PROJECT SUMMARY Increasing evidence suggests that frailty—a common problem of old age characterized by reduced physiologic reserve and inability to tolerate acute stressors—may determine inter-individual variability in outcomes after drug therapy and surgical procedures among older adults. While this understanding supports the idea of personalizing treatments based on a patient's frailty level, there is little empirical evidence on how to use frailty information to maximize benefits or avoid harms in older patients. There is a pressing need to understand how frailty affects the outcomes of various medical and surgical treatments. The candidate is a geriatrician and epidemiologist who has established a robust patient-oriented research program on frailty, geriatric pharmacoepidemiology, and prediction of functional outcomes after surgery at Hebrew SeniorLife Marcus Institute for Aging Research. He is also a dedicated mentor of trainees and junior faculty, who have published a number of peer-reviewed papers and have successfully competed for training and career development awards in aging research. The candidate's research program has a long-term objective to improve care of older adults with frailty by generating high-quality evidence, training future clinicians and researchers, and changing health systems and policy. Toward this goal, his current NIA-funded research focuses on use of a frailty index for Medicare data to determine who should be treated with a drug therapy or a surgical procedure and who should not due to lack of benefit or increased likelihood of harm. This K24 Mid-career Investigator Award proposal will allow the candidate to develop a formal mentoring program, expand his research, and become a more effective mentor and leader. The specific aims are to: 1) develop a mentoring program in frailty research for early-stage and new investigators from diverse clinical and research backgrounds; 2) conduct high-quality research to determine heterogeneity of treatment effects by frailty for a broad range of medical and surgical interventions; and 3) acquire new research skills in implementation science and enhance capacity in mentorship and leadership within and outside geriatrics. The outstanding collaborative environment of Hebrew SeniorLife and other Harvard-affiliated institutions will provide resources (e.g., various data sources, including Medicare data, computing environment, and career development training courses) and support (e.g., data scientists and research methodology experts) needed to accomplish the proposed activities. The advancement of the candidate's mentoring and research program, supported by this K24 award, will foster growth of well-trained clinician investigators in aging research and accelerate adoption of personalized medicine for older adults across medical and surgical specialties based on a patient's frailty level.

PROJECT NARRATIVE This Mid-Career Investigator Award aims to develop a formal mentoring program, expand high-quality patient- oriented research on frailty and outcomes of medical and surgical interventions, and cultivate Dr. Kim's capacity as a mentor and leader in aging research. This is relevant to public health because the growth of well-trained clinician investigators and new evidence will accelerate adoption of frailty in clinical decision-making for medically complex older adults. Thus, it accomplishes the National Institute on Aging's missions and initiatives by promoting personalized care to improve the health status of older adults.