Population Based Research in Geriatric Palliative Care

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Aging represents one of the largest public health challenges in our history. By 2030, 20 percent of the U.S. population will be over age 65, the group at highest actuarial risk of cancer, heart disease, dementia, and other chronic, complex illnesses. Geriatric palliative care is interdisciplinary care that focuses on providing relief from the symptoms and stress of serious illness with the goal of improving quality of life for older adults and families. Extensive national data demonstrate a high prevalence of physical, psychosocial, and financial suffering associated with serious illness; stress and burden related to caregiving for the more than 35 million individuals serving as informal caregivers to the seriously ill; and a healthcare system that fails to deliver appropriate and timely care to older adults with serious illness and their families. To address these issues, researchers have turned to an increasing number of large, population based survey and administrative datasets to answer pertinent questions in the field of geriatric palliative care. These large datasets have become essential to understanding how social factors, health policies, financing systems, organizational structures and processes, social networks, and personal behaviors affect patient and caregiver outcomes, access to healthcare, quality and cost of healthcare, and patterns of healthcare over time and across vulnerable subgroups. Single site and small multi-site studies are often unable to enroll a large enough sample to study individuals with a wide range of diagnoses, comorbid conditions, and functional limitations or to collect information on social determinants of health due to budgetary and time constraints of primary data collection. Existing population based studies, however, provide the opportunity to rapidly influence both policy and clinical practice in geriatric palliative care. Yet, the methodological challenges of this type of observational research are substantial including complex longitudinal data, hierarchical structures, informatively missing data due to death or dropout, proxy respondents, and complex survey-weighted designs. It is thus imperative to build a research program that attracts, trains, and supports a sustainable pool of geriatric palliative care investigators for ongoing, rigorously conducted, population based research. As such, Dr. Aldridge is seeking an Academic Leadership Career Award to develop a Population Based Research Program in Geriatric Palliative Care at Mount Sinai. This Program will train geriatric palliative care researchers to apply sophisticated research and statistical methodology used in other fields but not commonly applied to geriatric palliative care research, and develop sustainable research infrastructure to support new generations of researchers across faculty, fellows, residents, and medical students interested in population based research. Dr. Aldridge has been at the forefront of training and dissemination of research methods for observational data. As newly appointed Vice-Chair for Research and with more than a decade of experience utilizing these types of data, Dr. Aldridge is uniquely qualified to successfully achieve the aims of this award.