The overall objective of this K01 is to propel the continued upward trajectory of the career development of Dr. Rahemi as an independent researcher. Her research focus is on decision making for persons with Alzheimer’s disease and related dementias (ADRD) and their caregivers and the role of advance care planning (ACP), us- ing large datasets and data science. This K01 will position her to achieve her career goal of supporting ADRD- related decision making for end-of-life care in racial minority populations. Research: The specific aims are 1) to identify variation across racial/ethnic groups and cognitive function levels in the relationship between ACP and healthcare use and 2) to describe predictors of caregivers’ perception of patient care quality. To address these aims, she will obtain training in data science, including advanced statistics, explainable artificial intelligence (XAI), and state-of-the-science ADRD and aging. The Health and Retirement Study (HRS), including HRS post-mortem proxy interviews and HRS-linked Medicare data, will be used. This project will provide evidence on nuanced interactions between a mix of variables and racial disparities in end-of-life care for minority older adults with or at risk of ADRD and their caregivers—groups vastly overlooked in end-of-life research. Candi- date: Dr. Rahemi is an Assistant Professor of Nursing at Clemson University. She has substantial training in quantitative research using secondary data analytic approaches (e.g., HRS dataset analyses and training) to investigate ACP and healthcare use among minority and ADRD populations. Building upon her Carolina Center on Alzheimer’s Disease and Minority Research pilot project using HRS data, this K will allow her to model com- plex determinants of racial disparities in ACP and end-of-life care. Two training goals will support her success in becoming an independent researcher: 1) develop expertise in state-of-the-science on aging, ADRD, and ACP and 2) gain skills in advanced statistics, XAI, and secondary analysis of large datasets in interdisciplinary aging research. Mentors/Environment: This career development plan includes experiential and hands-on re- search training on related projects led by Dr.s Demiris and Jarrín. Dr. Rahemi and her mentors have developed a 3-pronged strategy to address her career goals and training needs: 1) a robust and interdisciplinary team of mentors and collaborators who will guide her research and career development; 2) an innovative research pro- ject integrated with her training goals that are scientifically relevant and rigorous; 3) an assembly of course- work, workshops, and seminars offered by artificial intelligence (AI) programs, the Alzheimer's Association In- terdisciplinary Summer Research Institute, the National Institute on Aging, and the Hartford Institutes for Geri- atric Nursing, complemented by professional interactions that build upon existing resources at Clemson Uni- versity and affiliated institutes. This project will provide training, mentorship, and research experiences founda- tional to Dr. Rahemi’s career development as an independent investigator improving ACP and eliminating dis- parities in end-of-life care among racial/ethnic minority older adults living with ADRD and their caregivers.

Compared to non-Hispanic, white older adults, older Black and Hispanic adults experience higher age-adjusted rates of Alzheimer’s disease and related dementias (ADRD), disparities in healthcare access and utilization, worse quality of care at the end of life, and lower rates of advance care planning. This project will address a significant gap in knowledge regarding the complex patterns and interactions of risk factors related to dispari- ties in end-of-life care across cognition levels and races/ethnicities. The goals of this career development award are to use advanced statistical and artificial intelligence methods to understand the factors related to advance care planning and end-of-life care quality among older adults living with ADRD and their caregivers.