This is a resubmission for a Paul B. Beeson Patient-Oriented Research Career Development Award in Aging (K23) by Marian Betz, MD, MPH. Dr. Betz's overall career goal is to be a leading independent researcher in geriatric injury prevention and emergency medicine in order to help maintain functional independence in older adults. Her innovative research proposal applies the model of a clinical decision rule to a public health intervention, through tiered assessment of brief older driver screening in ambulatory care settings followed by referral for more comprehensive testing. Candidate: Dr. Betz is a board-certified Emergency Medicine physician, Assistant Professor of Emergency Medicine at the University of Colorado Denver (UCD) School of Medicine and Assistant Professor of Epidemiology at the Colorado School of Public Health. She completed a Masters of Public Health and the Emergency Medicine Foundation Research Fellowship, and she has finished a number of studies related to older drivers and injury epidemiology and prevention. Dr. Betz has established close working relationships with her primary mentor (Dr. Robert Schwartz, a leading researcher in geriatrics with a long track record of mentoring) and co-mentors in Driving (Dr. David Carr, a national expert and researcher on older driver issues), Research Methodology (Dr. Jason Haukoos, a researcher with expertise in clinical decision rule methodology) and Qualitative Methods (Dr. Jaqueline Jones, a qualitative researcher with a focus on older adults and emergency medicine). Training: The proposed career development plan augments Dr. Betz's prior training and experience to focus on specific, advanced training in: (1) qualitative research methods; (2) decision rule derivation, validation and implementation; (3) public health issues in geriatric injury prevention; and (4) study management and leadership. Dr. Betz proposes to acquire these skills through intensive focused mentorship, relevant advanced coursework, and guided research. These training activities will help Dr. Betz gain the necessary skills and knowledge to implement an effective tiered older driver assessment program with brief screening in a clinical setting followed by appropriate referral to more comprehensive driver evaluation programs. Mentors/Environment: Dr. Betz has a strong mentorship team of leaders in geriatrics, driving, research methods, injury prevention, and emergency medicine who are committed to guiding her through her research and career development activities as she develops into an independent investigator. In addition, an advisory panel of experts in geriatrics, injury, and research career development will monitor Dr. Betz's progress in addition to providing additional topical guidance. The Department of Emergency Medicine is committed to supporting Dr. Betz's growth into an independent researcher, including financial and time support for her participation in the competitive Colorado Clinical and Translational Sciences Institute (CCTSI) Clinical Faculty Scholars Program (with intensive mentoring of junior research faculty) and a commitment of protected time and resources for this career development award. In addition, the UCD provides Dr. Betz with a rich research environment, including access to resources and collaborators at the CCTSI, the interdisciplinary UCD Center on Aging, and the UCD professional Schools of Medicine, Public Health, Nursing, and other disciplines. Research: With the aging of the U.S. population, there is an urgent need for efficient, effective and acceptable methods of identifying, retraining or restricting unsafe older drivers without unfairly restrictingthe mobility of those who are safe. This proposal applies the model of a clinical decision rule to a public health program through the development of tiered older driver assessment, with widespread brief screening followed by referral for additional evaluation of those with a positive screen. The research plan aims to examine the viewpoints of older drivers and providers concerning driver assessment (Aim 1), to validate and refine a brief question-based screening tool (Aim 2), and to examine the feasibility of pilot program implementation (Aim 3) in order to prepare for future implementation of a model tiered older driver assessment program (planned R01). Summary: This innovative proposal applies a common approach from clinical medicine (clinical decision rules) to an important issue in geriatric injury prevention (older driver safety in a way that considers and values the perspectives of older drivers, their families, and their providers. This approach might be applied to other geriatric injuries or other settings, and the proposed mentored, patient-centered training and research will help Dr. Betz develop into an independent, nationally-recognized investigator and leader in geriatric injury prevention.
Although age can affect a driver's ability to stay safe, driving can help older adults stay independent and mobile, so it is important that driving restrictions not be based on age alone. Healthcare providers are in a unique position to assess and counsel older drivers, but they need tools to help them identify which older drivers might be at risk of crashes and might benefit from further revaluation or retraining. A strategy of tiered older driver assessment-brief screening, then referral of those with an abnormal screen-could allow providers to identify and refer those drivers who need a comprehensive driving evaluation. This approach would avoid unfair restrictions on safe drivers and would prioritize driver evaluation resources for those most at risk and most likely to benefit from an evaluation. In preliminary research studies, we developed a brief screening tool for healthcare providers, but further work is needed to examine the perspectives of older drivers and healthcare providers, to validate the screening tool, and to test the feasibility of a program to use the screening tool in a clinic settng. The overarching objective of this career development award is to support the development of Dr. Marian Betz, MD, MPH, into a leader in geriatric injury prevention. She aims to derive, validate and implement a brief screening tool to help healthcare providers identify older drivers who would benefit from comprehensive driver evaluation sessions, which could help older adults stay independent, mobile and safe.
| Betz, Marian E; Kautzman, Mack; Segal, Daniel L et al. (2018) Frequency of lethal means assessment among emergency department patients with a positive suicide risk screen. Psychiatry Res 260:30-35 |
| Betz, Marian E (2018) Firearms and Suicide: Finding the Right Words. Acad Emerg Med 25:605-606 |
| Kandasamy, Deepika; Platts-Mills, Timothy F; Shah, Manish N et al. (2018) Social Disconnection Among Older Adults Receiving Care in the Emergency Department. West J Emerg Med 19:919-925 |
| Betz, Marian E; Brooks-Russell, Ashley; Brandspigel, Sara et al. (2018) Counseling Suicidal Patients About Access to Lethal Means: Attitudes of Emergency Nurse Leaders. J Emerg Nurs 44:499-504 |
| Urban, Chantel; Arias, Sarah A; Segal, Daniel L et al. (2018) Emergency Department patients with suicide risk: Differences in care by acute alcohol use. Gen Hosp Psychiatry : |
| Betz, Marian E; Haukoos, Jason S; Schwartz, Robert et al. (2018) Prospective Validation of a Screening Tool to Identify Older Adults in Need of a Driving Evaluation. J Am Geriatr Soc 66:357-363 |
| Arias, Sarah A; Boudreaux, Edwin D; Segal, Daniel L et al. (2017) Disparities in Treatment of Older Adults with Suicide Risk in the Emergency Department. J Am Geriatr Soc 65:2272-2277 |
| Scott, Kenneth A; Rogers, Eli; Betz, Marian E et al. (2017) Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta-Analysis. J Am Geriatr Soc 65:2596-2602 |
| Jones, Jacqueline; Dickerson, Anne; Flaten, Hanna K et al. (2016) Driving Rehabilitation Specialists' Perspectives on Older Driver Evaluations. Am J Occup Ther 70:7002270010p1-7 |
| Betz, Marian E; Arias, Sarah A; Segal, Daniel L et al. (2016) Screening for Suicidal Thoughts and Behaviors in Older Adults in the Emergency Department. J Am Geriatr Soc 64:e72-e77 |
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