Center for Health Promotion and Disease Prevention

 描述(申请人提供)：许多患有阿尔茨海默病、S病和相关痴呆症的老年人还患有一种或多种其他严重的慢性病，如心脏病或中风。这些患者的管理很复杂，有很高的不良后果风险。此外，多达一半的ADRD患者仍未得到诊断，这对提供全面的、以人为中心的护理构成了重大挑战。有鉴于此，并根据《应对阿尔茨海默病-S病国家计划》和《健康大脑倡议：国家和国家伙伴关系公共卫生路线图》提出的优先事项，我们建议与公共卫生、慢性病、初级保健、痴呆症和家庭支持专家小组合作，以：(A)侧重于痴呆症与四种主要死因(心脏病、癌症、慢性下呼吸道疾病、脑血管疾病)和三种常见和可治疗的慢性病(糖尿病、高血压、抑郁症)之间的相互作用；(B)回顾文献，对现有数据进行两次重点分析；以及(C)定期与我们的专家小组举行会议，将调查结果综合成主要建议。我们的重点文献审查将遵循健康与人类服务多种慢性病战略框架(MCC框架)的四个目标：(I)促进填补知识空白的研究；(Ii)向MCC护理提供者提供工具；(Iii)最大限度地自我护理管理；以及(Iv)促进卫生保健和公共卫生系统变革。这些审查将提供关于当前证据状况的背景，并为咨询小组关于以下方面的建议提供信息：痴呆症与共病的患病率、痴呆症对慢性护理结果的影响、对患有其他慢性病的环境最实用的筛查和痴呆症检测战略，以及针对ADRD患者的有效慢性病自我管理战略。为了补充这项工作并提供现实世界的视角，我们将对现有的两个数据来源进行分析。我们将使用北卡罗来纳大学S临床和翻译科学奖卡罗莱纳数据仓库的数据，检查1,000多名确诊为痴呆症的人的合并症患病率。其次，我们将审查一项正在进行的研究中对120名痴呆症患者/照顾者双方的访问数据，以确定慢性病症状的发生率，并深入分析ADRD患者在慢性病自我管理方面面临的挑战。我们将与专家小组合作，总结研究结果并提出关键建议，以确定最佳做法，并优先考虑未来的研究工作，以改善对痴呆症患者和伴发疾病的护理。这些发现将与患者和家属、护理专业人员、研究人员和政策制定者分享，以提高认识并促进对痴呆症和慢性病护理的创新、综合方法。

 DESCRIPTION (provided by applicant): Many older adults with Alzheimer s disease and related dementias (ADRD) also have one or more other serious chronic illness, such as heart disease or stroke. The management of these patients is complex, with high risk of adverse outcomes. Moreover, as many as half of persons with ADRD remain undiagnosed, presenting significant challenges to the provision of comprehensive, person-centered care. In light of this, and in line with priorities set forth by the National Plan to Address Alzheimer s disease (NAPA) and The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships (HBI), we propose to work with a panel of experts in public health, chronic disease, primary care, dementia and family support to: (a) focus on the interaction between dementia and four leading causes of death (heart disease, cancer, chronic lower respiratory disease, cerebrovascular disease) and three common and treatable chronic conditions (diabetes, hypertension, depression); (b) review the literature and conduct two focused analyses of existing data; and (c) meet regularly with our expert panel to synthesize findings into Key Recommendations. Our focused literature reviews will be guided by the four goals of the Health and Human Services Strategic framework for Multiple Chronic Conditions (MCC Framework): (i) facilitating research to fill in knowledge gaps; (ii) providing tools to MCC care providers; (iii) maximizing self-care management; and (iv) fostering health care and public health system change. These reviews will provide background on the current state of evidence and inform advisory panel recommendations regarding: the prevalence of dementia with co-occurring conditions, the impact of dementia on chronic care outcomes, the screening and dementia detection strategies most practical for settings with other chronic illness, and effective chronic disease self-management strategies for persons with ADRD. To complement this work and provide a real-world perspective, we will conduct analyses of two existing sources of data. We will examine the prevalence of comorbidities in over 1,000 persons with a dementia diagnosis, using data from the University of North Carolina Health System s Clinical and Translational Science Award (CTSA) Carolina Data Warehouse. Secondly, we will examine interview data from an ongoing study of 120 persons with dementia/caregiver dyads to determine the incidence of chronic illness symptoms and conduct an in-depth analysis of the challenges in self-management of chronic illnesses in persons with ADRD. Working with the expert panel, we will summarize findings and develop Key Recommendations that will identify best-practices and prioritize future research efforts to improve care for persons with dementia and co- occurring disease. These findings will be shared with patients and families, care professionals, researchers and policy makers to increase awareness and promote innovative, integrated approaches to dementia and chronic disease care.