Aging Well with COPD through Geriatrics-Palliative Care

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Project Summary The overall goal of this 5-year K76 resubmission is to support Anand S. Iyer, MD, MSPH to become a leader in geriatrics-palliative care with the skills to improve the health and well-being of older adults with chronic obstructive pulmonary disease (COPD). Dr. Iyer is a pulmonologist and AHRQ-K12 COPD outcomes researcher. COPD is the third leading cause of death for older Americans and accelerates loss of quality of life and functional independence. Research priorities of the NIA identify a critical need for innovative geriatrics-palliative care models to address unmet care needs for older adults, especially those from rural and underserved areas where COPD is prevalent and palliative care access is limited. However, no geriatrics- palliative care interventions have been systematically developed and tested for community-dwelling older adults with COPD. Through this K76, Dr. Iyer will gain advanced training in: 1) gerontology and geriatrics-palliative care; 2) clinical trials and implementation science; and 3) leadership development in aging. To support his career development, Dr. Iyer and his primary mentor, Cynthia Brown, MD, MSPH, have assembled a mentor team of experts in geriatrics (Seth Landefeld, MD), palliative care-implementation science (Marie Bakitas, DNSc, APRN), and COPD clinical trials (Mark Dransfield, MD). Dr. Iyer will seek advisement from international leaders in aging biology (Steven Austad, PhD), lung aging (Victor Thannickal, MD), geriatrics-palliative care (Christine Ritchie, MD, MSPH), and the aging brain in COPD (Karin Hoth, PhD). Supported by an AHRQ-K12, Dr. Iyer developed, “EPIC: Early Palliative Care In COPD”, a 6-month telehealth, palliative-nurse coach-led intervention for COPD patients and their family caregivers. Preliminary feasibility results in middle-aged COPD patients and their family caregivers are promising; however, it is not known how EPIC needs to be refined to meet the needs of older COPD patients, especially the old-old. Guided by Baltes’ Theory of Successful Aging, this K76 will: 1) Refine the geriatrics content of EPIC by engaging diverse stakeholder groups of older COPD patients, family caregivers, clinicians, staff, and policy leaders; and, 2) Conduct a hybrid type-1 effectiveness-implementation pilot randomized controlled trial of Geri-EPIC plus usual COPD care versus usual COPD care alone to determine feasibility and acceptability, to refine trial procedures, and to collect preliminary data on Life- Space mobility to inform a fully-powered trial at the R01 level. Ultimately, this K76 will position Dr. Iyer to be a leader in geriatrics-palliative care and patient-oriented aging research.