Each year, CHABLIS funds a select number of projects that advance the center’s mission of examining how demographic and economic factors influence individual healthy aging behaviors (HABs) and outcomes across the life course. You may learn more about the 2021–2022 and 2020–2021 pilot projects below, or learn how to apply for pilot funding here.

2023-24 Pilots:

Adaptive Assessment of Cognition and Metacognition in Aging

The project has two major goals. The first is to build the first-ever computerized adaptive test to measure global cognitive ability in older adults. This instrument should increase measurement precision and efficiency compared to current gold-standard measures (e.g., MoCA), significantly improving cognitive assessment for basic research and healthcare applications. The second goal is to further develop a measure of metacognitive awareness – or personal insight into one’s own cognitive ability. Metacognitive awareness varies across individuals and can differ from overall cognitive ability. A lack of awareness (“anosognosia”) in the cognitively impaired has been related to risky decisions and behaviors (e.g., financial, or medical decision making, dangerous driving), but these links and how social factors may play a role have been under explored in cognitively normal older adults.

Examining Geriatric Assessment, Androgen Deprivation and Biomarkers in Prostate Cancer Treatment

The incidence of advanced prostate cancer is increasing among older adults. Metastatic hormone-sensitive prostate cancer (mHSPC) is typically treated with androgen deprivation therapy (ADT) injections augmented with oral androgen receptor signaling inhibitors (ARSIs), although ARSI augmentation is associated with a 60% risk of any high-grade toxicity and a near 30% risk of serious adverse events (SAEs). To improve risk assessment for adverse outcomes and optimize the health of older adults with mHSPC needing ADT, Dr. Mir will lead an observational cohort study that will recruit 30 predominantly minority mHSPC patients aged 65 years and older who are old and planning to undergo ADT/ARSI treatment. The pilot will collect Cancer Aging Research Group (CARG) toxicity scores, wrist accelerometry data, and initial body composition data via wearable bioimpedance analysis (BIA) to identify potential risk factors for SAEs.

Language Use within the AD/ADRD Care Networks of Latino Older Adults: A Pilot Test of New NSHAP

Many Latinos are bilingual, and for those caring for family members living with Alzheimer’s Disease and related dementias (AD/ADRD), language barriers can severely compromise their caregiving efforts. Through the National Social Life, Health, and Aging Project (NSHAP), this pilot will develop and pilot two new instruments to better understand language use and its implications for caregiving. The first instrument will offer culturally accessible prompts to identify whether a person is giving care to or receiving care from someone with AD/ADRD and who else is involved in that care. This prompt will be used to produce respondent-specific care network maps using an open source network mapping tool. The second instrument will provide follow-up questions on the perceived language proficiency and community language use among members of the care-providing network.

Environment Exposures: Behavioral, Social, and Health impacts on older US Adults in the National Social Life, Health, and Aging Project

Exposure to air pollution is associated with increased incidence of many acute and chronic diseases, the burden of which is especially high among older adults. Understanding how air pollution impacts older adults requires us to quantify the amount of toxic environmental substances to which people are exposed. The goal of this pilot is to test feasibility of remote collection of direct indoor pollution assessment for NSHAP study respondents, collection of address histories from respondents to aid longer term/life course assessment of exposures, and measurement of airway function. This pilot is expected to lead to the generation of high quality longitudinal indoor pollution data and will help facilitate future research studying the effects of environmental exposures on a wide range of healthy aging behaviors including mobility, exercise, social connection, and physical and mental health.

Characterizing Fatigability, Fatigue, and Activity in Hospitalized Older Adults

Fatigue is a common and frequent symptom in older adults, and is associated with increased mortality, decreased activity, and functional capacity. The effect of fatigue on reducing activity is particularly deleterious for older adults during hospitalization since it results in sedentary behavior, deconditioning, and reduced exercise capacity. While clinicians might consider a variety of hospital-based interventions to reduce fatigue in order to promote healthy aging in older adults after hospital discharge, there is a lack of high-quality data to guide them in this practice. To address this gap, this pilot will measure fatigability, fatigue, and activity in older adults during and after hospital discharge to: 1) characterize the clinical/demographic predictors of changes in fatigability from hospitalization to 30 days post-discharge in older adults, 2) identify reliable and scalable instruments for measuring fatigability in hospitalized older adults, and 3) inform interventions aimed at reducing fatigue and/or increasing activity in hospitalized older adults.

