Enabling Older Adults to 'LiveWell' with Advanced Heart Failure: Development of a Palliative Rehabilitation Model

项目摘要/摘要 65岁及以上的美国人每年因心力衰竭(HF)住院的人数占70%，而且 这一人群中的许多人都受到多病、功能限制和高症状负担的负担。AS HF 晚期(纽约心脏协会III-IV级)疾病负担大幅增加，特别是 在生命的最后6个月中，80%的人至少住院一次，许多人认为 与功能衰退和无法参与生活角色和活动有关的苦恼。尽管广泛存在 认识到身体康复和姑息治疗在改善症状和质量方面的独特好处 对于心力衰竭患者的生活，这些服务在方法上是分开的，并且没有得到充分利用。到目前为止， 物理康复模型的设计并不能同时解决复杂的心理和社会问题 老年晚期心力衰竭患者的功能需求。为了优化这一弱势群体的生活质量， 需要新的康复策略，从整体上解决生物、心理和社会障碍。我的K23提案 将通过开发和测试LiveWell-HF来满足这一需求，这是一种基于家庭的物理治疗模型 辅以循证、心理策略，从早期综合姑息治疗改善 老年人因晚期心力衰竭住院后的应对和接受情况。具体地说，我的目标是1)发展 包含提供者和患者利益相关者输入的初步LiveWell-HF模型；2)使用 开放式先导研究设计；以及3)评估改进的LiveWell-HF模型的可行性、可接受性和保真度 通过进行试点随机对照试验。这些AIMS的发现也将成为R01疗效试验的依据 作为确定LiveWell-HF对医疗保健利用的影响和该模型的扩展的未来工作 为护理合作伙伴量身定做。这项提议的目标将得到我的职业发展活动的支持， 专注于1)开发姑息治疗方面的高级临床和研究专业知识，2)定性和混合 方法研究开发和完善循证康复干预措施，3)临床试验研究， 4)领导力发展。我的模范导师和顾问团队将由克里斯汀·里奇博士领导， 国际知名的老年学家和姑息治疗内科医生，具有丰富的指导经验 大病患者的混合方法研究和临床试验。我的互补专业知识 马萨诸塞州综合医院和哈佛医学院丰富的制度环境 学校，我的培训计划将使我能够成功地完成这方面的培训和研究目标 申请。这份K23计划书将为我提供开启职业生涯所需的技能和数据 身体康复、姑息治疗和老年医学领域的独立研究人员和领导者 心脏科。最终，这一系列研究可以改善患有晚期心力衰竭的老年人的生活体验 并改变身体康复策略的设计方式，以满足患有严重疾病的老年人的需求 生病了。

PROJECT SUMMARY/ABSTRACT Americans aged 65 years and older account for 70% of heart failure (HF)-related hospitalizations each year, and many in this population are burdened by multimorbidity, functional limitations, and high symptom burden. As HF becomes advanced (New York Heart Association Class III-IV) disease burden increases substantially, especially in the last 6 months of life when 80% of individuals are hospitalized at least once and many endorse significant distress related to functional decline and inability to participate in life roles and activities. Despite widespread recognition of the distinct benefits of physical rehabilitation and palliative care in improving symptoms and quality of life among individuals with HF, these services are separate in their approach and underutilized. To date, physical rehabilitation models have not been designed to simultaneously address the complex psychosocial and functional needs of older adults with advanced HF. To optimize quality of life in this vulnerable population, a novel rehabilitation strategy that holistically addresses biopsychosocial impairments is needed. My K23 proposal will address this need by developing and testing LiveWell-HF, a home-based physical therapy model supplemented with evidence-based, psychological strategies from early integrated palliative care to improve coping and acceptance among older adults after hospitalization for advanced HF. Specifically, I aim to 1) develop the preliminary LiveWell-HF model with provider and patient stakeholder input; 2) refine LiveWell-HF using an open pilot study design; and 3) evaluate the feasibility, acceptability, and fidelity of the refined LiveWell-HF model by conducting a pilot randomized controlled trial. Findings from these aims will inform a R01 efficacy trial as well as future work to determine the impact of LiveWell-HF on healthcare utilization and an extension of the model tailored for care partners. The aims of this proposal will be supported by my career development activities, which focus on 1) developing advanced clinical and research expertise in palliative care, 2) qualitative and mixed methods research to develop and refine evidence-based rehabilitation interventions, 3) clinical trials research, and 4) leadership development. My exemplary team of mentors and advisors will be led by Dr. Christine Ritchie, an internationally renowned geriatrician and palliative care physician with extensive experience conducting mixed methods research and clinical trials in patients with serious illness. The complementary expertise of my mentors and advisors, rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and my training plan will enable me to successfully complete the training and research aims in this application. This K23 proposal will provide me with the skills and data needed to launch my career as an independent investigator and leader at the intersection of physical rehabilitation, palliative care, and geriatric cardiology. Ultimately this line of research can improve the lived experience of older adults with advanced HF and change the way physical rehabilitation strategies are designed to meet the needs of older adults with serious illness.