Palliative needs of cognitively impaired patients during health care transactions

描述（由申请人提供）：患有认知障碍（CI）和多种健康状况的老年人除了对其疾病进行治疗外，通常还需要一定程度的支持性护理。一种支持性治疗是姑息治疗。姑息治疗是一种个性化的治疗方法，旨在满足处于进行性、限制生命的疾病各个阶段的人们的需求，其目标是提高生活质量和减少护理人员的负担。姑息治疗的重点是沟通，症状管理（身体和心理）和协调护理。了解老年认知障碍（CI）患者在疾病发展的不同阶段的姑息治疗需求，对于了解如何通过急性护理期为这一人群提供护理至关重要。尽管对CI患者的姑息治疗一直是最近研究的重点，但对经历急性疾病发作的老年CI患者的护理知之甚少。一种可能的选择是过渡护理模式（TCM），这是一种以证据为基础、护士主导的老年人护理模式。本研究旨在描述社区居住的CI老年人及其家庭照顾者在急性疾病发作时的姑息治疗需求和干预措施、生活质量和照顾者负担的影响。本研究将利用来自“从医院到家庭：认知障碍老年人/护理者”（R01AG023116-05；主要数据收集于2010年7月完成）的数据。专家小组将检查接受中医干预的研究参与者的电子病历，以确定与姑息治疗需求相关的具体姑息治疗干预措施。数据分析将包括描述性统计，未调整的双变量分析和调整的多变量分析（逻辑和广义线性模型）。对这些数据的二次分析为更好地了解这一人群的护理协调和姑息治疗以及改善未来的护理提供了有价值的机会。这项研究的结果将产生姑息治疗干预的概况，以支持有竞争力的NIH R01应用程序的开发，以测试改进的姑息治疗为重点的过渡护理模式。这项研究的结果有可能改变现有的姑息治疗实践，以优先考虑高危老年CI患者及其家庭照顾者。

DESCRIPTION (provided by applicant): Older adults with cognitive impairment (CI) and multiple health conditions often need some degree of supportive care in addition to treatment for their diseases. One type of supportive care is palliative care. Palliative care is an individualized approach to care designed to meet the needs of people at all stages of progressive, life-limiting illness with the goals to improve quality of life and minimize caregiver burden. The emphasis of palliative care is on communication symptom management (both physical and psychological), and coordination of care. Understanding the palliative care needs of older adults with cognitive impairment (CI) at various stages along the disease trajectory is critical to understanding how to provide care for this population through acute care episodes. Although palliative care for persons with CI has been the focus of recent studies, little is known about the care of older persons with CI who experience an episode of acute illness. One possible option is the Transitional Care Model (TCM), an evidence-based, nurse-led model of care for older adults. The proposed study aims to describe the effect of palliative care needs and interventions, quality of life and caregiver burden among community dwelling older adults with CI and their family caregivers through an episode of acute illness. This proposed study will utilize data from the "Hospital to Home: Cognitively Impaired Elders/Caregivers" (R01AG023116-05; primary data collection completed July 2010). An expert panel will examine the electronic medical records of study participants that received the TCM intervention to determine specific palliative care interventions associated with palliative care needs. Data analyses will involve descriptive statistics, unadjusted bivariate analyses and adjusted multivariable analysis (logistic and generalized linear modeling). Secondary analysis of these data offers a value opportunity to better understand care coordination and palliative care for this population and to improve future care. The findings from this study will generate a profile of palliative care interventions to support the development of a competitive NIH R01 application to test a modified palliative care focused Transitional Care Model. Findings from this study have the potential to change existing palliative care practice for this priority population of at risk older adults with CI and their family caregivers. PUBLIC HEALTH RELEVANCE: Care of older adults with cognitive impairment will be one the most serious public health challenges in the coming decades. Palliative care is essential for older adults with cognitive and serious or life limiting illnesses and can support their family caregivers through an acute episode of care. Secondary analysis of available NIA data offers a value opportunity to better understand care coordination and palliative care for this population and to improve future care.