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全国公认的老年医学学术领导者来改善老年人的功能，其研究议程侧重于理解和修改从合并症到残疾的途径。作为杜克大学临床研究培训项目的硕士生，我已经朝着这个目标迈进，并通过研究项目来检查特定共病条件的影响。有了比森职业发展奖，我将获得额外的教学培训，以及指导研究经验的定性方法和前瞻性数据收集涉及功能性结果在医学复杂的老年人。我的职业发展将由著名的老年医学研究员和经验丰富的导师Harvey Cohen博士监督，以及具有必要内容专业知识的才华横溢的导师和顾问团队，以成功完成两个拟议项目。 这两个项目都涉及到一个单一的总体目标，即制定干预措施，改善患有特别残疾的患者的功能结果。这两个项目都源自一个概念框架，该框架从损伤而不是疾病开始，以应对功能衰退中的并发症问题。我以前的研究经验和试点数据已经告知我在这个应用程序中重点选择的障碍。第一个项目涉及我目前正在收集的数据分析，并将评估认知障碍对视力障碍低视力康复功能结果的影响。第二个项目涉及前瞻性数据收集，并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数据分析，以开发一种新的干预措施，以适应一组重要的共病问题（视觉障碍/认知障碍或平衡障碍/疼痛/呼吸困难）。 公共卫生相关性：越来越多的美国人患有一种以上的健康问题，但大多数干预措施都是针对单一疾病，症状或损伤，因此无法满足更复杂的老年患者的需求。拟议的项目将产生必要的证据，为具有特定残疾条件组合的患者开发新的干预措施。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全面的治疗策略，以最大限度地提高患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.