My over-arching career goals as a geriatrician and clinical investigator are to conduct high quality patient- oriented research in aging and palliativ care, train the next generation of investigators to conduct this research and through my research and mentoring activities improve the health care of older persons living with advanced illness. Over the past 16 years, I have built a successful research program focused on outcomes, decision-making, and health care utilization in advanced dementia. My initial K24 was awarded in 2009. My productivity during its course is evident through the high impact of my research, mentees'accomplishments, and my leadership roles. Building on this success, I feel am at an optimal time to renew this award. The observational studies I have conducted to date have clearly shown that advanced dementia patients receive sub-optimal palliative care, but also elucidated opportunities for improvement. Designing and testing interventions targeting those opportunities is the current priority for the field, and the focus of my research during this K24 renewal. The initial K24 period was critical in providing the protected time needed to be an effective mentor, gain mentoring skills, and build a cadre of young investigators skilled in palliative care aging research. Renewal of my K24 is essential for this momentum to continue. The objectives for my 5-year K24 renewal period are: 1. To continue to build a research program focused on improving the quality of care for older patients with advanced dementia, with a new direction on clinical trials. This will be accomplished by: i. completion of currently funded observational studies, ii. new research involving cluster randomized clinical trials (RCTs) testing practice interventions in advanced dementia, and iii. formal training activities to deepen my expertise in clinical trials research;2. To use my research as a platform to mentor new investigators in aging-related palliative care research to help them become independent investigators and support the expansion of my research program and the field with highly trained faculty. This will be accomplished by: i. involvement of my trainees in my funded projects, ii. leveraging my research infrastructure to enable my mentees'investigations. iii. recruitment of high caliber mentees from varied disciplines committed to this field, iv. individual mentorship of these trainees in their research activities and career development, v. didactic sessions and formal coursework for mentees. IMPACT: The focus of my new research, career development and mentorship in clinical trials is the next necessary step to move the field of advanced dementia forward. The findings, methodological advancements, and infrastructure gained through this work, can be leveraged for the next phase of research translation: implementation and dissemination of proven interventions. Ultimately, my ongoing and new research proposed for the second cycle of my K24, coupled with my training of outstanding investigators in the field of palliative care and aging, and will help address the critical and pressing need to bring high quality and cost-effective palliative care to the bedside of the millions of older Americans.

Public Health Relevance

With the renewal of this k24 award, Dr. Susan Mitchell will continue to develop her successful research program aimed at improving the end-of-life experience of persons with advanced dementia and their families, with a new focus on the conduct of clinical trials research. She will use her research as a platform to mentor new investigators in field of palliative care and aging, and help them to become independent investigators. Taken together, her ongoing and new research, coupled with her training of outstanding investigators, will help address the critical and pressing need to bring high quality and cost-effective palliative care to the bedside of the millions of older Americans.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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National Institute on Aging Initial Review Group (NIA)
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Silverberg, Nina B
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Hebrew Rehabilitation Center for Aged
United States
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Stevenson, David G; Dusetzina, Stacie B; O'Malley, A James et al. (2014) High-risk medication use by nursing home residents before and after hospitalization. Med Care 52:884-90
Stevenson, David G; O'Malley, A James; Dusetzina, Stacie B et al. (2014) Effect of Part D coverage restrictions for antidepressants, antipsychotics, and cholinesterase inhibitors on related nursing home resident outcomes. J Am Geriatr Soc 62:1666-74
Tjia, Jennifer; Briesacher, Becky A; Peterson, Daniel et al. (2014) Use of medications of questionable benefit in advanced dementia. JAMA Intern Med 174:1763-71
Mitchell, Susan L; Shaffer, Michele L; Loeb, Mark B et al. (2014) Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia. JAMA Intern Med 174:1660-7
Fulton, Ana Tuya; Gozalo, Pedro; Mitchell, Susan L et al. (2014) Intensive care utilization among nursing home residents with advanced cognitive and severe functional impairment. J Palliat Med 17:313-7
Kramer, Daniel B; Kennedy, Kevin F; Spertus, John A et al. (2014) Mortality risk following replacement implantable cardioverter-defibrillator implantation at end of battery life: results from the NCDR. Heart Rhythm 11:216-21
Catic, Angela G; Berg, Andrea I; Moran, Julie A et al. (2013) Preliminary data from an advanced dementia consult service: integrating research, education, and clinical expertise. J Am Geriatr Soc 61:2008-12
Kramer, Daniel B; Mitchell, Susan L (2013) Weighing the benefits and burdens of witnessed resuscitation. N Engl J Med 368:1058-9
D'Agata, Erika; Loeb, Mark B; Mitchell, Susan L (2013) Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. J Am Geriatr Soc 61:62-6
Brown, Rebecca T; Kiely, Dan K; Bharel, Monica et al. (2013) Use of acute care services among older homeless adults. JAMA Intern Med 173:1831-4

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