Forum Syllabus - University of Washington

University of Washington Interdisciplinary Geriatric Research Forum September 20, 2007 9:00am – 4:00pm Fred Hutchinson Cancer Research Center

Co-sponsored by The University of Washington Center for Interdisciplinary Geriatric Research and the Institute on Aging

PROGRAM TABLE OF CONTENTS 1

Forum Objectives

2

Forum Agenda

3

Keynote Speaker, Dr. Landefeld’s Biography

4-7

Panelists’ Biographies: Sanjay Asthana, MD, FRCP (C) Shelly Gray, PharmD, MS Nancy Hooyman, PhD Heather Young, PhD, FAAN, GNP

8

Closing Speaker, Dr. Larson’s Biography

9-23

Poster Abstracts

24-25

Notes

FORUM OBJECTIVES

• Enhance awareness of interdisciplinary aging research at UW and its affiliated institutions • Provide ample opportunities for networking among attendees • Provide an opportunity to discuss collaborating with other colleagues

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University of Washington Interdisciplinary Geriatric Research Forum September 20, 2007 9:00am – 4:00pm Agenda: 8:30–9:00

Continental breakfast/ meet and greet

9:00–9:15

Introductions

9:15–10:00

Keynote address: Seth Landefeld, MD

10:00–10:30

Break

10:30–11:30

Panel presentation: Sanjay Asthana, MD, FRCP (C) Shelly Gray, PharmD, MS Nancy Hooyman, PhD Heather Young, PhD, FAAN, GNP

11:30–1:30

Roundtable discussions over lunch

1:30–2:30

Poster viewing

2:30–3:00

Break

3:00–4:00

Closing address: Eric Larson, MD, MPH, MACP

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Keynote Address: Seth Landefeld, MD Seth Landefeld, M.D. is Professor of Medicine at the University of California, San Francisco (UCSF), where he has served as Chief, Division of Geriatrics and Director, UCSF Center on Aging since 1997. Dr. Landefeld’s research focuses on improving care for older adults with serious illness, especially during and after hospitalization. His contributions include the development, implementation, and initial testing of the concept of Acute Care for Elders (ACE) Units. He has also developed and evaluated novel clinical and health systems approaches to improving the safety of prescription drugs in older patients. His research has also examined how medical error is handled in the culture of professional medicine and provided evidence about the effects of financial conflicts of interest on physician behavior. Dr. Landefeld received B.A. degrees from Harvard College and Oxford University, where he was a Rhodes Scholar. He received the M.D. degree from Yale University and trained in internal medicine at UCSF, where he was also chief resident. He completed a fellowship in clinical epidemiology at Brigham and Women’s Hospital and Harvard Medical School and served on the faculty of Case Western Reserve University from 19851997. He is an elected member of the American Society of Clinical Investigation and the Association of American Physicians.

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Panelist: Sanjay Asthana, MD, FRCP (C) Dr. Asthana is Duncan G. and Lottie H. Ballantine Chair in Geriatrics and Professor at the UW and Head of the Section of Geriatrics and Gerontology in the Department of Medicine. He serves as the Director of the Wisconsin Comprehensive Memory Program (WCMP) and the Veterans Affairs (VA) Geriatric Research, Education and Clinical Center (GRECC) at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. Additionally, he is Associate Director of the Wisconsin Alzheimer’s Institute (WAI). He received his MD from the University College of Medical Sciences at the University of Delhi, India, and completed his internal medicine residency in Canada. He then obtained fellowship training in geriatrics at the Johns Hopkins program, and completed an additional three-year research fellowship in Alzheimer’s disease (AD) at the Laboratory of Neurosciences of the NIA/NIH. Dr. Asthana’s first faculty appointment was in the Geriatrics Division of the University of Washington, where he was also closely associated with the Seattle VA GRECC and the Alzheimer’s Disease Research Center (ADRC) for over eight years. While in Seattle, in addition to his own independentlyfunded studies, he initiated the well-regarded AD research program at the Seattle/Tacoma VA GRECC. In August 2001, Dr. Asthana relocated to the UW-Madison where, under his leadership of the Section of Geriatrics and the VA GRECC, he established the current Alzheimer’s disease (AD) program. Since 2001, both the Section of Geriatrics and the VA GRECC have experienced significant expansion in their missions, including research funding currently equaling over $62 million. Dr. Asthana is widely recognized for his research in the neuroendocrinology of AD, and has published extensively in the field of hormones and cognition. He has received substantial funding from several sources including the NIH, VA, Alzheimer’s Association, and the Hartford Foundation to support his research studies. He serves as the primary mentor on two K23 awards (PIs: Drs. Carlsson, Gleason) including a Beeson Award in AD research, and is PI of a T32 training grant in aging. Dr. Asthana serves as an active grant reviewer on several Study Sections of the NIH, including the Aging Systems and Geriatrics and regularly reviews manuscripts in geriatrics and neuroscience for numerous prestigious medical journals. Finally, Dr. Asthana is one of the few Hartford Geriatric Leadership Scholars in the country and has recently received an NIH-funded Academic Leadership Award (KO7) in AD.

