DESCRIPTION (provided by applicant): Late-life disability, defined as needing help with daily activities, is common, burdensome, and costly to patients, families, and society. Late-life disability is influenced by medical vulnerabilities (including comorbid illnesses, aspects of medical care, medicines, procedures, neuropsychiatric conditions, and behaviors), social vulnerabilities (social supports, financial resources, communication and literacy, and ethnicity), and their interaction. The UCSF OAIC will focus its efforts on addressing predictors, characteristics, and outcomes of late-life disability in these vulnerable populations at increased risk for disability or death. The overriding goal of the UCSF OAIC will be to improve the health care and quality of life of vulnerable older adults with or at risk for disability through the follwing aims: 1) Catalyze research on disability in vulnerable older persons at UCSF by serving as a hub that brings together scholars and leverages resources; 2) Provide tangible, high-value support to funded projects at UCSF that stimulate new research on disability, and lead to new research opportunities for senior and junior investigators; 3) Support pilot studies that accelerat science and lead to research funding in late life disability; 4) Identify the future leaders of geriatrics research and support them with career development funding and exceptional mentoring; and 5) Develop a leadership and administrative structure that spurs interdisciplinary collaboration, making the OAIC greater than the sum of its parts. To achieve its aims, the UCSF OAIC will support 5 Cores under the leadership of PI Ken Covinsky. The LAC will provide leadership support for the entire UCSF OAIC. The RCDC will utilize the RCDC Scholars and Advanced Scholars Programs to identify, support, and nurture junior investigators who will become national leaders in aging research. The RDAC will enhance analyses of extramurally funded grants (External Projects), OAIC pilot projects, and RCDC projects, and will conduct a Development Project (DP). The DMAC will help investigators design studies with data sources ideal for disability research, support investigators adding disability measures to ongoing studies,
and conduct a DP. The PESC will promote innovative and promising research that enhances our understanding in ways that can mitigate late-life disability, and that leads to ROI funding. By evaluating how medical and social vulnerabilities contribute to the disablement process, the UCSF OAIC will make a meaningful contribution to our understanding of how to best care for older adults who are at risk for or developing disability, advance research and guide clinical practice.
PROJECT SUMMARY (See instructions): The UCSF OAIC RCDC will identify, support, and nurture talented junior investigators who will become national leaders in aging research and provide mentorship that will accelerate pathways to independence. Our primary mechanisms of achieving this aim will be through the RCDC Scholars Program and Advanced Scholars Program. The RCDC Scholars Program targets early career faculty and seeks to accelerate their path towards NIA K awards. The Advanced Scholars Program targets current K award recipients and accelerates the path towards their first ROI. RCDC Scholars will be provided generous levels of support designed to protect their time as they develop a portfolio of manuscripts and research that will make them competitive for K-awards. RCDC Advanced Scholars will receive program support that will support additional work that will be essential to a successful ROI application, but cannot be done with the limited project resources of their K-award. Both will also receive extensive mentoring and participate in an innovative series of seminars designed to develop skills essential to success in aging research, facilitate interdisciplinary communication, build knowledge and relationships that will stimulate translation between basic and clinical research, and accelerate their productivity. The RCDC leadership will also work with leaders ofthe Resource Cores to provide scholars access to additional support. The specific aims are to: 1. Identify junior faculty candidates with exceptional promise for careers in aging research. We will put a particular focus on candidates who can contribute to our focus area. 2. Provide salary support that will protect the time of RCDC Scholars, allowing them to develop essential skills and to compete for K-awards. 3. Provide program support for RCDC Advanced Scholars that will be focused on facilitating research that will lead to their first ROI or equivalent grant (e.g., VA merit review). 4. Provide structured mentoring focused on each scholar's scientific area, principles of aging, development of knowledge in translational research, and career development skills. 5. Sponsor a grant incubator program to provide pragmatic hands-on mentorship for grant applications. 6. Promote increased diversity among researchers in Geriatric Medicine, through the RCDC diversity supplement program and by encouraging application from candidates from diverse backgrounds. 7. Facilitate access to the OAIC Resource Cores and other relevant UCSF programs. 8. Provide a structured educational experience through a series of seminars and lectures.
PROJECT SUMMARY (See instructions): The goal ofthe Data Management and Accrual Core (DMAC) is to support investigators in the use of both existing and nascent data sources to conduct high-value, novel research on disability in vulnerable older adults. This goal includes 3 specific aims: (1) To assist in the design and data acquisition for studies of late life disability that use existing data; (2) To support the addition of disability-related measures to primary data collection studies, and to improve recruitment and retention of vulnerable older subjects in such studies; and (3) To develop methods for capturing functional status data from large databases and to validate these measurement approaches. , . To accomplish these aims, the DMAC will provide several types of services. First, the DMAC will provide consultation and data management support for research using existing data sources, with a particular focus on 3 high-value national datasets: the Health and Retirement Study, national VA data, and the Minimum Data Set, a national registry of data from nursing homes. These services will include (a) consultations with experts to help design studies of late-life disability using existing data sources; (b) an online resource library of information about use of the 3 supported datasets for research on late-life disability; and (c) data management support to access and prepare data files for research. Second, the DMAC will consult with investigators to add measures of function and disability to primary data collection studies, and to provide guidance on recruitment and retention of vulnerable older adults in research. Third, the DMAC will support a development project that investigates the usability and validity of national VA data for measuring functional status In older veterans. In addition to supporting core OAIC Investigators with these services, we have selected 2 external projects (EPs) to receive support from DMAC. For the first EP, the DMAC will provide consultation on adding functional status measures and improving recruitment in a study by Christine Miaskowski, PhD on chemotherapy-induced neuropathy in older adults. For the second EP, the DMAC will provide consultation on functional and quality of life measures and data management support for a trial by Dr. Leah Kariiner on the impact of bedside interpretation services for older hospitalized adults.
