Claude D. Pepper Older Americans Independence Center

Michael S Wolf, PhD, MPH
Principal Investigator
Jeffrey A. Linder, MD, MPH
Principal Investigator
Julia Benavente
Center Manager

The Northwestern Pepper Center’s mission is to improve primary care management of older, more medically complex adults living with multiple chronic conditions (MCC). We will identify and train future leaders in geriatrics and gerontology research through mentorship, sharing of resources, and pilot projects. The training emphasizes care for older adults with MCC, as they are at higher risk of poor outcomes and costly care.

The specific aims of the Northwestern Pepper Center are to:

Aim 1 Formalize a comprehensive, multidisciplinary, aging research program dedicated to improving healthcare, functional independence, and quality of life for older adults with MCC. 

We will unite internationally recognized geriatricians and aging research faculty to establish a formal presence as a collaborative center promoting new investigations around improving the primary care management, and overall health of medically complex older adults with MCC. Through an Information Dissemination Core, the Northwestern OAIC will leverage broad local, regional and national primary care networks to rapidly translate research findings, share evidence-based practices, and support their implementation. 

Aim 2 Expand Northwestern training and mentoring activities to develop future leaders in geriatrics and aging research who will transform healthcare to meet the needs of older adults with MCC. 

Junior faculty and fellows across multiple disciplines who have aging and MCC-related research interests will participate as mentored scientists within our OAIC, working closely with affiliated faculty to establish a successful career trajectory to becoming independent investigators. Our linked Research Education and Pilot/Exploratory Studies Cores, supported by three Resource Cores will provide trainees with substantive & methodological mentorship and extensive research opportunities through relevant External, Developmental and Pilot Projects.

Aim 3 Stimulate applied research on the innovative design of primary care models that align with the priorities of older adults with MCC through aging-specific research resources and expertise in healthcare system & technology design (‘Design Core’), patient-reported outcomes measurement (‘Measurement Core’) and quantitative & qualitative data analytics (‘Analytics Core’).

The Northwestern OAIC will provide 3 essential Resource Cores (Design, Measurement, Analytics) to support MCC-related Developmental Projects, such as: 1) developing multifaceted, technology-enabled interventions to promote clinician adherence to best practices in the management of older adults with MCC, and supporting older patients and their caregivers’ engagement in primary care and self-management of MCC; 2) the routine collection of patient-reported outcomes and priorities in primary care to improve clinical decision making; 3) developing assessment tools to quantify patients’ disease burden, treatment burden and overall medical care complexity for purposes of risk stratification; and 4) new methodological approaches to data harmonization across healthcare systems to better capture older adults’ health and frailty status. We will also seek out new MCC-related investigations through our Pilot/Exploratory Studies Core and an extensive portfolio of ongoing External Projects. 

Leadership & Administrative Core (LAC)
Leader 1:    Michael S. Wolf, PhD, MPH
Leader 2:    Jeffrey A. Linder, MD, MPH
Leader 3:    Lee Lindquist, MD, MPH, MBA

The Leadership/Administrative Core (LAC) oversees the daily operations of the Northwestern OAIC and the implementation of its mission, coordinating activities amongst all of the center Cores and organizational partners from the community, government, healthcare system, industry and other academic institutions. 

Research Education Core (REC)
Leader 1:     Sara M. Bradley, MD
Leader 2:    Allen Heinemann, PhD
Leader 3:    June McKoy, MD JD MBA

The Research Education Core (REC) is the mentorship arm of the OAIC, developing programs to assess the formative needs of Pepper Scholars and provide them with personalized educational, career development, and networking opportunities to facilitate their research.

Pilot/Exploratory Studies Core (PESC)
Leader 1:    Mary McDermott, MD
Leader 2:    Emily Rogalski, PhD

The Pilot/Exploratory Studies Core (PESC) is a primary home to our OAIC's scientific and scholarly training, responsible for the review and selection of at least 15 pepper scholars and 12 pilot project funding recipients and overseeing their progress throughout the award period.

