Geriatrics

Caregiver and patient

Who we are

Faculty 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.

About our teams

The OHSU Long Term Care Program includes two skilled nursing and long term care/memory care sites – The Mirabella and Holladay Park Plaza. We have built collaborative work groups at each site with an emphasis on team building and communication between long term care staff, on-site providers, and hospital care management teams. We also have a 2 week curriculum for interns that focuses on transitions of care in and out of skilled nursing. We explore geriatric syndromes, deprescribing, implicit bias as it relates to age, and social determinates of health as they related to geriatric populations. We also serve as a primary continuity long term care preceptorship site for geriatric fellows.

The OHSU Inpatient Geriatrics Program has been providing high quality geriatric care for older adults admitted to our hospital since 2015. Our team of geriatric specialists works hand in hand with medicine and surgical teams to reduce the hazards posed to older adults from the hospital environment and to adapt their care to their unique needs. We work with interdisciplinary teams to coordinate ongoing care needs after the hospital and make connections to primary care and other outpatient specialists with the goal of a smooth transition home. We also advocate for and assist with individualized advance care planning to ensure the care received supports the goals of every patient and their loved ones. Our team works side by side with the Trauma Surgery program to provide integrated geriatric care for older adults with injuries. This novel collaboration has been cited by the American College of Surgeons’ Trauma Verification program as a unique and significant asset to OHSU’s Trauma Program. Our inpatient staff are sought after educators and champions of system improvements to enhance the care received by all older adults at OHSU. We are involved in developing new care pathways like the hip fracture standard of care, improving cognitive care via development of delirium treatment protocols adapted to specific patient populations and adapting our electronic medical record to support safer prescribing for older adults.

In the news

Recent awards

OHSU Geriatrics Program: US News and World Report Top Program in Geriatrics 2012-20

Katie Drago: American Hospital Association Next Generation Leaders Fellow in Age Friendly Health Systems 2020-21

Emily Morgan: 2020 OHSU Continuing Professional Development Distinguished CME Lecturer Award

Julie Bernstein: 2019 Physician Assistant Citizen of the Year, Oregon Medical Association

Lisa Miura: 2019 Howard P. Lewis Distinguished Teaching Award, Oregon Chapter ACP , 2019 OHSU School of Medicine: Scholarly Project Outstanding Mentor Award

Chronic Kidney Disease in Long Term Care:

PI: Emily Morgan, MD

Development of a pilot program to integrate care for patients with significant renal disease across care sites (hospital, SNF/LTC, primary care, dialysis, etc).

Lower Extremity Wound Healing Curriculum for Medical Students:

PI: Foy White-Chu, MD

This evidence-based lower extremity wound healing course fills a medical school knowledge gap in lower extremity wound healing assessment and basic treatment.  Data continues to be collected to refine the process and evaluate the effectiveness. 

Geriatric Prescribing Context: An EHR based intervention to support safer prescribing for older adults.

PI: Kathleen Drago.

The goal of this work is to enhance safer prescribing for older adults by adapting the EHR’s ordering platform to automatically offer prescribers recommended doses for adults 75 years and older.

Acupuncture and opioids

PI: Sarah Goodlin, MD

Feru-guard

PI: Sarah Goodlin, MD

Ferulic acid and Angelica archangelica extract for behavioral symptoms in dementia

Improving POLST utilization for hospitalized Medicine patients with DNR code status

PI: Kathleen Drago.

This is a systems improvement initiative to assess and improve utilization of POLST to support hospitalized patients desiring limits for their ongoing medical care

Meta-LARC Advance Care Planning

Site PI: Diana Glidden, NP

This PCORI funded project utilizes the Serious Illness Conversation framework to increase goal-concordant care for people with serious illness.

Stopping Elder Accidents Deaths and Injuries

PI: Elizabeth Eckstrom, MD, MPH

This project implements the CDC STEADI fall prevention program across all primary care sites at OHSU

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.

