Medical Illness & Cognitive Impairment in Older Adults: Heart Failure as a Model

描述（由申请人提供）：本次职业发展奖申请的主要目标是使申请人能够发展必要的技能和专业知识，成为一名独立的研究者，专注于认知功能在老年人医疗疾病过程中的重要作用。认知障碍（CI）通常发生在老年人中常见的慢性疾病的背景下，并可能通过自我护理受损影响这些高风险患者的临床和生活质量。心衰（HF）是研究CI对疾病自我护理和长期预后影响的理想条件。我的研究计划的具体目的是：(1)前瞻性检查e65岁HF患者从住院到出院后3个月的认知功能；(2)前瞻性检查HF患者入院至出院后3个月的自我保健活动表现；(3)观察心衰患者出院后认知功能与自我护理活动表现的关系；(4)开发和试点测试一种干预措施，以增强心衰幸存者的自我保健实践，根据患者的认知状况量身定制。一个健全的培训计划将补充该研究计划，并为申请人提供成功成为独立研究者所需的工具；它将包括临床老年病学、心血管流行病学、纵向研究方法以及临床试验设计和实施等领域的课程和重点指导。在奖励期间开展的工作的结果将有可能为制定适合患者认知状况的自我保健干预措施提供信息，并改善患有慢性疾病的认知受损患者的健康。

DESCRIPTION (provided by applicant): The primary objective of this Career Development Award application is to enable the applicant to develop the skills and expertise necessary to become an independent investigator focusing on the important role cognitive function plays in the course of medical illness in older adults. Cognitive impairment (CI) often occurs in the context of chronic medical conditions that are common in older adults and likely influences clinical and quality of life outcomes in these high- risk patients, potentially through impaired self-care. Heart failure (HF) is an ideal condition through which to study the impact of CI on disease self-care and long-term outcomes. The specific aims of my research program are to: (1) prospectively examine cognitive function in patients aged e65 years from the time of hospitalization for HF through 3-months after hospital discharge; (2) prospectively examine the performance of self-care activities from the time of hospitalization for HF through 3-months after hospital discharge; (3) examine the relation between cognitive function and performance of self-care activities at selected time intervals following hospital discharge for HF; (4) develop and pilot test an intervention to enhance self- care practices for HF survivors that is tailored to a patient's cognitive status. A robust training plan will complement this research program and provide the applicant with the tools necessary to be successful as an independent investigator; it will include coursework and focused mentoring in the areas of clinical geriatrics, cardiovascular epidemiology, longitudinal research methodologies, and clinical trial design and implementation. The findings of the work conducted during the award period will have the potential to inform the development of self-care interventions that are tailored to the patient's cognitive status and to improve the health of cognitively impaired patients with chronic medical conditions. PUBLIC HEALTH RELEVANCE: Evidence suggests that cognitively impaired older patients have poor health outcomes including reduced quality of life, repeat hospitalizations, and increased mortality, yet the pathways by which this occurs are not well understood. Understanding the role cognitive impairment plays in patient self-care has significant implications for the design of self-care interventions and for improving the care of older adults with chronic medical conditions.