The Impact of Disruptive Events Among Community-Dwelling Persons with Dementia

RP2项目总结 阿尔茨海默病和相关痴呆症患者的传统经验模型 主要集中在身体和认知功能不可避免的萎缩上。我们团队最近的研究， 其他，以及临床经验表明，患有阿尔茨海默病和相关痴呆的人 经历突如其来的严重不良事件，显著改变疾病轨迹。这类“破坏性事件”可能 包括髋部骨折等创伤性损伤，肺炎等医疗事件，或社交或情绪问题 剧变，如配偶的死亡。迫切需要了解破坏性事件的影响 关于阿尔茨海默病患者和相关痴呆症及其家庭，包括功能衰退、存活率、 和增加个人护理的需要，以及它们对包括医疗保健在内的医疗保健系统的影响 成本和服务使用情况。我们将使用具有全国代表性的纵向健康和退休研究 与联邦医疗保险声称有关，以表征破坏性事件对社区居住的发生率和影响 阿尔茨海默病及相关痴呆症患者。我们将重点介绍三个破坏性事件的例子 先前的研究表明，阿尔茨海默病和相关痴呆症患者可能会受到不同程度的影响：(1) 髋部骨折(即手术危象)；(2)肺炎住院(即医疗危象)；或(3)配偶死亡 (即社会危机)。我们将研究这些事件对患者有意义的结局的影响， 家庭和卫生系统，通过a)比较非痴呆症患者的轨迹和结果 体验破坏性事件和b)比较阿尔茨海默病患者的轨迹和结果 以及经历或没有经历破坏性事件的相关痴呆症。我们的具体目标是：(一) 确定阿尔茨海默病及相关人群中破坏性事件的发生率 痴呆症；(2)比较阿尔茨海默病患者和非阿尔茨海默病患者破坏性事件的影响 (三)检查阿尔茨海默病及相关痴呆患者 并且不会经历破坏性事件。从这项建议中获得的知识将指导社会- 阿尔茨海默病和相关痴呆的居住者、照顾者和临床医生在决策中的作用 以及对破坏性事件后的结果进行规划，为预防或延迟干预措施的设计提供信息 破坏性事件后的负面结果，并导致政策变化，为我们的健康和社会做好准备 应对痴呆症患病率上升的系统。

RP2 PROJECT SUMMARY Traditional models of the experience of persons with Alzheimer’s disease and related dementias have largely focused on the inexorable dwindling of physical and cognitive function. Recent research by our group, others, and clinical experience suggest that persons with Alzheimer’s disease and related dementias experience sudden serious adverse events that markedly alter disease trajectory. Such “disruptive events” can include traumatic injuries such as hip fracture, medical events like pneumonia, or social or emotional upheavals such as the death of a spouse. There is a critical need to understand the impact of disruptive events on persons with Alzheimer’s disease and related dementias and families, including functional decline, survival, and need for increased personal care, as well as their impact on the healthcare system, including healthcare costs and service use. We will use the longitudinal, nationally representative Health and Retirement Study linked to Medicare claims to characterize the incidence and impact of disruptive events on community-dwelling persons with Alzheimer’s disease and related dementias. We will focus on three examples of disruptive events that prior work suggests may differentially impact persons with Alzheimer’s disease and related dementias: (1) hip fracture (i.e. surgical crisis); (2) hospitalization for pneumonia (i.e. medical crisis); or (3) death of a spouse (i.e. social crisis). We will examine the impact of these events on outcomes that are meaningful to patients, families, and health systems by a) comparing trajectories and outcomes for persons without dementia who experience disruptive events and b) comparing trajectories and outcomes for persons with Alzheimer’s disease and related dementias experiencing or not experiencing disruptive events. Our specific aims are: (1) To determine the incidence of the disruptive events among persons with Alzheimer’s disease and related dementias; (2) To compare the impact of disruptive events in persons with and without Alzheimer’s disease and related dementias; and (3) To examine persons with Alzheimer’s disease and related dementias who do and do not experience disruptive events. The knowledge gained from this proposal will guide community- dwelling persons with Alzheimer’s disease and related dementias, caregivers, and clinicians in decision making and planning for outcomes following disruptive events, inform the design of interventions to prevent or delay negative outcomes following a disruptive event, and lead to policy changes that prepare our health and social systems for the rising prevalence of dementia.