Aging Well with COPD through Geriatrics-Palliative Care

项目摘要 这项为期5年的K76重新提交的总体目标是支持医学博士Anand S.Iyer和MSPH 成为老年医学领域的领先者--拥有改善健康和福祉的技能的姑息治疗 患有慢性阻塞性肺疾病(COPD)的老年人。艾尔医生是一位肺科医生。 和AHRQ-K12慢性阻塞性肺疾病结局研究员。慢性阻塞性肺病是导致老年人死亡的第三大原因 并加速了生活质量和功能独立性的丧失。研究 NIA的优先事项确定了对创新老年医学-姑息治疗模式的迫切需求，以 解决老年人，特别是来自农村和服务不足地区的老年人未得到满足的护理需求 在慢性阻塞性肺病流行和姑息治疗有限的情况下。然而，没有老年病- 姑息治疗干预措施已被系统地开发和测试 社区居住的患有慢性阻塞性肺病的老年人。通过这款K76，艾尔博士将获得进阶 培训内容：1)老年学和老年医学--姑息治疗；2)临床试验和实施 科学；以及3)老龄化中的领导力发展。为了支持他的事业发展，艾尔博士 他的主要导师，医学博士，MSPH的辛西娅·布朗已经组建了一个专家导师团队 在老年病学(Seth Landeeld，医学博士)，姑息治疗-实施科学(Marie Bakitas，DNSc， 和COPD临床试验(Mark Dransfield，医学博士)。艾尔博士将向 衰老生物学(Steven Austad，博士)、肺衰老(Victor Thanickal，医学博士)等领域的国际领导者， 老年病学-姑息治疗(Christine Ritchie，MD，MSPH)，与慢性阻塞性肺病(COPD)的脑老化(Karin 霍斯，博士)。在AHRQ-K12的支持下，Iyer博士开发了“EPIC：早期姑息治疗 COPD“，一个为期6个月的远程健康，姑息护士指导的COPD患者干预和 他们的家庭照顾者。中年慢性阻塞性肺疾病患者的初步可行性研究 家庭照顾者是有希望的；然而，还不知道史诗需要如何改进才能满足 老年COPD患者的需求，特别是老年人的需求。在巴尔特斯理论的指导下 成功老龄化，这款K76将：1)通过参与各种不同的活动，完善EPIC的老年内容 老年COPD患者、家庭照顾者、临床医生、工作人员和政策的利益相关者团体 领导者；以及，2)实施混合类型1有效性--随机实施试点 Geri-EPIC加常规COPD治疗与单独使用常规COPD治疗的对照试验 可行性和可接受性，完善试验程序，收集有关生命的初步数据- 太空机动性，为R01级的全动力试验提供信息。最终，这款K76将定位于 Iyer博士将成为老年病学--姑息治疗和以病人为中心的老龄化研究--的领导者。

Project Summary The overall goal of this 5-year K76 resubmission is to support Anand S. Iyer, MD, MSPH to become a leader in geriatrics-palliative care with the skills to improve the health and well-being of older adults with chronic obstructive pulmonary disease (COPD). Dr. Iyer is a pulmonologist and AHRQ-K12 COPD outcomes researcher. COPD is the third leading cause of death for older Americans and accelerates loss of quality of life and functional independence. Research priorities of the NIA identify a critical need for innovative geriatrics-palliative care models to address unmet care needs for older adults, especially those from rural and underserved areas where COPD is prevalent and palliative care access is limited. However, no geriatrics- palliative care interventions have been systematically developed and tested for community-dwelling older adults with COPD. Through this K76, Dr. Iyer will gain advanced training in: 1) gerontology and geriatrics-palliative care; 2) clinical trials and implementation science; and 3) leadership development in aging. To support his career development, Dr. Iyer and his primary mentor, Cynthia Brown, MD, MSPH, have assembled a mentor team of experts in geriatrics (Seth Landefeld, MD), palliative care-implementation science (Marie Bakitas, DNSc, APRN), and COPD clinical trials (Mark Dransfield, MD). Dr. Iyer will seek advisement from international leaders in aging biology (Steven Austad, PhD), lung aging (Victor Thannickal, MD), geriatrics-palliative care (Christine Ritchie, MD, MSPH), and the aging brain in COPD (Karin Hoth, PhD). Supported by an AHRQ-K12, Dr. Iyer developed, “EPIC: Early Palliative Care In COPD”, a 6-month telehealth, palliative-nurse coach-led intervention for COPD patients and their family caregivers. Preliminary feasibility results in middle-aged COPD patients and their family caregivers are promising; however, it is not known how EPIC needs to be refined to meet the needs of older COPD patients, especially the old-old. Guided by Baltes’ Theory of Successful Aging, this K76 will: 1) Refine the geriatrics content of EPIC by engaging diverse stakeholder groups of older COPD patients, family caregivers, clinicians, staff, and policy leaders; and, 2) Conduct a hybrid type-1 effectiveness-implementation pilot randomized controlled trial of Geri-EPIC plus usual COPD care versus usual COPD care alone to determine feasibility and acceptability, to refine trial procedures, and to collect preliminary data on Life- Space mobility to inform a fully-powered trial at the R01 level. Ultimately, this K76 will position Dr. Iyer to be a leader in geriatrics-palliative care and patient-oriented aging research.