2022-23 Pilots:

Assessing Health and Burden Among Caregivers of Older Adults at High Risk for Hospitalization

Dr. Kareti’s pilot project has three main goals: to develop practical strategies for identifying and recruiting caregivers of older adults at high risk of hospitalization (OHH), use cognitive interviewing techniques to gain insight about the experiences of caregivers of OHH and refine survey instruments, and to enhance our understanding of their baseline well-being and support needs.

Sleep Disturbance and Depressive Symptoms in People Living with Mild Dementia: The mechanistic role of cortisol

An estimated 6.2 million Americans are affected by Alzheimer’s Disease and Related Dementias and the number is projected to grow to almost 12 million by 2040. Distressing symptoms such as sleep disturbance and depression are commonly reported in people living with mild dementia or mild cognitive impairment (PLwMD). Dr. Dong is investigating the cross-sectional and longitudinal association between sleep disturbances, depressive symptoms, and cognitive decline, and also examining the interrelationships among sleep disturbances, cortisol levels, and depression in PLwMD.

Piloting the Mind Over Matter Program for Urinary and Bowel Incontinence in Chicago

‘Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM),’ is a community-based behavioral modification workshop for urinary and bowel incontinence. Dr. Iyer (urogynecology) and Dr. Thompson (geriatrics) are piloting the MOM program at 2 south side Chicago locations to improve urinary and bowel incontinence in older women with this community-based intervention focused on healthy aging behaviors.

The Effect of the Doctor-Patient Relationship on Advance Care Planning and End of Life Care

Improving advance care planning (ACP) and end of life (EOL) care is an important part of efforts to improve population health for those aging in America. Tate investigates how the physician-patient relationship and trust in physicians, as demonstrated by the Comprehensive Care Physician (CCP) Program, may have impact ACP and EOL care delivery among patients who face additional socioeconomic and psychosocial barriers.

Developing a Longitudinal Measurement Metric and Risk Prediction Model to Identify Medicare Patients at High Risk of Hospitalization with Persistent Cost-related Medication Nonadherence (CRN) and Improve Insurance Coverage

There is a growing body of evidence in recent years that even after the implementation of Medicare Part D, cost-related medication non-adherence (CRN) has persisted, or even worsened, among the sickest Medicare patients, including those with multiple chronic conditions, depression, and stroke survivors. Zhang’s pilot aims to develop a new measurement metric of persistent, transient, and intermittent CRN over time and create a risk prediction model using a wide range of predictors for persistent and transient CRN. Identifying such patients will enable more effective policy intervention in terms of targeting and costs, improve access to health care and insurance coverage, and ultimately improve health outcomes for millions of Medicare beneficiaries who struggle to pay for critically important medications.

2021-22 Pilots:

Universal Early Screening For Alzheimer’s Disease and Related Dementia (ADRD) Via Automated Deep Pattern Discovery in Past Medical Encounters

A barrier to accurate screening for ADRD or cognitive impairment signaling early stage AD  is the limitation of current diagnostic and prognostic modalities. Chattopadhyay’s pilot project aims to design a reliable screening tool for ADRD up to 10 years in the future, enabled by novel learning algorithms that analyze deep comorbidity patterns emerging in the longitudinal history of past medical encourages of individual patients.

Sensory Health Trajectories Among Older Adults in the U.S.

A growing area of research recognizes the significance of declines in olfactory functioning in predicting numerous age-related health conditions and the importance of identification of factors that contribute to the impairment of olfaction. Goldman is using data from the National Social Life, Health and Aging Project (NSHAP) to examine how structural features and dynamics of older adults’ social networks and neighborhoods shape trajectories of olfactory functioning.

