The applicant, Dr. Jerry Gurwitz, proposes a coordinated program of research, education, and practice in geriatrics under the auspices of the Harvard Medical School Division on Aging. Dr. Jerry Avorn, Associate Professor in the Gerontology Division of the Harvard Department of Medicine, will be the applicant's sponsor. The research program will incorporate a multidimensional approach to systematically examine the problem of drug-induced illness in the elderly employing a single medication category, the nonsteroidal anti-inflammatory drugs (NSAIDs), as a model. The program will include three components: (1) a population-based pharmaco-epidemiologic investigation of the adverse effects of NSAIDs on antihypertensive control in the elderly; (2) a complementary randomized, controlled clinical study examining the NSA]ID/blood pressure interaction as well as renal effects of NSAIDs in a population of ambulatory elderly subjects; and (3) a direct application of the results of the pharmacoepidemiologic and clinical investigations to the study of clinical decision-making in the care of elderly patients. The educational component will include the development of an innovative curriculum in geriatric clinical pharmacology to be employed at all levels of medical education from medical school to continuing education programs for practicing physicians. Clinical activities will emphasize long-term care, and will include the development of a program for the education and training of medical house officers in this setting. The substantial research, educational, and clinical resources of the Harvard Division on Aging will be available to assure accomplishment of the goals set out in this application.
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