Critical Illness, Disability, and Vulnerability in Older Persons

老年人的危重疾病、残疾和脆弱性

• 批准号: 9122269
• 负责人: Lauren Ferrante
• 金额: $ 12.49万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9122269
• 关键词: Accounting; Admission activity; Age; Aging; Attention; Cessation of life; Clinical; Cognition; Cognitive; Critical Care; Critical Illness; Data; Data Quality; Dependence; Development; Discipline of Nursing; Elderly; Emotional; Epidemiology; Evaluation; Event; Evidence based intervention; Family; Future; Goals; Health; Home environment; Hospitalization; Illness impact; Impaired cognition; Independent Living; Institutionalization; Intensive Care Units; Intervention; Investigation; Longitudinal Studies; Matched Group; Measures; Medicine; Morbidity - disease rate; Nursing Homes; Outcome; Patients; Persons; Phenotype; Population; Public Health; Rehabilitation therapy; Research; Risk; Role; Services; Societies; Survivors; Work; adverse outcome; aged; cohort; design; disability; disability burden; experience; frailty; functional outcomes; functional status; improved; innovation; mortality; survivorship

 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.

 描述（由申请人提供）：在美国，每年有近140万老年人在一次重病中幸存下来。随着我们人口的老龄化和重症监护医学的进步，这一数字预计将增长，从而提高ICU生存率。在进行独立生活所必需的活动方面的残疾经常见于老年IU幸存者。这一发现具有重要的临床和公共卫生意义，因为残疾是 与死亡率增加、机构化以及更多地使用正规和非正规家庭服务有关。为了为制定旨在改善功能结果的循证干预措施提供信息，必须全面了解患重病的老年人的残疾流行病学。这种评价必须考虑到先前存在的虚弱和认知障碍的影响，这两个脆弱因素已知会增加没有重大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老年重症幸存者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得到了很好的描述，但危重病后的残疾负担相对于其他住院后观察到的残疾负担，以前尚未进行过评估。 本提案的总体目标是评价老年重症幸存者的残疾类型和负担，特别注意先前存在的残疾因素的作用，并量化重症后残疾与其他住院治疗后观察到的残疾的相对程度。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，评估先前存在的虚弱对ICU后新发或恶化的残疾的影响（在基本的，工具性的，和流动性的活动），并与长期疗养院入院，相对于危重的老年人没有脆弱;（2）评估先前存在的认知障碍和虚弱对重症老年人ICU后结局的独立和联合影响，包括死亡率、残疾和长期护理住院;和（3）评估危重病与新发或恶化的残疾以及长期入住疗养院的相关性，相对于一组因非危重病住院的老年人，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，包括每月对功能状态的评估和15年以上每18个月的综合评估，我们已经收集了一个相当大的和不断增长的危重老年人队列，他们在危重病之前和之后都进行了仔细的表型分析。我们的分析结果将用于制定有针对性的干预措施，以减少残疾和优化老年重症幸存者的功能结局，这是候选人和拟议研究的长期目标。