)评估先前存在的认知障碍和脆弱对危重老年人ICU后结局的独立和综合影响，包括死亡率、残疾和长期住院护理；以及(3)评估危重疾病与新的或恶化的残疾以及长期入住疗养院的联系，相对于一组匹配的患有非危重疾病住院的老年人，同时考虑虚弱和认知障碍。通过使用来自一项独特的老年人纵向研究的高质量数据，该研究包括在15年多的时间里每18个月进行一次功能状况评估和全面评估，我们收集了一个规模可观且不断增加的危重老年人队列，他们在危重疾病前后都进行了仔细的表型鉴定。我们的分析结果将被用于开发有针对性的干预措施，以减少危重疾病老年幸存者的残疾和优化功能结果，这是候选人和拟议研究的长期目标。

 DESCRIPTION (provided by applicant): In the U.S., nearly 1.4 million older persons survive an episode of critical illness every year. This number is expected to grow with the aging of our population and advances in critical care medicine leading to improved ICU survivorship. Disability in carrying out activities essential to independent living is frequently seen in older IU survivors. This finding has significant clinical and public health importance because disability is associated with increased mortality, institutionalization, and greater use of formal and informal home services. To inform the development of evidence-based interventions directed at improving functional outcomes, a comprehensive understanding of the epidemiology of disability among older persons who experience critical illness is essential. This evaluation must consider the impact of preexisting frailty and cognitive impairment, two vulnerability factors that are known to increase adverse outcomes in older persons without critical illness. Currently, relatively little is known about the effect of preexisting frailty and cognitive impairment on the type and burden of disability among older survivors of critical illness. Additionally, while hospitalization-associated disability has been well described, the burden of disability after critial illness relative to that observed after other hospitalizations has not been previously evaluated. The overall objective of this proposal is to evaluate the type and burden of disability among older survivors of critical illness, with special attention to the role of preexisting vulnerabilit factors and to quantifying the relative magnitude of disability after critical illness to that obseved after other hospitalizations. We will achieve this objective with the following three aims: (1) Among older persons with critical illness, to evaluate the effect of preexisting frailty on new or worsening post-ICU disability (in basic, instrumental, and mobility activities) and with long-term nursing home admissions, relative to critically ill older persons without frailty; (2) To evaluate he independent and combined effects of preexisting cognitive impairment and frailty on post-ICU outcomes in critically ill older persons, including mortality, disability, and long-term nursing hoe admissions; and (3) To evaluate the association of critical illness with new or worsening disability and with long-term nursing home admissions, relative to a matched group of older persons hospitalized with a non-critical illness, while accounting for frailty and cognitive impairment. By using high quality data from a unique longitudinal study of older persons that includes monthly assessments of functional status and comprehensive assessments every 18 months over the course of 15+ years, we have assembled a sizeable and growing cohort of critically ill older persons who have been carefully phenotyped both before and after their critica illness. The results of our analyses will be used to develop targeted interventions to reduce disability and optimize functional outcomes in older survivors of critical illness, which is the log-term goal of the candidate and proposed research.