Evaluating the Unmet Needs of Older Adults to Promote Functional Recovery after a Critical Illness (LANTERN)

每年有近200万65岁或65岁以上的人住进重症监护室;其中 幸存者中，有一半在随后的几个月内无法实现功能恢复。到目前为止，在重症监护室治疗后- 针对功能结局的干预尚未成功;此外，没有先前的ICU后干预 针对功能恢复的重点是老年人，他们更容易受到功能障碍的影响， 比他们的年轻人更年轻。我们的长期目标是开发干预措施， 老年ICU幸存者的结局。我们的初步数据表明，四个领域的未满足需求 (home环境，熟练的康复，听力和视力，以及非正式和正式的护理）可能会不利地影响- 在已经回家的老年人中（直接或经过短期康复治疗）， [2019 - 03 - 15][2019 - 03 - 02][2019 - 03 - 01][2019 - 01]本申请的总体目标是阐明未满足的需求， 老年ICU幸存者，评估这些未满足的需求与残疾、再入院和 随后6个月的死亡率，并评估解决这些未满足需求的障碍和促进因素。 中心假设是，老年ICU幸存者在上述领域有未满足的需求， 对潜在的干预目标感到不满，这些未满足的需求与残疾负担有关， 再入院率和死亡率。拟议研究的理由是，这项工作将直接告知 制定一项干预措施，以解决未满足的需求，促进老年ICU患者的功能恢复 幸存者中心假设将通过招募新的老年ICU幸存者队列进行检验， 以下具体目标：1）确定从ICU医院回家后多个领域未满足的需求- 评估这些未满足的需求是否与随后6个月的残疾负担有关， 并确定这些关联是否受到最初出院目的地（家庭或STR）的调节; 领域包括：家庭环境，熟练的康复服务，感官需求（听力和视力）， 非正式（无报酬）护理和正式（有报酬）家庭护理服务; 2）评估未得到满足的 这些多个领域的需求与随后6个月的再入院率和死亡率;以及 3)通过对一部分老年ICU幸存者（及其护理人员，如适用）进行定性访谈， 探索解决未满足需求的障碍，并收集患者和护理人员对ad中促进者的意见， 需要为未来的干预提供信息。这项研究是创新的，因为它将使用 老年病学透镜，以严格评估多个领域未满足的需求，这反过来又将直接告知 制定未来的干预措施，以促进老年ICU幸存者的功能恢复， 这些未满足的需求。本申请中提出的研究将为采取行动提供强有力的证据基础- 目标是减少老年人的残疾、再入院率和死亡率， 严重疾病，符合NIA的战略重点。

Nearly 2 million persons aged 65 years or older are admitted to an intensive care unit (ICU) each year; of those who survive, half will not achieve functional recovery over the subsequent months. To date, prior post-ICU in- terventions targeting functional outcomes have not been successful; moreover, no prior post-ICU interventions targeting functional recovery have focused on older adults, who are more vulnerable to poor functional out- comes than their younger counterparts. Our long-term goal is to develop interventions to improve functional outcomes among older ICU survivors. Our preliminary data suggest that unmet needs across four domains (home environment, skilled rehabilitation, hearing and vision, and informal and formal care) may adversely af- fect functional recovery among older adults who have returned home (either directly or after short-term rehab [STR]) after an ICU hospitalization. The overall objective of this application is to elucidate the unmet needs of older ICU survivors, evaluate the association of these unmet needs with disability, hospital readmissions, and mortality over the subsequent 6 months, and assess barriers and facilitators to addressing these unmet needs. The central hypothesis is that older ICU survivors have unmet needs in the aforementioned domains that rep- resent potential targets for intervention, and that these unmet needs are associated with disability burden, hos- pital readmissions, and mortality. The rationale for the proposed research is that this work will directly inform the development of an intervention to address unmet needs and facilitate functional recovery among older ICU survivors. The central hypothesis will be tested by enrolling a new cohort of older ICU survivors to achieve the following specific aims: 1) To identify unmet needs in multiple domains after return home from an ICU hospitali- zation, evaluate whether these unmet needs are associated with disability burden in the subsequent 6 months, and ascertain whether these associations are moderated by initial discharge destination (home or STR); the domains include: the home environment, skilled rehabilitation services, sensory needs (in hearing and vision), and informal (unpaid) care and formal (paid) home care services; 2) To evaluate the association of unmet needs in these multiple domains with hospital readmissions and mortality over the subsequent 6 months; and 3) Through qualitative interviews with a subset of older ICU survivors (and their caregivers, if applicable), to explore barriers to addressing unmet needs and to gather patient and caregiver input about facilitators in ad- dressing unmet needs to inform a future intervention. The proposed research is innovative because it will use a geriatrics lens to rigorously evaluate unmet needs across multiple domains, which in turn will directly inform the development of a future intervention to facilitate functional recovery among older ICU survivors by addressing these unmet needs. The research proposed in this application will provide a strong evidence base for actiona- ble targets to reduce disability, hospital readmissions, and mortality among older adults who have survived a critical illness, in line with NIA’s strategic priorities.