1. Research and Career Paths with Geriatric Emphasis
Sandhya Lagoo-Deenadayalan

2. Research in Geriatrics
Determine core outcome domains
Core outcome measurement instruments.
Systematic reviews to inform the process
Qualitative research with clinicians and patients
Basic science research
Structured surveys
Various stakeholders involved in the process, with particular attention to patients.

3. Research in Geriatrics
Areas of Interest:
Recovery Outcomes
Resilience
Function, Nutritional Status
Cognition
( pre and post)
Effects of intervention:
Pressure Ulcers
Nutrition
SSI, Sepsis
Prehabilitation
LOS/Readmissions/Discharge destination
Risk Stratification
Home Days
Biomarkers
Days in Skilled care
- frailty
Quality of Life
- resilience
- inflammation

4. Theme: To Better Understand and Optimize Physical Resilience

5. INTRAMURAL Geriatric Specific: Pepper Pilot Projects Bollinger Award
Duke Ahead
DIHI grants
Duke Endowment

6. GEMSTAR AWARD (NIA – AGS)
Grants for Early Medical/Surgical Subspecialists' Transition to Aging Research (GEMSSTAR) (R03)
R03 Small Grant Program
Goal of GEMSSTAR FOA:
Provide support for early-stage physician-scientists, trained in medical or surgical specialties, to launch careers as future leaders in research on aging or in geriatrics.  
GEMSSTAR FOA provides small grants to conduct transdisciplinary research on aging or in geriatrics research that will yield pilot data for subsequent aging- or geriatrics-focused research projects. 
GEMSSTAR FOA seeks to encourage the provision of supportive environments for candidates, and NIA will consider the extent to which a supportive environment is available to candidates in selecting GEMSSTAR candidates.

7. Veterans Health Administration
Career Development Awards
SCE –COE
Merit Awards

8. Veteran’s Administration
PA : Reducing Over screening for Breast, Cervical, and Colorectal Cancers among Older Adults (RO1)
PA : Use of Technology to Enhance Patient outcomes and Prevent Illness (R21)
PAR Translational Research on Aging: Small Business Innovation Awards (R43-44)
PAR : Intervening with Cancer Caregivers to Improve Patient Health Outcomes and Optimize Health Care Utilization (RO1) PA : Underactive Bladder in Aging (RO1)
PA : Family and Interpersonal Relationship in an Aging Context (R01)

9. Engagement Award
The Eugene Washington PCORI Engagement Award program offers two different funding opportunities:
The Engagement Award: Knowledge, Training & Development, and Dissemination Awards;
Engagement Award Initiative Notice (EAIN) for Research Meeting and Conference Support

10. Dissemination and Implementation of PCORI-Funded Patient-Centered Outcomes
PCORI seeks to support the dissemination and implementation of results from PCORI-funded comparative effectiveness research studies. PCORI recognizes that the generation of evidence will be useful only if research results reach those who can use this information in their health decisions.

11. AHRQ
Funding to conduct exploratory and developmental research grants (R21)
Projects in the early and conceptual stages of development
Expected to contribute to the evidence base of how health information technology (IT) improves health care quality and outcomes. 

13. Chuck Scales, MD MSHS
Assistant Professor, DCRI and Division of Urology
Research interests:
Urinary Stone Disease
Overactive Bladder
Surgical Outcomes in Older Adults
Funding
NIA GEMSSTAR R03
AGS Jahnigen Award
Philanthropic funding

14. MADCO-PC study:
Markers of Alzheimer’s Disease & neuro-Cognitive Outcomes after Perioperative Care
-140 surgical patients enrolled, 110 completed 6 week follow up.
-Total LPs- 381, Total fMRI scans- 131
-1st study to combine fMRI imaging, CSF analysis & cognitive testing to understand mechanisms of postoperative delirium and cognitive dysfunction in older adults.
PI- Miles Berger, MD PhD, Assistant Prof, Duke Anesthesiology, Pepper Center Senior Investigator

15. MADCO-PC Study Interim Conclusions:
I. Surgical patient enrollment complete, now enrolling matched non-surgical controls
II. Significant neuroinflammation occurs after non-cardiac/non-neurologic surgery.
III. CSF AD biomarkers (tau, Abeta) and bioactive lipids, inflammatory marker assays underway- expect data 4/2017.

