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Prognostic Indices for Hospitalized Older Adults with and without Alzheimer’s Disease and Related Dementias

Award Number: R01AG079982
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2023
PERIOD OF PERFORMANCE END DATE: 05/31/2028

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Prognostic Indices for Hospitalized Older Adults with and without Alzheimer’s Disease and Related Dementias - Project Summary/Abstract We will develop and externally validate electronic health record (EHR)-based prognostic indices to improve healthcare quality for hospitalized older adults by identifying patients most likely to qualify for (and benefit from) specific health services. Our indices will predict: 1) 6-month mortality to guide hospice referral decisions; and 2) 2-year mortality to guide outpatient palliative care referrals and inform medication deprescribing. We will develop each of these indices for patients with and without Alzheimer’s disease and related dementias, since previous studies suggest that the trajectory of decline differs between older adults with and without Alzheimer’s disease and related dementias. Function is critically important to prediction in older adults, particularly those with Alzheimer’s disease and related dementias, and we have shown that the prognostic power of function increases with age. A major limitation that has hindered the effectiveness of predictive indices for hospitalized older adults has been the lack of functional data in the EHR. Recently, recognizing the critical role of function in providing high quality healthcare to older adults, hospital systems have started to routinely assess and document functional status. This development facilitates our proposal since we now have access to routine functional data from several hospitals, allowing us to incorporate these data into prognostic indices. With EHRs becoming ubiquitous in healthcare systems, our externally validated indices could be integrated into the EHR in most hospitals. To facilitate use in hospitals without EHR integration, we will develop parsimonious indices (also for ADRD and non-ADRD patients) available on ePrognosis, our free and widely used online compendium of geriatric prediction indices. We will set a new standard for equity-conscious prognostic model building by “baking equity” into model selection and incorporating neighborhood disadvantage as predictor representing social determinants of health. We have established a 4 site Collaboratory, which all routinely collect physical function data, clinical diagnoses, standardized delirium assessments, laboratory values, and physiologic measures: UCSF & Cleveland Clinic (development cohort); and Beth Israel Deaconess Medical Center & Johns Hopkins (external validation cohort). We propose to: (1) Develop full prognostic indices designed to be embedded in EHRs for 6-month and 2-year mortality for hospitalized older adults with and without Alzheimer’s disease and related dementias; (2) Develop parsimonious web-based prognostic indices designed to be accessed through ePrognosis for 6-month and 2-year mortality for older adults with and without Alzheimer’s disease and related dementias; (3) To internally validate the effectiveness of these prognostic indices; and (4) to externally validate these indices. These indices will help clinicians improve healthcare quality for older adults by prompting alignment of patient prognosis with health services (i.e. hospice and palliative care referrals) and deprescribing decisions.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $740,530 )
2025	2025	NORTHERN CALIFORNIA INSTITUTE FOR RESEARCH AND EDUCATION, INC.	4150 CLEMENT ST # 151	SAN FRANCISCO	CA	94121	SAN FRANCISCO	USA	Aging Research	000	3	8/13/2025	NON-COMPETING CONTINUATION	$740,530
														Subtotal = $740,530

Issue Date FY: 2024 ( Subtotal = $766,615 )
2024	2024	NORTHERN CALIFORNIA INSTITUTE FOR RESEARCH AND EDUCATION, INC.	4150 CLEMENT ST # 151	SAN FRANCISCO	CA	94121	SAN FRANCISCO	USA	Aging Research	000	2	6/10/2024	NON-COMPETING CONTINUATION	$766,615
														Subtotal = $766,615

Issue Date FY: 2023 ( Subtotal = $821,181 )
2023	2023	NORTHERN CALIFORNIA INSTITUTE FOR RESEARCH AND EDUCATION, INC.	4150 CLEMENT ST 151 NC	SAN FRANCISCO	CA	94121	SAN FRANCISCO	USA	Aging Research	000	1	8/24/2023	NEW	$821,181
														Subtotal = $821,181

Grand Total All Awards = $2,328,326

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Prognostic Indices for Hospitalized Older Adults with and without Alzheimer’s Disease and Related Dementias

Award Number: R01AG079982

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2023

PERIOD OF PERFORMANCE END DATE: 05/31/2028

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