The causes and consequences of disability are of fundamental concern to a US population whose age structure is shifting dramatically. An important impediment to the development of interventions to prevent disability and restore independent function has been an incomplete understanding of the disabling process. This application is a competing renewal of an NIA MERIT award, which provides support for the PEP Study, a unique and highly innovative, ongoing study of 754 community-living persons, aged ? 70. Over the past 17+ years, participants have completed comprehensive assessments at 18-month intervals and have been interviewed monthly to reassess their functional status and ascertain intervening events, other health care utilization, and deaths. Findings from the PEP Study have greatly enhanced our understanding of the disabling process. To date, 90 original reports have been published, including 76 since the start of the award. Recent linkages with Medicare claims and Connecticut Tumor Registry have further enriched PEP as an unparalleled platform for disability research. Building on our earlier work, this 5-year renewal will rigorously evaluate the role of common, but relatively neglected intervening events on the disabling process, investigate the functional antecedents, outcomes, and prognostic determinants of a new cancer diagnosis, elucidate the public health importance of multiple modifiable patient-centered factors on functional outcomes, and determine whether hospice services are being targeted appropriately at the end of life.
The Specific Aims are: (1) to identify modifiable factor, from multiple patient-centered domains, that are associated with disability burden and poor functional recovery after a major surgical procedure; (2a) to determine the functional outcomes among older persons who are admitted to an emergency department (ED) but not hospitalized, relative to those who are admitted to an ED and hospitalized and to those who were not admitted to an ED; (2b) to identify modifiable factors, from multiple patient-centered domains, that are associated with poor functional outcomes after an ED admission; (3a) to identify distinct sets of functional trajectories in the year immediately before and after a new cancer diagnosis, evaluate the relationship between the pre- and post-cancer trajectories and determine whether these results differ based on the cancer-specific prognosis; (3b) to identify the patient-centered and cancer-specific factors that are associated with functional decline after a new cancer diagnosis; and (4) among decedents, to evaluate the relationship between the presence and burden of restricting symptoms and disability, respectively, and subsequent enrollment in hospice. This hypothesis-driven research will take advantage of the most comprehensive set of functional data on such a large cohort of older persons, with an excellent participation rate, remarkably low attrition, and little missing data. By further elucidating the epidemiology of disability and recovery, the proposed research will help to inform the development of effective and efficient interventions directed at maintaining and restoring independent function among older persons.
Continued epidemiologic research is needed to enhance our understanding of the disabling process and inform the development of preventive and restorative interventions in older persons. The next phase of the PEP Study will evaluate the role of common, but relatively neglected intervening events on the disabling process, investigate the functional antecedents, outcomes, and prognostic determinants of a new cancer diagnosis, elucidate the public health importance of multiple modifiable patient-centered factors on functional outcomes, and determine whether hospice services are being targeted appropriately at the end of life. The results of this research will guide efforts to reduce disability, maximize functioning, and enhance quality of life among older persons.
Showing the most recent 10 out of 41 publications
