R01AG076489

Emergency General Surgery Delirium Recovery Model: A Collaborative Care Intervention - Project Summary

Delirium is a complex neuropsychiatric syndrome characterized by acute and fluctuating changes in cognition and consciousness. Delirium survivors suffer from a cluster of cognitive, physical, and psychological disabilities. These disabilities lead to high healthcare utilization, lower quality of life, and loss of functional independence. Worse, a single episode of delirium increases the risk of Alzheimer's disease and related dementias.

Based on work from our group and the work of others, over 25% of patients who undergo emergency intra-abdominal surgery suffer from at least one episode of delirium during the index hospitalization, putting them at high risk for cognitive decline. There is a fundamental gap in knowledge regarding the best way to prevent cognitive, psychological, and functional decline in patients who undergo emergency general surgery and subsequently develop delirium.

The long-term goal of this line of research is to improve the health and quality of care for older emergency general surgery survivors. The objective of this application is to apply the concepts of collaborative care to a high-risk patient population. Indiana University School of Medicine and University of Wisconsin School of Medicine and Public Health researchers have over 20 years of experience developing innovative and effective collaborative care models that integrate with primary care and specialty physicians to address the complex biopsychosocial needs of patients with chronic disease states, such as dementia and depression.

Our team has developed a specific collaborative care model called the Emergency General Surgery Delirium Recovery Program. This proposal aims to conduct a randomized controlled trial to evaluate the efficacy of 12 months of collaborative care in improving the cognitive, functional, and psychological recovery of emergency intra-abdominal surgery patients who suffer at least one episode of delirium in the post-operative period and are at least 65 years old.

The trial has the following specific aims:

1) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the cognitive recovery of older emergency general surgery delirium survivors.
2) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the physical recovery of older emergency general surgery delirium survivors.
3) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the psychological recovery of older emergency general surgery delirium survivors.

The research proposed in this application is innovative because it represents a new and substantive departure from the status quo. Previous collaborative care models focused on chronic care management and they lack rapid adaptability. We have also adapted the intervention to be completed solely via telehealth. This contribution will be significant as broad application of the Emergency General Surgery Delirium Recovery Program at hospitals across the country could result in better health and improved quality of care for a particularly vulnerable patient population.

University Of Wisconsin System

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Madison, Wisconsin 53715 United States

Single Zip Code

Research Project Grant (Parent R01 Clinical Trial Required) (PA-20-183)

Amendment Since initial award the total obligations have increased 294% from $2,075,345 to $8,173,947.