The UCSF OAIC Kenneth Covinsky MD MPH UCSF

The UCSF OAIC Kenneth Covinsky, MD, MPH UCSF Division of Geriatrics SFVAMC Section of Geriatrics and Palliative Medicine

Theme • Characteristics and Outcomes of Late Life Disability: A Focus on Vulnerable Populations

Disability Theme • Traditional – Research that examines factors that lead to “loss of independence” – Research that informs how we can reduce risk of functional decline • But…. • What is the “I” in OAIC? – ADL Disability is not a terminal outcome

Outcome of ADL Disability • The “I” should include broad spectrum of elders • We know very little about how to improve quality of life in complex elders with disability – Geriatric science has the tools to improve the independence and quality of life of disabled elders • The quality of health care for complex elders with disability is poor – Geriatric science has the tools to improve care and health outcomes for these patients • Bringing together Geriatrics and Palliative Medicine

Example: “Successful Aging” • RCDC Scholar Alex Smith – Qualitative Study: In Depth Interviews of Disabled Elders at On Lok • ¾ think they aged successfully • Most think their quality of life is good • Key factors: – – – Adaptation (personal, medical, society) Maintaining valued activities Being useful to others Dignity, Sense of control Symptom management • Rowe and Kahn have served field well. But we need to move forward?

Vulnerable Populations • Bringing together medical and social views of vulnerability – Medical: Comorbidity, functional and cognitive impairment – Social: Poverty, Social isolation, adverse circumstance • Interaction of medical and social vulnerability informs – Determinants of disability and its outcomes – Interventions

Examples: Early Development in Vulnerable Populations • Brie Williams: RCDC Scholar – Older Prisoners: Prevalence and Impact of Functional Impairment (Physical/Cognitive) • Margot Kushel: External Project – The aging homeless

Organization of UCSF OAIC • Principles – We view our resources as venture capital – We make investments in PEOPLE who do projects – Our job is to identify the people who will be leaders and innovators in aging research • Provide the project support that will catalyze their development • Provide mentorship, intellectual+ operational support • People principle proving a great mechanism of making our center a true Center – Operation discussions focus on people

Core Structure • 2 resource cores – Data, Measures, and Accrual (DMAC) (Steinman) – Research Design and Analysis (RDAC) (Boscardin) • 2 Developmental Cores – RCDC (Walter/Yaffe) – PESC (Ritchie/Williams) • LAC

Core 1: Data, Measures, Accrual • Data Set Expertise – HRS, CMS, VA • Measures – Use of measures of functioning, disability, quality of life (Geriatric spins) • Accrual – Assistance identifying older and vulnerable subjects

DMAC Examples • External Project: Peripheral Neuropathy in older Cancer Patients (RO 1: Miaskowski) – Add measures of physical function • Development Project – Abstraction of functional measures from electronic data (natural language processing)

Core 2: Research Design and Analysis • Analysis – Proposal Development – Analytic Services • Examples – External Project: Fang (R 01): Predicting complications of anticoagulant therapy – Development Project: Algorithms to calculate optimism in prediction models (open source software)

Core 3: RCDC • Support early career faculty at key points of career vulnerability – RCDC Scholars: New faculty provided financial support and mentorship that will lead to K-award – RCDC advanced scholars: K funded faculty provided project support and mentorship that will lead to RO 1 – Substantial $ support (30 -60 K/yr X 2 years), mentorship, seminars, nudging

RCDC Scholar: Ryan Greysen • Hospital Medicine: Readmissions and Transitions – Central hypothesis: Real issues leading to readmission are not the typical disease measures • Functional and Cognitive Impairment, social support, caregiver stress • K 23 (10!!!) – HRS readmission study – Qualitative studies: Patients/Caregivers post DC

Example: Sei Lee (Advanced Scholar) • Improve diabetes management, outcomes, care of frail elders – Current Beeson Scholar who will transition to R 01 – Plan: Longitudinal Study of Nursing Home Residents – RCDC support: Pilot data collection –subject assembly, measures

Core 4: PESC (Ritchie) • Support for preliminary data/developmental work that will lead to a R 01 – Targets: More advanced than RCDC scholars – Open to those not established in aging • Substantial awards (30 K X 2 years)

PESC Examples • Surgical Outcomes in Nursing Home Patients (Finlayson) – Pilot: Assemble cohorts of nursing home patients who have surgery using merged MDS-Medicare Data – R 01: Outcomes of Surgery vs Conservative therapies in cholecystitis • Improving decision making, advance care planning in elders with multimorbidity (Sudore: www. prepareforyourcare. org) – Funded with VA IIR, RO 1 – Pilot: Translation of materials into Spanish – Outcome: PCORI grant

Thank You