Healthcare System & Technology Design Core (Design Core)
Leader 1:     David C Mohr, PhD
Leader 2:    Rachel Kornfield, PhD
Leader 3:    Andrew Berry, PhD

The Healthcare System & Technology Design Core provides expertise to junior investigators, Core and National Pepper Center Network faculty in the design, development, evaluation, and implementation of technology-enabled services for older adults with MCC. 

Information Dissemination Core (IDC)
Leader 1:    Ron Ackermann, MD, MPH
Leader 2:    David Liebovitz, MD

The Information Dissemination Core (IDC) distributes research findings through an array of communication channels to patients, families, care practices and policymakers. The IDC also solicits ideas from stakeholders to inform the development of new research projects and products.

Patient-Reported Outcomes Measurement Core (Measurement Core)
Leader 1:     David Cella, PhD
Leader 2:    Daniel K Mroczek, PhD
Leader 3:     Eileen Graham, PhD

The Patient-Reported Outcomes Measurement Core provides measurement expertise for the entire Northwestern OAIC and national Pepper Center Network and serves as a resource to the Research Education Core for junior faculty seeking skills in measurement and the deployment of tools in primary care.

Quantitative and Qualitative Data Analytics Core (Analytics Core)
Leader 1:     Leah Welty, PhD
Leader 2:     Kenzie Cameron, PhD, MPH
Leader 3:    Laura Curtis, MS
Leader 4:     Mary Kwasny, ScD

The Data Analytics Core provides expertise on quantitative and qualitative research design and analytic methods supporting affiliated faculty, cores, and pilot projects, while developing new methods for determining older adults’ health status to better inform clinical decision making.

REC Scholar, Research & Grants Funded During Pepper Supported Time Years /
Diana Chirinos, PhD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine (Epidemiology)
Differential Associations Between Spousal Bereavement, Physical Functioning, and Health Outcomes Among White and Latino Older Adults
2023-2025 /
19 (total)
5 (1st/Sr)
Allison Pack, PhD
Research Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics)
Adaptation and Pilot Testing of the Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) Study
2022-2024 /
3 (total)
1 (1st/Sr)
Daniel Rees Lewis, PhD
Research Assistant Professor / Northwestern University, Segal Design Institute & Mechanical Engineering
Leveraging Human-Computer Interaction and Learning Sciences to Support Older Adults’ Use of Telehealth Software for Chronic Disease Self-care
2022-2024 /
15 (total)
5 (1st/Sr)
Minjee Kim, MD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Neurology
Technology-Enabled Screening Strategy for Obstructive Sleep Apnea (TEST-OSA) in Primary Care Older Patients with Multiple Chronic Conditions
2022-2024 /
6 (total)
4 (1st/Sr)
Kelly Jarvis, PhD
Research Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Radiology
Heart-brain MRI evaluation of hemodynamic coupling in hypertension and healthy aging
  • Heart-brain MRI for the evaluation of hemodynamic coupling in aging and Alzheimer’s disease (1K01AG080070)

2022-2024 /
1 (total)
0 (1st/Sr)
Prakash Jayabalan, MD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation
The Development of Novel Therapeutic Walking Exercise Strategies in Sedentary Individuals with Knee Osteoarthritis
2022-2024 /
5 (total)
1 (1st/Sr)
Emi C. Bretschneider, MD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Obstetrics and Gynecology (Female Pelvic Medicine and Reconstructive Surgery (Urogynecology))
Ready for Advances in Bladder health for Older Women (The RAInBOW Study)
2022-2024 /
11 (total)
3 (1st/Sr)
Marquita Lewis-Thames, PhD
Research Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences
Designing a Telehealth-Based Tool for Rural Older Adults with Cancer and Cancer-Related Distress: Testing for Usability and Acceptability
  • Assessing the usability and utilization of telehealth among COVID-era rural older cancer survivors (IRG-21-144-27)

2021-2023 /
14 (total)
5 (1st/Sr)
Whitney Welch, PhD
Research Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine (Behavioral Medicine)
Remote Sensor-Based Frailty Detection in Older Adults
  • Micro-randomized trial of a physical activity intervention to manage pain symptoms among older cancer survivors (1K01CA255414)