Circadian Biology of the Endocannabinoid System in Aging

Although the literature shows that aging is associated with well-documented alterations in the circadian system, including reduced exposure to both external and internal synchronizing agents, the impact of circadian misalignment on cardometabolic (CM) rate risk among older adults is unknown. Hanlon is studying whether the 24-hour profile in circulating endocannibinoids (eCBs), which aid in modulation of appetite, glucose metabolism, and reward driven eating, is modified in older adults when compared to middle aged adults. Hanlon further seeks to study whether a dietary intervention may impact eCB rhythm and CM risk.

Comparison of Hospital-Associated Disability (HAD) in Elderly Hospitalized Patients Before and During COVID-19 Pandemic

For older adults, the effects of hospitalization superimposed on the normal effects of aging can be a powerful accelerator of that path and result HAD. The COVID-19 pandemic is also likely to increase the risk for development of HAD in hospitalized patients with and without COVID-19. Martinez’s work will examine the prevalence of HAD among hospitalized older adults during the pandemic and study the the effectiveness of the implementation of a clinical decision support tool that guides physical therapy (PT) referral decisions on appropriateness of PT in context of the pandemic.

Using 24-hour Ambulatory Blood Pressure Monitoring (ABPN) to Examine Association Between Blood Pressure Phenotypes and Cognitive Impairment among African Americans

Prior studies using 24-hour ambulatory blood pressure (BP) monitoring (ABPM) found that associations between specific BP phenotypes and increased small vessel cerebrovascular disease was linked with cognitive impairment. However, African Americans were largely excluded from these studies. Price aims to understand the prevalence of BP phenotypes among a sample of African American older adults, and determine if these phenotypes are associated with cognitive impairment in this population.

2020-21 Pilots:

Health Care Spending, Mortality and the Macroeconomic and Distributional Effects of Health Inequality at Older Ages

In existing work, Kaplan and colleagues have analyzed the joint economic and health implications of different polices by integrating an expanded SIR model of virus spread into a macroeconomic model with realistic income and wealth inequality, as well as occupational and sectoral heterogeneity. However, this work has so far not considered the role of age as a dimension of heterogeneity. The aim of this pilot project is to fill this gap by expanding both the epidemiological and economic blocks of the model to include older people.

The Rise and Consequences of Alternative Work Arrangements for the Aging Workforce

Koustas’ recent work has found rates of self-employment and gig work to be higher among older workers. As gig workers will not obtain health insurance through their gig employer, documenting whether they obtain health care coverage for themselves and their dependents through other means is important for contextualizing the welfare implications of gig work and for understanding the labor supply of gig workers. The aims of this pilot project are to clean and process new data elements, and to explore and develop new research designs to answer questions around gig work and health insurance in the United States.

The Significance of Race, Skin Color, and Discrimination for Health and Aging

Perceived discrimination, especially ethnoracial discrimination, is a significant predictor of the incidence and/or severity of a variety of health outcomes. However, most studies that focus on perceptions of discrimination between-groups fail to define what is meant by ‘racism,’ and rarely consider alternative measures of ‘race’ beyond dichotomous self-identification measures. Monk’s prior research shows that disparities in socioeconomic status among blacks associated with their skin tone rival or exceed SES disparities between blacks and whites as a whole. This pilot study uses innovative measures of skin color, perceived discrimination, and ethnoracial identity to examine their role in shaping health and aging among older adults.

Impact of Pharmacogenetics in a High Utilizer Program for Older Adults at Increased Risk of Hospitalization

Progress in pharmacogenomics (PGx) has led to identification of genetic variants that impact response or toxicity for hundreds of drugs. To address barriers to implementation, O’Donnell has developed a genomic prescribing system (GPS), which incorporates preemptive PGx test results and translates patient-specific genotypes into concise, real-time guidance integrated into the University of Chicago Medical Center’s (UCM) EPIC electronic health record. This pilot will evaluate whether the Comprehensive Care Physician (CCP) Program, designed to improve care for older adults at increased risk of hospitalization by giving them a physician who will care for them in and out of the hospital, may provide a stronger setting in which to assess the effect of the GPS system for PGx.