DESCRIPTION (provided by applicant): I am a Geriatrician and junior faculty member at the University of California, San Francisco. My long-term goal is to become an independent researcher focused on optimizing the healthcare of disenfranchised older adults, such as geriatric prisoners. I seek a K23 award to provide me with the support necessary to accomplish the following goals: (1) to acquire additional skills in clinical research including longitudinal study design, prognostic modeling, hierarchical modeling, measurement and survey design, and assembling a prospective longitudinal cohort; and (2) to develop an independent clinical research career. The rapidly growing number of geriatric prisoners is a healthcare crisis in US prisons, an economic crisis for state governments, and has precipitated profound public health challenges in the communities to which aging prisoners are released. However, research about older prisoners is scarce. The specific aims of my proposed research address important knowledge gaps by applying the multidisciplinary perspective of Geriatrics to the healthcare of aging prisoners. The proposed research will accomplish the following aims: (1) provide the largest assessment to date of the health and functional status of geriatric prisoners and compare these levels to population-based norms; (2) examine risk factors associated with adverse health events in prison and incorporate these into a clinical tool to risk-stratify geriatric prisoners according to their risk of adverse health events; (3) determine the association between disability specific to the prison environment and adverse health events; and (4) select and develop high-fidelity measures to assess health, functional status, cognitive status, and healthcare needs of older adults after release. My strong mentoring team led by Dr. Kenneth Covinsky an NIA K24 awardee, has expertise in geriatrics, prison health, measurement science and in assembling and following a prospective cohort. This application will also provide pilot data and lay the groundwork for an R01 application focused on improving the health and healthcare of older adults after release from incarceration. RELEVANCE (See instructions): This application will describe the healthcare needs of older prisoners, create a clinical prediction tool for adverse health outcomes, and establish a cohort of older adults nearing release to measure medical, cognitive and functional status and plans for post-release healthcare. Results can be used to guide care, improve costs and decrease adverse health outcomes of incarcerated older adults and of those transitioning back to community healthcare.

This application will describe the healthcare needs of older prisoners, create a clinical prediction tool for adverse health outcomes, and establish a cohort of older adults nearing release to measure medical, cognitive and functional status and plans for post-release healthcare. Results can be used to guide care, improve costs and decrease adverse health outcomes of incarcerated older adults and of those transitioning back to community healthcare.