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Panelist: Shelly L. Gray, PharmD, MS Shelly L. Gray, Pharm.D., MS, is Professor in the School of Pharmacy, University of Washington. Her research focuses on the pharmacoepidemiology of medication-related problems in older adults. Past work has included examining the effect of benzodiazepine drug use on physical function and physical performance measures in older adults. Currently, she is examining whether certain medication with anti-inflammatory effects may protect older adults from functional decline. Dr. Gray serves on the Editorial Board for several journals including the Journal of the American Geriatrics Society, the American Journal of Geriatric Pharmacotherapy and Annals of Pharmacotherapy.

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Panelist: Nancy R. Hooyman, PhD Dr. Nancy R. Hooyman, Professor in Gerontology and Dean Emeritus at the School of Social Work, received her Ph.D. in Sociology and Social Work from the University of Michigan. She is co-director of the School’s Institute for Multigenerational Health Development and Equality and recipient of the School’s first endowed professorship in gerontology, the Nancy R. Hooyman Professorship. Under her leadership as Dean for 14 years, the School of Social Work was ranked third out of 135 graduate programs by US News and World Report. She is author of eleven books and over 120 articles and chapters related to gerontology and women’s issues and is a frequent presenter at conferences on gerontology, resilience and well-being, older women, end-of-life care, caregiving and gerontological curricular change. Her co-authored books include a widely used text, Social Gerontology: A Multidisciplinary Perspective (8th edition); Feminist Perspectives on Family care: Policies toward Gender Justice; Taking Care of Older Relatives, one of the first widely used books on family caregiving, and Living through Loss: Interventions across the Lifespan. She is a Fellow and chair of the Social Research Policy and Practice Section of the Gerontological Society of America and has received numerous awards for her service as Past-President of the Society for Social Work and Research, Past-President of the National Association of Deans and Directors of Social Work; past-Board member of the National Institute for the Advancement of Social Work Research; and Past Chairperson of the Action Network for Social Work Education and Research, a legislative coalition among the five professional national social work organizations. She has served on the Advisory Boards for all the Hartford Foundation Geriatric Initiatives, and is a National Mentor and a member of the selection committee for the Hartford Scholars Program. She served as Investigator of the Hartford Geriatric Enrichment in Social Work Education Project (GeroRich), a national curriculum change initiative and is co-Principal Investigator of the CSWE National Center on Gerontological Social Work Education, co-PI of the Hartford-funded Planning Grant National Center for Family Care Initiatives, and PI of the Hartford Practicum Partnership Project at the School of Social Work. In Seattle, she is active on the board of Senior Services and is chairing the United Way Impact Council on Older Adults.

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Panelist: Heather M. Young, PhD, FAAN, GNP Dr. Young is the Grace Phelps Distinguished Professor, Director of the John A. Hartford Center for Geriatric Nursing Excellence and Director of Rural Health Research Development at the Oregon Health & Science University, School of Nursing at Southern Oregon University. Dr. Young’s research and clinical interests focus on environments that promote healthy aging. She has played an instrumental role in shaping long term care policies in Washington State through her evaluation research. She has been a co-investigator on two longitudinal studies of family caregiving, one among families with a member with Alzheimer’s Disease and one which explored long term care decision making and caregiving among Japanese American families who were caring for older adults with physical and/or cognitive limitations. Dr. Young received her PhD in Nursing from the UW School of Nursing and received its Distinguished Alumna award in 1996. For over a decade, Dr. Young held a joint appointment on faculty at the University of Washington School of Nursing and as the Chief Operations Officer for a retirement community company. In this capacity, she was responsible for an academic-corporate partnership, and for designing and managing programs in independent living, assisted living, and skilled nursing. In addition. Her current research focuses on the medication management in rural assisted living settings and in technological approaches to promoting medication safety in rural hospitals. She joined the faculty at OHSU in 2003, and lives in Ashland, OR.

