Promoting Independence Through Pain and Symptom Management

描述（由申请人提供）：大多数老年人会患上一种或多种慢性疾病，这些疾病可能伴随多年，通常伴有症状窘迫和进行性功能依赖。现在有充分的证据表明，在这些疾病的晚期阶段，生活质量很差。这个OAIC的目标是建立一个研究项目，重点研究患有严重疾病的老年人的疼痛和其他症状与独立性和功能的关系。OAIC是由该中心的负责人在20世纪90年代末启动的总额为3440万美元的赠款基础上建立的。这些拨款还催生了另外42项拨款，总额为1880万美元，用于支持研究、职业发展和基础设施建设。在这项提案中，我们通过加强与精神病学，医学，骨科和希伯来老人之家等同事的合作来扩大这一研究基础。这些合作是新的研究项目和对老年病学和姑息治疗感兴趣的初级教师的来源。OAIC的三个核心将由致力于老年病学的个人领导，第四个核心由临床试验方法方面的专家领导，他是老年病学的CAQ，第五个核心由资深老年学家领导。OAIC将招募和培训学术领袖，并将支持试点和探索性研究。建立2个研究核心（研究设计与分析、测量与数据管理），应用目前在老龄化研究中尚未广泛使用但高度适用于老龄化研究的创新方法。该中心将汇集a)资深老年病专家的领导，他们是长期的同事，在成功的研究和培训项目建设方面有着共同的记录；B)具有大量研究贡献的高级教师；c)有前途的初级调查员。我们中心的主题植根于医学最深刻的传统：关注减轻痛苦的首要地位。尽管这一优先事项可能是古老的，但医学研究，特别是老年研究，正准备将现代技术和知识引入OAIC计划的一个新领域——有效改善疼痛和其他症状，以改善老年人的功能和促进独立性。拟议的中心将连接老年病学和姑息治疗，并作为老年病学研究的一个新的重点领域的典范。

DESCRIPTION (provided by applicant): Most older adults will develop one or more chronic illnesses with which they may live for years, often with symptom distress and progressive functional dependence. There is now abundant evidence that the quality of life during these advanced stages of disease is poor. The goal of this OAIC is to establish a research program focused on the relationship of pain and other symptoms to independence and function in older people with serious illness. The OAIC is built from a foundation of grants totaling $34.4 million started by the Center's principals in the late 1990s. These grants have spawned an additional 42 grants totaling $18.8 million supporting research, career development, and infrastructure. In this proposal, we expand this research foundation through strengthened collaborations with colleagues in Psychiatry, Medicine, Orthopedics and at the Hebrew Home for the Aged, among others. These collaborations are the source for new research projects and junior faculty with interests in geriatrics and palliative care. Three of the OAIC cores will be led by individuals who have devoted their careers to geriatrics, a fourth is led by an expert in clinical trials methods who is CAQ'ed in geriatrics, and the fifth is led by a senior gerontologist. The OAIC will recruit and train academic leaders, and it will support pilot and exploratory studies. It will also establish 2 research cores (research design and analysis, measurement and data management) that will apply innovative methods not currently in widespread use in aging research but that are highly applicable to aging. The Center will bring together a) leadership by senior geriatricians who are long-standing colleagues with a shared track record of successful research and training program building; b) senior faculty with a substantial body of research contributions; and c) promising junior investigators. Our Center's theme has its roots in the deepest traditions of medicine: attention to the primacy of the relief of suffering. Ancient though this priority may be, medical research in general, and geriatric research in particular, are poised to bring modern techniques and knowledge to what is in fact a new area of focus for the OAIC program - the effective amelioration of pain and other symptoms to improve function and promote independence in older adults. The proposed Center will bridge geriatrics and palliative care and serve as a model for a new focused area of research within geriatrics. PUBLIC HEALTH RELEVANCE: Substantial data suggest that the care of older adults living with serious illness is in need of improvement. The proposed OAIC would establish a sustainable infrastructure to support the development of new investigators in geriatric palliative care research, support research in geriatric palliative care, and develop or adapt instruments, designs, and analytic methods necessary to improve care for seriously ill older adults.