Aging in place for older adults with cancer: The role of physical function and home environment

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Project Summary and Abstract This award will support Dr. Jensen-Battaglia’s long-term goal of developing the expertise and skills needed to become an independent investigator exploring the overlapping roles of physical function and environment in health outcomes for older adults with cancer. By 2050, 20% of new cancer diagnoses will be among those age 80 or older, comprising an estimated 6.9 million cases worldwide. The majority of older adults in the United States (U.S.) prefer to remain in their homes as they age (i.e., ‘age in place’), which is associated with health benefits. Conversely, both unsupportive neighborhood environment and residential relocation are associated with increased healthcare utilization, decreased survival, and falls. Although impairments in physical function are common and highly modifiable, we do not yet know if older adults with cancer are at greater risk for residential relocation as a result of these impairments compared to those without cancer. Whether negative health outcomes such as healthcare utilization, mortality, and falls associated with relocation are due to relocation itself or associated changes in the neighborhood environment remains unclear. Dr. Jensen-Battaglia will address these gaps in her proposed project by prospectively evaluating the association between impairments in physical function and residential relocation among community dwelling older adults in the U.S., and examining how this association differs for those with cancer compared to those without cancer. Additionally, she will assess how residential relocation modifies the effect of neighborhood environment on future health for those with cancer. For the F99 phase, Dr. Jensen-Battaglia will leverage data from a nationally representative sample of U.S. Medicare beneficiaries [National Health and Aging Trends Study (NHATS)] to refine a novel measure of mobility-related physical function, assess whether this is associated with increased risk of residential relocation, and evaluate if cancer diagnosis positively modifies this relationship. She will also explore how the relationship between mobility-related physical function and residential relocation differs across home environments and cancer types. For the K00 phase, she will create a dataset linking the NHATS with Medicare claims and area-based measures, and evaluate if residential relocation positively modifies the effect of worsening (compared to stable or improving) neighborhood environment supports on cancer-related health outcomes. Dr. Jensen-Battaglia has worked closely with her sponsors to develop a training plan which supports successful completion of the predoctoral research project and smooth transition to a competitive, cancer-focused postdoctoral placement. This includes training to improve knowledge of the patient cancer care experience, obtain expertise in analysis of residential relocation dynamics, and identify a postdoctoral mentor. Together, the proposed research and training plan provide optimal opportunities and structure for Dr. Jensen- Battaglia to develop new skills and progress toward becoming an independent cancer researcher.