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Closing Address: Eric B. Larson, MD, MPH, MACP Dr. Eric Larson is Executive Director of Group Health’s Center for Health Studies. A graduate of Harvard Medical School, he trained in internal medicine at Beth Israel Hospital, in Boston, completed a Robert Wood Johnson Clinical Scholars and MPH program at the University of Washington, and then served as Chief Resident of University Hospital in Seattle. He served as Medical Director of University of Washington Medical Center and Associate Dean for Clinical Affairs from l989-2002. His research spans a range of general medicine topics and has focused on aging and dementia topics, including a long running study of aging and cognitive change set in Group Health Cooperative - The UW/Group Health Alzheimer's Disease Patient Registry/Adult Changes in Thought Study. He has served as President of the Society of General Internal Medicine, Chair of the OTA/DHHS Advisory Panel on Alzheimer's Disease and Related Disorders and was Chair of the Board of Regents (2004-05), American College of Physicians.

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Abstract 1 Religious Struggle, Coping, and Plasma Interleukin-6 in Middle-aged and Older Patients Prior to Cardiac Surgery Amy Ai, MA, MSW, PhD Abstract Background: Plasma levels of cytokines have been associated with adverse cardiac outcomes and with negative emotions in the medical and psychosomatic literature, respectively. Research on faith-health linkage has focus on positive outcomes. Few researchers have investigated the association between these psychobehavioral factors and cytokines in cardiac patients. To meet gaps, this study explored the potential impact of religious struggle and general coping strategies on Interleukin-6(IL-6) in middle-aged and older patients undergoing cardiac surgery, controlling for key medical and psychological correlates in multivariate analysis. Methods: 235 patients (mean age 61) were recruited at the University of Michigan Health Systems. Psychobehavioral factors were obtained two days before operation, using standardized instruments. Medical information was obtained from the hospital's Society of Thoracic Surgeons' Adult Cardiac Database(STS). Blood samples were drawn on the morning of operation for the measurement of IL-6. Variables of major interest and significant correlates were analyzed through multiple regression analysis following a pre-planned sequence. Results: Religious struggle (p=.011), behavioral coping (p=.013), and medical correlates, such as left ventricular ejection fraction, were positively associated with plasma IL-6. The main pattern for coping factors maintained in alternative models, though the magnitude of medical covariates was marginalized. No demographics and mood state measures were influential. Conclusion: Faith-based struggle and behavioral coping strategy may vary with pre-operative plasma levels of IL-6. The clinical and pathophysiological significance of this association, however, remains to be determined. The findings also underline the importance of controlling objective medical indicators in analyzing the relationship between psychobehavioral factors and biomarkers.

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Abstract 2 Secular Spirituality? - Faith Factors Relate to Outcomes in Middle-aged and Older Patients Undergoing Coronary Artery Bypass Surgery. Amy Ai, MA, MSW, PhD Abstract This prospective study replicated the findings in an earlier survey with a sample of patients from a Middlewest cardiac center. Same medical outcomes and some similar faith factors and controls, as well as a new faith factor, sense of reverence in secular contexts, were examined. Face-to-face interviews were conducted with 177 patients (age 65+) two weeks before heart surgery. Medical variables were retrieved from the Medical Center's Society of Thoracic Surgeons' Database. Sense of reverence in secular contexts predicted fewer postoperative complications (PC) and shorter hospital length of stay (LOS), before PC is introduced into the equation. Controlling for PC reduced the initial influence of reverence on LOS, suggesting the mediating role of PC between reverence and LOS. Prayer was associated with the reduced PC but not LOS. Neither attendance at religious services nor spiritual experiences that enhanced one's belief was related to outcomes. Women had longer LOS, but no age influence, nor interaction between demographics and faith factors, was evident. The similarity and differences between the two studies were discussed in relation to contextual factors and some measures.

