Healthy Aging: Optimizing Physical and Mental Functioning Across the Aging Continuum -- Cycle 3 2023

This reissued Healthy Aging Targeted PCORI Funding Announcement seeks to fund high-quality, comparative clinical effectiveness research (CER) projects that focus on optimizing physical and mental functioning for community-dwelling older adults and their caregivers.

Research Initiative Highlights

By 2060, the number of Americans over 65 is projected to reach around 95 million, making up almost a quarter of the U.S. population. The number of people of color among the older adult population is also projected to increase significantly. Many older adults live with multiple chronic conditions, with a disproportionately greater burden experienced by people of color. Most older adults, including those with multiple chronic conditions, prefer to stay in their homes and communities for as long as possible, a concept referred to as “aging in place.” Family members or close friends often serve as the primary caregiver to older adults and play a critical role in helping them age in place by directly addressing their care needs and helping them navigate a fragmented health care system. As the needs of older adults become more complex, the caregiving role also intensifies, often resulting in a detrimental impact on caregiver well-being. Currently, the health care system is not well-equipped to address the complex care needs of the rapidly growing and diverse older adult population in the United States.

The Healthy Aging Targeted PFA will solicit applications for CER studies that focus on different phases of the aging continuum and aim to achieve one or more of the following four goals:

• maintaining function and independence
• facilitating chronic disease management
• supporting individuals with functional impairment
• reducing caregiving burden and improving caregiver quality of life

The different phases of the aging continuum include on one end the healthiest older adults who have no chronic conditions, followed by those who may have one or two well-managed conditions. Their main goal is to maintain function and independence. Next on the continuum are older adults with chronic or multiple chronic conditions whose primary health focus is to manage their conditions and slow or reverse progression, followed by those with significant functional impairment (physical and/or cognitive) who are at higher risk for adverse events, require more support and are likely to have higher health care utilization and expenditures. Finally, at the other end of the continuum are seriously ill older adults who may need end-of-life care.

Applications may focus on populations in different phases of the aging continuum except for those at the two extremes, i.e., the healthiest of older adults with no chronic health condition and those with serious/advanced illness who require end-of-life care.

For this reissuance, PCORI especially encourages applications focused on improving the health care and health outcomes for older adults with multiple chronic conditions and those with sensory impairments such as loss of vision or hearing, as well as care models for individuals living with Alzheimer’s Disease and Related Dementias (ADRD). Applications of particular interest are those examining interventions that emphasize caregiver needs as well as those focusing on delivery models that integrate primary and specialty care as well as community-based services. PCORI further encourages applications focused on populations benefiting from a health equity approach, including those who are underserved, underrepresented or historically excluded.

Applications evaluating interventions delivered primarily in institutional settings such as hospitals and nursing homes will be considered non-responsive to the funding announcement.

Special Areas of Emphasis

While the funding announcement is open to many comparative clinical effectiveness research questions, the following Special Areas of Emphasis (SAEs) are of particular interest to PCORI:

• Functional Sensory Impairment
  PCORI is interested in patient-centered comparative clinical effectiveness research (CER) projects focused on older adults who experience sensory impairments associated with aging—more specifically, hearing or vision impairment. Areas of interest include studies proposing to compare different screening strategies to promote early detection and management strategies, both of which address important decisional dilemmas faced by patients and their caregivers. Interventions in diverse healthcare settings and within underserved populations experiencing disparities in both access and in outcomes are also especially encouraged.
• Care Coordination/Models of Care for Older Adults with Multiple Chronic Conditions
  Older adults living with multiple chronic conditions have complex care needs that are frequently addressed through a variety of healthcare encounters without a centralized, patient-centered approach. These fragmented encounters with both the formal and informal healthcare system often lead to missed prevention and treatment opportunities that result in poor health outcomes. PCORI is interested in patient-centered comparative clinical effectiveness research (CER) studies focusing on care coordination approaches and other models of care delivery that leverage system-level integration of primary and specialty care as well as community-based resources to facilitate the management of multiple chronic conditions for older adults and their caregivers and to improve health outcomes.
• Interventions for Caregivers of Older Adults Living with Alzheimer’s Disease & Related Dementias (ADRD)
  Older adults living with ADRD can experience significant impairment in their physical and mental functioning over time as ADRD are identified, diagnosed and treated, and as they progress. Varied combinations of caregivers assist with the increasing needs of older adults as they move through these stages, and caregivers themselves experience changes in their own health and well-being as a result. PCORI is interested in studies dually focused on targeting people with ADRD and their caregivers that address caregiver burden, education and health system supports with patient- and caregiver-centered outcomes. Studies that focus on populations that experience disparities in caregiving needs (such as unhoused individuals, low literacy, rural) and ADRD diagnosis (such as Latino/a, African American) are especially encouraged.

The purpose of identifying these SAEs is to encourage submissions to these areas, not to limit submissions to these topics. Applicants addressing a SAE should identify the area that is best associated with their research approach.

Applicants are strongly encouraged to propose individual or cluster randomized controlled trials; however, well-specified natural experiments will also be considered. Applicants are required to pay special attention to issues of intervention implementation with an aim of facilitating widespread uptake of findings after completion of the study. Toward that end, hybrid type I and hybrid type II designs may also be considered appropriate. Applicants should propose well-justified outcomes that are clinically meaningful, considered important by patients and/or their caregivers and can be impacted upon by interventions evaluated in CER studies ranging from three to five years in duration.

For questions regarding this funding announcement, please reach out to [email protected].