Developing Interventions to Improve Function in Seniors with Comorbid Conditions

描述(由申请人提供)：我的目标是通过成为国家公认的学术老年病学领导者来改善患有共病的老年人的功能，研究议程侧重于了解和修改导致从共病到残疾的途径。作为杜克大学临床研究培训计划的硕士研究生，我已经朝着这个目标前进了一步，并通过研究特定共病条件的影响的研究项目取得了进展。有了比森职业发展奖，我将获得额外的教学培训，以及在定性方法和涉及医学复杂老年人功能结果的前瞻性数据收集方面的指导研究经验。我的职业发展将由哈维·科恩博士监督，他是一位著名的老年病学研究人员和经验丰富的导师，以及一支才华横溢的导师和顾问团队，他们拥有成功完成两个拟议项目所需的内容专业知识。 这两个项目都与一个总体目标有关，即开发干预措施，改善患有特别致残的各种疾病组合的患者的功能结果。这两个项目都源于一个概念框架，该框架始于损伤--而不是疾病--以应对功能衰退的共病问题。我之前的研究经验和试点数据已经为我在本申请中重点关注的减值项目的选择提供了依据。第一个项目涉及对我目前正在收集的数据的分析，并将评估认知障碍对视力障碍低视力康复中功能结果的影响。第二个项目涉及前瞻性数据收集，将评估共病疼痛和呼吸困难对太极平衡障碍计划的影响。在每个项目中，我将结合定量和定性的数据分析，以开发一种新的干预措施，以适应一系列重要的并存问题(视力障碍/认知障碍或平衡障碍/疼痛/呼吸困难)。 公共卫生相关性：越来越多的美国人遭受不止一种健康问题的困扰，但大多数干预措施针对的是单一的疾病、症状或损害，因此无法满足更复杂、更年长的患者的需求。拟议的项目将产生为具有特定致残条件组合的患者开发新干预措施所需的证据。这项工作是朝着我的最终目标迈出的必要一步，我的最终目标是设计综合治疗策略，以最大限度地发挥有各种健康问题的老年人的功能。

DESCRIPTION (provided by applicant): My goal is to improve function in older adults with comorbidity by becoming a nationally recognized leader in academic geriatrics with a research agenda focused on understanding and modifying the pathway that leads from comorbidity to disability. I have progressed toward this goal as a Master's degree candidate in Duke's Clinical Research Training Program and through research projects that examine the impact of specific comorbid conditions. With a Beeson Career Development Award, I would acquire additional didactic training as well as mentored research experience in qualitative methodology and prospective data collection involving functional outcomes in medically complex older adults. My career development will be overseen by Dr. Harvey Cohen, a renowned geriatrics researcher and experienced mentor, as well as a talented team of mentors and advisors with the necessary content expertise to successfully complete two proposed projects. Both projects relate to a single overall aim, which is to develop interventions that improve functional outcomes in patients who suffer from particularly disabling combinations of conditions. Both projects are derived from a conceptual framework that begins with impairments - rather than diseases - to confront the problem of comorbidity in functional decline. My previous research experience and pilot data have informed the selection of impairments that I focus on in this application. The first project involves an analysis of data that I am currently collecting and will evaluate the impact of cognitive impairment on functional outcomes in low vision rehabilitation for visual impairment. The second project involves prospective data collection and will evaluate the impact of comorbid pain and dyspnea on a Tai Chi program for balance impairment. In each project, I will incorporate quantitative and qualitative data analyses to develop a novel intervention that accommodates an important set of comorbid problems (visual impairment/cognitive impairment or balance impairment/pain/dyspnea). Public health relevance: An increasing number of Americans suffer from more than one health problem, yet most interventions are aimed at a single disease, symptom, or impairment and thus fail to meet the needs of more complicated, older patients. The proposed projects will generate evidence needed to develop novel interventions for patients with specific combinations of disabling conditions. This work is a necessary step toward my ultimate goal, which is to design comprehensive treatment strategies to maximize function in older adults with a variety of health problems.