Preparation for Future Care in Older Adults

描述(申请人提供)：这个K01奖将允许候选人深化和扩大她对老年人未来护理准备(PFC)的研究。PFC被定义为当个人制定明确的计划时，涉及的想法和行动，即如果他们变得虚弱，他们将在哪里、何时、如何以及从谁那里接受护理。超过50%的老年人没有具体的护理计划，20%的人积极避免任何计划。对许多人来说，危机护理决策会导致不适当的护理安排，包括卫生保健过度或利用不足，以及过早死亡。鉴于人口老龄化，未能或没有能力为未来的护理做好准备是公共政策和公共卫生的一个问题。拟议的研究计划将为设计和实施研究奠定基础，这些研究将为临床和基于政策的干预措施提供信息，以增强老年人口的PFC。 该研究计划旨在通过以下方式启动一项关于PFC的系统研究计划：(1)描述PFC在护理需求风险高于平均水平的老年人中的自然过程；(2)调查PFS的四个前驱因素：个性、认知功能和损害、抑郁和内科疾病；(3)检查PFC随时间对主观幸福感、功能状态和卫生保健利用的影响。数据将作为NIA资助的阿尔茨海默氏症患者一级亲属纵向调查(ADAPT)的辅助研究的一部分收集。此外，将在NIH资助的一项正在进行的初级保健患者抑郁症研究(DOS)和HCFA的Medicare Current Benefits数据中进行二次数据分析，以评估PFC的前因和后果。 教育计划包括(1)辅导和咨询，以增加候选人对人格、认知功能和损伤、抑郁症、内科疾病和功能状态的知识；(2)学术课程和指导研究经验，以发展其评估和分析卫生保健利用的技能；(3)课程和研究经验，以教授她用于纵向分析的先进统计方法。候选人将结合终身发展、流行病学、卫生服务和晚年精神病理学的观点，将PFC发展为一个充满活力的、多学科的科学研究领域，有可能影响公共卫生和公共政策。

DESCRIPTION (provided by applicant): This K01 Award will allow the candidate to deepen and expand her research on Preparation for Future Care (PFC) in older adults. PFC is defined as thoughts and actions involved when individuals formulate explicit plans for where, when, how, and from whom they will receive care if they become frail. More than 50% of older adults have no concrete plans for care, and 20% actively avoid any planning. For many, crisis care decisions lead to inappropriate care arrangements, including health care over-or-under-utilization, and premature death. Given the aging of the population, failure or inability to prepare for future care presents a problem for public policy and public health. The proposed program of research will lay the foundation for designing and implementing studies that will inform clinical and policy-based interventions to enhance PFC in the older population. The research plan is designed to initiate a program of systematic research on PFC by (1) describing the natural course of PFC in older adults at greater than average risk for care needs, (2) investigating four antecedents of PFS: Personality, Cognitive Functioning and Impairment, Depression, and Medical Illness, (3) examining the consequences of PFC over time with regard to Subjective Well-being, Functional Status, and Health Care Utilization. Data will be collected as part of an ancillary study to a NIA-funded longitudinal investigation of first-degree relatives of Alzheimer's patients (ADAPT). In addition, secondary data analyses will be performed in an ongoing NIH-funded study of depression in primary care patients (DOS), and HCFA's Medicare Current Beneficiaries data, in order to assess the antecedents and consequences of PFC. The educational plan includes (1) Tutorials and consultation to increase the candidate's knowledge of Personality, Cognitive Functioning and impairment, Depression, Medical Illness and Functional Status, (2) academic coursework and mentored research experiences to develop her skills in assessment and analysis of health care utilization, (3) coursework and research experiences to teach her advanced statistical methods for longitudinal analysis. The Candidate will combine perspectives from life-span development, epidemiology, health services, and late life psychopathology to develop PFC as a vibrant, multidisciplinary field of scientific inquiry with the potential to influence public health and public policy.