2021-2023 /
8 (total)
2 (1st/Sr)
Emma L Barber, MD
Assistant Professor / Northwestern University, Feinberg School of Medicine, Department of Obstetrics and Gynecology (Gynecologic Oncology)
A pilot study of prehabilitation during the neoadjuvant window of opportunity in older women with ovarian cancer (Fit4Surgery)
  • Patient-Tailored Physical Activity Intervention Among Older Women with Gynecologic Cancers Undergoing Chemotherapy (FIT4TREATMENT) (1R01AG081291)

2021-2023 /
17 (total)
3 (1st/Sr)
Mary Clare Masters, MD
Fellow / Northwestern University, Feinberg School of Medicine, Department of Medicine (Infectious Diseases)
Associations between plasma biomarkers of the Senescence-Associated Secretory Phenotype and frailty in older persons with HIV
  • Associations between plasma biomarkers of the Senescence-Associated Secretory Phenotype and frailty in older persons with HIV (UWSC14341 BPO#71232//5R33AG067069)
  • Associations between sleep disorders and frailty in older PWH (K12)

2021-2023 /
6 (total)
5 (1st/Sr)
Rebecca Lovett, PhD
Fellow / Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics)
Development and Pilot Testing of the 'EHR-enabled Activity promotion using CBT via Telehealth for Depression (ENACT-D)' Intervention for Older Adults in Primary Care
2021-2023 /
7 (total)
2 (1st/Sr)

Past Scholars
Rachel O'Conor, PhD, MPH, Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics) (2020-2022)
Miriam Rafferty, DPT PhD, Northwestern University, Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation (2020-2022)
Katherine O’Brien, MD, Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics) (2020-2022)
Theresa Rowe, DO MS, Northwestern University, Feinberg School of Medicine, Department of Medicine (General Internal Medicine & Geriatrics) (2020-2022)
Sadiya Khan, MD MSc, Northwestern University, Feinberg School of Medicine, Department of Medicine (Cardiology) and Department of Preventive Medicine (Epidemiology) (2020-2022)

1. Project Title: Prevalence of microvascular dysfunction and association with functional limitation in older adults with chronic obstructive pulmonary disease
  Leader: Sadiya Khan, MD, MSc

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are major public health epidemics and commonly coexist in older adults (65+ years). Broadly, cardiovascular causes account for 50% of all deaths in patients with COPD. Specifically, 1 in 3 patients with COPD also have prevalent HF, and this associated with greater functional intolerance, worse health-related quality of life, and increased healthcare expenditures compared with patients with COPD and without HF. Given the high burden of mortality and morbidity with comorbid COPD and HF, identifying key risk factors to prevent functional decline related to HF risk in older adults is critically important. Therefore, we propose an observational, cross-sectional study in older adults (?65 years) with COPD who have no known history of coronary artery disease or heart failure to examine cross-sectional associations between severity of COPD and microvascular dysfunction, functional status with 6-minute walk test, dyspnea symptoms, and cardiac biomarkers.

The specific aims of this pilot are: (1) Determine the cross-sectional association between severity of COPD (GOLD Stages) and microvascular dysfunction; (2) Determine the cross-sectional association between severity of COPD (GOLD Stages) and 6-minute walk test, patient reported outcome for dyspnea, and cardiovascular biomarkers.

2. Project Title: Designing a Telehealth-Based Tool for Rural Older Adults with Cancer and Cancer-Related Distress: Testing for Usability and Acceptability
  Leader: Marquita Lewis-Thames, PhD

Older adults have difficulties identifying symptoms of anxiety and reduced likelihood of knowing when to access mental health services. One in four adults >65 years old lives in a rural or small town, where mental health specialists and similar resources are often dispersed or located in distal urban centers. To this end, rural older adults with cancer-related anxiety or distress (CRD) are particularly vulnerable to poorer mental health and cancer-related outcomes. This project proposes a strategy to improve CRD outcomes for rural older adults via a telehealth–based program that supports the management of CRD by integrating clinical and community-based resources.

