Geriatric Conditions and Disablement in the Older Adult Population

描述（由申请人提供）：老年疾病，虽然经常被忽视和忽视，是老年人健康状况的重要贡献者。然而，与疾病相比，老年病作为一个群体，在目前的残疾发展和进展模式中尚未明确定位。相反，在这些模型中，条件似乎在多个点上起作用和相互作用。 医学博士克莉丝汀·埃罗尔，M.P.H.建议调查老年疾病在老年人残疾途径中的地位，以获得指导临床科学家研究职业发展奖（K 08）。Dr. Adolle是密歇根大学（UM）医学院家庭医学和内科学系的助理教授，在老年学研究所（UM）和VA安阿伯医疗保健系统老年病研究、教育和临床中心（GRECC）任职。她以前的横断面研究已经证明了老年人中老年疾病的患病率和残疾相关性。由NIH-NCRR KL 2指导临床学者奖（UM）资助，她研究了老年疾病和慢性疾病如何使用潜在类别分析在老年人中组合在一起。她对KL 2奖的研究为她的K 08提案中的研究目标和方法奠定了基础。 K 08奖拟议研究的总体目标是调查老年疾病在老年人口残疾途径中的地位。这项研究将检查五种老年疾病：痴呆、福尔斯、尿失禁、营养不良和多感觉障碍。该研究将提出一个概念模型，其中老年疾病具有共同的风险因素，在老年人中具有加速的积累轨迹，并导致共同的结果（例如，残疾）。这项研究将检验这一模式：首先，从中年人开始，一直到最年长的老年人，审查老年病的发病率和纵向进程（个别和总体）;其次，审查老年病作为残疾的预测因素（将死亡率作为一个竞争性结果考虑在内）。通过调查如何老年条件开始，积累，并共同发生在老年人随着时间的推移，拟议的研究旨在增加新的知识的地方老年条件的残疾途径，从而有助于正在进行的努力，从理论上联系的条件。 拟议的研究将利用来自健康与退休研究（HRS）的独特纵向数据，这是一项具有全国代表性的健康访谈调查，以及来自HRS补充老化，人口统计学和记忆研究（亚当斯）的数据。它还将利用与HRS和亚当斯相关联的新可用的医疗保险管理数据，以进一步详细说明条件和疾病（诊断代码）。 Dr. Reicholle的职业目标是成为学术家庭医学的独立研究员，专注于老年人的健康状况，特别是老年疾病、综合征和残疾。她未来的研究方法将集中在老年人的大型流行病学研究的实施和分析。K 08奖的研究和职业发展培训旨在支持（1）获得老年疾病流行病学的先进方法技能和专业知识，以及（2）为老年人的大型流行病学研究设计和实施主要数据收集的培训。她的K 08奖提案的导师团队包括：初级导师Jersey Liang博士，公共卫生学院卫生管理与政策系教授; Blaum，医学博士，医学硕士，内科老年病科教授和共同导师Kenneth朗加，医学博士，哲学博士、内科学系普通内科学部教授。 具体的职业发展培训活动包括：- 通过密歇根大学社会研究所和公共卫生学院的导师和课堂作业进行高级统计方法的培训，包括纵向分析，潜在轨迹分析，分层线性建模和生存分析，--通过与导师的教程和CMS 101的课程出席率，进行医疗保险管理数据使用方面的培训：介绍使用医疗保险数据进行研究（医疗保险管理数据基本讲习班）通过明尼苏达大学研究数据援助中心（ResDAC），通过参与NIA资助的亚当斯试点研究，为老年人的大型流行病学研究提供原始数据收集培训（脑健康的国家趋势）（导师：朗加），开发一个关于老年病的实验模块，提交供考虑在2014年HRS浪潮中投入使用（导师：朗加），并参与比较老龄化研究计划（导师：梁）。 公共卫生相关性：这项研究调查了老年人如何获得老年病的条件，如福尔斯和尿失禁，以及这些条件如何导致老年人成为残疾。了解老年疾病的早期发展可以导致干预措施，以预防或延迟它们。

DESCRIPTION (provided by applicant): Geriatric conditions, although frequently unrecognized and overlooked, are important contributors to the health status of older adults. However, geriatric conditions as a group, in contrast to diseases, have not been clearly located within current models of disability development and progression. Rather, conditions appear to operate and interact at multiple points in these models. Christine Cigolle, M.D., M.P.H. proposes to investigate the place of geriatric conditions in the disablement pathway in older adults for the Mentored Clinical Scientist Research Career Development Award (K08). Dr. Cigolle is an Assistant Professors in the Departments of Family Medicine and Internal Medicine at the University of Michigan (UM) Medical School, with appointments in the Institute of Gerontology (UM) and the VA Ann Arbor Healthcare System Geriatrics Research, Education and Clinical Center (GRECC). Her previous cross-sectional research has demonstrated the prevalence and the disability association of geriatric conditions among older adults. Funded by a NIH-NCRR KL2 Mentored Clinical Scholars Award (UM), she investigated how geriatric conditions and chronic diseases group together in older adults using latent class analysis. Her research for the KL2 Award lays the foundation for the research aims and methodologies in her K08 proposal. The overall goal of the proposed research for the K08 Award is to investigate the place of geriatric conditions in the disablement pathway in the older adult population. The research will examine five geriatric conditions: dementia, falls, urinary incontinence, poor nutrition, and multisensory impairment. The research will propose a conceptual model in which geriatric conditions share common risk factors, have an accelerated trajectory of accumulation in older adults, and result in common outcomes (e.g., disability). The research will