This application is for a Mentored Research Scientist Development Award (K01) for Katherine Ornstein, PhD, an Instructor in Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. I propose to develop expertise in five areas that will allow me to develop a line of research into the downstream effects of end of life care on family networks: 1) data linkages; (2) economic and policy issues facing older adults with serious illness and their families including knowledge of healthcare delivery and treatments at the end of life; (3) cost analysis and use of claims data; (4) analysis of complex longitudinal surveys; and (5) social network analysis. Under the guidance of my mentorship team led by Albert Siu, MD MSPH, Professor and Chairman of the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai, I will use the skills obtained in these training areas to begin to fill outstanding gaps in our understanding of how end of life care intensity impacts families with three research projects, for which the K01 will allow me protected research time. End of life care for older patients with serious illness such as dementia commonly includes high intensity treatments which may be burdensome and costly. Our understanding of how these treatments impact patients' families' health and healthcare utilization both before and after a patient's deat is limited. Current end of life healthcare cost estimates do not consider potential downstream costs associated with the healthcare expenditures of family members who care for their seriously ill loved ones. First, I will investigate the differential impact of end of life treatmens on spousal healthcare expenditures following death of older patients with serious illness using longitudinal survey data from the HRS cohort combined with individual Medicare claims and regional data from the Dartmouth Atlas of Healthcare (Aim 1). Next, I will determine the association between healthcare treatment intensity and caregiver healthcare expenditures for patients with end-stage dementia using data from HRS and a clinical cohort of dementia patients and their caregivers (Aim 2). Finally, I will characterize the trajectory of healthcare utilization for spouses before and after patient death using Denmark population registry data (Aim 3). In addition to these research aims, my K01 award period will focus on preparation of an R01 grant proposal to link healthcare utilization of decedents to the health and healthcare of all adult family members using population registries. These projects are feasible only if I have protected time for new training and research, which K01 funding will provide.

Public Health Relevance

End of life care for older patients with serious illness such as dementia commonly includes burdensome and costly life-sustaining treatments (e.g., intubation). Our understanding of how these treatments impact patients' families both before and after a patient's death is limited. By studying the impact of end of life treatment on the healthcare utilization of family members, we can improve EOL decision making, better meet healthcare needs of the families of the seriously ill, and improve accuracy of cost estimates of care.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01AG047923-03
Application #
9061563
Study Section
Neuroscience of Aging Review Committee (NIA)
Program Officer
Bhattacharyya, Partha
Project Start
2014-09-15
Project End
2019-04-30
Budget Start
2016-05-01
Budget End
2017-04-30
Support Year
3
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Icahn School of Medicine at Mount Sinai
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Ornstein, Katherine A; Aldridge, Melissa D; Garrido, Melissa M et al. (2017) The Use of Life-Sustaining Procedures in the Last Month of Life Is Associated With More Depressive Symptoms in Surviving Spouses. J Pain Symptom Manage 53:178-187.e1
Reckrey, Jennifer M; Ornstein, Katherine A; Wajnberg, Ania et al. (2017) Teaching Home-Based Primary Care. Home Healthc Now 35:561-565
Soones, Tacara; Federman, Alex; Leff, Bruce et al. (2017) Two-Year Mortality in Homebound Older Adults: An Analysis of the National Health and Aging Trends Study. J Am Geriatr Soc 65:123-129
Ornstein, Katherine A; Schulz, Richard; Meier, Diane E (2017) Families Caring for an Aging America Need Palliative Care. J Am Geriatr Soc 65:877-878
Ankuda, Claire K; Harris, John; Ornstein, Katherine et al. (2017) Caregiving for Older Adults with Obesity in the United States. J Am Geriatr Soc 65:1939-1945
Ornstein, Katherine A; Penrod, Joan; Schnur, Julie B et al. (2017) The Use of a Brief 5-Item Measure of Family Satisfaction as a Critical Quality Indicator in Advanced Cancer Care: A Multisite Comparison. J Palliat Med 20:716-721
Ornstein, Katherine A (2017) Broadening Our Understanding of Caregiver Outcomes Across Cultures: What Does ""Caregiver Relationship"" Actually Capture? J Womens Health (Larchmt) 26:3-4
Zhu, Carolyn W; Cosentino, Stephanie; Ornstein, Katherine A et al. (2017) Interactive Effects of Dementia Severity and Comorbidities on Medicare Expenditures. J Alzheimers Dis 57:305-315
Ornstein, Katherine A; Kelley, Amy S; Bollens-Lund, Evan et al. (2017) A National Profile Of End-Of-Life Caregiving In The United States. Health Aff (Millwood) 36:1184-1192
Jones, Masha G; Ornstein, Katherine A; Skovran, David M et al. (2017) Characterizing the high-risk homebound patients in need of nurse practitioner co-management. Geriatr Nurs 38:213-218

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