The specific aims of this pilot are: 

Aim 1: Assess barriers and facilitators of telehealth access from rural older cancer patients, caregivers, and healthcare professionals to guide the development of a telehealth delivered CRD management tool.

Aim 2: Develop a theoretically-grounded telehealth CRD management tool using a human-centered design.

Aim 3: Conduct user testing to inform the final version and an intervention protocol to test the implementation an effectiveness of the telehealth CRD management tool.

3. Project Title: Adaptation and Pilot Testing of the Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) Study
  Leader: Allison Pack, PhD

We will adapt and pilot test a technology-enabled, primary care strategy for routinely monitoring medication use and adherence among older adults with multiple chronic conditions and polypharmacy. An ongoing Northwestern trial (‘TAKE IT’; R01DK110172) has been able to leverage an electronic health record (EHR) platform and its linked patient portal (Epic, MyChart [MyNM]) to: 1) routinely engage new adult kidney transplant recipients via monthly portal-based adherence assessments; 2) flag and phenotype reported adherence concerns; 3) alert care teams via secure messaging of the specific adherence concern(s); and 4) mobilize available resources tailored to identified barriers (e.g. SMS text reminders for cognitive barriers, a comprehensive medication review via phone or video telehealth to address regimen complexity, social work referral for social or economic concerns, etc.) following a standard protocol. With this award, we will adapt the TAKE IT strategy for use in primary care, targeting older adults with MCC and polypharmacy (using Medicare Part D medication therapy management criteria of ?8 medications). This intervention, renamed as the PATTERN study (Phenotyping Adherence Through Technology-Enabled Reports and Navigation) will then be pilot tested at one Northwestern Medicine (NM) primary care practice to determine its acceptability, feasibility, and preliminary fidelity.

The specific aims are:

Aim 1: Adapt the PATTERN intervention for use in primary care using input from key stakeholders.

Aim 2: Assess the PATTERN intervention’s feasibility and acceptability for use in primary care.

4. Project Title: Leveraging Human-Computer Interaction and Learning Sciences to Support Older Adults’ Use of Telehealth Software for Chronic Disease Self-care
  Leader: Daniel Rees Lewis, PhD

There is currently a gap between the existing and needed clinical support to help older adults learn to manage their conditions. The current system of care does not help patients with chronic conditions (e.g., diabetes) learn effective self-care, and there are few programs developed for older adults. Consequently, there is increased pressure on primary care clinicians, who must help teach older adults to manage their conditions in just a few short minutes they have to meet. This project will seek to leverage Human Computer Interaction (HCI) and Learning Science (LS) methods and designs to create telehealth supports for older adults responsible for learning to manage their own health. I will focus on older adults with type II diabetes, and at least one of hypertension and high cholesterol. While older adults can find software challenging, HCI research shows by attending to their needs we can help them effectively use software (Brewer et al., 2016). Helping older adults to better use telehealth can increase learning and improve health outcomes for older adults while reducing the burden on primary care.

Aim 1: Use cognitive task analysis (CTA) methods to understand the barriers older adults have when using telehealth for self-care management.

Aim 2: Apply findings from Aim 1 to design a learning module to support using existing diabetes telehealth software and then engage in iterative redesign for and with older adults.

5. Project Title: Technology-Enabled Screening Strategy for Obstructive Sleep Apnea (TEST-OSA) in Primary Care Older Patients with Multiple Chronic Conditions
  Leader: Minjee Kim, MD

We will adapt and pilot test a technology-enabled, primary care strategy to promote the timely detection and treatment of sleep apnea among older adults at high risk due to multiple chronic conditions.

Obstructive sleep apnea (OSA), characterized by repeated episodes of upper-airway obstruction during sleep, is estimated to affect up to 35% of older adults 65 and older, yet it is vastly underdiagnosed. Undiagnosed and untreated OSA is associated with an increased risk for incident hypertension, coronary heart disease, heart failure, stroke, and mortality, as well as increased motor vehicle crashes, mood disorders and reduced quality of life. OSA is a leading cause of sleep disturbance in older adults and has been linked to more rapid accumulation of chronic diseases and multimorbidity.

