Longitudinal Patterns of Symptoms, Medication and Hospice Use in Nursing Home Residents Approaching End of Life

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LONGITUDINAL PATTERNS OF SYMPTOMS, MEDICATION AND HOSPICE USE IN NURSING HOME RESIDENTS APPROACHING END OF LIFE The candidate’s long-term career objective is to make a sustained impact as a geriatric palliative care research leader by mentoring promising, multidisciplinary investigators in aging research. The candidate’s professional life has been dedicated to the conduct of patient-oriented research in geriatric pharmacoepidemiology for nursing home and hospice patients, focusing specifically on the topic of deprescribing. Establishing the evidence for the risks and benefits of prescribing and deprescribing decisions, and identifying which patients will receive the greatest benefit from deprescribing based on a shift from curative to symptom-oriented care, is challenging. Institutionalized frail older adults are a particularly vulnerable population because of their high burden of polypharmacy, risk of medication-related adverse events, limited life expectancy, and lack of randomized controlled trial data for medication efficacy. Training a multidisciplinary group of junior investigators is key to building the deprescribing evidence base. Studies are needed that can ultimately inform the design of tools that identify when nursing home residents are entering the final stages of their life and the development of interventions to optimize medication use when that happens. Thus, the objectives of this K24 are: 1. To enhance the candidate’s capacity to effectively mentor a multidisciplinary group of mentees in patient-oriented research, and 2. To expand the candidate’s clinical research program in geriatric palliative care and deprescribing in directions that create new and innovative opportunities for mentees, including qualitative methods for mixed-methods studies. This will be accomplished by: i. recruitment of promising mentees from varied disciplines committed to aging research, ii. individual mentorship of these trainees in their research activities and career development, and iii. didactic sessions and formal coursework for mentees. The candidate’s research brings together expertise in geriatrics and aging research, palliative medicine and hospice care, and pharmacoepidemiology. The candidate’s research program about nursing home residents and hospice enrollees grows out funding from the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Cancer Society and the Donoghue Foundation. These studies have contributed to the creation of rich data resources that will be used by mentees, including a nationwide dataset of all nursing home residents from 2011-2016 that links the Minimum Data Set 3.0 to Medicare Part D data, Certification and Survey Provider Enhanced Reporting data, Area Resource Files and Medicare Hospice Utilization Public Use Files. Resources supporting training, development, and execution of the proposed research include the University of Massachusetts Medical School’s (UMMS) Center for Clinical and Translational Science, UMMS’ Graduate School of Biomedical Sciences, UMMS’ Clinical and Population Health Research program, and the UMMS’ Quantitative Methods Core.