Medical Illness & Cognitive Impairment in Older Adults: Heart Failure as a Model

描述(由申请者提供)：本职业发展奖申请的主要目标是使申请者能够发展必要的技能和专业知识，成为一名独立的研究人员，专注于认知功能在老年人医疗疾病过程中所起的重要作用。认知障碍(CI)通常发生在慢性疾病的背景下，这种疾病在老年人中很常见，可能会影响这些高危患者的临床和生活质量，可能是通过损害自我护理。心力衰竭(HF)是研究CI对疾病、自我护理和长期预后的影响的理想条件。我的研究计划的具体目的是：(1)前瞻性地检查65岁的患者从心力衰竭入院到出院后3个月的认知功能；(2)前瞻性地检查从心力衰竭入院到出院后3个月的自我护理活动的表现；(3)检查认知功能与出院后选定时间间隔内自我护理活动的表现之间的关系；(4)开发并试行一种干预措施，以加强心力衰竭幸存者的自我护理实践，该干预措施是根据患者的认知状况量身定制的。一个健全的培训计划将补充这项研究计划，并为申请者提供作为一名独立研究人员取得成功所必需的工具；它将包括临床老年病学、心血管流行病学、纵向研究方法和临床试验设计和实施领域的课程工作和重点指导。在获奖期间进行的工作结果将有可能为根据患者的认知状况量身定做的自我护理干预措施的发展提供信息，并改善患有慢性疾病的认知障碍患者的健康。 公共卫生相关性：有证据表明，认知受损的老年患者的健康结果很差，包括生活质量下降、重复住院和死亡率增加，但发生这种情况的途径尚不清楚。了解认知障碍在患者自我护理中的作用，对于设计自我护理干预措施和改善患有慢性疾病的老年人的护理具有重要意义。

DESCRIPTION (provided by applicant): The primary objective of this Career Development Award application is to enable the applicant to develop the skills and expertise necessary to become an independent investigator focusing on the important role cognitive function plays in the course of medical illness in older adults. Cognitive impairment (CI) often occurs in the context of chronic medical conditions that are common in older adults and likely influences clinical and quality of life outcomes in these high- risk patients, potentially through impaired self-care. Heart failure (HF) is an ideal condition through which to study the impact of CI on disease self-care and long-term outcomes. The specific aims of my research program are to: (1) prospectively examine cognitive function in patients aged e65 years from the time of hospitalization for HF through 3-months after hospital discharge; (2) prospectively examine the performance of self-care activities from the time of hospitalization for HF through 3-months after hospital discharge; (3) examine the relation between cognitive function and performance of self-care activities at selected time intervals following hospital discharge for HF; (4) develop and pilot test an intervention to enhance self- care practices for HF survivors that is tailored to a patient's cognitive status. A robust training plan will complement this research program and provide the applicant with the tools necessary to be successful as an independent investigator; it will include coursework and focused mentoring in the areas of clinical geriatrics, cardiovascular epidemiology, longitudinal research methodologies, and clinical trial design and implementation. The findings of the work conducted during the award period will have the potential to inform the development of self-care interventions that are tailored to the patient's cognitive status and to improve the health of cognitively impaired patients with chronic medical conditions. PUBLIC HEALTH RELEVANCE: Evidence suggests that cognitively impaired older patients have poor health outcomes including reduced quality of life, repeat hospitalizations, and increased mortality, yet the pathways by which this occurs are not well understood. Understanding the role cognitive impairment plays in patient self-care has significant implications for the design of self-care interventions and for improving the care of older adults with chronic medical conditions.