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

项目概要： 髋部骨折后原位老化的数量和质量都很差，这些结果没有改善 在过去的20年里，老年人社区的建筑环境具有很强的 对原位老化质量的影响4-6-在通常的髋部骨折护理中尚未得到解决。这是 特别是对于那些生活在社会经济弱势社区的老年人来说， 用于支持高质量建筑环境基础设施的资源较少。5摇摇欲坠的人行道和路缘石， 弱势社区与老年人行动不便增加400%有关。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奖中，Falvey博士提出了一种新的社区和市政工程模型。 致力于促进髋部骨折（ENRICH）后的高质量原位老化。ENRICH独特地结合了 从髋部骨折恢复的先前工作中成功的移动干预，主动识别邻居- 消除髋部骨折后过渡期的康复障碍，帮助获得所需的服务， 设备，以弥补与建筑环境有关的差距，并提供有针对性的额外修复， 侧重于完成日常护理后在现实环境中的社区一级流动性。的目标 ENRICH正在促进社区的更大流动性，并允许老年人参与社区活动 提高老龄质量活动到位。 为了使ENRICH适合巴尔的摩，该项目将1）收集有关哪些因素（例如住房）的信息 使用医疗保险索赔数据， 与美国人口普查局数据相关联; 2使用此数据指导与患者和临床医生利益相关者的访谈 阐明ENRICH的有意义的调整; 3）用24名患者对调整后的ENRICH干预进行试点测试 生活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博士法尔维的职业生涯作为一个独立的临床科学家， 康复和老龄化领域的领导者。他建议在纵向和横向上获得互补技能， 混合方法数据分析，以患者为中心的结果研究，医疗差异，以及 临床试验他的导师团队由Jay Magaziner博士领导，能够帮助他完成这项研究 成功，并支持其职业发展。

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.