1. Improving Care for Older Adults with Serious Illness Amy S. Kelley, MD MSHS Brookdale Leadership in Aging, 2009 Fellow Mount Sinai School of Medicine June 8, 2011

2. Aims of Brookdale Fellowship “ I aim to be a leader working to promote appropriate, preference-guided medical decision making for older adults” Research skills and mentored experience National discussion regarding policy to improve care Brookdale network

5. Aim: Examine the relationship between functional status and hospital use in the last 6 months of life. Participants: 2,493 Health and Retirement Study (HRS) decedents Data: HRS, Medicare claims and the Dartmouth Atlas. Outcome: Total hospital days in the last 6 months of life. Methods: Two-part regression models Adjust for patient characteristics, regional resources and hospital care intensity (HCI).

6. Patient CharacteristicsHospital Days, (95% CI) Functional Status, reference group Independent Stable, Severe (4-6 ADL) impairments 3.50 (0.41,7.26) Declined, Independent to Moderate 4.72 (2.31,7.63) Declined, Moderate to Severe 7.94 (4.97,11.91) Declined, Independent to Severe 9.13 (6.85,11.50) Race, reference group non-Hispanic white African American 6.13 (3.58,8.83) Hispanic 5.03 (1.49,9.44) Medical Conditions Alzheimer’s/Dementia -2.89 (-4.18,-1.45) Chronic Kidney Disease 2.57 (0.94,4.30) Congestive Heart Failure 1.91 (0.51,3.50) Diabetes 2.48 (1.07,3.90) Stroke or TIA 2.10 (0.28,4.02) Relative Live Nearby -1.62 (-2.87,-0.47) Hospice Admission within 6 months-1.89 (-3.25,-0.70) Hospital Beds per 10,000 residents in HRR (mean+1std vs mean-1std) 1.42 (0.07,2.83) Specialists per 100,000 residents in HRR (mean+1std vs mean-1std) 2.02 (0.64,3.35) Hospital Care Intensity Index (mean+1std vs mean-1std)2.23 (0.62,3.87) Characteristics Associated with Hospital Days in Last 6 Months

8. HRS Investigators meeting Drs. Ken Langa and Ken Covinsky Future efforts to improve the HRS for use in aging and palliative care research.

10. Evidence-based training in communication skills Funded by the National Cancer Institute Anthony Back, Robert Arnold, James Tulsky and Walter Baile GERITALK Intensive Communication skills training for Geriatrics and Palliative Medicine fellows Pilot tested 2010-2011 Added to Fellowship Core Curriculum 2011

11. American Geriatrics Society Jr Faculty Research SIG steering committee Vice-Chair 2010-2011 Mentoring Program 2011 90+ Mentor-Mentee matches, biggest to date! Steering Committee Chair: 2011-2012 Liaison to AGS Research Committee

12. Future Directions “ I aspire to be a leader in promoting high-quality preference-guided health care to older adults with serious illness.” Career Development Award Independent Investigator National role in shaping policy to improve care Clinical work in Geriatrics and Palliative Care Translate research to clinical / educational programs Teaching / Mentoring

13. Thank You Brookdale Foundation, Leadership in Aging Fellowship Mentors : Catherine Sarkisian, MD MSHS Sean Morrison, MD Susan Ettner, PhD Neil Wenger, MD, MPH