Developing Interventions to Improve Function in Seniors with Comorbid Conditions
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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.
