Geriatrics Emergency care Applied Research Network 2.1 - AdvanCing and Expanding Dementia care (GEAR 2.1 - ACED)
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PROJECT ABSTRACT: Older adults with ADRD present to EDs at rates up to 50% higher than peers without dementia. Persons living with dementia (PLWD) are poorly identified in the ED, have surges in ED visits before formal diagnoses, are more likely to have avoidable ED visits, and are twice as likely to be admitted to the hospital or return after an ED visit. They struggle in the ED and hospital environment, and experience numerous challenges, including delirium, which is an independent risk factor for accelerated dementia progression. Nonetheless, despite multiple calls in the National Plans to Address Alzheimer’s Disease, limited research has been performed to optimize the emergency care of PLWD. The emergence of blood-based biomarkers and new therapies for Alzheimer’s disease will increase reliance on emergency care when patients present to the ED with new symptoms and findings or adverse effects from treatment. Yet despite calls to address these challenges, ED-based ADRD research remains fragmented and poorly integrated into national health care. We propose extending and augmenting the early NIA-funded Geriatric Emergency care Applied Research (GEAR) 2.0 infrastructure that was created to address these research gaps. GEAR identified priority research areas in PLWD include: 1. ED care, 2. Care transitions, 3. Detection, and 4. Communication and shared decision making. Goals of the GEAR 2.1 – AdvanCing and Expanding Dementia care (ACED) proposal are to enhance GEAR partnerships, augment GEAR’s infrastructure to include multimodal data relevant for dementia research and support critical and high yield emergency care dementia research opportunities. Specifically, we will: (1) Develop partnerships supporting an emergency care dementia research infrastructure, (2) Expand and optimize the GEAR research data ecosystem for dementia and geriatric emergency care, and (3) Advance interdisciplinary acute care research with resources and funding opportunities to support high yield emergency care ADRD research. This infrastructure will create multiple opportunities leveraging GEAR’s robust study selection process that includes PLWD and an interdisciplinary advisory board to review and support studies with high scientific rigor and importance to community populations. Proposed studies will be conducted within the growing network of GEAR member sites that include 12+ healthcare systems across the US, representing over 60 EDs to conduct multicenter pilot studies and demonstration projects. Such preliminary study data may be used to generate proof-of-concept feasibility testing, preliminary findings for larger observational studies, or emulate multicenter clinical trials. This will grow intra- and inter-networks both within and across participating healthcare systems, promoting the spread and partnerships of interdisciplinary aging studies and sciences. This “priming” of the research pipeline for collaborative, interdisciplinary studies will fortify a network for evidence-based science, optimizing emergency care for PLWD and their care partners.
