• 8 week mentored research experience with a top expert in aging related research
  • Clinical epidemiology
  • Health services research
  • See list below of 2006 mentors and potential projects
• Prestigious national program with training site here at UCSF
• Funded by NIH and several philanthropists
• Weekly clinical experiences in geriatrics
• Present your research at the national meeting of the American Geriatrics Society in May, 2007 (Seattle)
• Generous stipend (estimated at $3462)

Additional information and application at: http://www.afar.org/medstu.html

Deadline: February 7th, 2006

If you want to apply or have any questions please contact Elena Cherkasova at 415-221-4810, ext 4240 or Elena.cherkasova@med.va.gov

Mary-Margaret Chren, MD

I am part of a multidisciplinary research group of UCSF faculty that focuses on health services research, particularly research aimed at understanding, measuring, predicting, and improving complex aspects of health of older patients, such as their experiences and preferences. I am particularly interested in effectiveness research, especially the extent to which treatments improve both survival and the experiences of patients with nonfatal cancers common in older persons, such as skin cancer and prostate cancer. For example, we have developed and tested measures of disease-specific quality of life, and are currently conducting a large cohort study evaluating the effectiveness of treatments for nonmelanoma cancer (including quality of life). Similarly, we have studied ethnic differences in the experiences of patients with prostate cancer, and are designing and testing a measure of patients' preferences for treatments for prostate cancer. A student who spent time doing research in our group would work with the tools of this kind of research, including psychometrics, clinimetrics, and statistical analysis. Depending on a student's interest, study topics could include the experiences of patients with nonfatal cancers or skin diseases, among others, and study designs could involved both primary data collection, secondary data analysis, or a structured literature review.

Louise Walter, MD

Impact of Health Status on Colorectal Cancer Screening in Older Adults

The goal of this project is to improve our ability to target colorectal cancer screening to healthy elderly veterans who may reasonably benefit and to avoid screening in unhealthy elderly veterans for whom the burdens outweigh the potential benefits. Because persons with limited life expectancies may be harmed by screening, and because life expectancy is better predicted by health status than by age alone, most colorectal cancer screening guidelines recommend screening decisions take into account an older person’s health status. However, it is unclear to what extent colorectal cancer screening is actually targeted to healthy older persons and avoided in unhealthy older persons with limited life expectancies. This study describes how patterns of use and outcomes of colorectal cancer screening vary according to health status among older veterans. This project will provide information necessary to design guidelines, interventions, and quality indicators that encourage screening healthy elderly veterans who are often under-screened and discourage screening unhealthy elderly veterans who are more likely to be harmed than benefit. This is an ongoing study in which students may participate in a structured review of the literature, in analyses of existing data, and in potentially reviewing some medical charts to understand why some healthy elderly veterans are not screened while some unhealthy elderly veterans are screened.

Sara Knight, PhD

Improving assessment of patient preferences in localized prostate cancer care

Disproportionately affecting the elderly, prostate cancer has special relevance to health care delivery in the VA system with Veterans age 65 and over reaching a peak of 9.3 million in the year 2000. Treatment options differ in side effects, but no alternative is clearly advantageous in prolonging survival. Thus, patient preferences are critical considerations in the choice of treatment for localized prostate cancer. From our previous work, we have concluded that, first, patients desire to have their preferences considered in prostate cancer care, second, there are serious inadequacies in clinicians’ understanding of patient preferences, and, third, there is inadequate evidence for the validity and reliability of current preference assessment methods to support their use by clinicians and patients in individual decision making. These conclusions have led to the current project. Our immediate objective in this work is to develop and test a practical and psychometrically strong method to assess patients’ preferences. To accomplish these goals, we will conduct incremental studies using both qualitative and quantitative methodologies, including focus groups, structured cognitive interviews, and psychometric studies. This project is ongoing. A student working with our investigative team during the summer of 2006 will participate in the analysis qualitative data, collection of survey data from study participants, and development of structured literature review. These experiences will provide an opportunity for a student to learn about the construction and validation of a new measure and to develop expertise in both qualitative and quantitative methods.

Michael Steinman, MD

I would be interested in working with a student on research related to the quality of medication prescribing in older patients. A series of projects are underway and I will work with an interested student to indentify one will best suit the time frame and student needs for the summer of 2006. Likely projects would include secondary analysis of existing data, and would include opportunities for the student to perform a review of the pertinent medical literature and design, conduct, and interpret the data. Data sources may include national data sets of outpatient office visits, such as the National Ambulatory Medical Care Survey, or other research datasets such as data from the VA Enhanced Pharmacy Outpatient Clinic study. Research questions could include: Do recommendations for improving medication use differ with and without consultation with the patient? What factors predict inappropriate medication use? What percentage of office visits by elders are for acute vs. chronic problems, and is this related to the patient’s insurance status? What percentage of office visits by elders are related to adverse medication events?

Sandra Moody-Ayers, MD

Potential projects include the following:

1. End-of-life decision-making
a. This project will address whether ethnic-racial differences in choice for life-prolonging interventions minimize when goals of care discussions include a broad range of palliative treatment approaches and whether sociocultural factors (e.g., socioeconomic status and experiences of prior unfair treatment or discrimination in society and in the healthcare system), health status factors, and patient’s values and beliefs about end-of-life care influence end-of-life decisions.
b. A potential student project would be pilot testing questionnaire, and potentially collecting preliminary data for a paper.

2. Secondary data analysis
a. Using the Health and Retirement Study dataset examine the relationship between veteran status and race-ethnicity and health outcomes—this project could be preliminary data/study for a grant

Kenneth Covinsky, MD, MPH

We conduct research examining the broad determinants of health outcomes in older adults. We are particularly interested in understanding the determinants of disability in the elderly and the impact of disability on other health outcomes. We currently have a series of projects underway that use population-based datasources to understand the determinants of health outcomes such as disability in the elderly. Our most recently funded project seeks to understand the impact of mid-life symptoms of arthritis and back pain on late life disability. A student working with us in the summer of 2006 would have the opportunity to participate in this project. Students would learn about the epidemiology of disability in the elderly, as well as develop skills in data analysis and interpretation.