Predicting Transitions Among Community-Dwelling Elders

描述（由申请人提供）：此申请是对指导研究科学家发展奖（K01）的请求，以进一步推动Ilene Zuckerman博士在老龄化和长期护理流行病学领域的研究，重点是药物相关问题。药物不良事件是老年人从独立社区生活过渡到依赖环境（如养老院）的危险因素。药物相关行为导致药物不良事件和随后的转变是可以通过有效的干预来预防的。筛查过渡期可以确定高危老年人，以便采取干预措施，避免可预防的过渡期。扎克曼博士开发这个应用程序的目标是建立一个研究议程，研究与老年人转变相关的因素。核心假设是，社会人口统计学、临床、行为和药物使用因素可以区分经历从独立到依赖环境转变的老年人和那些没有经历过这种转变的老年人。本研究的目标将通过追求三个具体目标来实现：1)估计从独立生活到依赖生活的转变与依赖生活之间的关联

DESCRIPTION (provided by applicant): This application is a request for a Mentored Research Scientist Development Award (K01) to further Dr. Ilene Zuckerman's research in the area of epidemiology of aging and long-term care, with a focus on medication-related issues. Adverse drug events are risk factors for elders transitioning from independent community living to dependent environments such as nursing homes. Medication-related behaviors that lead to adverse drug events and subsequent transitions are preventable with effective intervention. Screening for transitions can identify high-risk elders for interventions to avoid preventable transitions. Dr. Zuckerman's goal for this application is to build a research agenda that examines factors associated with transitions in the elderly. The central hypothesis is that socio-demographic, clinical, behavioral and medication use factors can discriminate elders who experience transitions from independent to dependent settings from those who do not. The objective of the proposed research will be accomplished by pursuing three specific aims: 1) estimate the association between transitions from independent to dependent living and medication use factors in the elderly; 2) develop a predictive model for transitioning from independent to dependent living; and 3) develop and pilot test a screening instrument, based on the predictive model, to discriminate older adults who will experience a transition from those who will not. To accomplish the first two aims, multivariable analysis of survey and administrative claims data will be performed. Qualitative methods will be used to develop and pilot test the screening instrument in Aim #3. In addition to experience gained from completing the proposed research, Dr. Zuckerman will engage in learning activities to enhance her quantitative and qualitative research skills. The proposed training and research are based on her professional interests and build on current work and previous experience. The project represents her continuing efforts to improve the safety of drug use for older adults by understanding the association between drug use factors and elder transitions from independent to dependent environments. Dr. Zuckerman is particularly well prepared to undertake this proposed research, with clinical experience in geriatric pharmacotherapy and epidemiological training. In addition, the mentor and co-mentors have extensive epidemiology of aging research expertise. This research is significant in that it bridges the disparate literature that has separately examined medication use factors and transitions. It is an incremental and important step to building a research agenda that examines socio-demographic, clinical and behavioral factors that affect medication use and transitions in the elderly. Thus, the findings will allow Dr. Zuckerman to build a research agenda that addresses her long term goal to reduce the incidence and prevalence of preventable adverse drug events in the elderly, and to design and evaluate interventions that are targeted toward preventable risk factors for transitions.