End of Life in the Very Old

描述（由申请人提供）：美国很大比例的死亡涉及老年人：80岁以上的人占死亡人数的44%，85岁以上的人占29%。然而，几乎没有以人口为基础的数据来描述高龄人士的死亡、医疗保健选择和临床轨迹。拟议研究的首要目标是提供85岁以上老年人广泛样本的信息，以改善老年生命结束时的护理。为了实现这一目标，我们建议继续对健康、衰老和身体成分队列（Health- abc）的参与者进行随访，这是一个基于双种族人群的样本，目前约有1600人，平均年龄为85岁。我们的前瞻性研究将对这些参与者的临床过程进行随访，在4年内对参与者及其替代决策者（SDMs）进行面对面基线评估和季度电话评估，并在受访者死亡后对SDMs进行随访访谈。本研究的目的是：(i)描述高龄患者的临床轨迹和死亡风险，（ii）评估参与者和SDM在死亡风险极高的情况下的晚年决策，以及（iii）检查高龄患者住院和急诊护理的预测因素。预期的结果和影响包括澄清高危老年人护理水平的选择和决定因素。

DESCRIPTION (provided by applicant): A large proportion of deaths in the U.S. involve the very old: people aged 80+ comprise 44% of deaths and people 85+ 29%. Yet little population-based data are available to describe dying, health care choices, and clinical trajectories in persons who have reached very old age. The overriding goal of the proposed study is to provide information on a broad-based sample of elders aged 85+ in order to improve care at the end of life in advanced age. To accomplish this goal, we propose to continue follow-up of participants in the Health, Aging, and Body Composition cohort (Health-ABC), a bi-racial population-based sample that currently numbers about 1600 with an average age of 85. Our prospective study will follow the clinical course of these participants with an in-person baseline assessment and quarterly telephone assessments with participants and their substitute decision makers (SDMs) over 4 years, as well as a follow-back interview with SDMs after respondent deaths. The objectives of the research are to (i) characterize clinical trajectories and risk of death in very old age, (ii) assess participant and SDM decision-making in late life in the presence of very high risk of dying, and (iii) examine predictors of hospitalization and emergency department care in very old age. Expected outcomes and impact include clarification of choices and determinants of levels of care in older people at high risk of dying. PUBLIC HEALTH RELEVANCE: Little population-based data are available to describe dying, health care choices, and clinical trajectories in persons who have reached very old age. The overriding goal of the proposed study is to provide information on a broad-based sample of elders aged 85+ in order to improve care at the end of life in advanced age. To accomplish this goal, we propose to continue follow- up of participants in the NIH Health, Aging, and Body Composition cohort (Health-ABC) over an additional 3 years. Health ABC is a bi-racial community-based sample from Pittsburgh, PA and Memphis, TN that currently numbers about 1600 with an average age of 85.