This proposal outlines a five-year plan for preparing a well-trained clinician-educator for a productive academic career in geriatric medicine. The goals of the plan include expertise in clinical research and advanced skills in the practice and teaching of clinical care of the elderly. Research goals will be met through a carefully planned epidemiologic investigation of possible predictors of functional ability in the elderly, conducted under the sponsorship of an outstanding multidisciplinary team of four scholars in the field of aging. Proposed clinical and educational goals will be addressed through formal curriculum development activities and multilevel clinical teaching and practice. The proposed sequence of three research projects will evaluate several possible determinants and consequences of the collective functional ability of future U.S. elderly populations. Longitudinal health and functional data from a representative sample of U.S. elders in the NIA-NCHS Longitudinal Study of Aging (n=7541) will be used to: 1.assess the potencies of hypothesized predictors of cumulative functional ability by constructing gender-specific mathematical models of four-year probabilities of transition (between levels of functional ability) and the following covariates: age, morbidity, physical impairment, activity level and health beliefs. 2.assess the relation between functional ability and subsequent mortality by constructing race- and gender-specific mathematical models of six-year mortality and the following covariates: age and functional ability. The results of (1) and (2) will then be used to simulate the number of functionally dependent U.S. elders that can be anticipated during the years 1994-2044 under a range of assumptions about future prevalences of four risk factors for functional dependency and death: morbidity,, physical impairment, inactivity, and health beliefs. The results of these studies will assist in targeting for modification the most potent predictors of functional ability in the elderly. The simulations will also guide the development of effective policies and plans for the care of the dependent elderly of the future.
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