My patient-oriented research platform in preventing falls and fractures in older adults has given me the opportunity to develop skills in complex intervention development for frail populations. These skills include analysis of longitudinal and administrative data, qualitative methods, pilot studies, randomized trials, and economic analysis. Complexity Science and Adaptive Leadership models have been informative conceptual frameworks for designing interventions for complex syndromes and healthcare settings. As an Associate Professor at Duke University Medical Center, I have begun to train aging researchers from diverse professions and specialties in aging research methods, however, I would benefit from protected time to develop a mentoring program in intervention development for complex problems in older adults. The immediate goal of this K24 proposal is to expand my research platform by integrating my fall and fracture research programs, and improve my mentoring skills through training the next generation of patient oriented researchers developing pragmatic interventions to reduce falls and fractures. My long-term career goal is to develop and implement pragmatic interventions to reduce the devastating consequences of osteoporotic fractures in older adults. Environment: Duke University Medical Center is a rich environment for aging researchers. The Duke Center for the Study of Aging and Human Development includes faculty with a wide range of expertise across the University. The Duke Claude O. Pepper Older Americans Independence Center provides research support services; I currently serve on the Leadership Core and co-chair the Research Career Development Core. My research and mentoring activities also occur within the Durham VA Geriatrics Research and Education Center, where I am Assistant Director, the Durham VA Health Services Research Center of Excellence (COIN and CREATE Centers), the Duke Clinical Translational Science Award Center (CTSA), and the Duke School of Nursing NIH-funded ADAPT Center. Research: Key elements of my mentoring plan (Specific Aim 1) include training and curriculum development in my research area to improve my mentoring skills. Specifically, I will participate in formal mentor training through the Duke CTSA Mentor Pipeline Program, run a mid-career peer mentoring group of patient oriented researchers focused on mentoring, and develop a 12 part workshop series on Intervention Development.
For Specific Aim 2, I will enhance my research skills through formal professional development and practical experiences in pragmatic study design (adaptive designs, community engaged research).
For Specific Aim 3, I will mentor patient oriented research in fall and fracture prevention emerging from 6 current grants and involving 7 trainees. These projects include 3 studies newly proposed for this application. The centerpiece of these studies is the development and pilot testing of nurse-led multifactorial fall prevention protocols within an existing regional Fracture Liaison Service, delivered using telehealth technologies to expand their scope and reach. At the conclusion of the award, I will be well positioned to obtain funding for a large pragmatic trial testing integrated fall and fracture prevention programs delivered within a health system and targeted to high risk older adults.

Public Health Relevance

The prevalence of osteoporosis and associated fractures rises exponentially with age through the 10th decade, making it one of the greatest threats to health and independence among older adults. At the same time, the fastest growing segment of the population is precisely this group at greatest risk. According to the World Health Organization, the number of people worldwide aged 80 years and older will quadruple between 2000 and 2050; this population is sometimes referred to as the 'oldest old', and has historically been under- represented in osteoporosis studies. At age 50 years, a woman in the U.S. has approximately a 1 in 2 and a man has a 1 in 4 chance of experiencing a major fracture in their remaining lifetime. A majority of osteoporotic fractures occur after a low trauma fall, with 1 in 3 adults over age 65 years falling experiencing at least 1 fall annually, and 1 in every 10-12 falls resulting in a fracture. Thus, fall and fracture prevention in older adults are integrally linked. This K24 award will expand my research platform in fall and fracture prevention for older adults by: 1) mentoring the next generation of patient-oriented researchers in projects that expand the scope of my currently funded research, and 2) allowing me to gain new research skills and pilot data to support a subsequent pragmatic trial in community telehealth fall and fracture prevention interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24AG049077-04
Application #
9485194
Study Section
Neuroscience of Aging Review Committee (NIA)
Program Officer
Joseph, Lyndon
Project Start
2015-08-01
Project End
2020-04-30
Budget Start
2018-05-01
Budget End
2019-04-30
Support Year
4
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Hall, Rasheeda K; Sloane, Richard; Pieper, Carl et al. (2018) Competing Risks of Fracture and Death in Older Adults with Chronic Kidney Disease. J Am Geriatr Soc 66:532-538
Cary Jr, Michael P; Hall, Rasheeda K; Anderson, Amber L et al. (2018) Management Team Perceptions of Risks and Strategies for Preventing Falls Among Short-Stay Patients in Nursing Homes. Health Care Manag (Frederick) 37:76-85
Lee, Richard H; Sloane, Richard; Pieper, Carl et al. (2018) Clinical Fractures Among Older Men With Diabetes Are Mediated by Diabetic Complications. J Clin Endocrinol Metab 103:281-287
Toles, Mark; Leeman, Jennifer; Colón-Emeric, Cathleen et al. (2018) Implementing a Standardized Transition Care Plan in Skilled Nursing Facilities. J Appl Gerontol :733464818783689
Yap, Tracey L; Kennerly, Susan M; Horn, Susan D et al. (2018) TEAM-UP for quality: a cluster randomized controlled trial protocol focused on preventing pressure ulcers through repositioning frequency and precipitating factors. BMC Geriatr 18:54
Colón-Emeric, Cathleen S; Corazzini, Kirsten N; McConnell, Eleanor S et al. (2018) Resident Vignettes for Assessing Care Quality in Nursing Homes. J Am Med Dir Assoc 19:405-410
Cary Jr, Michael P; Goode, Victoria; Crego, Nancy et al. (2018) Hospital Readmission in Total Hip Replacement Patients in 2009 and 2014. Arch Phys Med Rehabil 99:1213-1216
Hall, Rasheeda K; Luciano, Alison; Pieper, Carl et al. (2018) Association of Kidney Disease Quality of Life (KDQOL-36) with mortality and hospitalization in older adults receiving hemodialysis. BMC Nephrol 19:11
Pavon, Juliessa M; Sloane, Richard J; Pieper, Carl F et al. (2018) Poor Adherence to Risk Stratification Guidelines Results in Overuse of Venous Thromboembolism Prophylaxis in Hospitalized Older Adults. J Hosp Med 13:403-404
Whitson, Heather E; Duan-Porter, Wei; Schmader, Kenneth et al. (2017) Response to Letter From De Alfieri et al.: Biological Resilience of Elderly Hospitalized Patients. J Gerontol A Biol Sci Med Sci 72:142

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