PROJECT SUMMARY / ABSTRACT Persons aged 65 years and older account for over 22 million emergency department (ED) visits annually. Recent efforts to reduce unnecessary hospitalizations following ED evaluation have resulted in approximately 65% of older adult ED patients being discharged home. This vulnerable time period post-ED discharge has significant clinical and public health importance as it has been associated with an increased likelihood of morbidity and mortality as well as unscheduled ED recidivism and hospital admission. Despite high rates of adverse outcomes in this period of transition, little is known regarding the experiences and specific challenges faced by older adults during transitions home from the ED. Having a clear understanding of patients' priorities regarding health-related quality of life, functional disability, communication barriers, and condition-specific symptoms after ED discharge is essential to inform clinical conversations and the development of interventions targeting care transitions for older adults. The overall objective of this proposal is to use a sequential exploratory mixed-methods approach to develop and validate the Patient Reported Outcome Measure - Older adult care Transitions from the ED (PROM-OTED) tool, a novel care transitions PROM for older persons experiencing ED discharge care transitions. We will achieve this objective with the following two aims: 1) To develop the PROM-OTED tool, characterizing outcomes of ED discharge care transitions prioritized by older persons. We will use an iterative qualitative approach including concept identification, member checking for concept ranking, cognitive interviewing for question development, and expert panel item-reduction by a modified Delphi process; and 2) To conduct internal validity testing of the PROM-OTED tool. We will perform quantitative survey evaluation of the tool's initial psychometric properties and feasibility among older persons who recently experienced an ED discharge care transition. In alignment with the “National Institute on Aging: Strategic Directions for Research, 2020-2025”, findings of this proposal will improve our understanding of the needs of an aging society to inform intervention development and policy decisions. Specifically, this work will have significant impact by developing a measure to assess whether outcomes prioritized by older adults in the ED are currently met and identify opportunities for improvement in the clinical and research arenas. During the award period, the candidate will acquire relevant skills and benefit from mentorship by accomplished clinician-researchers with complementary skill sets. This investigation will serve as preliminary work towards a future NIA K award application, in line with the candidate's long-term objectives of assessing the PROM-OTED tool in a larger national ED sample, including those with Alzheimer's disease and related dementias (ADRD), and subsequently developing care transition interventions to help older adults successfully navigate ED discharge care transitions.

PROJECT NARRATIVE Given their growing proportion of the population, older adults are predicted to comprise an increasingly larger share of ED visits in the coming years, with recent efforts to avoid hospitalizations following ED evaluation having resulted in approximately 65% of older adult ED patients being discharged home. Despite associations with adverse health outcomes, little is known regarding outcomes prioritized by older adults experiencing ED discharge care transitions. The objective of this proposal is to use a sequential exploratory mixed-methods approach to develop and validate the Patient Reported Outcome Measure - Older adult care Transitions from the ED (PROM-OTED) tool, a novel care transitions PROM intended to inform clinical conversations at the point of ED discharge and the development of interventions to enhance care transitions for older adults.