16. The Duke Geriatric Workforce Enhancement Program (GWEP)
Eleanor McConnell PhD, MSN, RN
Mitchell Heflin, MD, MHS

17. GWEP Objectives Collaborate with community agencies to:
Convene a community-based interagency care team (ICT) to optimize services for seniors
Create a Best Practices Compendium for the care of vulnerable older adults residing in the community
Recruit and train Geriatric Resource Teams (GRT’s) in primary care practices
Engage and empower seniors and family caregivers in teaching and learning about geriatric care management and resources, communication, and advocacy
Expand expertise in geriatric care management through IP advanced traineeships and applied learning experiences for other learners

18. Geriatric Resource Teams
Who: interprofessional teams
What: resource for geriatric expertise
Where: primary care practices within community-based settings
Why: improve quality of care for older adults
How: year long commitment to educational programs and practice setting specific quality improvement activities

19. GRT Educational Program
Communication:
IPEC training
workshop
Competencies:
Best practices dementia care, medications, transitions
Continuous Improvement: Narrative Case Reviews
Connections: Referrals to ICT, community agencies
Improved care
of older adults
GWEP Faculty

20. Veteran’s Administration CDA
Enhanced Nutrition in the Perioperative Period

21. DVAMC POSH PROGRAM
Aim 1: To establish an interprofessional (IP), multidisciplinary service that ushers patients from their initial PCP surgical referral to their post-operative follow-up.
Aim 2: To concurrently provide a point-of-care educational experience that is patient- and family-centered, crosses traditional boundaries of discipline and profession, and establishes communication and continuity across settings and systems
Perioperative medicine at Duke has received prior funding from several sources.

22. Hartford Foundation "Collaborative Peri-operative Care Model."
“An Enhanced Protein Weight Loss Intervention”

24. Project CALM Confusion Avoidance Led by Music
I’m Neema Sharda, one of the Geriatric Fellows at Duke. I’m here today to bring you on board to Project CALM – or, Confusion Avoidance Led by Music
Music provides robust brain activation of long term memories & emotions. Music has a powerful role in several industries – entertainment, luxury, advertising – and has a history with the healthcare world since the work of Florence Nightingale, and it is making a resurgence! A recently published study in the lancet suggests that music played during the peri-operative setting decreases the perception of pain. Additionally, music has been shown to temper behavioral issues with those with dementia. MUSIC IS EVERYWHERE!
Heidi White, MD, MHS, MEd Neema Sharda, MD
Shelley McDonald, DO, PhD Loretta Matters, MSN, RN
Judy Prewitt (DUHS Operational Leader)
February 22, 2016

25. Project CALM
POSH Clinic Evaluation
Preop/OR/PACU
Postop Recovery on the Surgical Floor
The Project
By harnessing the impact of pleasant autobiographical memories, personalized music can mitigate pain & anxiety and reduce delirium in older adults undergoing elective surgical procedures
Limited use of non-pharmacological pain mediation
Limited effective treatment for delirium
Patients & families unaware of the benefits of personalized music
Unmet Need
THE PROJECT:
By modulating pain & the need for pain medications, we have the capacity to also modulate two of the primary factors that can lead to delirium.
We plan to make music an insular experience with headphones that seal out the background noise of the hospital.
By making music personal, we aim to invoke positive memories & peaceful emotions that elevates the potential for the ancient soothing power of song.
Our target audience will initially be patients participating in the Perioperative Optimization of Senior Health (POSH) program. At their pre-op visit, we will have the opportunity to introduce the concept & acquire their music preference.
UNMET NEED:
The consequential cost of delirium ranges from ~$16,000-64,000 per patient
There are limited effective treatments for acute delirium, so to be most effective, we must focus on prevention.
The current standard of care undervalues non-pharmacological aspects of pain modulation and delirium prevention, which is unfortunate since the hospital elder life program has shown cost savings by implementing non-pharmacological interventions
Project CALM will increase awareness of the benefits of personalized music
INNOVATIVE SOLUTIONS:
When it is married with current technology in the hands of patients utilizing personal music preference, we have a powerful vehicle for person-centered care.
We have experience with this innovation & technology in other settings, such as SNFs & ALFs. The acute care setting should not be left behind – and we have assembled stakeholders for this setting.
We will be able to meet the musical needs of our patients by taking advantage of streaming libraries.
Finally, we will be able to create an avenue for nursing assistants to develop specialized skills as Geriatric Patient Care Advocates as they help us implement this intervention
Innovative Solutions
Headphones create an insular music experience
Streaming provides an extensive music library easily crafted to individual preferences
Online curriculum and specialized skills for nursing assistants