EPIDEMIOLOGY OF AGING (EPI 673) SPRING 2006 INSTRUCTORS: M. Jane, MPH, Ph.D. Research Assistant Professor of Pharmacy Practice, Medicine & Public Health University of Arizona Phone: 520-792-1450 x6692 Fax: 520-629-1801 e-mail: mohlerconsulting@theriver.com Office Hour: by appointment Zhao, Ph.D., MPH Associate Professor of Public Health University of Arizona Phone: 520-626-9011 Fax: 520-626-9900 e-mail: zchen@u.arizona.edu Office Hour: by appointment CLINICAL PRECEPTOR: Janet Campion, MD ROOM: Drachman Building (A123/125) TIME: Thursday 4:00 pm 7:00 pm PROPOSED CROSS-LISTED: Gerontology, Epidemiology, Public Health, Sociology, Pharmacy, Nursing RECOMMENDED COURSES: Public Health 576 (Introduction To Biostatistics) and Epidemiology 596A (Basic Principles in Epidemiology) COURSE DESCRIPTION: This is a course in the principles and methods of epidemiology as applied to the study of aging. It assumes basic knowledge of pathophysiology, and epidemiological and biostatistical methods. Major research issues in the epidemiology of aging, as well as the methods to study them, will be presented and discussed. This course will examine concepts including: Trends in aging and the health of aging populations; Health transition, and explanations and consequences of mortality decline; Determinants of health and survival; Distinctions between normal aging, disease and disability; Health promotion and primary, secondary and tertiary prevention, as applied to older persons; The epidemiology of selected diseases, syndromes and conditions common to old age;
The aged health care continuum and how different types of care/ health care systems are used in prevention, intervention and treatment, and supportive care and; Special concepts and key methodological considerations for conducting epidemiologic studies of older persons (e.g., cohort effects, agespecific rates, age standardization, use of proxies, appropriate measures, adjusting for comorbidities, and longitudinal analyses). Learning Objectives: By the end of the course students should be able to: 1) Describe trends in the epidemiology of aging. 2) Describe the patterns of occurrence of major etiologic (risk) factors and their relationship to diseases and conditions of the aged. 3) Locate, identify and appropriately use routinely collected data on aged disease occurrence. 4) Review and evaluate the scientific merit and feasibility of critical articles within the epidemiologic aging evidence-base, and synthesize information from a variety of demographic, gerontological and geriatric studies. 5) Describe basic pathophysiological and psychopathologic mechanisms related to aging 6) Select appropriate research instruments appropriate to operationalizing research questions in the aged. 7) Identify potential sources of bias, confounding and error in aging research. 8) Design effective studies by applying epidemiological methods across the spectrum of aging disease and conditions. 9) Design and write methodologically sound and well-organized written proposals. 10) Design and present well organized epidemiologic, clinical and research information accurately using professional media 11) Discuss ethical issues as they are related to performing research in the aged (autonomy and decision making; right to pain control, palliation and supportive care; Advanced directives, choice in dying and euthanasia; Allocation of resources; Health insurance and health care access; and Research in aging- human subjects protection.) FORMAT AND REQUIREMENTS: The course will be organized as a combination of lecture, seminar and external experience. participation is required. Each class will provide an overview of the week s topic presented by course instructors and invited clinicians and researchers in aging, with in-depth discussion of the week s readings, individualized work, or fieldtrips. Each student will be expected to have thoroughly read the material assigned each week and to participate in discussions. Preparedness, participation, class exercises and homework will account for 30% of the class grade. The Midterm will consist of a written proposal critique, mini-proposal or three-manuscript critique. This will account for 30% of the course grade. Students will be required to write a final review paper on a disease or condition of aging or an abbreviated NIH-style proposal narrative (8-10 single spaced pages) of their choosing (with instructor approval), and to present the content of this paper or proposal in a 20-30 minute PowerPoint presentation. This paper/proposal and presentation will account for the other 40% of the final grade.
COURSE MATERIAL: (recommended text) 1. Human Aging--Biological Perspectives (Second Edition), by Augustine Gaspar Digiovanna, McGraw-Hill Higher Education, a division of the McGraw-Hill companies. 2000. (Required for students without previous aging content) 2. Epidemiology for Public Health Practice (Third Edition), by Robert H. Friis, Thomas A. Sellers, An Aspen Publication, Jan 2004. (Required for students without previous epidemiologic course) Other selected readings will be based upon class assessment of competencies and areas of interest. SCHEDULE OF TOPICS: Epidemiological Methods in Aging Research A) Introduction to the Course Outline 1 January 12 Pre-Assessment Overview Profile of Older Adults Target Conditions of Aging B) Epidemiology Transitions Healthy People 2010 Ecological Approaches A) Aging Vs. Disease 2 January 19 Theories of Aging B) Biomarkers and How They Relate to 3 4 5 6 January 26 February 2 February 9 February 16 Theories of Aging A) Aging Quiz B) The Biology of Aging Anatomic, Physiological and Functional Alterations with Aging A) Study Design for the Aged Selection of study population Cross-sectional (define cases) Cohort (survival issues) Clinical trials (participation and follow-up) B) ADL and IADL--Functional Status A&B) Outcome Assessments for the Aged By proxy and cognitive impairment Sociodemographics Medical and Reproductive History Nutrition and PA A&B) Measuring HR-QOL Stini ( absent) and Coons ( absent) Homework for Following Week Theories of Aging Articles Biomarker Biology of Aging Reading ADL/IADL Measurement Exercise HR-QOL readings Risk Adjustment
7 8 February 23 March 2 A) Biostatistical Issues in Aging Research Controlling for Comorbidity: Risk Adjustment Controlling for Age, Cohort and Period Effect Loss to F/U B) Risk adjustment exercise A) Settings Across the Continuum B) Services Across the Continuum ( absent) Gooden Search of Evidence-based community services for elders Midterm proposal 9 March 7 A) Informed Consent in Aging Research (Cognitive Impairment & End of Life) B) Midterm Proposal Review Dahl Complete informed consent (based on proposal reviewed for midterm) Spring Vacation (March 12-20) A) Midterm Proposal informed consent Students 10 March 23 Discussion B) Predictive modeling A&B) Relationships and Aging Satariano 11 12 13 March 30 April 6 April 13 A) Mobility Impairment Research Osteoarthritis Balance and Gait Impairment Fractures & Falls B) Sexuality A) Cognitive Impairment Lecture B) Instruments in Measuring Cog Impair Boyer Campion 14 15 16 Final April 20 A) Chronic Co-morbidity in Frail Elders Intervention in Frail Elders B) Hospice Sensory Impairments A) Hearing B) Sight A) Healthy Aging B) Planning an Aging Longitudinal Cohort Fain TBA (Gore?) April 27 Harris Messer Thursday May 4 / (Finals May 6-May 13) Final: Student Presentations Student Presentations May 11 EVALUATION OF STUDENTS PERFORMANCE: Pre and Post Competency Assessment GRADING:
30% Preparedness, participation, homework, exercises 30% Midterm take home exam Proposal critique, 3-paper critique or mini-proposal 40% Final review paper on a disease or condition related to elderly (8-10 pages single spaced) or an NIH-type proposal narrative (8-10pages single spaced)