As many as 18 million Americans over age 65 suffer from some form of disability or functional impairment. Yet little is known about how long elders will live with disability prior to death, information that is important for planning from the perspectives of both patients and policy makers. Furthermore, while disability is widely assumed to negatively impact quality of life, quality of life concerns of elders with late life disability ave not been well described.
The research aims are (1) using the NIA funded Health and Retirement Study, to provide the first nationally representative estimates of the amount of time elders spend in disabled states prior to death, and examine how key demographic characteristics impact this amount of time;(2) using a cross sectional primary data study, to test and refine a conceptual model of quality of life for disabled elders;(3) to pilot a longitudinal study of factors influencng quality of life over time. The candidate will leverage the diverse population of elders in San Francisco by recruiting subjects for Aims 2 and 3 from On Lok, the San Francisco Department of Aging and Adult Services, and UCSF affiliated clinic and home based services for older adults. This research topic is suited to the candidate's overarching goal of becoming a national leader at the geriatrics/palliative medicine interface. The candidate does not have formal training in the principles of geriatrics research, psychosocial aspects of aging and quality of life, longitudinal studies, and leadership. Through a mixture of coursework, structured tutorials, and conferences, over the course of the award period the candidate will: (1) improve clinical skills and knowledge in geriatrics;(2) gain skills in psychosocial aspects of aging and quality of life research;(3) acquire skills and experience in the design, assembly, and analysis of longitudinal cohort studies in diverse populations;and (4) become a leading aging researcher at the interface of geriatrics and palliative medicine.
The number of Americans with late life disability will increase dramatically over the next several decades, and this has major potential impacts on quality of life, caregiver burden, and use of health and social services. The core mission of palliative medicine is improving quality of life. This training grant positions the candidate to be a leader a the geriatrics/palliative medicine interface, focused on improving quality of life in late life disability.
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|Whitlock, Elizabeth L; Diaz-Ramirez, L Grisell; Glymour, M Maria et al. (2017) Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med 177:1146-1153|
|Romo, Rafael D; Allison, Theresa A; Smith, Alexander K et al. (2017) Sense of Control in End-of-Life Decision-Making. J Am Geriatr Soc 65:e70-e75|
|Cagle, John G; McClymont, Keelan M; Thai, Julie N et al. (2016) ""If You Don't Know, All of a Sudden, They're Gone"": Caregiver Perspectives About Prognostic Communication for Disabled Elderly Adults. J Am Geriatr Soc 64:1299-306|
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|Smith, Alexander K; Ritchie, Christine S; Miao, Yinghui et al. (2016) Self-Reported Hearing in the Last 2 Years of Life in Older Adults. J Am Geriatr Soc 64:1486-91|
|Schonberg, Mara A; Smith, Alexander K (2016) Discussing Long-term Prognosis in Primary Care: Hard but Necessary. JAMA Intern Med 176:678-80|
|Harrison, Krista L; Adrion, Emily R; Ritchie, Christine S et al. (2016) Low Completion and Disparities in Advance Care Planning Activities Among Older Medicare Beneficiaries. JAMA Intern Med 176:1872-1875|
|Smith, Alexander K; Ritchie, Christine S; Wallhagen, Margaret L (2016) Hearing Loss in Hospice and Palliative Care: A National Survey of Providers. J Pain Symptom Manage 52:254-8|
|Cenzer, Irena S; Tang, Victoria; Boscardin, W John et al. (2016) One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. J Am Geriatr Soc 64:1863-8|
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