This application for the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76) describes the five-year career development plan of Dr. Victoria Tang, a geriatrician and young physician- scientist in the Division of Geriatrics at the University of California, San Francisco. Dr. Tang?s long-term career goal is to develop a research niche that bridges the field of aging and surgery to improve the care of older surgical patients. The specific career development goals outlined in this application include developing expertise in implementation science, intervention development, clinical trial design/analysis, and building a research niche that bridges the field of aging and surgery to improve the care of older surgical patients at the national level. The primary mentor for accomplishing these career development goals is Dr. Ken Covinsky, Professor of Medicine at UCSF and Principle Investigator of the UCSF Older Americans Independence Center. Dr. Covinsky will be assisted by co-mentor Dr. Emily Finlayson, Professor of Surgery and Director of UCSF?s Center for Surgery in Older Adults. The career development plan of Dr. Tang includes individualized mentorship with her mentorship team, formal coursework, one-on-one tutorials, and leadership training. The overall objective of the research plan is to understand the role of psychosocial vulnerability in post- operative outcomes with the largest cohort of older surgical patients to date and to develop a pilot test a psychosocial intervention to improve depressive symptoms, coping skills, and social support. The central hypothesis of this project is that preoperative psychosocial vulnerability is associated with post-operative functional recovery, and a greater understanding of psychosocial vulnerability and interventions designed to mitigate its effects will improve post-operative outcomes, such functional recovery.
The specific aims of the project include (1) determining the independent association between pre-operative psychosocial vulnerability with 2-year overall mortality and functional decline following major surgery; (2) understanding how psychosocial vulnerability impacts post-operative recovery in older surgical patients through semi-structured interviews with older surgical patients and caregivers; and (3) comparing 6-month functional recovery outcomes between those randomized to a psychosocial intervention (navigator-led social support and problem solving therapy) versus usual care.
These aims will permit a better understanding of psychosocial vulnerability, a geriatric-specific risk factor, in older adults that may be especially important in a time of major surgery. The application is relevant to NIH and NIA because Dr. Tang?s career goal is to leverage an understanding of the geriatric-specific risk factors to elucidate potential aspects needing interventions and to improve shared surgical decision-making among older adults and their physicians.
The proposed research is relevant to public health because a growing number of older adults are undergoing major surgery, which can lead to medical and functional decline. Thus, the proposed research seeks to improve our knowledge of psychosocial vulnerability in older adults undergoing surgery to improve surgical outcomes in this population. The project will determine the independent association of psychosocial vulnerability with mortality and functional decline, explore how psychosocial vulnerability impacts post- operative recovery, and pilot-test of a psychosocial intervention on post-operative functional recovery.
