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.
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.
|McMANUS, David D; Chong, Jo Woon; Soni, Apurv et al. (2016) PULSE-SMART: Pulse-Based Arrhythmia Discrimination Using a Novel Smartphone Application. J Cardiovasc Electrophysiol 27:51-7|
|Vasunilashorn, Sarinnapha M; Guess, Jamey; Ngo, Long et al. (2016) Derivation and Validation of a Severity Scoring Method for the 3-Minute Diagnostic Interview for Confusion Assessment Method--Defined Delirium. J Am Geriatr Soc 64:1684-9|
|McManus, David D; Saczynski, Jane S; Lessard, Darleen et al. (2016) Reliability of Predicting Early Hospital Readmission After Discharge for an Acute Coronary Syndrome Using Claims-Based Data. Am J Cardiol 117:501-7|
|Huang, Wei; FitzGerald, Gordon; Goldberg, Robert J et al. (2016) Performance of the GRACE Risk Score 2.0 Simplified Algorithm for Predicting 1-Year Death After Hospitalization for an Acute Coronary Syndrome in a Contemporary Multiracial Cohort. Am J Cardiol 118:1105-1110|
|Hshieh, Tammy T; Saczynski, Jane; Gou, Ray Yun et al. (2016) Trajectory of Functional Recovery After Postoperative Delirium in Elective Surgery. Ann Surg :|
|Waring, Molly E; McManus, David D; Lemon, Stephenie C et al. (2016) Perceiving one's heart condition to be cured following hospitalization for acute coronary syndromes: Implications for patient-provider communication. Patient Educ Couns 99:455-61|
|Tisminetzky, Mayra; Gurwitz, Jerry; McManus, David D et al. (2016) Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome. Am J Med 129:608-14|
|Goldberg, Robert J; Saczynski, Jane S; McManus, David D et al. (2015) Characteristics of contemporary patients discharged from the hospital after an acute coronary syndrome. Am J Med 128:1087-93|
|Tisminetzky, Mayra; McManus, David D; Erskine, Nathaniel et al. (2015) Thirty-day Hospital Readmissions in Patients with Non-ST-segment Elevation Acute Myocardial Infarction. Am J Med 128:760-5|
|Gleason, Lauren J; Schmitt, Eva M; Kosar, Cyrus M et al. (2015) Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults. JAMA Surg 150:1134-40|
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