Surrogate Decision Making for Hospitalized Older Adults

描述（由申请人提供）：这是Alexia Torke的指导性患者导向研究职业发展奖（K23）的提案。Torke博士开始了她的医学生涯，作为一名临床医生教育者，专注于医学伦理学。在埃默里大学当了五年教员后，她回到培训班，完成了伦理学和初级保健方面的奖学金。她目前是印第安纳州大学医学助理教授和印第安纳州大学老龄化研究中心的研究科学家。她的研究现在集中在老年人决策的医学和伦理方面。Torke博士的长期目标是改善那些不能自己做决定的住院老年人的医疗护理。这个职业发展奖将为她提供完成这一目标的关键一步所需的培训和保护时间：描述这些患者的决策过程。Torke博士建议对老年人及其代理决策者进行前瞻性观察研究。本研究的具体目的是描述代理决策的频率、特征和临床背景，并从代理人的角度确定成功沟通和高质量决策的重要决定因素。65岁及以上的患者将在入院时被确定，并在住院期间接受随访。将从治疗医生、病历审查和与替代决策者的深入访谈中收集数据。这些结果将作为未来干预措施的基础，以改善无法做出自己的医疗决定的老年人的护理。Torke博士还设计了一个教育计划，将进一步发展她作为一个独立的研究者。Torke和她的导师已经确定为对她的职业发展至关重要的四个领域：老龄化和临床老年医学;沟通理论;赠款写作;和临床试验设计。Torke博士将参加相关的国家会议，并完成与这四个领域相关的正式课程。她还将通过参加印第安纳州大学内的老年人急性护理单位和记忆护理实践来扩大她的临床老年医学知识。

DESCRIPTION (provided by applicant): This is a proposal for a Mentored Patient-Oriented Research Career Development Award (K23) for Alexia Torke. Dr. Torke began her medical career as a clinician educator in general internal medicine with a focus on medical ethics. After five years as a faculty member at Emory University, she went back into training to complete a fellowship in ethics and primary care. She is currently an Assistant Professor of Medicine at Indiana University and a Research Scientist at the Indiana University Center for Aging Research. Her research now focuses on both medical and ethical aspects of decision making for older adults. Dr. Torke's long term goalis to improve the medical care ofhospitalized older adults who are unable to make their own decisions. This Career Development Award would provide her with the training and protected time needed to accomplish a crucial step toward that goal: characterizing the decision making process as it occurs for these patients. Dr. Torke proposes to conduct a prospective, observational study of older adults and their surrogate decision makers. The specific aims ofthis study are to describe the frequency, characteristics, and clinical context of surrogate decisions, and to identify important determinants of successful communication and high quality decision making from the surrogate's perspective. Patients 65 and older will be identified on admission and followed during their hospital stay. Data will be collected from treating physicians, from medical record review and from in-depth interviews with surrogate decision makers. These results will serve as the basis for future interventions to improve the care of older adults who are unable to make their own medical decisions. Dr. Torke has also designed an educational plan that will further her development as an independent investigator. The plan focuses on four areas that Dr. Torke and her mentors have identified as crucial to her career development: aging and clinical geriatrics; communication theory; grant writing; and clinical trial design. Dr. Torke will attend relevant national conferences and complete formal course work related to each of these four areas. She will also expand her knowledge of clinical geriatrics by participating in the Acute Care for the Elders Unit and the memory care practice located within Indiana University.