Geriatrics

About Geriatrics

geriatricsFaculty in the OHSU Internal Medicine/Geriatrics Program are engaged in numerous projects to improve the health of older adults as well as improve the health care system in its care of elders through participation in local, regional, and national research collaborations. The Geriatrics research team has a focus on healthy aging, end- of-life planning and care, falls prevention, electronic health tools, and interprofessional education to enhance the care of older adults.

Selected Research Projects

Healthy Aging Alliance Co-Directors Elizabeth Eckstrom, MD, MPH, Henryk Urbanski, PhD, DSc, Lisa Wood, PhD, RN Funding Agency: Oregon Clinical and Translational Research Institute The OHSU Healthy Aging Alliance seeks to promote healthy aging  through  partnerships, discovery, education, and outreach. We engage in team-based translational research to truly change the aging trajectory toward health and quality of life. 

Motivational interviewing and fall prevention. PI: Hiroko Kiyoshi-Teo, PhD; Co-PI: Lisa Miura, MD. Research study examining the impact of motivational interviewing on fall prevention for older Veterans living in the community.

Stopping Elderly Accidents, Deaths and Injuries  (STEADI) Funding source: CDC. Co-PI: Emily Morgan MD, Elizabeth Eckstrom MD. This project implements the CDC's STEADI initiative in the Internal Medicine & Geriatrics clinic. The goal is to screen every patient 65 and older for falls risk, and for those at risk for falling, conduct further assessments and interventions to reduce their risks for falls.

The Value of Emergency Care for Injured Older Adults. Funding source: Agency for Healthcare Research and Quality (AHRQ) PI: Craig Newgard MD, Co-Investigator: Elizabeth Eckstrom MD MPH. The goal of this project is to evaluate current Emergency Medical Systems (EMS) triage practices and trauma care for injured older adults, validate new triage guidelines to better identify seriously injured patients, and compare the value of different EMS triage practices for trauma care using long-term outcomes and costs.

Capturing Dementia: clinical strategies to improve dementia diagnosis and management in primary care. Unfunded. PI: Emily Morgan, MD. The goal of this research is to investigate the impact of a comprehensive set of EHR tools for diagnosis and management of dementia, coupled with a short provider training, on primary care assessment and management of Alzheimer Disease and related dementias (ADRD).

Veterans Affairs Office of Health Equity "ICD Decision Aid for Vulnerable Elders" 4/2014-10/2014 $76,000; Project lead: Sarah Goodlin, MD, FACC, FAAHPM 20% effort. This project assessed the ability of older Veterans with heart failure to understand and use a decision aid about implantable defibrillators.

Medtronic Investigator Initiated Research Program 1545 Evaluation of a Decision Aid for ICD as Primary Prevention Goodlin, S - Patient-centered Education and Research $37,000 2011- 2013; Principal Investigator. This study refined and evaluated a decision aid regarding implantable defibrillators for people with heart failure.

Innovations in Consult Management, Office of Specialty Care, Veterans Affairs 5/2011- 9/2013 $2,173,000 PI: Sarah Goodlin, MD, FACC, FAAHPM. This special project developed an interdisciplinary collaborative dementia care program and electronic consults (E-consults) then disseminated the E-consult program through specialty care with in the Northwest Network for the VA.

Office of Rural Health, N20-FY13Q1-S1-P00530 "Rural Collaborative Management of Dementia" $2,201,053 9/2012-9/2015 PI: Sarah Goodlin, MD, FACC, FAAHPM. This project disseminated our Collaborative Dementia Care program throughout the Northwest Network of the VA. Specifically we implemented tele-health and E-consults, as well as provider education and training.

Selected Education Projects

Implementing a Chronic Wound Care Curriculum for Internal Medicine Residents. PI: E. Foy White-Chu MD CWSP; Co-Investigators: Tri Le MD, Renee Cordrey PT PhD©; Unfunded. The objective was to determine if a 1.5 hour practice-based learning session (didactic + case-based teaching + workshop skills practice) would change IM resident wound care practice behavior.

