This application for an NIA Mentored Patient-Oriented Research Career Development (K23) award seeks support to develop a program of research related to understanding the mechanisms of health disparities in Parkinsonism. As part of the education plan, the PI proposes to: 1) Increase her understanding of health behavior theory, geriatrics and health disparities;2) Gain additional epidemiological skills in study design and health measurement;and 3) Acquire the analytic skills associated with psychometric and longitudinal data analysis. Along with these educational goals, there is an associated research project. The principal research objective of this project is to understand the patient-level factors related to healthcare disparities in the diagnosis and treatment of Parkinsonian signs. Specifically, this study proposes to evaluate how older adults'aging beliefs affect the recognition of Parkinsonian signs, and how race, culture and socioeconomic status impact this relationship. To achieve these goals, there are three specific aims: 1) To validate a screening instrument for Parkinsonian signs by comparing it with neurological examination;2) To examine older adults'beliefs regarding movement changes and their association with Parkinsonian signs and relevant patient-level characteristics;and 3) To determine the association between beliefs about aging, subsequent comorbidities, including falls and fractures, and the detection and treatment of Parkinson's and Alzheimer's disease. After validation of a screening instrument for Parkinsonian signs, this measure will be incorporated into a cross-sectional and prospective evaluation of the relationship between aging beliefs and Parkinsonian signs, particularly as it is modified by socioeconomic factors. Subjects will be recruited and surveyed in primary care clinics and outcomes will be determined through the electronic health record. Successful completion of this project will lead to the development of educational interventions targeting improved understanding of aging related functional decline among older adults. This application will provide critical support for the PI to become an independent researcher and a leader in health services research in aging and neurodegenerative diseases.
Aging-related movement problems are common in older adults and lead to increased disability and death. Underserved minorities may be particularly vulnerable to under-recognition and treatment of these movement problems. This research aims to understand why patients may not get appropriate and timely therapy in order to develop public health strategies to improve care for older adults.
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