UCLA proposes to establish an OAIC that comprehensively addresses independence issues in subjects ranging from the well to the institutionalized elderly. In all cases, intervention studies are based on existing research projects with proven track records and will be performed by nationally recognized teams. Initially, there are three intervention and two intervention development studies; later, two added intervention studies are planned. All of these except one of the intervention development studies target people at high risk for independence loss. One study addresses an exercise trial coupled with a motivational program in fall-prone elderly, and one deals with health-related decision-making skills of elders. The three geriatric assessment interventions focus on community-dwelling elders with multiple risk factors for decline, hospitalized elders who are medically unstable, and patients who are designated as """"""""short-stayers"""""""" in nursing homes. Common to all three geriatric assessment studies are efforts to prevent institutionalization and trials of procedures designed to improve the probability that assessment recommendations are implemented. Subjects of the last intervention are nursing home residents whose problems are exacerbated by nursing care that reinforces dependency due to incontinence and restraint management. All projects are linked by common efforts to motivate target subjects to implement and maintain independence-enhancing interventions. Thus, the major theme of the proposed UCLA Center is to translate effective intervention procedures into the daily practices of patients and care- providers. Evaluation and administrative procedures that will guide the evolution of Pilot and Intervention Development Projects into major interventions have been articulated within the Administrative and Research Development Cores. A Research Development Core uses the major intervention studies as settings for enriching the training of junior faculty. In addition, pilot projects are planned that relate to each intervention program. Mentorship programs based on the extensive professional resources within the system are designed both to support the major research projects and develop the geriatric research skills of an interdisciplinary group of junior faculty. The Research Resources Core will provide support to all projects by assisting with measurement methods and techniques for assessing cost and effectiveness. A core for Dissemination of Information is also planned.
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