This application in response to SIP13-072, Expanding Information about Dementia and Co-occurring Chronic Conditions among Older Adults, will provide critical information to clinicians, policy makers and researchers to establish/refine guidelines and target interventions to improve quality of care for older adults with cognitive impairment (CI) and multiple chronic conditions (MCC). It will address major research gaps in public health practice information previously identified through SIP 10-037 and other potential priority areas of the Healthy Aging Program in the CDC's National Center for Chronic Disease Prevention and Health Program, Division of Population Health, viz., "multiple chronic conditions", "provision of clinical preventive services" and "service utilization outcomes-hospitalizations." Component One consists of a secondary analysis of the combined Health and Retirement Study/Medicare administrative data database to measure the impact of CI and MCC on receipt of necessary and preventive care and ambulatory-care-sensitive hospitalizations. It will address several specific limitations of earlier studies on health services use by persons with CI and MCC: focus on over- or under-use rather than quality of care; focus on single chronic conditions rather than MCC;simplistic conceptualization and operationalization of MCC;failure to examine the impact of NPC on other service utilization;and inability to examine level of CI. Component Two consists of the use of an expert-panel guided literature review and public policy agenda development strategy proposing collaboration with selected Healthy Aging Research Network Centers having particular expertise in/focus on CI, the BioBehavioral Heart Health (B2H2) Collaboration, the International Research Community on Multimorbidity, and CDC Project Scientists. Component One Aims: In a nationally representative sample of adults age 65 and older:
Aim 1 : To provide baseline descriptive statistics and ensure that Aims 2 and 3 follow SMART principles, measure the occurrence and co-occurrence of CI and MCC as: one-year period prevalence of CI (none, mild, moderate/severe) and chronic conditions using counts, published indices, intersection of comorbidities, geriatric syndromes and physical disability, and empirically derived clusters of comorbidities;
Aim 2 : In a cross- sectional analysis, compare the use of NPC and H-ACS in individuals with and without MCC (measured as indicated above) and/or with mild or moderate/severe CI;
Aim 3 : Test a model to examine whether receipt of inadequate NPC mediates the relationship between MCC and/or CI and higher likelihood of H-ACS. Component Two Aims Aim 1: Conduct a guided literature review to update findings from SIP 10-037 regarding gaps in knowledge about MCC in older adults;
Aim 2 : Assemble and engage a 5-8 member expert panel to develop, vet and disseminate a public health agenda for the Healthy Aging Research Network.

Public Health Relevance

The proposed project addresses unmet public health needs by documenting the current patterns of care received by older adults with cognitive impairment (CI) and multiple chronic conditions (MCC) to identify subgroups at high risk for inadequate care and unnecessary hospitalizations, and suggest appropriate interventions and guidelines. A public health agenda specific to individuals with or at risk for the co-occurrence of CI and MCC will be developed and disseminated.

National Institute of Health (NIH)
National Center for Chronic Disease Prev and Health Promo (NCCDPHP)
Health Promotion and Disease Prevention Research Centers (U48)
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Special Emphasis Panel (ZDP1-EEO (7E))
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Case Western Reserve University
Public Health & Prev Medicine
Schools of Medicine
United States
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