Project start date: 2003-01-15
Project end date: 2007-12-31
5K24AG021507-05 (2007): $140153
Research Training In Disability And Disabling Disorders
Thomas Michael Gill, Professor Of Medicine, Epidemiology And Pu
Yale University 47 College Street, Ste 203 New Haven, Ct 065208047
Grant 5K24AG021507-03 from National Institute On Aging, IRG: NIA
Project start date: 2003-01-15
Project end date: 2007-12-31
5K24AG021507-03 (2005): $138932
5K24AG021507-02 (2004): $137955
Grants awarded to Thomas Michael Gill
Research Training In Geriatric Clinical Epidemiology
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Yale University 47 College Street, Ste 203 New Haven, Ct 065208047
Grant 5T32AG019134-07 from National Institute On Aging, IRG: ZAG1
Abstract: This is the first competing renewal of the Yale Research Training Program in Geriatric Clinical Epidemiology. The objective of the Yale Program is to develop a cadre of physician scientists and PhD investigators with expertise in geriatric clinical epidemiology who will be equipped to address the myriad of unanswered questions concerning the diagnosis, treatment, management, prevention, and prognosis of the health problems experienced by the ever increasing number of older persons. We will accomplish this objective by providing highly qualified physicians, who are already well trained in geriatrics and/or subspecialties with age-related relevance, and outstanding PhD-trained investigators with 2 to 3 years of rigorous research training. Our trainees will develop skills in each of seven essential areas 1) formulation of significant and focused research questions and hypotheses; 2) design of observational and experimental studies to address focused research questions; 3) techniques for successful execution of specific study designs; 4) critical analysis of the scientific literature, including research methods and data quality; 5) interpretation of findings; 6) verbal and written communication of scientific methods and findings; and 7) development and implementation of strategies for research support. These skills will be developed through a training experience that includes both didactic and experiential components. The didactic curriculum includes a series of modules offered through the Robert Wood Johnson Clinical Scholars Program, key courses offered through the K30-sponsored Investigative Medicine Program, and advanced courses offered through the School of Public Health. The central component of the Yale Program is a mentored research experience, which includes structured meetings with Program Faculty in geriatrics/gerontology and a supervised research project tailored to the trainee s experiences and interests, with the goal of producing one or more first-authored, peer-reviewed publications and a grant application to support further research. Trainees have the option of obtaining an MPH or a PhD. During the initial funding cycle, the Yale Program has successfully recruited and retained a full complement of highly qualified MD and PhD trainees and has started to export its graduates to tenure-track, research-intensive positions at top-tier academic institutions. We request continued funding for five postdoctoral positions per year for the next five years.
Project start date: 2001-05-01
Project end date: 2011-04-30
5T32AG019134-07 (2007): $272307
2T32AG019134-06 (2006): $279409
Research Training In Disability & Disabling Disorders
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Internal Medicineyale University
47 College Street, Ste 203
new Haven, Ct 065208047
Grant 2K24AG021507-06 from National Institute On Aging, IRG: NIA
Abstract: This application supports a renewal of the Mid-career Investigator (K24) Award in Patient-Oriented Research from the NIA to Thomas Gill, MD, a geriatrician and epidemiologist who has been on the faculty at Yale since 1994. During the first 4 years of this award, Dr. Gill has been the primary or secondary mentor to 14 junior investigators. Significant accomplishments during the current funding period include a dramatic increase in the number of senior-authored (from 2 to 14) and first-authored (from 9 to 16) reports, receipt of 8 career development awards by Dr. Gill´s trainees, renewal of Dr. Gill´s first R01 with MERIT Award designation, receipt of a second R01, and expansion of Dr. Gill´s research program to include large-scale clinical trials. Dr. Gill´s long-term career objective is to build a premier program in patient-oriented research related to disability and disabling disorders. The specific aims of this competitive renewal are to complete the proposed research projects and to further strengthen and expand Dr. Gill´s formal mentorship program for junior investigators, which he successfully established during the initial funding period. Dr. Gill´s mentorship program is designed to attract junior investigators, across disciplines, who are pursuing patient-oriented aging research related to disability and disabling disorders. This includes functional assessment in general as well as the functional consequences of highly prevalent disease-specific conditions such as arthritis, heart disease, and depression (among others). By addressing fundamental issues related to the epidemiology and prevention of disability, Dr. Gill´s internationally recognized research program provides a superb platform for his greatly expanded mentorship program, which includes didactic training, hands-on research training, and a research infrastructure. The Yale environment provides the ideal setting, replete with interdisciplinary research and training programs, to foster Dr. Gill, the proposed research projects, and the mentorship program. Successful renewal of the K24 Award will strengthen and expand the infrastructure for Dr. Gill´s mentorship program, create new opportunities for his trainees to actively participate in large-scale research projects, provide resources for pilot studies, and facilitate Dr. Gill´s ongoing career development. Dr. Gill envisions continued growth of his research and mentorship program over the next several years, culminating in a new Center for Disability and Disabling Disorders