Many approaches have been taken to improve primary care detection of OSA, yet evidence has been highly variable with regard to the acceptability, feasibility, and effectiveness of what has been recently summarized as a range of ‘fragmented’ interventions not limited to high-risk older adults. Yet with widespread use of electronic health records (EHR), there are opportunities to overcome existing screening barriers, streamline clinical workflows, and activate care teams to enable the timely diagnosis of OSA and initiation of appropriate treatment. With this Pepper Scholar application, I will model an existing intervention (Toolbox Detect; R01AG069762) leveraging consumer technology (iPad), tethered to the EHR for routinely screening for cognitive impairment as part of Medicare Annual Wellness Visits (AWV), for use in the early detection of OSA among high-risk adults meeting AHA criteria or with MCC. This Technology-Enabled Screening Targeting Obstructive Sleep Apnea (TEST-OSA) strategy will promote the primary care detection and treatment of OSA among high-risk adults.

It is hypothesized that TEST-OSA, compared to usual care, will increase timely diagnosis of OSA and treatment initiation, without added burden to clinicians. My specific aims are to:

Aim 1 Develop and refine the TEST-OSA primary care strategy for high-risk older adults, including those with MCC using input from key stakeholders.

Aim 2 Pilot Test the TEST-OSA strategy to determine its acceptability, feasibility, and fidelity in primary care and explore any patient, provider, or health system barriers to implementation.

6. Project Title: Heart-brain MRI evaluation of hemodynamic coupling in hypertension and healthy aging
  Leader: Kelly Jarvis, PhD

Cardiovascular risk factors, such as hypertension and physical inactivity, are among “potentially modifiable” dementia risk factors that can be influenced in mid to later life. However, mechanisms underlying heart-brain hemodynamic coupling are not well understood. In order to successfully inform new approaches for preventing, delaying or improving quality of life for those suffering from multiple chronic conditions of the heart and brain, interactions between these two major organs need to be further explored.

MRI is an established diagnostic tool for assessing cardiovascular function and neuroimaging markers of cerebrovascular disease and neurodegeneration. In the past decade, 4D flow MRI has emerged as a powerful technique for measuring 3D hemodynamics in the heart and brain vessels. Previously, I developed imaging tools for visualization and quantification of cardiovascular hemodynamics, demonstrating the comprehensive and individualized analysis of complex flow pathways. Using these techniques, I found significant age-related changes in aortic stiffness assessed by pulse wave velocity (PWV). Results in 100 healthy controls (19-79 years) showed a strong correlation with age (r=0.79, p<0.001). Next, will be to study how these changes interact with cerebrovascular hemodynamics and neuroimaging markers of disease.

Abnormalities in heart and brain regions, however, have been historically assessed independently in scanners dedicated for either cardiovascular or neuroimaging studies. Recent developments in MRI provide the ability to image faster and thus an opportunity for integrating cardiovascular 4D flow MRI with neuroimaging in a single patient exam. I have designed a preliminary “heart-brain MRI” protocol and acquired pilot data in 12 healthy individuals (age: 24-76) to demonstrate feasibility (Jarvis et. al. ISMRM abstract 2022). This novel approach will be used for comprehensive assessment of heart-brain coupling in an initial study of cognitively healthy adults.

AIM: Apply novel heart-brain MRI methods in study of hypertension and normal cognitive aging.

a. Establish normative heart-brain MRI values and quantify interactions across adult lifespan.

b. Evaluate potential impacts of hypertension on hemodynamic coupling.

