The aim of this R-15 application is to study determinants of preventive services provided by area agencies on aging (AAA) to both disabled and non-disabled elderly populations. Our study is predicated on the growing recognition that new cohorts of older adults can benefit from preventive services. Such services can help forestall or slow the development of disability. Preventive programs can also keep older adults stay involved in meaningful activities and civic engagement throughout their lives. We hypothesize that area agency directors, the organizational leaders for coordinated service delivery to older adults in the US, will play a key role in facilitation of preventive service delivery to this group. We anticipate that directors will prioritize services based (1) on their attitudes about the value and cost-benefits of preventive services in late life; and (2) their willingness to participate in generating resources to fund such programs. We have developed and will test a model of determinants of preventive service delivery by AAAs. This model considers direct effects of environmental/community and organizational characteristics on service delivery, as well as indirect effects on service delivery, through leader attitudes and initiatives. To test our model hypotheses we will conduct a mail survey of all six hundred and fifty five (655) area agency directors in the United States. Data analyses for the survey will be conducted with a focus on structural equation modeling. Our survey will be complemented by a historical study component based on oral histories with the forty longest-serving AAA directors. These directors will be asked about the way in which preventive service provisions have changed over time and what key factors played a role in their development and implementation. To facilitate the successful completion of this study, and to ensure that the purpose of the R- 15 is met, Force and Kahana have partnered with a senior investigator, Richard Fortinsky, who will serve as Co-Investigator. We believe that this collaboration will result in an innovative and scientifically sound study. The proposed three year project, will afford an opportunity for the new investigators who come from a teaching-intensive college to begin independent research careers. The conduct of this study will also strengthen the research environment for both faculty and students at Mount Saint Mary College (MSMC), a small teaching college, located in Newburgh NY, with no previous NIH funded research grants.