PROJECT SUMMARY (See instructions): The overarching goal ofthe Pilot/Exploratory Studies Core (PESC) is to promote innovative and promising research that addresses the predictors, characteristics, and outcomes of late-life disability, especially In vulnerable populations. We are especially interested in the interaction of serious clinical conditions, disability, and social disadvantage. The goals ofthe PESC will be achieved by accomplishing the following specific aims: Aim 1: Solicit and select innovative proposals from highly qualified applicants; Aim 2: Provide investigators of PESC studies with the support and infrastructure ofthe OAIC Cores; Aim 3: Integrate PESC studies and investigators with resources from the UCSF Clinical and Translational Science Institute (CTSI) and other relevant resources at UCSF; Aim 4: Monitor the progress of PESC studies; and Aim 5: Provide mentorship and resources to transform PESC funded studies Into successful independently-funded projects. The PESC will focus on identifying projects from outstanding investigators who are conducting aging research that is likely to lead to external funding and is aligned with the OAIC theme. Leadership ofthe PESC will be under the direction of Christine Ritchie, MD, MSPH, who has a strong track record of independent funding and mentoring. We considered 11 pilot project candidates and chose 3 as initial pilot studies: 1) Dr. Emily Finlayson will determine the functional trajectories after breast cancer surgery In elderly women living in nursing homes to inform surgical decision-making; 2) Dr. Salomeh Keyhani will use Natural Language Processing to extract measures of social risk and functional status from electronic medical records of hospitalized older adults to improve readmission risk prediction; and 3) Dr. Rebecca Sudore will test an Innovative web-based preparation guide In a county healthcare system among diverse, vulnerable adults, in order to enable them to make more informed, in-the-moment decisions during the course of disability and serious illness. Each pilot focuses on the OAIC theme of late-life disability in a vulnerable older population (e.g., frail nursing home residents, older chronically-ill hospitalized patients, and disenfranchised older adults with disability, serious illness, and limited health literacy). In addition, each pilot will provide data that will directly support future external funding applications to Inform interventions to maintain or restore independence and quality of life In elders.
PROJECT SUMMARY (See instructions): The overarching goal ofthe Research Design and Analysis Core (RDAC) is to provide OAIC investigators access to statistical services at all stages of the research lifecycle. By establishing a central hub of statistical expertise, the RDAC will ensure smooth delivery of statistical knowledge and rigor across the spectrum of scientific research at the OAIC. This will improve the quality of OAIC research studies, help nurture trainees, facilitate Interdisciplinary research groups, and ultimately enhance research on prediction, characterization, and outcomes of late-life disability, especially in vulnerable populations. The RDAC will promote wider use of state of the art statistical practice, lower barriers of access to basic statistical services to all research groups including trainees, provide access to specialized statistical resources (such as state ofthe art prognostic model development, complex longitudinal and latent class analysis, and causal inference methods), and develop statistical procedures targeted to solving problems in aging research, and more specifically to challenges that commonly arise in research on disability and function. We propose to accomplish this goal through the following specific aims: (1) to establish a central hub of statistical expertise; (2) to participate in the design of new studies and grant applications; (3) to promote adoption of state-of-the art prognostic modeling techniques and statistical methodology in aging research; (4) to provide data analysis services to aging researchers; (5) to collaborate in the preparation of research manuscripts; (6) to build connections between OAIC and quantitative researchers; and (7) to oversee a developmental project on statistical methods and software for validating the prognostic model building process.
The theme ofthe UCSF OAIC is "Predictors, Characteristics, and Outcomes of Late-life Disability: A Focus on Vulnerable Populations." OAIC leaders are dedicated to better understanding and addressing late-life disability in vulnerable populations-vulnerable due to either advanced illness or to social disadvantage. The OAIC leadership has played a leading role in bringing together these two different models of vulnerability. The LAC will build on the enviable track record of OAIC team, whose research accomplishments and mentoring in these areas has often shifted paradigms in aging and improved clinical care. The LAC will play the central role in coordinating the 5 UCSF OAIC cores, in maintaining communication across programs, and identifying new opportunities, both within and outside the OAIC. The LAC will monitor the success of each core based on tangible metrics of productivity: Research leading to publications in the highest impact journals and new NIH grant funding. The LAC will monitor, stimulate, evaluate, remediate, and report progress toward the goals ofthe OAIC. The LAC will also maintain the substantial collaborations with other UCSF research centers, including the UCSF CTSI and RCMAR, and will establish new collaborations which will leverage OAIC resources and develop new and established investigators in aging research. The overall goal ofthe LAC is to provide the leadership and administration to support the activities ofthe entire UCSF OAIC. To achieve this goal, the LAC has 10 Specific Aims: 1. To provide overall leadership, direction, and coordination for OAIC Cores 2. To provide day-to-day management of the UCSF OAIC. 3. To manage fiscal matters, review use of Core resources, and make reallocation decisions 4. To ensure communications with key individuals and programs. 5. To assess scientific opportunities for new uses of Core resources, and to plan for such uses, with special consideration of opportunities for translation between clinical research, practice and policy. 6. To assess and plan areas of collaboration among UCSF OAIC Cores and with other OAICs 7. To solicit, review proposals for RCDC Awards, PESC Pilot Projects, and Development Projects. 8. To organize activities of the UCSF OAIC advisory and review panels 9. To monitor Core progress and implement necessary remediation. 10. To accomplish Annual Meeting participation and a successful Mid-Cycle Review.