7. Project Title: The Development of Novel Therapeutic Walking Exercise Strategies in Sedentary Individuals with Knee Osteoarthritis
  Leader: Prakash Jayabalan, MD

Knee osteoarthritis (OA) and cardiovascular disease (CVD) are the two most prevalent medical conditions in individuals above the age of 70. Physical inactivity resulting from OA is known to increase CVD risk in elderly patients and thus shorten their lifespan. Muscle weakness and chronic inflammation are also known to be a significant component of both diseases, and non-steroidal anti-inflammatory drugs (NSAIDs), commonly used to treat OA-related pain are also associated with an increased risk of CVD. Moderate intensity physical activity is strongly advocated for the treatment of both diseases. Randomized clinical trials of walking exercise have shown significant short-term improvements in knee pain, functional status, and quality of life in patients with OA and, in turn, beneficial effects on cardiovascular parameters. However, more recent randomized controlled trials of walking exercise programs in elderly persons with knee OA reported dropout rates as high as 20-40%, indicating reluctance to adopt walking as a lasting form of exercise. Evidence suggests that patients stop exercising due to exercise-induced exacerbation of symptoms, beliefs that exercise could be damaging to their knees, and reduced capacity to perform exercises at intensities and durations recommended, further worsening concurrent CVD parameters. In elderly sedentary individuals with knee OA and CVD, there remains a pivotal need for a physical activity intervention that allows for sustained walking exercise engagement, reducing joint pain and cardiometabolic risk while improving function and cardiovascular parameters.

The study we propose is a randomized controlled trial in individuals with mild to moderate knee OA (n=30 in each group), evaluating the symptomatic, biochemical, and biomechanical benefits of 3 walking exercise treatments: 1) LBPP treadmill walking 2) aquatic walking 3) standard of care land-based walking exercise for the same duration.

Specific Aim 1: Delineate within-participant longitudinal changes in joint pain, quadriceps strength, function (Knee Osteoarthritis Outcome score, KOOS), quality of life (SF-36), NSAID use and serum biomarkers of joint disease, following 12 weeks of off-loaded walking exercise (either LBPP or aquatic walking versus land walking exercise).

Specific Aim 2: Delineate differences in longitudinal changes of cardiovascular parameters (blood pressure, VO2 max, HbA1c and lipid profile) and cardiometabolic markers (serum adiponectin, and inflammatory mediators), following 12 weeks of these respective walking strategies.

8. Project Title: Ready for Advances in Bladder health for Older Women (The RAInBOW Study)
  Leader: Emi C. Bretschneider, MD

I will develop a patient-centered, individualized overactive bladder (OAB) program uniquely designed for older women that: 1) systematically assesses baseline comorbid conditions and medication use using an integrated online portal-based tool; 2) closely monitors OAB symptoms, treatment response and adverse effects via an online portal-based tool; and 3) proactively adjusts treatments to minimize bothersome OAB symptoms utilizing telehealth visits and expediting the transition to advanced therapies as indicated. I aim to study the impact of this program on patient symptom severity and bother, overall health status and overall quality of life. Over 1-year, women 65 years of age or older with OAB who present to Northwestern’s Integrated Pelvic Health Program (N=60) will be invited to participate in a study comparing outcomes in women (n=30) treated via normal care pathway and (n=30) treated in an OAB program with the integrated online portal-based tools.

Specific aim 1: To develop an online portal-based tool using a human-centered design to systematically assess patient-reported medication use, comorbid conditions and overall health status as well as OAB-condition specific questions such as symptoms, symptom severity, treatment adherence, treatment response, treatment-related adverse effects and patient satisfaction.

Specific aim 2: To perform a pilot study of the online portal-based technology compared to usual care in order to test the usability, acceptability and feasibility of the tool.

9. Project Title: Differential Associations Between Spousal Bereavement, Physical Functioning and Health Outcomes Among White and Latino Older Adults
  Leader: Diana Chirinos, PhD

Our study will examine how bereavement impacts physical functioning and overall health in a diverse sample of older adults. We will capitalize on two ongoing NIH-funded studies of older adults (5R01HL152442-03) and bereavement (5K01HL149987-03) with harmonized measures and recruit additional bereaved participants (predominantly Latino) allowing us to test novel hypotheses that go beyond the goals of the parent studies. New participants will complete an in-person visit where data on physical functioning, mental and physical health will be collected. In addition, Latino bereaved spouses will participate in an in-depth interview aimed at identifying potential resilience factors during the visit. Individual differences in coping with a loss arise from individual perceptions, social contexts, and cultural beliefs. Thus, Latino culture-specific values (e.g., familism, religiosity) as well as factors such as social support and household composition may play an important role in the grieving process and have a protective effect on the impact of bereavement on physical functioning and health outcomes. Identification of those factors will not only inform our understanding of risk but will also aid in the development of culturally sensitive interventions.

