The Stanford Center on Advancing Decision Making for Aging (CADMA) will promote the study of decision making processes and the determinants of choices that affect health and well-being in the later years of life. CADMA researchers plan to conduct basic and applied research on decision making processes with a goal of developing and implementing practical methods for improving fundamental decisions affecting the well-being of the elderly. The research will be conducted by collaborating psychologists, psychiatrists, geriatricians and other physicians, experts on medical informatics, epidemiologists, and economists. CADMA research will initially focus on the following areas: 1) Decision making involved in day-to-day life, such as choices regarding exercise and diet, that influence health and functional status at advanced ages; 2) decision support at the time of clinical encounters for elderly patients who face difficult medical choices by integrating decision support tools with electronic medical records systems; and 3) understanding the roles that aging-related changes in emotion and cognition play in decision making, especially those surrounding complex (e.g., health care plan choice) and/or emotionally charged (e.g., advance directives) topics. Support is proposed for administrative and communications/dissemination infrastructure (Core A) and new project development (Core B). Both of these cores build upon ongoing activities of Stanford's Center for Health Policy and its Center for Primary Care and Outcomes Research, administratively integrated centers that support research spanning the Medical School, the School of Humanities and Sciences, the Graduate School of Business, and external affiliated institutions such as the Veterans Affairs Palo Alto Health Care System and the Palo Alto Medical Foundation. CADMA will support early stage research and its development into longer term, comprehensive projects, followed by practical implementation via several linked mechanisms: Establishing formal procedures for soliciting and evaluating proposals for pilot projects; providing ongoing project evaluation and mentorship by senior faculty; conducting seminars and using other venues for collaboration and information exchange; giving advice and support for proposals for large-scale research projects; and facilitating collaboration with community affiliates and other external bodies for further testing and dissemination of the products of Roybal Center research. The three first-year pilot projects illustrate the CADMA focus on decision making processes. One of the projects will include the development of new software, called e-Preference, that supports patient access to health decision aids through an interface to electronic medical records; this project will also assess the usability of this technology for shared decision making by older patients and their physicians, A second examines whether older adults exhibit deficits similar to younger adults in affective forecasting, by applying a paradigm that Stanford researchers have used in younger adults for measuring prediction, experience, and recollection of emotional responses to monetary incentives. The third will investigate the roles of emotion and cognition in decision making, exploring whether a focus on deliberative and effortful mental processing could aid older people in making good health plan choices. Each project builds upon multidisciplinary collaboration and has the potential to contribute to a growing body of research that will translate into useful decision making tools.
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