Make CME Matter: How a national skills workshop may impact practice change for patients with chronic wounds.PI: E. Foy White-Chu MD CWSP; Co-Investigators: Lisa Gould MD, Lynne Grant CWON, Ken Schmader MD, Renee Codrey PT PhD©; Funding support from Wound Healing Society. The objective was to determine if participating in a national interdisciplinary wound care CME skills workshop would change clinicians' reported wound care practice.

Office of Rural Health N20-FY15-S1-P01185 Rural Provider and Health Care Staff Training Through Process Improvement $821,090 9/2013-9/2016 PI: Sarah Goodlin. In this project we implemented education about cognitive impairment and back pain management using process improvement with interdisciplinary provider teams.

Office of Rural Health N20-FY14Q1-S1-P00767 E-Consult Rural Health Expansion 9/2013- 9/2016 $ 991,641 PI: Sarah Goodlin. This project expanded e-consults in multiple specialties throughout VISN 20 , the Northwest Network of the VA. We worked with interdisciplinary teams to develop and implement E-consults on Backpain and multiple other topics.

Selected Publications

  1. Li, F, Harmer, P, Fitzgerald, K, Eckstrom, E, Stock, R, Galver, J, Maddalozzo, G, Batya, SS, Tai Chi Enhances Postural Stability in Parkinson's Disease Patients, NEJM, 2012;366:511-9
  2. Cayea, D, Eckstrom, E, Christmas, C, Update in Geriatric Medicine, JGIM, 2012: 27(3):371-5.
  3. Lin, JS, O'Connor, E, Rossum, RC, Perdue, LP, Eckstrom, E, Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force, Annals of Intern Med,2013;159:601-612: doi:10.7326/0003-4819-159-9-201311050-00730.
  4. Feeny DH, Eckstrom E, Whitlock EP, Perdue LA. A Primer for Systematic Reviewers on the Measurement of Functional Status and Health-Related Quality of Life in Older Adults. (Prepared by the Kaiser Permanente Research Affiliates Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 13-EHC128-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2013.

  5. Miura LN, Srikantom SV, Schenck J. Double Fixation: Bilateral Bisphosphonate-Related Hip Fractures. Amer J Med 2017;130(1):e13-15. Published online July 21, 2016. In press for January 2017. PubMed ID: 27452682.