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Abstract 3 Perceptions of Depression and Primary Care Provider Behavior in Older versus Younger Patients C. Bolkan, PhD1, E. Chaney, PhD1, L. Rubenstein, MD2,3, A. Lanto, MA3, & E.Yano, PhD2,3 1 VA Puget Sounds Healthcare System; Department of Health Services, University of Washington; 2 University of California, Los Angeles, 3 VA Greater Los Angeles HSR&D Center of Excellence Objectives: Depression is a leading cause of disability and also substantially affects medical costs and quality of life. Improvements in depression care may have greatest impact on older patients, however, representative samples of depressed primary care patients are rarely evaluated by age. Additionally, patient perception of involvement in care has important implications for patient-oriented, recovery based treatment. We explored differences in patient perceptions about depression (as measured by openness to treatment) cross sectionally by young (< 59, n = 433) and older (60 +, n = 328) patients in VA primary care. We also examined patients’ self-report of their primary care provider’s (PCP) behavior regarding their mental health care by age group. Methods: This study included a population based sample of 761 patients from 10 VA primary care clinics in 3 VA networks across diverse regional areas. All participants screened positive for depression using the PHQ9 and were enrolled in an evidence-based care model study (TIDES) to investigate the effectiveness of collaborative care for the treatment of depression. Enrolled participants received a computer assisted telephone administered survey and answered questions regarding sociodemographic information, depression symptoms, and health status information. They were also asked about their perceptions of depression (i.e., “If your doctor told you that you were depressed, would you accept that?”). Finally, the participants answered questions about their provider’s behavior regarding mental health care (i.e., “During your last visit, did your doctor ask you about being sad or depressed?”). Results: Chi-square tests of independence were performed to examine the relationships between participant perception of depression and age. Older participants differed significantly on each perception item compared to younger participants. More specifically, fewer older participants than younger participants believed that people should continue to take anti-depressants after they feel better, X2 (1, N = 717) = 39.06, p = .00), that biological/chemical changes in the brain contribute to depression, X2 (1, N = 721) = 23.47, p = .00), that talking to a professional helps those with emotional problems, X2 (1, N = 755) = 10.41, p = .00), or that emotional problems get better with treatment, X2 (1, N = 748) = 9.15, p = .01). In addition, older participants were also less likely to agree with their physician regarding the need to take medication for depression, X2 (1, N = 755) = 10.41, p = .00), accept their physician’s diagnosis of depression, X2 (1, N = 757) = 14.72, p = .00), and reported being less agreeable to needing treatment for their current depression, X2 (1, N = 753) = 71.63, p = .00) when compared to younger patients. Further chi-square analyses confirmed differences between older and younger participants’ perception of provider behaviors during their last visit. Older participants reported that their providers were less likely to inquire about being sad or depressed, X2 (1, N = 628) = 3.90., p = .05), alcohol use, X2 (1, N = 634) = 3.79., p = .05), or self-harm thoughts, X2 (1, N = 640) = 17.19., p = .00) compared to younger participants. Older participants also reported that their providers were less likely to prescribe medication for an emotional problem, X2 (1, N = 642) = 8.69., p = .00), or change an existing prescription, X2 (1, N = 643) = 11.78., p = .00). (Continued on next page) - 11 -

(Abstract 3 continued) Conclusions: The findings from this preliminary analysis of depressed patients highlights two disconcerting trends among participants in this study: (a) older primary care patients reported being potentially less open to receiving treatment for emotional problems and more affected by stigma attached to mental illness, and (b) PCPs might be less likely to ask older patients about specific emotional problems related to depression. These findings are particularly concerning considering that this was a sample of participants who all had significant depressive symptoms. Addressing older individuals’ self-perception of the need for mental health care may be crucial in promoting recovery from late life depression. Additionally, recognition of older adults’ unique barriers (i.e., stigma, ageism) to participating in depression treatment is necessary. An improved understanding of patients’ perceptions regarding depression and treatment can play an important role in improving helpseeking behavior, treatment compliance, and treatment effectiveness.

