Geriatric conditions, although frequently unrecognized and overlooked, are important contributors to the health status of older adults. However, geriatric conditions as a group, in contrast to diseases, have not been clearly located within current models of disability development and progression. Rather, conditions appear to operate and interact at multiple points in these models. Christine Cigolle, M.D., M.P.H. proposes to investigate the place of geriatric conditions in the disablement pathway in older adults for the Mentored Clinical Scientist Research Career Development Award (K08). Dr. Cigolle is an Assistant Professors in the Departments of Family Medicine and Internal Medicine at the University of Michigan (UM) Medical School, with appointments in the Institute of Gerontology (UM) and the VA Ann Arbor Healthcare System Geriatrics Research, Education and Clinical Center (GRECC). Her previous cross-sectional research has demonstrated the prevalence and the disability association of geriatric conditions among older adults. Funded by a NIH-NCRR KL2 Mentored Clinical Scholars Award (UM), she investigated how geriatric conditions and chronic diseases group together in older adults using latent class analysis. Her research for the KL2 Award lays the foundation for the research aims and methodologies in her K08 proposal. The overall goal of the proposed research for the K08 Award is to investigate the place of geriatric conditions in the disablement pathway in the older adult population. The research will examine five geriatric conditions: dementia, falls, urinary incontinence, poor nutrition, and multisensory impairment. The research will propose a conceptual model in which geriatric conditions share common risk factors, have an accelerated trajectory of accumulation in older adults, and result in common outcomes (e.g., disability). The research will test this model, --first, by examining the incidence and longitudinal course of geriatric conditions (individually and in aggregate), beginning with adults in middle age and extending to the oldest old;and --second, by examining geriatric conditions as a predictor of disability (taking mortality into account as a competing outcome). By investigating how geriatric conditions begin, accumulate, and co-occur in older adults over time, the proposed research aims to add new knowledge about the place of geriatric conditions in the disablement pathway and thus to contribute to ongoing efforts to link the conditions theoretically. The proposed research will utilize unique longitudinal data from the Health and Retirement Study (HRS), a nationally-representative health interview survey, and data from the HRS supplemental Aging, Demographics, and Memory Study (ADAMS). It will also make use of newly available Medicare administrative data linked to the HRS and ADAMS to further specify conditions and diseases (diagnosis codes). Dr. Cigolle's career goal is to become an independent researcher in academic Family Medicine, focusing on older adult health status, especially geriatric conditions and syndromes and disability. Her future research methods will focus on implementation and analysis of large epidemiologic studies of older adults. The research and career development training in the K08 Award proposal are designed to support both (1) the acquisition of advanced methodological skills and expertise in the epidemiology of geriatric conditions and (2) training in the design and implementation of primary data collection for large epidemiologic studies of older adults. Her mentorship team for the K08 Award proposal includes: Primary Mentor Jersey Liang, Ph.D., Professor, Department of Health Management and Policy, School of Public Health;Co-Mentor Caroline S. Blaum, M.D., M.S., Professor, Division of Geriatrics, Department of Internal Medicine;and Co-Mentor Kenneth Langa, M.D., Ph.D., Professor, Division of General Internal Medicine, Department of Internal Medicine. Specific career development training activities include: --training in advanced statistical methodologies, including longitudinal analysis, latent trajectory analysis, hierarchical linear modeling, and survival analysis via tutorials with mentors and classwork through the Institute for Social Research and School of Public Health at the University of Michigan, --training in the use of Medicare administrative data via tutorials with mentors and course attendance at CMS 101: Introduction to the Use of Medicare Data for Research (Basic Workshop in Medicare Administrative Data) through the Research Data Assistance Center (ResDAC) at the University of Minnesota, and --training in primary data collection for large epidemiologic studies of older adults via participation in the NIA- funded ADAMS pilot study (National Trends in Brain Health) (Mentor: Langa), development of an experimental module on geriatric conditions to be submitted for consideration for fielding in the 2014 wave of the HRS (Mentor: Langa), and involvement in the Comparative Aging Research Program (Mentor: Liang).
This research investigates how older adults acquire geriatric conditions, such as falls and urinary incontinence, and how these conditions cause older adults to become disabled. Understanding the early development of geriatric conditions can lead to interventions to prevent or delay them.
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