Project start date: 2003-01-15
Project end date: 2013-02-28
Research Training In Disability And Disabling Disorders
Thomas Michael Gill, Professor Of Medicine, Epidemiology And Pu
Yale University 47 College Street, Ste 203 New Haven, Ct 065208047
Grant 1K24AG021507-01 from National Institute On Aging, IRG: NIA
Abstract: The specific aims of this Midcareer Investigator Award in Patient-oriented Research are (1) to further establish the candidate s independent patient-oriented research program in the epidemiology and prevention of disability among community-living older persons; and (2) to establish a formal mentorship program for junior investigators, across disciplines, who are pursuing patient-oriented aging research related to disability and disabling disorders. This includes functional assessment in general as well as the functional consequences of highly prevalent disease-specific conditions such as arthritis, heart disease, diabetes, stroke, cancer, depression, and dementia. The candidate s ultimate objective is to build a premier program in patient-oriented research related to disability and disabling disorders. During the past ten years, the candidate has established a highly successful and independent patient-oriented research program addressing fundamental issues related to the epidemiology and prevention of disability. A K24 Award will permit the candidate to further advance the scientific knowledge base of this serious and pervasive problem in geriatric medicine by affording him the protected time to complete the patient-oriented research projects proposed in this application. This program of research, in turn, will provide the platform for the candidate s greatly expanded mentorship program, which will include didactic training, hands-on research mentorship, and a research infrastructure (data analytic and research assistant support). The candidate plans to accept two to three junior investigators into the program during each of the first two years. Subsequently, the number of accepted candidates per year will vary to achieve the ultimate goal of having 5 to 6 active trainees at any one time. The Yale environment provides the ideal setting, replete with interdisciplinary research and training programs, interdisciplinary expertise and collaboration, and resources (e.g., methodological consultation, biostatistical support, access to study populations and databases) to foster the candidate, the proposed research projects, and the mentorship program. In summary, the candidate s accomplishments in patient-oriented research, his ability and commitment to mentoring junior investigators, and the research and training strengths of Yale combine to provide an ideal context for successfully carrying out the specific aims of this proposal.
Keywords: disabling disease, disease /disorder prevention /control, frail elderly, functional ability, geriatric medicine, physical therapy, body physical activity, clinical trial, epidemiology, role model, clinical research, human subject, interview, patient oriented research, training
Project start date: 2003-01-15
Project end date: 2007-12-31
1K24AG021507-01 (2003): $137504
VULNERABILITY, INTERVENING EVENTS & DISABILITY IN AGING
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Yale University 47 College Street, Ste 203 New Haven, Ct 065208047
Grant 5R01AG017560-05 from National Institute On Aging, IRG: EDC
Abstract: Functional dependence is a common and morbid problem for community-living older persons, with prevalence rates exceeding 10 percent for dependence in basic (i.e. self-care) activities of daily living (ADLs) and 15-20 percent for dependence in instrumental activities of daily living (IADLs) and mobility. The overall aim of this revised application, which is being led by a New Investigator, is to further elucidate the mechanisms underlying the development of, and recovery from, functional dependence among community-living older persons. Our primary aim is to determine the effects of baseline vulnerability and intervening events on the risk of functional dependence. Baseline vulnerability is defined on the basis of three factors (physical capability, cognitive status, and age) that we have found to be most strongly associated with the development of functional dependence. Intervening events include acute hospital admissions and nonhospital events, defined as episodes of illness, injury or other problems associated with restricted activity. Our two secondary aims are to identify the specific nonhospital events that are associated with the onset of functional dependence, and to identify the factors that either facilitate or impede recovery from functional dependence. We will use data from an ongoing longitudinal study of 753 community-living persons, 70+ years, who upon enrollment were independent in their basic ADLs. Baseline vulnerability and functional status were determined during a comprehensive home- based assessment which will be repeated at 18 months. Participants are subsequently followed with monthly telephone interviews for three years to ascertain their exposure to intervening events and to reassess their functional status. Our primary outcome is the onset of persistent ADL dependence, defined as a new disability (requiring personal assistance) in one or more basic ADLs that is present for at least two consecutive months. Important secondary outcomes include new dependence in IADL function and mobility. The unique strengths of this research include the availability of high quality data from a well-defined cohort of community-living older persons; nearly complete ascertainment of intervening events and updated information on functional status gathered from monthly telephone interviews; and the research team s vast experience in longitudinal studies of functioning in older persons. The results of this research will provide important insights into the mechanisms underlying the disablement process and will facilitate the development of effective and efficient strategies to prevent the onset and progression of functional dependence among at-risk elders.