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Abstract 4 Minority Disparities in ADL Limitations Among Medicare Beneficiaries Marcia A. Ciol, PhD, Anne Shumway-Cook, PhD, Jeanne M. Hoffman, PhD, Kathryn M. Yorkston, PhD, Brian J. Dudgeon, PhD, Leighton Chan, MD Objective: To estimate the proportion of Medicare beneficiaries with limitations by racial and ethnic groups from 1992 to 2004, and to study the influence of age and sex in the probability of having those limitations. Design: Annual, in-person survey. Participants interviewed up to four consecutive years. Setting: Community. Participants: 65,396 beneficiaries, age ≥ 65, who participated in the Medicare Current Beneficiaries Survey from 1992 to 2004. Main Outcome Measures: Number of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) for which the person had difficulties. Results: The mean yearly proportion of participants with any ADL limitation over the 13 years varied among groups: Asians/Pacific Islanders (25%, range during the 13 years, 19-29%), Whites (28%, range 25-33%), Hispanics (30%, range 25-37%), Blacks (36%, range 31-40%) and American/Alaskan Natives (38%, range 24-57%). For all participants, the proportion with any ADL (IADL) limitation decreased from 33.5% (41.8%) in 1992 to 27.1% (34.7%) in 2004. These findings were consistent in almost all minority groups. It appears as if the reduction in these proportions were due to decrease in reporting in the most severe category for ADL and in the moderate categories of IADL. Number of ADLs or IADLs with limitations is higher for females than males, and increases with age. Asians and Hispanics report more limitations than Whites and Blacks, starting around age 80. Conclusion: The proportion of those with activity limitations has decreased slightly over the last decade. However, there are still disparities in disability that have persisted over time.

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Abstract 5 Effects of Interdisciplinary Discussions on Attitudes and Perceptions Among Dental, Social Work and Pharmacy Students. J. Diercks, PharmD candidate; A. Lam, PharmD, FASCP; HA. Kiyak, PhD University of Washington Objective: Interdisciplinary teamwork and collaboration are important learning experiences for health professional students. This study evaluates students’ attitudes and perceptions about interdisciplinary learning. Methods: Subjects of the study are health professional students participating in an interdisciplinary project involving three disciplines: Dentistry, Pharmacy and Social Work. These students worked together in the University of Washington Mobile Geriatric Dental Clinic sites in adult day health centers in King County, Washington. The design of this study is a pre/post 15-item Likertscaled survey, administered anonymously to the students before and after their participation in the interdisciplinary project. Categories of questions in the survey included knowledge of each profession, attitudes towards interdisciplinary care, and project participation. Student demographic data was also collected. The averages of the pre- and post-survey scores were calculated. The 2-tailed student t-test was used for statistical analysis to assess differences, with significance set at p-value < 0.05. Results: Data from 12 participants, (6 dental, 4 pharmacy and 2 social work students, average age 25.6+1.57 years, 9 females and 3 males), showed an increase in the students’ knowledge of each other’s professions and improvements in attitude towards interdisciplinary learning after participation in the project. The mean pre- and post-Likert scaled scores were 3.95+0.196 and 4.42+0.145, respectively (p= 4.94e-08). Implications: The results of this study showed interdisciplinary learning activities impact positively on a student’s attitudes and/or perceptions of each other’s profession. Interdisciplinary activities involving different health professional programs should be encouraged and promoted.

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Abstract 6 Age-related effects of a cognitive task on gait speed and frontal plane stability during narrowbase walking Valerie E. Kelly1, Matthew Schrager2, Robert Price1, Luigi Ferrucci2, Anne Shumway-Cook1 Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA; 2Clinical Research Branch, National Institute on Aging, Baltimore, Maryland, USA 1

Purpose: Age-related changes in frontal plane stability during walking are associated with impaired balance and increased fall risk in older adults. Clinically, tandem and narrow-base walking are used to assess gait stability. Adding a cognitive task to narrow-base walking (i.e. dual tasking) may further challenge stability, allowing identification of early balance deficits not detected under single task conditions. The purpose of this study was to examine age-related effects of a cognitive task on velocity and frontal plane stability during narrow-base walking. Methods: Thirty-six healthy adults participated, categorized by age: