Claude D. Pepper Older Americans Independence Center at*

描述(由申请者提供)：耶鲁大学OAIC活动将侧重于多因素老年健康状况--老年人常见的健康状况，由多种因素组合而成，可通过多因素干预措施加以预防，并引发多种可能的结果。在前几期OAIC支持的基础上，我们将重点寻找解决障碍的解决方案，这些障碍阻碍了对多因素老年病的病因、预防、治疗和结果的更全面了解。我们建议的投资组合包括： 1)从老年综合征模型的新视角调查复发性心肌梗塞和肺炎等传统疾病实体；2)方法论项目，通过开发纵向方法来分析诱发事件对结果的影响，并处理风险因素或治疗与结果之间的双向(反馈环)常见情况，以及确定多因素干预策略的作用机制的方法，将我们的流行病学和干预研究推向更高的复杂性水平；3)现有技术的新应用，如地理信息系统，以评估现实世界实施多因素干预的渗透性和有效性；4)对多个领域的新的和现有的测量方法进行分类、分析和传播，供所有OAIC的研究人员使用；5)探索性项目，如制定一项战略，在面临多因素的老年健康状况时引出老年人的治疗目标；以及6)利用意想不到的研究机会，鼓励潜在的翻译研究，如拟议的试点项目，该试点检查氧化应激反应随人类衰老的变化。最后一个项目特别令人兴奋，因为在细胞水平上指导这项工作的范例与在人类水平上指导耶鲁OAIC工作的范例相似，因此有望在多因素老年健康状况的病因、预防和治疗方面取得突破性发现。 为了支持这些项目和其他项目，耶鲁开放式教育信息中心将包括以下核心内容：1)领导力/行政；2)研究职业发展，将提供早期职业、过渡性职业和附属教师发展奖；3)试点/探索性研究；4)实地研究；5)数据管理/信息学；6)生物统计学。

DESCRIPTION (provided by applicant): Yale OAIC activities will focus on multifactorial geriatric health conditions-health conditions common among older persons that result from combinations of multiple factors, that may be prevented by multifactorial interventions, and that trigger multiple possible outcomes. Building on the foundation laid over previous periods of OAIC support, we will focus on identifying solutions to barriers impeding a more complete understanding of the etiology, prevention, treatment, and outcomes of multifactorial geriatric conditions. We propose a portfolio that includes: 1) investigations of traditional disease entities such as recurrent MI and pneumonia from the novel perspective of the geriatric syndrome model; 2) methodologic projects that take our epidemiologic and intervention studies to the next level of complexity by developing longitudinal methods for analyzing the effect of precipitating events on outcomes and for handling the common occurrence of bi-directionality (feed back loops) between risk factor or treatment and outcome and methods for determining the mechanisms of action of multifactorial intervention strategies; 3)novel applications of existing technologies, such as Geographic Information Systems, to evaluate the penetration, and effectiveness of real world implementation of multifactorial interventions; 4) the categorization, analysis, and dissemination of new and existing measures of multiple domains for use by investigators throughout all OAICs; 5) exploratory projects such as the development of a strategy for eliciting older persons' treatment goals when faced with multifactorial geriatric health conditions; and 6) capitalizing on unanticipated research opportunities and encouraging potential translational research as exemplified by a proposed pilot which examines alterations in oxidative stress responsiveness with human aging. This last project is particularly exciting because the paradigms guiding this work at the cellular level parallel those guiding Yale OAIC work at the human level, thus offering the promise of breakthrough discoveries concerning the etiology, prevention and treatment, of multifactorial geriatric health conditions. To support these, and other, projects the Yale OAIC will include the following Cores: 1) leadership/ administrative; 2) research career development which will offer early career, transitional career, and affiliated faculty, Development awards; 3) Pilot/exploratory studies; 4) Field; 5) Data Management/lnformatics; 6) Biostatistics.