This K01 Award will allow the candidate to deepen and expand her research on Preparation for Future Care (PFC) in older adults. PFC is defined as thoughts and actions involved when individuals formulate explicit plans for where, when, how, and from whom they will receive care if they become frail. More than 50% of older adults have no concrete plans for care, and 20% actively avoid any planning. For many, crisis care decisions lead to inappropriate care arrangements, including health care over-or-under-utilization, and premature death. Given the aging of the population, failure or inability to prepare for future care presents a problem for public policy and public health. The proposed program of research will lay the foundation for designing and implementing studies that will inform clinical and policy-based interventions to enhance PFC in the older population. The research plan is designed to initiate a program of systematic research on PFC by (1) describing the natural course of PFC in older adults at greater than average risk for care needs, (2) investigating four antecedents of PFS: Personality, Cognitive Functioning and Impairment, Depression, and Medical Illness, (3) examining the consequences of PFC over time with regard to Subjective Well-being, Functional Status, and Health Care Utilization. Data will be collected as part of an ancillary study to a NIA-funded longitudinal investigation of first-degree relatives of Alzheimer's patients (ADAPT). In addition, secondary data analyses will be performed in an ongoing NIH-funded study of depression in primary care patients (DOS), and HCFA's Medicare Current Beneficiaries data, in order to assess the antecedents and consequences of PFC. The educational plan includes (1) Tutorials and consultation to increase the candidate's knowledge of Personality, Cognitive Functioning and impairment, Depression, Medical Illness and Functional Status, (2) academic coursework and mentored research experiences to develop her skills in assessment and analysis of health care utilization, (3) coursework and research experiences to teach her advanced statistical methods for longitudinal analysis. The Candidate will combine perspectives from life-span development, epidemiology, health services, and late life psychopathology to develop PFC as a vibrant, multidisciplinary field of scientific inquiry with the potential to influence public health and public policy.
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