Specific aims:

Aim 1: To examine the association between bereavement status (bereaved vs. non-bereaved), physical functioning (perceived functional limitations), physical (# of chronic conditions, inflammation), and mental health (quality of life, depressive and anxiety symptoms) outcomes among older adults.

Aim 2: To assess differences by ethnicity (Latino vs. NHW) in the association between bereavement status, physical functioning, and physical and mental health outcomes among older adults.

Aim 3. To identify contextual and cultural factors that facilitate coping with bereavement among Latino older adults.

DEVELOPMENT PROJECTS (5 Development Projects Listed)
1. Project Title: Minimizing Misclassification of Comorbidities
  Leader: Mary Kwasny, ScD and Laura Curtis, MS
  Core(s): Quantitative and Qualitative Data Analytics Core (Analytics Core)
  • Misclassified comorbidities limit accurate estimation of relationships between risk factors and health outcomes. 
  • Comorbidities are often self-reported rather than derived from health records
  • This Development Project combines and expands methods using EHR data (e.g. PheKB) to better classify comorbidities. 

2. Project Title: New index representing medical complexity
  Leader: Laura Curtis, MS and Mary Kwasny, ScD
  Core(s): Quantitative and Qualitative Data Analytics Core (Analytics Core)
  • Most existing health care indices are either disease specific or designed to assess overall health of the patient
  • This Development Project will create a new index combining the burden of illness in the health care system (e.g. more conditions or providers) and the burden of treatment for the patient (self-monitoring, lab visits, patient's perception).
  • Ultimate goal: better inform the health care system about patient needs to obtain the maximum benefit of health care interactions.

3. Project Title: An Individualized, Patient-Centered PRO Monitoring System
  Leader: Eileen Graham, PhD
  Core(s): Patient-Reported Outcomes Measurement Core (Measurement Core)

Conduct a DP to build an individualized, patient-centered system for primary and specialist care settings to monitor relevant patient-reported outcomes (PROs) among older adults living with MCC and determine whether PROs can predict clinical outcomes.

4. Project Title: Technology-Enabled Primary Care for Mental and Physical Health MCCs
  Leader: Andrew Berry, PhD
  Core(s): Healthcare System & Technology Design Core (Design Core)

This Development Project will:

- identify patient barriers to effective communication with internal medicine providers among older adults with symptoms of anxiety and depression and their caregivers 

- develop a low fidelity prototype of a patient organizational system to enhance communication with providers that will be detailed in a design document. 

5. Project Title: Summative Design Guideline Development
  Leader: Andrew Berry, PhD
  Core(s): Healthcare System & Technology Design Core (Design Core)

This Development Project will: 

- Develop and disseminate a methodology guide that summarizes best practices for applying user-centered design (UCD) to optimize technology-enabled services for older adults with MCC. 

