My goal is to improve function in older adults with comorbidity by becoming a nationally recognized leader in academic geriatrics with a research agenda focused on understanding and modifying the pathway that leads from comorbidity to disability. I have progressed toward this goal as a Master's degree candidate in Duke's Clinical Research Training Program and through research projects that examine the impact of specific comorbid conditions. With a Beeson Career Development Award, I would acquire additional didactic training as well as mentored research experience in qualitative methodology and prospective data collection involving functional outcomes in medically complex older adults. My career development will be overseen by Dr. Harvey Cohen, a renowned geriatrics researcher and experienced mentor, as well as a talented team of mentors and advisors with the necessary content expertise to successfully complete two proposed projects. Both projects relate to a single overall aim, which is to develop interventions that improve functional outcomes in patients who suffer from particularly disabling combinations of conditions. Both projects are derived from a conceptual framework that begins with impairments - rather than diseases - to confront the problem of comorbidity in functional decline. My previous research experience and pilot data have informed the selection of impairments that I focus on in this application. The first project involves an analysis of data that I am currently collecting and will evaluate the impact of cognitive impairment on functional outcomes in low vision rehabilitation for visual impairment. The second project involves prospective data collection and will evaluate the impact of comorbid pain and dyspnea on a Tai Chi program for balance impairment. In each project, I will incorporate quantitative and qualitative data analyses to develop a novel intervention that accommodates an important set of comorbid problems (visual impairment/cognitive impairment or balance impairment/pain/dyspnea). Public health relevance: An increasing number of Americans suffer from more than one health problem, yet most interventions are aimed at a single disease, symptom, or impairment and thus fail to meet the needs of more complicated, older patients. The proposed projects will generate evidence needed to develop novel interventions for patients with specific combinations of disabling conditions. This work is a necessary step toward my ultimate goal, which is to design comprehensive treatment strategies to maximize function in older adults with a variety of health problems.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZAG1-ZIJ-4 (M1))
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Salive, Marcel
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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Clark, Nathan; Fan, Vincent S; Slatore, Christopher G et al. (2014) Dyspnea and pain frequently co-occur among Medicare managed care recipients. Ann Am Thorac Soc 11:890-7
Whitson, Heather E; Malhotra, Rahul; Chan, Angelique et al. (2014) Comorbid visual and cognitive impairment: relationship with disability status and self-rated health among older singaporeans. Asia Pac J Public Health 26:310-9
Whitson, Heather E; Arnold, Alice M; Yee, Laura M et al. (2014) Serum carboxymethyl-lysine, disability, and frailty in older persons: the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 69:710-6
Hastings, S Nicole; Whitson, Heather E; Sloane, Richard et al. (2014) Using the past to predict the future: latent class analysis of patterns of health service use of older adults in the emergency department. J Am Geriatr Soc 62:711-5
Colon-Emeric, Cathleen S; Whitson, Heather E; Pavon, Juliessa et al. (2013) Functional decline in older adults. Am Fam Physician 88:388-94
Bowling, C Barrett; Booth 3rd, John N; Safford, Monika M et al. (2013) Nondisease-specific problems and all-cause mortality in the REasons for Geographic and Racial Differences in Stroke study. J Am Geriatr Soc 61:739-46
Whitson, Heather E; Whitaker, Diane; Potter, Guy et al. (2013) A low-vision rehabilitation program for patients with mild cognitive deficits. JAMA Ophthalmol 131:912-9
Henninger, Debra E; Whitson, Heather E; Cohen, Harvey J et al. (2012) Higher medical morbidity burden is associated with external locus of control. J Am Geriatr Soc 60:751-5
Johnson, Kimberly S; Hastings, S Nicole; Purser, Jama L et al. (2011) The Junior Faculty Laboratory: an innovative model of peer mentoring. Acad Med 86:1577-82
Whitson, Heather E; Steinhauser, Karen; Ammarell, Natalie et al. (2011) Categorizing the effect of comorbidity: a qualitative study of individuals' experiences in a low-vision rehabilitation program. J Am Geriatr Soc 59:1802-9

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