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.

Public Health Relevance

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.

National Institute of Health (NIH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Patmios, Georgeanne E
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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McClymont, Keelan M; Lee, Sei J; Schonberg, Mara A et al. (2014) Usefulness and effect of online prognostic calculators. J Am Geriatr Soc 62:2444-5
Thai, Julie N; Walter, Louise C; Eng, Catherine et al. (2013) Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults. J Am Geriatr Soc 61:264-9
Smith, Alexander K; White, Douglas B; Arnold, Robert M (2013) Uncertainty--the other side of prognosis. N Engl J Med 368:2448-50
Smith, Alexander K; Lo, Bernard; Sudore, Rebecca (2013) When previously expressed wishes conflict with best interests. JAMA Intern Med 173:1241-5
Smith, Alexander K; Walter, Louise C; Miao, Yinghui et al. (2013) Disability during the last two years of life. JAMA Intern Med 173:1506-13
Smith, Alexander K (2013) Palliative care: an approach for all internists: comment on "Early palliative care in advanced lung cancer: a qualitative study". JAMA Intern Med 173:291-2
Bischoff, Kara E; Sudore, Rebecca; Miao, Yinghui et al. (2013) Advance care planning and the quality of end-of-life care in older adults. J Am Geriatr Soc 61:209-14