The increasing prevalence of chronic disease in the aging U.S. population presents substantial challenges to delivering medical care that is both patient-centered and consistent with evidence-based guidelines. Dr. Boyd's prior work demonstrated that the application of disease-specific guidelines to older patients with multimorbidity is limited by the complexity, expense, and burden ofthe recommended therapeutic regimens and monitoring requirements. Optimal care for our aging society entails the development of practical evidence-based treatment models for medically-complex older patients that permit flexible goal-setting according to patient preferences and perceived treatment burden. The overall goal of this project is therefore to develop a practical tool for assessing treatment burden among older patients with multimorbidity, to assist in medical decision making. Toward this end, Dr. Boyd proposes to study older individuals with an index diagnosis of diabetes in combination with other comorbid conditions as a model for examining treatment burden in multimorbidity. We propose to characterize the domains and moderators of treatment burden in this population via a secondary analysis of data from the Guided Care project, a study of older adults with multi-morbidity (Aim 1), as well as through a series of focus groups (aim 2). We will synthesize these data and data from the literature to develop a clinically practical measure of treatment burden (Aim 3), and, finally, we will pilot test this instrument in a clinical setting (Aim 4), as preparation for an ROl study to evaluate the clinical utility of the instrument for improving patient adherence and outcomes for a broader population of patients with multi-morbidity. This work will provide the foundation for a clinical research career focused on improving decision making and outcomes for older people with multimorbidity. Dr.
Boyd aims to become an independent clinical investigator dedicated to improving care for older people with multimorbidity. In concert with her sponsors, Dr. Boyd has charted a research path that is a direct extension of her prior work, and will be conducted within a structured career development plan that includes coursework, mentoring, and a multidisciplinary research advisory committee.

Public Health Relevance

Many older adults have multiple co-existing conditions, but it is not known how to best manage these conditions simultaneously. Dr.
Boyd aims to improve clinical decision-making and outcomes for older people with multimorbidity.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG032910-05
Application #
8531804
Study Section
Special Emphasis Panel (ZAG1-ZIJ-4 (M1))
Program Officer
King, Jonathan W
Project Start
2009-09-15
Project End
2014-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
5
Fiscal Year
2013
Total Cost
$114,042
Indirect Cost
$8,448
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Lane, Natasha E; Wodchis, Walter P; Boyd, Cynthia M et al. (2017) Disability in long-term care residents explained by prevalent geriatric syndromes, not long-term care home characteristics: a cross-sectional study. BMC Geriatr 17:49
Green, Ariel R; Segal, Jodi; Tian, Jing et al. (2017) Use of Bladder Antimuscarinics in Older Adults with Impaired Cognition. J Am Geriatr Soc 65:390-394
Pollack, Craig Evan; Blackford, Amanda L; Schoenborn, Nancy L et al. (2016) Comparing Prognostic Tools for Cancer Screening: Considerations for Clinical Practice and Performance Assessment. J Am Geriatr Soc 64:1032-8
Schoenborn, Nancy L; Bowman 2nd, Theron L; Cayea, Danelle et al. (2016) Primary Care Practitioners' Views on Incorporating Long-term Prognosis in the Care of Older Adults. JAMA Intern Med 176:671-8
Schoenborn, Nancy L; Cayea, Danelle; McNabney, Matthew et al. (2016) Prognosis communication with older patients with multimorbidity: Assessment after an educational intervention. Gerontol Geriatr Educ :1-11
Green, Ariel R; Oh, Esther; Hilson, Liam et al. (2016) Anticholinergic Burden in Older Adults with Mild Cognitive Impairment. J Am Geriatr Soc 64:e313-e314
Schoenborn, Nancy L; Bowman 2nd, Theron L; Cayea, Danelle et al. (2016) Discussion Strategies That Primary Care Clinicians Use When Stopping Cancer Screening in Older Adults. J Am Geriatr Soc 64:e221-e223
Puhan, Milo A; Yu, Tsung; Stegeman, Inge et al. (2015) Benefit-harm analysis and charts for individualized and preference-sensitive prevention: example of low dose aspirin for primary prevention of cardiovascular disease and cancer. BMC Med 13:250
Stegeman, Inge; Bossuyt, Patrick M; Yu, Tsung et al. (2015) Aspirin for Primary Prevention of Cardiovascular Disease and Cancer. A Benefit and Harm Analysis. PLoS One 10:e0127194
St Sauver, Jennifer L; Boyd, Cynthia M; Grossardt, Brandon R et al. (2015) Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity. BMJ Open 5:e006413

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