 

  1. Drago K, Sharpe J, De Lima B, Alhomod A and Eckstrom E. Safer Prescribing for Hospitalized Older Adults with an EHR-Based Prescribing Context. J Am Geriatr Soc. 2020. Accepted for publication
  2. Stout M, Garcia A, White-Chu F. Pressure Ulcers. In: Ham RJ, ed. Primary Care Geriatrics, 7th edition.  Philadelphia, PA: Elsevier Saunders; 2020 – in Press.
  3. Eckstrom, E, Kalin, L, Kinder, N. (2020). Older Patients. In Feldman, M & Christensen, J. Behavioral Medicine: A Guide for Clinical Practice, 5th edition (pp. 137-147). New York: McGraw-Hill Education
  4. Levin, C., Morgan, E., Kassakian, S. et al. Increasing Cognitive Assessment Rates in an Internal Medicine Clinic: A Quality Improvement Project. Journal Gen Int Medicine (2020). https://doi.org/10.1007/s11606-019-05628-w
  5. Croff, R, Gowen, L, Lindauer, A, Shofner, S, Brown, K, Eckstrom, E. Including older rural adults in research: Practical guidance for addressing the NIH Inclusion Across the Lifespan policy. Journal of Clinical and Translational Science, 1-6. doi:10.1017/cts.2020.12
  6. Kirkpatrick JN, Hull SC, Fedson S, Mullen B, Goodlin SJ, Allocating Scarce Resources and Triaging Patients during the COVID-19 Pandemic, Journal of the American College of Cardiology (2020), doi: https://doi.org/10.1016/j.jacc.2020.05.006
  7. Puckett C, Goodlin SJ. A Modern Integration of Palliative Care into the Management of Heart Failure Canad J Cardiology in press 2020
  8. Runkel KM, Rdesinski RE, Miura LN. Hospitalist Perceptions of Fall Prevention: A Comparison of Two Health Care Systems. Amer J Med Quality 2020; e1-6. Published online May 8, 2020. PubMed ID: 32383632.
  9. Sobanski, PZ et al. Palliative Care for people living with heart failure – European Association for Palliative Care Task Force expert position statement. Cardiovascular Res 2019 Aug 6. pii: cvz200. doi: 10.103/cvr/cvz200
  10. White-Chu EF, Le T, Cordrey R. Implementing a chronic wound care workshop for internal medicine residents. Adv Skin Wound Care. 32 (2): 85-87, 2019. PMID: 30653187
  11. Zauflik, M, Eckstrom, E. Matching Older Research Subjects to Disease Demographics: First you Need to Know the Demographics. J Am Geriatr Soc. 2019. Online first: onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.16196
  12. Zive, D, Newgard, CD, Lin, A, Caughey, AB, Malveau, S, and Eckstrom, E. Injured Older Adults Transported by Emergency Medical Services: One Year Outcomes by POLST Status, Prehospital Emergency Care, 2019. DOI: 10.1080/10903127.2019.1615154
  13. Eckenhoff, R. G., Maze, M., Xie, Z., Culley, D. J., Goodlin, S. J., Zuo, Z., Wei, H., Whittington, R… Anesthesiology 2019 Dec 14
  14. Bernstein JM, Graven P, Drago K, Dobbertin K and Eckstrom E. Higher Quality, Lower Cost with an Innovative Geriatrics Consult Service. J Am Geratr Soc. 2018;66(9): 1790-1795. PMID: 30094830
  15. Driving Dilemmas: A Guide to Driving Assessment in Primary Care. Clinics in Geriatric Medicine. 2018 Feb; 34(1):107-115. PMID:29129210.
  16. Li F, Harmer P, Fitzgerald K, Eckstrom, E, Akers, L, Chou, L, Pidgeon, D, Voit, J, Winters-Stone, K. Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial. JAMA Intern Med. 2018;178(10):1301–1310. doi:10.1001/jamainternmed.2018.3915
OGEC

In 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.