Keywords: aging, disease /disorder proneness /risk, functional ability, longitudinal human study, clinical research, human old age (65+), human subject
Project start date: 2000-09-01
Project end date: 2005-08-31
5R01AG017560-05 (2004): $285511
5R01AG017560-04 (2003): $337704
VULNERABILITY, INTERVENING EVENTS & DISABILITY IN AGING
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Internal Medicineyale University
47 College Street, Ste 203
new Haven, Ct 065208047
Grant 5R01AG017560-02 from National Institute On Aging, IRG: EDC
Abstract: Functional dependence is a common and morbid problem for community-living older persons, with prevalence rates exceeding 10 percent for dependence in basic (i.e. self-care) activities of daily living (ADLs) and 15-20 percent for dependence in instrumental activities of daily living (IADLs) and mobility. The overall aim of this revised application, which is being led by a New Investigator, is to further elucidate the mechanisms underlying the development of, and recovery from, functional dependence among community-living older persons. Our primary aim is to determine the effects of baseline vulnerability and intervening events on the risk of functional dependence. Baseline vulnerability is defined on the basis of three factors (physical capability, cognitive status, and age) that we have found to be most strongly associated with the development of functional dependence. Intervening events include acute hospital admissions and nonhospital events, defined as episodes of illness, injury or other problems associated with restricted activity. Our two secondary aims are to identify the specific nonhospital events that are associated with the onset of functional dependence, and to identify the factors that either facilitate or impede recovery from functional dependence. We will use data from an ongoing longitudinal study of 753 community-living persons, 70+ years, who upon enrollment were independent in their basic ADLs. Baseline vulnerability and functional status were determined during a comprehensive home- based assessment which will be repeated at 18 months. Participants are subsequently followed with monthly telephone interviews for three years to ascertain their exposure to intervening events and to reassess their functional status. Our primary outcome is the onset of persistent ADL dependence, defined as a new disability (requiring personal assistance) in one or more basic ADLs that is present for at least two consecutive months. Important secondary outcomes include new dependence in IADL function and mobility. The unique strengths of this research include the availability of high quality data from a well-defined cohort of community-living older persons; nearly complete ascertainment of intervening events and updated information on functional status gathered from monthly telephone interviews; and the research team´s vast experience in longitudinal studies of functioning in older persons. The results of this research will provide important insights into the mechanisms underlying the disablement process and will facilitate the development of effective and efficient strategies to prevent the onset and progression of functional dependence among at-risk elders
Keywords: aging, disease /disorder proneness /risk, functional ability longitudinal human study clinical research, human old age (65+), human subject
Project start date: 2000-09-01
Project end date: 2005-08-31
5R01AG017560-02 (2001): $466982
1R01AG017560-01A1 (2000): $489446
Research Training In Geriatric Clinical Epidemiology
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Yale University 47 College Street, Ste 203 New Haven, Ct 065208047
Grant 5T32AG019134-05 from National Institute On Aging, IRG: NIA
Abstract: Applicants ) The objective of this training program is to develop a cadre of physician-scientists with expertise in geriatric clinical epidemiology, capable of addressing the complex and multidimensional health problems of older persons. We will accomplish this objective by providing physicians already well trained in geriatrics and/or subspecialties with age-related relevance with 2 - 3 years of research training. The geriatric clinical epidemiology trainees will develop skills in each of seven essential areas 1) formulation of significant and focused research questions; 2) design of observational and experimental studies; 3) techniques for successful execution of specific study designs; 4) critical analysis of the scientific literature; 5) interpretation of findings; 6) verbal and written communication of scientific methods and findings; and 7) development and implementation of strategies for research support. These skills will be developed through a training experience that includes both didactic and experiential components. The core didactic curriculum is a 1-year long course, Quantitative Clinical Epidemiology, which includes epidemiologic and research methods, biostatistics, data processing, and health policy. Advanced courses, provided through the new Investigative Medicine Program and the School of Public Health, include clinical investigation, longitudinal data analysis, and ethics in research. Trainees will have the option of obtaining an MPH or a PhD. The central component of the research training program is a supervised research experience under the guidance of a geriatric faculty mentor. There is a broad array of interdisciplinary and ongoing research projects upon which trainees can draw for the experiential component of their research training. The unique strengths of the proposed training program include a distinguished history of geriatric clinical epidemiology research; the breadth and depth of available mentors and research expertise; an outstanding didactic research curriculum; availability of a broad spectrum of research experience opportunities and an excellent research infrastructure; an outstanding pool of trainee candidates; and a program director widely recognized for developing successful geriatric clinical investigators.
