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 is 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 has three specific aims:

1. To determine the predictors of mortality.
2. To measure functional deterioration and hospitalization.
3. To develop risk adjustment models for each of these outcomes.

A fourth aim is to measure health status transitions and resource use in the last year of life.  A fifth aim is 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 short-term career objectives are:

• To expand the scope and depth of his independently funded research program on outcomes in frail elders.
• To extend his skills in quantitative methods and learn new qualitative methods.

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 has developed an extensive program of research focused on the needs of frail and vulnerable elders. He has published the results of much of his research. His results suggest that a substantial number of caregivers suffer from many symptoms of depression. Further, he has found that hospital costs are higher in patients with lower Activities of Daily Living (ADL) functioning.

Future Plans: Dr. Covinsky will continue conducting work focused on understanding the determinants of outcomes in older populations. This will include work examining the impact of functional and health status measures on outcomes in vulnerable elders.

Highlights and Specific Accomplishments:

• Associate Professor of Medicine, University of California, Berkeley and 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, et al. 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:M253-9.
• 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;161:1703-8.
• Walter LC, Covinsky KE. Cancer Screening in Elderly Patients: A Framework for Individualized decisionmaking. JAMA 2001;285:2750-6.
• Walter LC, Brand RJ, Covinsky KE, et al. 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, et al. 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;16:793-9.
• 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, Covinsky KE, et al. Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA 2002;287:2090-7.
• 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, Covinsky KE, et al. 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:M449-454.
• 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, et al. 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, et al. 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;51:50-5.
• Lindenberger EC, Landefeld CS, Covinsky KE, et al. Unsteadiness reported by older hospitalized patients predicts functional decline. Journal of the American Geriatrics Society 2003;51:621-6.
• Mehta KM, Yaffe K, Covinsky KE, et al. 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:M461-467.
• Covinsky KE, Newcomer R, Dane CK, et al. 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;52:712-8.
• 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;116:174-8.
• 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;140:681-8.
• 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, et al. 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, et al. 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;51:451-8.
• Covinsky KE, Eng C, Lui LY, et al. The last two years of life: Functional trajectories of frail older people. Journal of the American Geriatrics Society 2003;51:492-8.
• Covinsky KE, Newcomer R, Dane CK, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine 2003;18:1006-14.

AHRQ Research Portfolios: Care Management: Long-term Care; Training.
AHRQ Goals: Safety and Quality

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