PROJECT SUMMARY: The quantity and quality of aging in place after a hip fracture is poor, and these outcomes have not improved substantially over the last 20 years. The built environment in an older adult’s neighborhood has a strong influence on the quality of aging in place 4-6—yet has not been addressed in usual hip fracture care. This is especially concerning for older adults who live in socioeconomically disadvantaged neighborhoods, which have fewer resources to support high-quality built environment infrastructure. 5 Crumbling sidewalks and curbs in disadvantaged neighborhoods are associated with a 400% increase in mobility disability for older adults. 7 Older adults living in disadvantaged neighborhoods are also more likely to perceive their neighborhoods to be unsafe, and thus less likely to participate in physical activity outside. In this Beeson K76 award, Dr. Falvey proposes a novel model of ENgaging community and municipal seRvICes to promote high-quality aging in place after Hip fracture (ENRICH). ENRICH uniquely combines successful mobility interventions from prior work on hip fracture recovery, proactively identifying neighborhood- level barriers to recovery during the transition home after hip fracture, helping obtain needed services and equipment to bridge gaps related to the built environment, and provide targeted additional rehabilitation that focuses on community level mobility in a real-world environment after completion of usual care. The goal of ENRICH is promoting greater mobility in the community and allowing older adults to participate in community activities to improve the quality of aging in place. To tailor ENRICH for Baltimore, this project will 1) gather information on which factors (e.g. housing) most strongly impact the number of healthy days spent at home after hip fracture, using Medicare claims data linked with US Census Bureau data; 2 use this data to guide interviews with patient and clinician stakeholders to elucidate meaningful adaptations of ENRICH; and 3) pilot test the adapted ENRICH intervention with 24 older hip fracture patients living in disadvantaged neighborhoods. Completing these aims will help launch Dr. Falvey’s career as an independent clinician-scientist and leader in the fields of rehabilitation and aging. He proposes to gain complementary skills in longitudinal and mixed methods data analysis, patient-centered outcomes research, healthcare disparities, and conduct of clinical trials. His mentorship team, led by Dr. Jay Magaziner, is well-positioned to help him complete the study successfully and support his career development.

PROJECT NARRATIVE The public health significance of our proposed ENRICH intervention is high, given the aging population and the poor outcomes experienced by older adults recovering from hip fracture. The patient-centered development and implementation of the ENRICH program represents an important paradigm shift in hip fracture rehabilitation, and provides a framework for promoting high quality aging in place for other disabled older adult populations.