# UCSF Older Americans Independence Center

> **NIH NIH P30** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $403,172

## Abstract

ABSTRACT/SUMMARY
The clinical course of Alzheimer's disease and related dementia syndromes is marked by progressive cognitive
decline and functional disability. At end-of-life, hospice is a model of care that aims to ameliorate disability by
optimizing quality of life for people who are dying and their families. Virtually all research on end of life care of
persons living with dementia, especially in hospice, has focused on the dementia as a principal diagnosis and
proximate cause of death. Yet older persons at the end of life frequently have many co-existing conditions.
Many hospice enrollees whose indication for hospice care is a diagnosis other than dementia still have co-
existing dementia. The co-existence of dementia with hospice indications such as cancer or congestive heart
failure is likely to have profound implications for care and outcomes. To address the goals of the National Plan
to Address Alzheimer's Disease to enhance care quality and expand supports for caregivers and those with
dementia, we need to ensure that end-of-life quality of life is optimized for people with dementia, whether
dementia is the primary cause of death, or co-exists with another end of life condition.
The overarching goal of the UCSF Older Americans Independence Center (OAIC) is to prevent late-life
disability when possible, and to improve the quality of life of older people with disability when prevention is not
possible (amelioration). The proposed administrative supplement extends this goal specifically to vulnerable
older adults who have Alzheimer's disease and related dementias. This proposal fits within the conceptual
framework that guides the UCSF OAIC, which holds that care for elders with disability and dementia must
consider the wider medical and social context. We will leverage the expertise of the OAIC Data Analysis Core
and the nationally representative National Health Aging and Trends Study (NHATS) to shed light on an
understudied population: hospice enrollees with comorbid dementia.
Our proposal aims to quantify and compare characteristics and outcomes of older adults dying with comorbid
dementia while receiving hospice care for another condition contextualized in comparison to two groups: A)
hospice recipients with a primary diagnosis of dementia and B) hospice decedents with neither a primary
diagnosis of dementia nor comorbid dementia (e.g. without dementia). Data from the ADRD supplement would
provide critical preliminary data for a compelling NIA ADRD R01 application that uses NHATS to examine end-
of-life experiences and costs for persons dying in hospice with comorbid dementia. Our findings will help
identify opportunities to improve hospice care and policy for hospice decedents dying with or from dementia.
Such research aligns with NIA strategic directions for 2020 to support research that improves our
understanding of ADRD (goal D) and to inform intervention development and policy decisions (goal E).

## Key facts

- **NIH application ID:** 10119175
- **Project number:** 3P30AG044281-08S1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** KENNETH E. COVINSKY
- **Activity code:** P30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $403,172
- **Award type:** 3
- **Project period:** 2013-07-15 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10119175

## Citation

> US National Institutes of Health, RePORTER application 10119175, UCSF Older Americans Independence Center (3P30AG044281-08S1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10119175. Licensed CC0.

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