Health, function, and health outcomes of geriatric prisoners

简介（由申请人提供）：我是加州大学旧金山分校的老年医学专家和初级教员。我的长期目标是成为一名独立的研究人员，专注于优化被剥夺权利的老年人的医疗保健，比如老年囚犯。我希望获得K23奖，为我实现以下目标提供必要的支持：(1)获得临床研究方面的额外技能，包括纵向研究设计、预后建模、分层建模、测量和调查设计，以及组建前瞻性纵向队列；(2)发展独立的临床研究事业。老年囚犯数量的迅速增长不仅给美国监狱带来了医疗危机，给州政府带来了经济危机，也给老年囚犯所在社区带来了深刻的公共卫生挑战。然而，关于老年囚犯的研究很少。我提出的研究的具体目的是通过应用老年病学的多学科视角来解决老年囚犯医疗保健的重要知识差距。拟议的研究将实现以下目标：(1)对老年囚犯的健康和功能状况进行迄今为止最大规模的评估，并将这些水平与基于人口的标准进行比较；(2)审查与监狱中不良健康事件相关的风险因素，并将这些因素纳入临床工具，根据不良健康事件的风险对老年囚犯进行风险分层；(3)确定监狱环境特有的残疾与不良健康事件之间的关系；(4)选择并制定高保真度的评估指标，评估老年人出狱后的健康状况、功能状况、认知状况和医疗保健需求。我强大的指导团队由Kenneth Covinsky博士领导，他是NIA K24奖获得者，在老年病学、监狱卫生、测量科学以及召集和跟踪前瞻性队列方面具有专业知识。该应用程序还将提供试点数据，并为R01应用程序奠定基础，该应用程序的重点是改善老年人出狱后的健康和医疗保健。相关性（见说明）：该应用程序将描述老年囚犯的医疗保健需求，为不良健康结果创建临床预测工具，并建立即将释放的老年人队列，以测量医疗、认知和功能状态以及释放后医疗保健计划。结果可用于指导护理，提高成本，减少监禁老年人和那些过渡到社区医疗保健的不良健康后果。

DESCRIPTION (provided by applicant): I am a Geriatrician and junior faculty member at the University of California, San Francisco. My long-term goal is to become an independent researcher focused on optimizing the healthcare of disenfranchised older adults, such as geriatric prisoners. I seek a K23 award to provide me with the support necessary to accomplish the following goals: (1) to acquire additional skills in clinical research including longitudinal study design, prognostic modeling, hierarchical modeling, measurement and survey design, and assembling a prospective longitudinal cohort; and (2) to develop an independent clinical research career. The rapidly growing number of geriatric prisoners is a healthcare crisis in US prisons, an economic crisis for state governments, and has precipitated profound public health challenges in the communities to which aging prisoners are released. However, research about older prisoners is scarce. The specific aims of my proposed research address important knowledge gaps by applying the multidisciplinary perspective of Geriatrics to the healthcare of aging prisoners. The proposed research will accomplish the following aims: (1) provide the largest assessment to date of the health and functional status of geriatric prisoners and compare these levels to population-based norms; (2) examine risk factors associated with adverse health events in prison and incorporate these into a clinical tool to risk-stratify geriatric prisoners according to their risk of adverse health events; (3) determine the association between disability specific to the prison environment and adverse health events; and (4) select and develop high-fidelity measures to assess health, functional status, cognitive status, and healthcare needs of older adults after release. My strong mentoring team led by Dr. Kenneth Covinsky an NIA K24 awardee, has expertise in geriatrics, prison health, measurement science and in assembling and following a prospective cohort. This application will also provide pilot data and lay the groundwork for an R01 application focused on improving the health and healthcare of older adults after release from incarceration. RELEVANCE (See instructions): This application will describe the healthcare needs of older prisoners, create a clinical prediction tool for adverse health outcomes, and establish a cohort of older adults nearing release to measure medical, cognitive and functional status and plans for post-release healthcare. Results can be used to guide care, improve costs and decrease adverse health outcomes of incarcerated older adults and of those transitioning back to community healthcare.