Summaries of Independent Scientist (K) Awards

Covinsky, Kenneth

Institution: Regents of the University of California
Grant Title: Comprehensive Outcomes of Frail Elders in the Community
Grant Number: K02 HS00006
Duration: 5 years (2000-2005)
Total Award: $496,800

Project Description: The goal of this research was to identify the determinants of comprehensive health outcomes (mortality, functional change, hospitalization, and quality of life) in frail nursing home eligible patients who continue to live in the community. The project had five aims:

1. To determine the predictors of mortality.
2. Functional deterioration and hospitalization.
3. To develop risk adjustment models for each of these outcomes.
4. To measure health status transitions and resource use in the last year of life.
5. To understand the determinants of quality of life, from the perspective of frail elders.

Career Goals: The candidate is a general internist and health services researcher committed to outcomes research in frail and older patients with chronic illness. His long-term objectives are to be a national leader in health services research in older people, to develop a geriatric health services research laboratory, and to translate his initial research findings to future studies to measure and improve the quality of care of frail elders.

Progress to Date: Dr. Covinsky completed his K02 grant in 2006. The project included a series of studies, all focused on identifying the determinants of outcomes in frail elders. The primary data source was DataPACE which contained comprehensive information on 5,982 patients at the original 12 Program of All-Inclusive Care for the Elderly (PACE) demonstration sites. A series of analyses was conducted that addressed a wide range of outcomes relevant to the care of frail elders, including functional decline, mortality, hospitalization, falls, and caregiver outcomes. Go to publications below for more detail.

Highlights and Specific Accomplishments:

• Associate Professor of Medicine, University of California San Francisco (UCSF).
• Society of General Internal Medicine (National Council, 2002-2005).
• Gerontological Society of America.
• New York Hospital Fund Families and Health Care Advisory Panel.
• Editorial Board, Annals of Internal Medicine (2001-2004).
• Paul Beeson Faculty Scholar in Aging Research.

K-Generated Publications:

Covinsky KE, Kahana EM, Kahana B, Kercher K, Schumacher JG, Justice AC.  History and mobility exam index to identify community dwelling elderly persons at risk of falling. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences 2001;56:M253-M259.

Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K.  A prospective study of physical activity and cognitive decline in elderly women: Women who walk. Archives of Internal Medicine 2001. 161:1703-08.

Walter LC, Covinsky KE. Cancer screening in elderly patients: A framework for individualized decision-making. JAMA 2001. 285:2750-56.

Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 2001. 285:2987-94.

Covinsky KE, Eng C, Liu LY, Sands LP, Sehgal AR, Walter LC, Weiland D, Eleazar GP, Yaffe K. Reduced employment in caregivers of frail elders: Impact of ethnicity, patient clinical characteristics, and caregiver characteristics. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences 2001. 56A:707-13.

Walter LC, Eng C, Covinsky KE. Screening mammography for frail older women: What are the burdens? Journal of General Internal Medicine 2001. 16:779-84.

Steinman MA, Sands LP, Covinsky KE. Self-restrictions of medications due to cost in seniors without prescription coverage: A national survey. Journal of General Internal Medicine 2001. 16:793-99.

Covinsky KE, Covinsky MH, Palmer RM, Sehgal AR. Serum albumin concentration and clinical assessments of nutritional status in hospitalized elders: Different sides of different coins? Journal of the American Geriatrics Society 2002;50:631-37.

Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, Covinsky KE. Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA 2002;287:2090-97.

Mehta K, Yaffe K, Covinsky KE. Cognitive impairment, depressive symptoms, and functional decline in older people. Journal of the American Geriatrics Society 2002;50:1045-50.

Sands LP, Yaffe, K, Liu L, Stewart A, Eng C, Covinsky KE. The effects of acute illness on ADL decline over 1 year in frail older adults with and without cognitive impairment. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences 2002;57:M449-54.

Tan EJ, Lui L, Eng C, JA, Covinsky KE. Differences in mortality of black and white patients enrolled in the in the program of all-inclusive care for the elderly (PACE). Journal of the American Geriatrics Society 2003;51:246-51.

Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS. Loss of independence in activities of daily living in older adults hospitalized with medical illness: Increased vulnerability with age. Journal of the American Geriatrics Society 2003;51:451-58.

Covinsky KE, Eng C, Lui LY, Sands LP, Yaffe K. The last two years of life: Functional trajectories of frail older people. Journal of the American Geriatrics Society 2003;51:492-98.

Walter LC, Lui L, Eng C, Covinsky, KE. Risk of hip fracture in disabled community-living older adults. Journal of the American Geriatrics Society 2003;51:50-55.

Lindenberger EC, Landefeld CS, Sands LP, Counsell SR, Fortinsky RH, Palmer RM, Kresevic DM, Covinsky KE. Unsteadiness reported by older hospitalized patients predicts functional decline. Journal of the American Geriatrics Society 2003;51:621-26.

Mehta KM, Yaffe K, Langa KM, Sands L, Whooley M, Covinsky KE. Additive effects of cognitive function and depressive symptoms on mortality in older community-living adults. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences 2003;58:M461-67.

Covinsky KE, Newcomer R, Dane CK, Sands LP, Yaffe K. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine 2003;18:1006-14.

Holroyd-Leduc J, Mehta KM, Covinsky KE. Urinary incontinence and its association with death, nursing home admission, and functional decline. Journal of the American Geriatrics Society 2004;52:712-18.

Walter LC, de Garmo P, Covinsky KE. Association of older age and female sex with inadequate reach of screening flexible sigmoidoscopy. American  Journal of Medicine  2004;116:174-78.

Walter LC, Davidowitz NP, Heineken PA, Covinsky KE. Pitfalls of converting practice guidelines into performance measures: Lessons learned from a VA performance measure. JAMA 2004;291:2466-70.

Walter LC, Lindquist K, Covinsky KE. Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age. Annals of Internal Medicine 2004;140:681-88.

Carey EC, Walter LC, Lindquist K, Covinsky KE. Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. Journal of General Internal Medicine 2004;19:1027-33.

Ku KL, Covinsky KE, Sands LP, Fortinsky RH, Counsell SR, Landefeld CS. Reports of financial disability predict functional decline and death in older patients discharged from the hospital. Journal of General Internal Medicine 2005. 20:168-74.

Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS. Loss of independence in activities of daily living in older adults hospitalized with medical illness: Increased vulnerability with age. Journal of the American Geriatrics Society 2003;51:451-58.

Covinsky KE, Eng C, Lui LY, Sands LP, Yaffe K. The last two years of life: Functional trajectories of frail older people. Journal of the American Geriatrics Society 2003;51:492-98

Covinsky KE, Newcomer R, Dane CK, Sands LP, Yaffe K. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine 2003;18:1006-14.

Sands LP, Wang Y, McCabe GP, Jennings K, Eg C, Covinsky KE. Rates of acute care admissions for frail older people living with met versus unmet activity of daily living needs. Journal of the American Geriatrics Society 2006;54:339-44.

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