The ENRICH Study: Engaging Community and Municipal Services to Promote High Quality Aging in Place After Hip Fracture

项目总结： 髋部骨折后就地老化的数量和质量都很差，而且这些结果并没有改善 在过去的20年里。老年人社区的建筑环境有很强的 4-6岁时对老化质量的影响--但在通常的髋部骨折护理中尚未涉及。这是 尤其是对生活在社会经济不利社区的老年人，他们有 用于支持高质量建成环境基础设施的资源减少。5条摇摇欲坠的人行道和路缘 处于不利地位的社区与老年人行动不便增加400%相关。7岁以上 生活在弱势社区的成年人也更有可能认为他们的社区是 不安全，因此不太可能参加户外体育活动。 在这个Beeson K76奖项中，福尔维博士提出了一个新的模式，让社区和市政 促进髋部骨折后高质量老龄化的服务(RICH)。丰富独一无二的组合 从髋部骨折恢复的先前工作中成功地进行活动干预，主动识别邻居- 在髋部骨折后过渡回家期间消除康复障碍，帮助获得所需的服务和 设备，以弥合与建筑环境相关的差距，并提供有针对性的额外修复 重点是在完成日常护理后，在真实世界环境中的社区层面的流动性。的目标是 丰富正在促进社区的更大流动性，并允许老年人参与社区 老龄质量提升活动开展到位。 为了为巴尔的摩量身定做，该项目将1)收集有关哪些因素(例如住房)的信息 最大的影响是髋部骨折后在家度过的健康天数，使用医疗保险索赔数据 与美国人口普查局的数据相关联；2使用这些数据指导与患者和临床医生利益相关者的访谈 3)对改编后的RICH干预进行了24次预试。 居住在贫困社区的老年髋部骨折患者。 完成这些目标将有助于启动法尔维博士作为一名独立临床医生和科学家的职业生涯 在康复和老龄化领域处于领先地位。他建议在纵向和纵向上获得互补的技能 混合方法数据分析，以患者为中心的结果研究，医疗保健差异，以及 临床试验。他的指导团队由Jay Magaziner博士领导，能够很好地帮助他完成这项研究 成功，并支持他的职业发展。

PROJECT SUMMARY: The quantity and quality of aging in place after a hip fracture is poor, and these outcomes have not improved substantially over the last 20 years. The built environment in an older adult’s neighborhood has a strong influence on the quality of aging in place 4-6—yet has not been addressed in usual hip fracture care. This is especially concerning for older adults who live in socioeconomically disadvantaged neighborhoods, which have fewer resources to support high-quality built environment infrastructure. 5 Crumbling sidewalks and curbs in disadvantaged neighborhoods are associated with a 400% increase in mobility disability for older adults. 7 Older adults living in disadvantaged neighborhoods are also more likely to perceive their neighborhoods to be unsafe, and thus less likely to participate in physical activity outside. In this Beeson K76 award, Dr. Falvey proposes a novel model of ENgaging community and municipal seRvICes to promote high-quality aging in place after Hip fracture (ENRICH). ENRICH uniquely combines successful mobility interventions from prior work on hip fracture recovery, proactively identifying neighborhood- level barriers to recovery during the transition home after hip fracture, helping obtain needed services and equipment to bridge gaps related to the built environment, and provide targeted additional rehabilitation that focuses on community level mobility in a real-world environment after completion of usual care. The goal of ENRICH is promoting greater mobility in the community and allowing older adults to participate in community activities to improve the quality of aging in place. To tailor ENRICH for Baltimore, this project will 1) gather information on which factors (e.g. housing) most strongly impact the number of healthy days spent at home after hip fracture, using Medicare claims data linked with US Census Bureau data; 2 use this data to guide interviews with patient and clinician stakeholders to elucidate meaningful adaptations of ENRICH; and 3) pilot test the adapted ENRICH intervention with 24 older hip fracture patients living in disadvantaged neighborhoods. Completing these aims will help launch Dr. Falvey’s career as an independent clinician-scientist and leader in the fields of rehabilitation and aging. He proposes to gain complementary skills in longitudinal and mixed methods data analysis, patient-centered outcomes research, healthcare disparities, and conduct of clinical trials. His mentorship team, led by Dr. Jay Magaziner, is well-positioned to help him complete the study successfully and support his career development.