Project start date: 2001-05-01
Project end date: 2006-04-30
5T32AG019134-05 (2005): $313883
5T32AG019134-04 (2004): $321423
5T32AG019134-03 (2003): $330711
Epidemiology Of Disability And Recovery In Older Persons
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Internal Medicineyale University
Grant 5R37AG017560-09 from National Institute On Aging, IRG: ECDA
Abstract: Among community-living older persons, disability in essential activities of daily living, such as bathing, dressing, walking, and transferring, is common, highly morbid, and costly. During the current funding period, we have provided strong evidence to support an emerging paradigm of disability as a reversible, and often recurrent, event. We have also demonstrated that illnesses and injuries leading to either hospitalization or restricted activity represent important sources of disability and that habitual physical activity is an independent predictor of both time to and duration of recovery of independent function. The overall objective of this renewal application is to further elucidate the epidemiology of disability and recovery among older persons, with particular emphasis on disability subtypes and on disability transitions among persons admitted to a nursing home and at the end of life. We propose 3 linked sets of primary specific aims and hypotheses, complemented by a set of 3 secondary aims. The premise underlying the proposed research is that disability is a complex and highly dynamic process with considerable heterogeneity and multiple potential pathways. The inherent complexity of disability has historically not been well appreciated, largely because prior longitudinal studies have almost invariably included long intervals, ranging from 6 months to 6 years, between disability assessments. To accomplish our specific aims and test our hypotheses, we will use high quality data from the Yale PEP Study, a unique and highly innovative, ongoing study of 754 initially nondisabled, community-living persons, aged 70 years or older, with a median follow-up (to date) of 67 months. Participants have completed comprehensive home-based assessments at baseline and, subsequently, at 18-month intervals and have been followed monthly via telephone interviews to reassess their functional status, ascertain potential intervening events, and identify admissions to the nursing home and deaths. The research proposed in this renewal application addresses a fundamental problem in geriatric medicine and gerontology and builds upon a large body of work that has been completed during the current funding period. By further elucidating the epidemiology of disability and recovery among older persons, the proposed research will help to inform the development of effective and efficient interventions designed to maintain and restore independent function among older persons
Keywords: aging, disease /disorder proneness /risk, epidemiology, functional ability human mortality, longitudinal human study, nursing home clinical research, human old age (65+), human subject
Project start date: 2000-01-01
Project end date: 2010-08-31
5R37AG017560-08 (2007): $611591
5R37AG017560-07 (2006): $628203
2R37AG017560-06 (2005): $649756
Epidemiology Of Bathing Disability In Elderly Persons
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Yale University 47 College Street, Ste 203 New Haven, Ct 065208047
Grant 5R01AG022993-04 from National Institute On Aging, IRG: ECDA
Abstract: Among community-living older persons, disability in bathing (i.e. washing and drying one s whole body) is highly prevalent, is a strong predictor of morbidity and mortality, and is a primary indication for home aide services. Yet, the evidence base to help guide the prevention and remediation of bathing disability is relatively scant. The long-term objective of this research is to rigorously evaluate targeted and clinically sensible intervention strategies to enhance safe and independent bathing among community-living older persons. The Specific Aims of the research proposed in the current application, which has been extensively revised in response to the prior review, are (1) to determine the burden and patterns of disability in bathing among community-living older persons; (2) to determine whether disability in bathing is associated with subsequent adverse outcomes, such as nursing home admission and death, independent of potential confounders, including disability in other basic activities of daily living (ADLs); (3) to evaluate the relationship between potential risk factors that are intrinsic to the individual, especially those that may be modifiable, and disability in bathing; and (4) to identify potential environmental impediments to independent bathing. To accomplish these aims, we will use high quality data from an ongoing prospective study of 754 community-living older persons, including monthly assessments of ADL function for 7 years and comprehensive home-based assessments at 18-month intervals. The proposed research addresses a fundamental problem in geriatric medicine and rehabilitation, builds upon a large body of previously completed work, including epidemiologic studies related to ADL disability and the home environment, and takes advantage of the most comprehensive and complete set of bathing related data on such a large cohort of community-living older persons, with an excellent participation rate and remarkably low attrition. By rigorously evaluating the epidemiology of bathing disability, the research proposed in this revised application will facilitate the development of subsequent interventions directed at the prevention and remediation of disability in bathing.
