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

RP 2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的不可阻挡的萎缩。我们小组最近的研究， 其他人和临床经验表明，阿尔茨海默病和相关痴呆症患者 发生突发严重不良事件，显著改变疾病轨迹。这种“破坏性事件”可以 包括诸如髋骨骨折之类创伤性损伤、诸如肺炎之类的医疗事件、或者社交或情感事件 比如配偶的死亡。迫切需要了解破坏性事件的影响 对阿尔茨海默病和相关痴呆症患者及其家庭的影响，包括功能衰退、存活率、 对个人护理的需求增加，以及对医疗保健系统的影响，包括医疗保健 成本和服务使用。我们将使用纵向的、具有全国代表性的健康和退休研究， 与医疗保险索赔相关联，以描述破坏性事件对社区住宅的发生率和影响 阿尔茨海默病和相关痴呆症患者。我们将重点讨论三个破坏性事件的例子 先前的研究表明，可能会对阿尔茨海默病和相关痴呆症患者产生不同的影响：（1） 髋骨骨折（即手术危机）;（2）因肺炎住院（即医疗危机）;或（3）配偶死亡 (i.e.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， a）比较没有痴呆症的人的轨迹和结果， 经历破坏性事件和B）比较阿尔茨海默病患者的轨迹和结果 以及经历或不经历破坏性事件的相关痴呆。我们的具体目标是：（1） 确定阿尔茨海默病及相关疾病患者中破坏性事件的发生率 （2）比较破坏性事件对阿尔茨海默病患者和非阿尔茨海默病患者的影响 （3）检查患有阿尔茨海默氏症和相关痴呆症的人， 并且不经历破坏性事件。从这一建议中获得的知识将指导社区- 阿尔茨海默病和相关痴呆症患者、护理人员和临床医生在决策中的作用 以及对破坏性事件发生后的结果进行规划，为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，使我们的健康和社会 老年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.