test this model, --first, by examining the incidence and longitudinal course of geriatric conditions (individually and in aggregate), beginning with adults in middle age and extending to the oldest old; and --second, by examining geriatric conditions as a predictor of disability (taking mortality into account as a competing outcome). By investigating how geriatric conditions begin, accumulate, and co-occur in older adults over time, the proposed research aims to add new knowledge about the place of geriatric conditions in the disablement pathway and thus to contribute to ongoing efforts to link the conditions theoretically. The proposed research will utilize unique longitudinal data from the Health and Retirement Study (HRS), a nationally-representative health interview survey, and data from the HRS supplemental Aging, Demographics, and Memory Study (ADAMS). It will also make use of newly available Medicare administrative data linked to the HRS and ADAMS to further specify conditions and diseases (diagnosis codes). Dr. Cigolle's career goal is to become an independent researcher in academic Family Medicine, focusing on older adult health status, especially geriatric conditions and syndromes and disability. Her future research methods will focus on implementation and analysis of large epidemiologic studies of older adults. The research and career development training in the K08 Award proposal are designed to support both (1) the acquisition of advanced methodological skills and expertise in the epidemiology of geriatric conditions and (2) training in the design and implementation of primary data collection for large epidemiologic studies of older adults. Her mentorship team for the K08 Award proposal includes: Primary Mentor Jersey Liang, Ph.D., Professor, Department of Health Management and Policy, School of Public Health; Co-Mentor Caroline S. Blaum, M.D., M.S., Professor, Division of Geriatrics, Department of Internal Medicine; and Co-Mentor Kenneth Langa, M.D., Ph.D., Professor, Division of General Internal Medicine, Department of Internal Medicine. Specific career development training activities include: --training in advanced statistical methodologies, including longitudinal analysis, latent trajectory analysis, hierarchical linear modeling, and survival analysis via tutorials with mentors and classwork through the Institute for Social Research and School of Public Health at the University of Michigan, --training in the use of Medicare administrative data via tutorials with mentors and course attendance at CMS 101: Introduction to the Use of Medicare Data for Research (Basic Workshop in Medicare Administrative Data) through the Research Data Assistance Center (ResDAC) at the University of Minnesota, and --training in primary data collection for large epidemiologic studies of older adults via participation in the NIA- funded ADAMS pilot study (National Trends in Brain Health) (Mentor: Langa), development of an experimental module on geriatric conditions to be submitted for consideration for fielding in the 2014 wave of the HRS (Mentor: Langa), and involvement in the Comparative Aging Research Program (Mentor: Liang). PUBLIC HEALTH RELEVANCE: This research investigates how older adults acquire geriatric conditions, such as falls and urinary incontinence, and how these conditions cause older adults to become disabled. Understanding the early development of geriatric conditions can lead to interventions to prevent or delay them.