The family system has significant impact on the health and health care utilization of elderly persons. There is limited research available on the function of the family system in the geriatric population. Family function includes structural variables such as number and proximity of relatives and dynamic variables such as a family's ability to communicate, make decisions, adapt and plan. Function is also related to a family's ability to act cohesively and cooperatively. We hypothesize that elders living without the support of a functional family will report a lower quality of life, have increased morbidity and mortality over three years, have a higher rate of nursing home placement, physician visits and will have more frequent hospitalizations. The research will validate and assess the reliability of an innovative measure of family structure and function, the Family Inventory of Function and Environment (FIFE appendix 1) designed specifically for the elderly. The P.I. and mentor have been developing and piloting this tool for the last year. The subjects, community dwelling elderly, university hospital clinic patients and veterans, will be followed for 3 years to test the above hypothesis. This research effort, done with close supervision by the mentors in conjunction with formal course work at CWRU and the University of Michigan in epidemiology and Public Health, will train the P.I. in the methodology of longitudinal prospective studies and the psychometric evaluation of screening instruments on elderly persons. Future planned studies include randomized clinical trials on dysfunctional families testing the effect of such intervention as increased surveillance, individual, group or family therapy on the outcomes described in the original hypotheses. Teaching activities will be in the areas of geriatrics, family dysfunction and the related area of alcoholism. The P.I. will be uniquely qualified to teach in these clinically important areas which are currently underemphasized in family medicine residencies and are often nearly absent in internal medicine and medical student curricula. The P.I. is currently performing didactic and clinical teaching. Trainees will include medical students, residents, and geriatric fellows.
