Chronic Disease and Health Outcomes of Older Adults with Opioid Use Disorders

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! Project Summary/Abstract: This project is a revised application for a Mentored Patient-Oriented Research Career Development Award. My long-term goal is to be a leader in aging and addiction research with expertise in developing chronic care delivery models coordinated within substance use treatment for older adults. This career award will provide additional training and facilitate the completion of the proposed mentored research to continue my career development into an independent clinician investigator. The proposed research addresses a critical knowledge gap in the setting of an epidemic of older adults with substance use disorders. Although it is recognized that older adults with opioid use disorders (OUD) are often medically and socially complex, very little is known regarding their specific health status and needs of this vulnerable population. My proposed career development plan will allow me to address this knowledge gap by working with a team of mentors as well as with the New York City Department of Health and Mental Hygiene and the New York City Health + Hospitals' integrated healthcare system who will supervise and collaborate on the following training goals: (1) to achieve expertise in advanced quantitative methods as applied to large administrative datasets for addiction health services research; (2) to develop skills in qualitative research theory and practice; and (3) to attain proficiency and experience in the development of a care intervention. I will attain these training goals with guidance from my mentorship team complemented by formal coursework and seminars, and by conducting a research agenda that uses a mixed methods approach with the following specific aims: (1) describe the prevalence and risk factors for high utilization of acute healthcare, high medical costs, multiple chronic conditions, and mortality among older adults with OUD; (2) examine staff and patient attitudes, acceptance, and barriers regarding the integration of geriatric models of care into opioid treatment programs; (3) develop and pilot for feasibility, a geriatric-based care model for geriatric conditions and chronic disease management for older adults with OUD to be tested in an R01. This proposal is directly aligned with the priorities of the National Institute on Drug Abuse’s strategic planning workgroup on the "Complexity of Substance Use Disorders and the Continuum of Substance Use Problems" to better understand substance use among individuals with complex conditions. This research will set a future research agenda for widely integrating an evidence-based model of geriatric- based chronic disease assessment and management into existing substance use treatment programs. !