This is an Application for a comparative two year extension for a Special Emphasis Research Career Award (SERCA) in behavioral geriatrics. The focus of this SERCA on the inter-relationships between elderly and the health care system in the initiation and discontinuation of psychotropic drug use by elderly people in nursing homes. The SERCA consists of two phases: (1) career development and (2) interdisciplinary research. My plans for career development phase are fourfold: To learn about psychotropic drugs by taking graduate level courses in pharmacotherapeutics; To gain experimental knowledge about how health providers decide whether or not elderly people in nursing homes should use psychotropic drugs and the system for monitoring such use by participating in clinical rounds with geriatrics teams in nursing homes; To learn about current research on the use of psychotropic drugs by elderly by making site visits to three nationally known research groups; and To develop for myself a network of other researchers with whom I can interact in the future by attending scientific meetings and gain critical feedback about my research in progress by presenting results of my studies at these meetings. In the interdisciplinary research phase, I want to conduct two exploratory studies: A record review study of the use of neuroleptic and antianxiety drugs by elderly people in 10 nursing homes, and An interview study of care providers' decisions when they initiate or discontinue neuroleptic or antianxiety drugs for elderly in the same 10 nursing homes. This 2-year SERCA extension will afford me both the knowledge and specialized research experience to design and implement a research proposal in psychotropic drugs that will be competitive at the R01 level. My long range goal is to develop a research program that will include randomized clinical trials for interventions aimed at the most efficacious and humane use and none use of psychotropic drugs by nursing home elderly.
