Predicting Transitions Among Community-Dwelling Elders

描述(由申请者提供)：本申请是为了获得导师研究科学家发展奖(K01)，以促进Ilene Zuckerman博士在老龄化和长期护理流行病学领域的研究，重点是与药物相关的问题。药物不良事件是老年人从独立社区生活过渡到养老院等依赖环境的危险因素。通过有效的干预，导致不良药物事件和随后的过渡的药物相关行为是可以预防的。对过渡进行筛查可以确定高危老年人进行干预，以避免可预防的过渡。扎克曼博士在这项应用中的目标是建立一个研究议程，检查与老年人过渡相关的因素。中心假设是，社会人口统计、临床、行为和用药因素会将经历从独立环境向依赖环境转变的老年人与那些没有经历这种情况的老年人区分开来。拟议研究的目标将通过追求三个具体目标来实现：1)估计从独立生活到依赖生活的转变与 其中包括：1)研究老年人的用药因素；2)开发从独立生活向依赖生活过渡的预测模型；3)根据预测模型开发和试行筛查工具，以区分将经历过渡的老年人和不会经历过渡的老年人。为了实现前两个目标，将对调查和行政索赔数据进行多变量分析。将使用定性方法开发和试行目标3中的筛查工具。除了从完成拟议研究中获得的经验外，Zuckerman博士还将参与学习活动，以提高她的定量和定性研究技能。拟议的培训和研究是基于她的专业兴趣，并建立在目前的工作和以前的经验的基础上。该项目代表了她通过了解药物使用因素与老年人从独立环境过渡到依赖环境之间的联系，为提高老年人使用药物的安全性所做的持续努力。扎克曼博士尤其做好了准备， 这项研究建议结合老年药物治疗和流行病学培训的临床经验。此外，导师和共同导师拥有广泛的老龄化流行病学研究专长。这项研究具有重要意义，因为它连接了不同的文献，这些文献分别检查了药物使用因素和过渡。这是建立一个研究议程的渐进和重要的一步，该议程检查影响老年人用药和过渡的社会人口学、临床和行为因素。因此，这些发现将使扎克曼博士能够建立一个研究议程，以实现她的长期目标，即减少老年人中可预防的不良药物事件的发生率和流行率，并设计和评估针对过渡期可预防风险因素的干预措施。

DESCRIPTION (provided by applicant): This application is a request for a Mentored Research Scientist Development Award (K01) to further Dr. Ilene Zuckerman's research in the area of epidemiology of aging and long-term care, with a focus on medication-related issues. Adverse drug events are risk factors for elders transitioning from independent community living to dependent environments such as nursing homes. Medication-related behaviors that lead to adverse drug events and subsequent transitions are preventable with effective intervention. Screening for transitions can identify high-risk elders for interventions to avoid preventable transitions. Dr. Zuckerman's goal for this application is to build a research agenda that examines factors associated with transitions in the elderly. The central hypothesis is that socio-demographic, clinical, behavioral and medication use factors can discriminate elders who experience transitions from independent to dependent settings from those who do not. The objective of the proposed research will be accomplished by pursuing three specific aims: 1) estimate the association between transitions from independent to dependent living and medication use factors in the elderly; 2) develop a predictive model for transitioning from independent to dependent living; and 3) develop and pilot test a screening instrument, based on the predictive model, to discriminate older adults who will experience a transition from those who will not. To accomplish the first two aims, multivariable analysis of survey and administrative claims data will be performed. Qualitative methods will be used to develop and pilot test the screening instrument in Aim #3. In addition to experience gained from completing the proposed research, Dr. Zuckerman will engage in learning activities to enhance her quantitative and qualitative research skills. The proposed training and research are based on her professional interests and build on current work and previous experience. The project represents her continuing efforts to improve the safety of drug use for older adults by understanding the association between drug use factors and elder transitions from independent to dependent environments. Dr. Zuckerman is particularly well prepared to undertake this proposed research, with clinical experience in geriatric pharmacotherapy and epidemiological training. In addition, the mentor and co-mentors have extensive epidemiology of aging research expertise. This research is significant in that it bridges the disparate literature that has separately examined medication use factors and transitions. It is an incremental and important step to building a research agenda that examines socio-demographic, clinical and behavioral factors that affect medication use and transitions in the elderly. Thus, the findings will allow Dr. Zuckerman to build a research agenda that addresses her long term goal to reduce the incidence and prevalence of preventable adverse drug events in the elderly, and to design and evaluate interventions that are targeted toward preventable risk factors for transitions.