Health, function, and health outcomes of geriatric prisoners

个人描述(申请人提供)：我是加州大学旧金山分校的一名老年医学专家和初级教员。我的长期目标是成为一名独立研究员，专注于优化被剥夺公民权的老年人的医疗保健，比如老年囚犯。我寻求K23奖项，为我提供实现以下目标所需的支持：(1)在临床研究中获得更多技能，包括纵向研究设计、预后建模、分层建模、测量和调查设计，以及建立一个预期的纵向队列；以及(2)发展独立的临床研究事业。老年囚犯数量的迅速增长是美国监狱的医疗危机，也是州政府的经济危机，并在老年囚犯被释放到的社区引发了深刻的公共卫生挑战。然而，关于老年囚犯的研究很少。我提议的研究的具体目的是通过将老年病学的多学科视角应用于老年囚犯的医疗保健来解决重要的知识差距。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提供迄今最大规模的评估，并将这些水平与基于人口的正常水平进行比较；(2)检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，根据他们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联系；以及(4)选择和制定高保真措施，以评估释放后老年人的健康、功能状况、认知状况和医疗保健需求。我的强大指导团队由NIA K24奖获得者肯尼斯·科文斯基博士领导，在老年病学、监狱卫生、测量科学以及组装和跟踪预期队列方面拥有专业知识。该应用程序还将提供试点数据，并为R01应用程序奠定基础，该应用程序专注于改善出狱后老年人的健康和医疗保健。相关性(参见说明)：该应用程序将描述老年囚犯的医疗保健需求，创建不良健康结果的临床预测工具，并建立即将获释的老年人队列，以衡量医疗、认知和功能状态以及释放后医疗保健计划。结果可以用来指导护理，提高成本，减少被监禁老年人和那些重新过渡到社区医疗保健的人的不良健康后果。

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.