Keywords: aging, epidemiology, functional ability, human old age (65+), self care, community, data management, geriatrics, health care service utilization, longitudinal human study, nursing home, person with disability, quality of life, rehabilitation, behavioral /social science research tag, clinical research, human subject
Project start date: 2004-08-15
Project end date: 2008-06-30
5R01AG022993-04 (2007): $234853
5R01AG022993-03 (2006): $380570
5R01AG022993-02 (2005): $500427
1R01AG022993-01A1 (2004): $511898
PREVENTION OF FUNCTIONAL DISABILITY IN AT RISK ELDERS
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Internal Medicineyale University
47 College Street, Ste 203
new Haven, Ct 065208047
Grant 5K23AG000759-04 from National Institute On Aging, IRG: NIA
Abstract: Adapted from applicant´s ). According to intervention strategies to date have focused largely on the restoration of function among disabled elderly persons in the context of rehabilitation after an acute medical event, such as a stroke or hip fracture. There have been few attempts to develop strategies aimed at "prehabilitation" (PREHAB), which is the prevention of functional dependence and decline among persons who have not sustained an acute illness or injury. The overall objective of this project is to test the efficacy of a home-based PREHAB strategy to prevent functional decline in a high-risk group of physically impaired, community-living elderly persons who do not have severe memory loss or impaired orientation. Community-living persons, over 75 years will be screened for eligibility during non-urgent clinic visits at two large primary care sites. After comprehensive home assessment, 160 physically impaired elders will be randomized, using a blocked design that is stratified by clinic site, severity of physical impairment, and age to receive either the control group strategy (EDUCATE), a 6-month education program covering several content areas in general health practices and health promotion, or a home-based intervention strategy (PREHAB) -- which is a 6-month training program of physical therapy, to include muscle strengthening, joint range of motion, foot care, and balance, gait, transfer, and stair training, plus functional therapy to include training and instruction in safe and effective performance of the task needed to complete ADLs and selected IADLs, provision of appropriate adaptive equipment, and environmental modifications. Functional assessments will be completed in all participants at baseline and at six and twelve months by trained staff who will be kept unaware of group assignments. The specific aims of the project are 1) to determine whether the home-based PREHAB strategy is superior to the EDUCATE strategy in preventing decline in ADL-IADL function, and in decreasing the use of formal and informal care, including home care and nursing home care; 2) if the PREHAB strategy proves successful to identify the predictors of response to the intervention and to determine whether its benefit is mediated, as hypothesized, by improvements in both physical capability and functional self-efficacy
Keywords: functional ability, human old age (65+), rehabilitation gait, health behavior, health education, person with disability, physical therapy, quality of life, self concept, self help clinical research, human subject
Project start date: 1998-01-01
Project end date: 2002-12-31
5K23AG000759-04 (2001): $132083
5K23AG000759-03 (2000): $132005
1K08AG000759-01A1 (1998): $105516
Research Training In Geriatric Clinical Epidemiology
Thomas Michael Gill, Professor Of Medicine, Epidemiology & Pu
Internal Medicineyale University
47 College Street, Ste 203
new Haven, Ct 065208047
Grant 5T32AG019134-08 from National Institute On Aging, IRG: ZAG1
Project start date: 2001-05-01
Project end date: 2011-04-30
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