Project Abstract Candidate: Elissa Kozlov’s career goal is to be an independent investigator dedicated to improving the mental health outcomes of older adults with serious illness and their families, while establishing herself as a leader in the field of geriatric mental health care and palliative care. She is a licensed clinical psychologist with expertise in geriatrics and palliative care, and she has authored 25 peer-reviewed (15 first-authored) manuscripts. Research: Up to 70% of adults with serious illness have symptoms of anxiety. Undiagnosed and undertreated anxiety contributes to higher risk of pain, depression, fatigue, dyspnea, and polypharmacy. Patients with high symptom burden and anxiety heavily impact family caregivers, which nearly 8 million older adults in the U.S. rely on for assistance. Decades of research reveal the negative effects of caregiving on caregivers, (e.g., high levels of stress, depression, and anxiety). Furthermore, there is a mutuality of distress in the caregiver/patient dyad — when patients suffer psychologically, the caregiver suffers too. Unfortunately, older adults and their caregivers have limited access to mental health resources because of shortages of mental health providers as well as logistical issues including time constraints, transportation, and scheduling. The objective of this study is to evaluate the feasibility, acceptability, and preliminary efficacy of Mindfulness Coach, an mHealth Mindfulness Therapy intervention developed by the Veterans Affairs, to reduce anxiety in older adults with serious illness and their family caregivers. An efficacious and scalable behavioral intervention that mitigates symptoms of patient and caregiver anxiety has the potential to reduce distress and enhance coping in the patient–caregiver dyad without contributing to polypharmacy or burdensome appointments. Research is urgently needed to evaluate the feasibility, acceptability, and preliminary efficacy of dyadic mHealth mindfulness therapy in older adults with serious illness and their caregivers. Career Development: Dr. Kozlov has assembled an interdisciplinary team of mentors (Primary: Drs. Dong & Reid, Mentorship Committee [Israel, Duberstein, and Hoover]) with expertise in geriatrics, mental health, dissemination and implementation sciences, caregiving, and mHealth. Her career development plan integrates coursework, seminars, and mentorship in the following areas: (1) Skills in mHealth interventions, data analysis and clinical trials, 2) Dyadic interventions and analyses in geriatrics and palliative care, 3) Dissemination and Implementation sciences (D&I), and 4) Leadership and grantsmanship. With support from the Rutgers University Institute for Health, Health Policy and Aging Research, The School of Public Health and RWJ Barnabas Healthcare System, Dr. Kozlov is positioned to lead geriatric mental health initiatives that are supported by rigorous, programmatic research. The proposed research, training, and mentorship plan will provide Dr. Kozlov with the data, skills and experience needed to become a leader in implementing and delivering innovative mental health care to older adults with serious illness and their caregivers.

Older adults with serious illness and their caregivers have high rates of anxiety and limited access to effective, non-pharmacological treatments. A recent National Academy of Medicine report recommended increased emphasis on disseminating and implementing evidence-based psychotherapies in order to have maximal public health impact. Through this work, I will identify a sustainable and potentially scalable dyadic intervention and delivery model to manage symptoms of anxiety in older adults with serious illness and their caregivers in primary care.