Aging Well with COPD through Geriatrics-Palliative Care

项目摘要 本次5年K76重新提交的总体目标是支持Anand S。Iyer，MD，MSPH至 成为老年病姑息治疗的领导者，掌握改善老年人健康和福祉的技能。 慢性阻塞性肺疾病（COPD）的老年人。艾耶医生是个肺病学家 和AHRQ-K12 COPD结局研究员。COPD是老年人死亡的第三大原因。 加速生活质量和功能独立性的丧失。研究 NIA的优先事项确定了对创新老年病姑息治疗模式的迫切需求， 解决老年人未得到满足的护理需求，特别是来自农村和服务不足地区的老年人 在慢性阻塞性肺病流行且姑息治疗有限的地方。不过，没有老年医学- 姑息治疗干预措施已经系统地开发和测试， 社区居住的COPD老年人。通过K76，Iyer博士将获得先进的 培训内容：1）老年学和老年病姑息治疗; 2）临床试验和实施 科学;和3）老龄化的领导力发展。为了支持他的职业发展，Iyer博士 和他的主要导师，辛西娅布朗，医学博士，MSPH，已经组建了一个专家导师团队 在老年病学（Seth兰德费尔德，医学博士）、姑息治疗实施科学（玛丽巴基塔斯，DNSc， APRN）和COPD临床试验（Mark Dransfield，MD）。艾耶博士将寻求 衰老生物学的国际领导者（Steven Austad，博士），肺衰老（维克托Thannickal，医学博士）， 老年人姑息治疗（克莉丝汀里奇，医学博士，MSPH）和慢性阻塞性肺病的大脑老化（卡琳 Hoth，PhD）。在AHRQ-K12的支持下，Iyer博士开发了“EPIC：早期姑息治疗”， 慢性阻塞性肺病”，一项为期6个月的远程保健，针对慢性阻塞性肺病患者的姑息性护士教练主导的干预， 他们的家庭照顾者。在中年COPD患者中的初步可行性结果及其 家庭照顾者是有前途的;然而，目前还不知道如何EPIC需要完善，以满足 老年COPD患者的需求，尤其是老年人。以巴尔特的 成功的老龄化，这K76将：1）通过参与不同的细化EPIC的老年医学内容 老年COPD患者、家庭护理人员、临床医生、工作人员和政策相关群体 领导者;以及2）进行混合型1有效性-实施试点， 一项Geri-EPIC加常规COPD治疗与常规COPD单独治疗的对照试验，以确定 可行性和可接受性，完善试验程序，并收集生命的初步数据- 空间机动性，为R 01级的全动力试验提供信息。最终，K76将定位于 博士Iyer将成为老年病姑息治疗和以病人为导向的老龄化研究的领导者。

Project Summary The overall goal of this 5-year K76 resubmission is to support Anand S. Iyer, MD, MSPH to become a leader in geriatrics-palliative care with the skills to improve the health and well-being of older adults with chronic obstructive pulmonary disease (COPD). Dr. Iyer is a pulmonologist and AHRQ-K12 COPD outcomes researcher. COPD is the third leading cause of death for older Americans and accelerates loss of quality of life and functional independence. Research priorities of the NIA identify a critical need for innovative geriatrics-palliative care models to address unmet care needs for older adults, especially those from rural and underserved areas where COPD is prevalent and palliative care access is limited. However, no geriatrics- palliative care interventions have been systematically developed and tested for community-dwelling older adults with COPD. Through this K76, Dr. Iyer will gain advanced training in: 1) gerontology and geriatrics-palliative care; 2) clinical trials and implementation science; and 3) leadership development in aging. To support his career development, Dr. Iyer and his primary mentor, Cynthia Brown, MD, MSPH, have assembled a mentor team of experts in geriatrics (Seth Landefeld, MD), palliative care-implementation science (Marie Bakitas, DNSc, APRN), and COPD clinical trials (Mark Dransfield, MD). Dr. Iyer will seek advisement from international leaders in aging biology (Steven Austad, PhD), lung aging (Victor Thannickal, MD), geriatrics-palliative care (Christine Ritchie, MD, MSPH), and the aging brain in COPD (Karin Hoth, PhD). Supported by an AHRQ-K12, Dr. Iyer developed, “EPIC: Early Palliative Care In COPD”, a 6-month telehealth, palliative-nurse coach-led intervention for COPD patients and their family caregivers. Preliminary feasibility results in middle-aged COPD patients and their family caregivers are promising; however, it is not known how EPIC needs to be refined to meet the needs of older COPD patients, especially the old-old. Guided by Baltes’ Theory of Successful Aging, this K76 will: 1) Refine the geriatrics content of EPIC by engaging diverse stakeholder groups of older COPD patients, family caregivers, clinicians, staff, and policy leaders; and, 2) Conduct a hybrid type-1 effectiveness-implementation pilot randomized controlled trial of Geri-EPIC plus usual COPD care versus usual COPD care alone to determine feasibility and acceptability, to refine trial procedures, and to collect preliminary data on Life- Space mobility to inform a fully-powered trial at the R01 level. Ultimately, this K76 will position Dr. Iyer to be a leader in geriatrics-palliative care and patient-oriented aging research.