PROJECT SUMMARY Palliative care focuses on improving quality of life for people with serious illness and their family caregivers at any stage of illness and aligning medical treatments with a persons' values and goals. Older adults with serious illnesses such as heart failure (HF) or chronic obstructive pulmonary disease (COPD) have numerous palliative care needs. However, palliative care is often provided late in illness by palliative care specialists, near the end of life. In addition, palliative care is a limited resource that is not available to many of the patients with HF or COPD and their family caregivers, especially in urban poor and rural settings. Furthermore, many older adults with HF or COPD have comorbid cognitive impairment and dementia which are associated with worse outcomes. In prior work, I tested the effect of early palliative care interventions for adults with HF or COPD. In this application, I propose new research to determine how to adapt and implement early palliative care into the primary care setting for patients with HF or COPD who have cognitive impairment or Alzheimer's disease and related dementias. The overall goals of this proposal are to (1) train mentees (through increased mentoring time) to increase the cadre of successful patient-oriented researchers who will improve care and outcomes for older adults with serious illness and cognitive impairment, and (2) expand my research skills and experience in cognitive impairment and implementation science research for seriously ill older adults in primary care. I will accomplish these goals through additional training, research experience, and mentorship from experts in cognitive impairment, implementation science, and mentoring. During the K24, I will work closely with mentees to develop individual career plans and conduct research to further their development as independent investigators in palliative care, aging, and cognitive impairment. The research proposed in this application will: (1) determine how cognitive impairment influences participation in early palliative care and palliative care outcomes; we will analyze cognitive function and quality of life data from two of my multisite clinical trials (one completed, one active) of older adults with HF or COPD, and (2) engage primary care stakeholders (clinicians, leaders, staff, patients, and caregivers) to identify which palliative care interventions to implement in primary care and how to implement them. The proposed research, conducted with implementation science collaborators and mentees, will provide new knowledge on how to adapt and implement early palliative care into primary care for older adults with HF or COPD and cognitive impairment, including Alzheimer's disease and related dementias. I am thrilled to train the next generation of patient-oriented researchers in palliative care, aging, and cognitive impairment. With my record of research and mentoring success and the resources from the K24 and the Univers...