  6. Miura LN, Boxer RS. Women in Medicine and the Ticking Clock. Ann Fam Med2013;11(4):381-382. PubMed ID: 23835825.
  7. Miura LN, DiPiero AR, Homer LD. Effects of a Geriatrician-Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes. J Am Geriatr Soc 2009;57:159-167. PubMed ID: 19054192.
  8. Miura LN and Smith RL. Influenza: Its Prevention and Control in the Nursing Home.Family Practice Recertification 2001;23(11):23-30.
  9. Bonow RO, Ganiats TG, Beam CT, Blake K, Casey DE Jr, Goodlin SJ, Grady KL, Hundley RF, Jessup M, Lynn TE, Masoudi FA, Nilasena D,Piña IL, Rockswold PD, Sadwin LB, Sikkema JD, Sincak CA, Spertus J, Torcson PJ,Torres E, Williams MV, Wong JB; American College of Cardiology Foundation; American Heart Association Task Force on Performance Measures; American Medical Association-Physician Consortium for Performance Improvement. ACCF/AHA/AMA-PCPI2011 performance measures for adults with heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association-Physician Consortium for Performance Improvement. Circulation. 2012 May15;125(19):2382-401.
  10. Goodlin SJ, Wingate S, Albert NM, Pressler SJ, et al. Investigating Pain in Heart Failure Patients: The Pain Assessment, Incidence, and Nature in Heart Failure(PAIN-HF) Study. J Card Fail. 2012;18(10):776-83.
  11. Kovacs AH, Landzberg M, Goodlin SJ. Advance Care Planning and End of Life Management of Adult Patients With Congenital Heart Disease World J Pediatric Congen Heart Surg 2013;4(1):62 -69.
  12. Whellan DJ; Goodlin SJ; Dickinson M; Heidenreich PA; Jaenicke C; Stough WG; Rich MW, On behalf of the Quality of Care Committee Heart Failure Society of America. End-of-life Care in Patients with Heart Failure J Card Fail 2014;20(2) 121-134
  13. LeMond L, Camacho SA, Goodlin SJ.Palliative care and decision making in advanced heart failure. Curr Treat Options Cardiovascular Med. 2015 Feb;17(2):359. PMID:25619163
  14. Jurgens CY, Goodlin S, Dolansky M, Ahmed A, Fonarow GC, Boxer R, Arena R, Blank L, BuckHG, Cranmer K, Fleg JL, Lampert, RJ Lennie TA, Lindenfeld J, Ileana L Piña, Todd P Semla, Trebbien P, Rich MW. Heart Failure Management in Skilled Nursing Facilities: A Scientific Statement From the American Heart Association and the Heart Failure Society of America. J Card Fail 2015;21(4): 261-364 also published as: Circ Heart Fail. 2015;8:655-687
  15. Kalra A, Foreman DE, Goodlin SJ. Medical decision making for older adults: an international perspective comparing the United States and India J Ger Cardiol2015: (12)329-332
  16. Kirkpatrick JN, Hauptman PJ, Goodlin SJ. Bundling Informed Consent and Advance Care Planning in Chronic Cardiovascular Disease: We Need to Talk. JAMA Intern Med.2015;175(1):5-6.
  17. Kirkpatrick N, Hauptman PJ, Swetz KM, Blume ED, Gauvreau K, Maurer M, Goodlin SJ. Palliative Care for Patients with End-Stage Cardiovascular Disease and Devices:A Report From the Palliative Care Working Group of the Geriatrics Section ofthe American College of Cardiology. JAMA Intern Med. 2016 May 23. doi:10.1001/jamainternmed.2016.2096
  18. Dworkin A, Lee DSH, An AR, Goodlin SJ. A Simple Tool to Predict Development of Delirium Following Elective Surgery J Amer Geriatric Soc 21 SEP 2016, online
  19. Meyers DE, Goodlin SJ. End-of-Life Decisions and Palliative Care in Advanced Heart Failure Can J Cardiol. 2016 Sep;32(9):1148-56. Epub 2016 May 13.
  20. Light-McGroary KA, Goodlin SJ, The Challenges of Understanding and Managing Pain In the Heart Failure Patient;Curr Opin Support Palliat Care 2013, 7:14–20
  21. Lemond L, Camacho A, Goodlin SJ Palliative Care and Decision Making in Advanced Heart Failure Curr Treat Options Cardiovasc Med. 2015 Feb;17(2):359.
  22. LeMond L, Goodlin SJ. Management of Heart Failure in Patients Near the End ofLife--There is So Much More to Do. Card Fail Rev 2015: 1(1) 31-34
  23. Totten AM, White-Chu EF, Wasson N, Morgan E, Kansagara D, Davis-O'Reilly C, Goodlin S, Home-Based Primary Care Interventions Systematic Review Agency for Healthcare Research and Quality www.ahrq.govContract No.:2902012-00014-I. 2015
  24. McGrath,L. &Goodlin, S.J. Palliative Care in Older Adults with Cardiovascular Disease: Addressing Misconceptions to Advance Care. Curr Cardiovasc Risk Rep(2017) 11: 6.

Oregon Geriatric Education Center

OGECIn the next half century, the population of older adults in the United States is projected to more than double in size - from 31 million to 80 million. Nine of Oregon's rural counties contain 20% or more residents over the age of 65. Many older adults receive care from health professionals whose educational preparation focused on younger persons. Older adults have complex health care needs, and health care professionals trained in the care of older adults are needed to optimize health for this growing population. The Oregon Geriatric Education Center (OGEC) had past funding to provide this training from the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services(HHS) under grant number UB4HP19057. While grant funding has concluded, the OGEC has a repository of training materials that are still available. The information or content and conclusions in these repository materials are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the US Government.

Resources

Geriatric Assessment Card Set 2014