RESEARCH (12 Projects Listed)
1. Project Title: Management of Complex Medication Regimens among Older Adults with Alzheimer's Disease and Related Dementias and their Caregivers
  Leader(s): O'CONOR, RACHEL
    NIH K01AG070107 / ( 2021 - 2025 )
  Alzheimer s disease and related dementias (ADRD) are progressive diseases characterized by their debilitating impact on cognitive function. Adults ages 65 years and older represent the majority of cases, and are managing not only ADRD, but multiple chronic conditions (MCC) that are common with advancing age. Adherence to prescribed medication regimens is critical to optimize both cognitive and physical health, but is especially difficult in the context of multidrug regimens. Little is known about how older adults with ADRD self-manage their medications, how these responsibilities transition to caregivers as the disease progresses, how capable caregivers are to fulfill these responsibilities, and how ambulatory care practices support patients and caregivers to ensure safe medication use and adherence. This K01 application seeks to provide training for Dr. Rachel O Conor to launch an independent research agenda focused on understanding the cognitive and psychosocial determinants of chronic disease self-management behaviors and health outcomes for older adults and their caregivers as they manage complex chronic conditions, including ADRD. To achieve this goal, her short-term training goals are to: acquire scientific knowledge in ADRD pathophysiology and care, gain exposure to the clinical management of older adults with ADRD in geriatric and specialty memory clinics, gain experience conducting research with cognitively impaired individuals and their caregivers, and obtain formal training in longitudinal data analysis and advanced statistical techniques. The objective of the proposed research is to examine medication self-management behaviors among a diverse sample of older adults with ADRD + MCC and their caregivers. Dr. O Conor will partner with the Northwestern Alzheimer s Disease Center and an ongoing, NIA-funded cognitive aging cohort study to conduct complementary mixed methods investigations. The research aims are to 1) Examine the evolving strategies employed by older adults with ADRD and their caregivers to self- manage multidrug regimens as the disease progresses over time; 2) Characterize barriers primary care clinicians face engaging older adults and caregivers in the management of ADRD and MCC; 3) Investigate associations between cognitive decline and medication self-management behaviors among older adults managing complex multidrug regimens; 4) Explore factors influencing associations between cognitive decline and medication self- management behaviors. The proposed investigations will inform the development and evaluation of a primary care based intervention to support older adults with ADRD + MCC and their caregivers in their medication management, and serve as the foundation for a unique cohort study to prospectively investigate how older adults with early stage ADRD + MCC and their caregivers transition medication self-management roles over the disease course, and its impact on health outcomes.
  Leader(s): WOLF, MICHAEL S
    NIH R01AG030611 / ( 2007 - 2025 )
  We request to continue our NIA cohort study ( LitCog ; R01AG030611). LitCog studies the confluence of increased medical morbidity resulting in complex patient self-management (SM) roles, and cognitive decline, which may affect older patients health literacy (HL) skills and chronic illness self-care. Functionally independent, cognitively normal adults ages 55-74 (N=900) were recruited from community primary care practices in Chicago. Participants have completed comprehensive cognitive, psychological, social, behavioral, and functional health assessments every 3 years (4 interviews; 2008-2018). The sample is diverse by race, socioeconomic status and medical morbidity; uncommon among cognitive aging studies. A 1st renewal award (LitCog II) examined changes in cognition, HL and SM skills over 6 years and their associations with physical and mental health. We found cognitive function to be strongly associated with HL; both decline together over time. Cognitive function and HL also determine older adults SM skills; all predict functional health status and its decline. A 2nd renewal (LitCog III) has allowed us to capture new health behaviors, chronic disease outcomes, and healthcare use from medical, pharmacy records a decade post-baseline. Cognitive function, HL and SM skills impact all of these outcomes. LitCog III is almost complete; 774 of 900 (86%) subjects are alive and available for further study. We now propose to conduct follow-up assessments 12 and 15 years post-baseline (LitCog IV). With 6 interviews over 15 years, specific trajectories of decline in cognition, HL, SM skills and health status can be closely studied. The prevalence of and adjustment to increasing morbidity, disability, cognitive impairment (including Alzheimer s Disease & Related Dementias (ADRD)) allow for new outcomes for investigation. Mortality data will also now be available with extended follow-up. Our primary aim is to 1) evaluate trajectories in cognitive function, HL and SM skills over 15 years among older adults, and their associations with health outcomes. LitCog is an exceptionally unique cognitive aging cohort study as it is framed in the context of health services research. Our goal has been to inform health system strategies for effectively managing older patients by understanding how cognition changes and influences HL and SM skills necessary for achieving optimal health. Modifiable factors that may mediate/moderate associations are also explored as potential intervention targets. The involvement and roles of caregivers has specifically emerged as an important social determinant of patients health. An administrative ADRD supplement (LitCog IIIA) has expanded our inquiry by including interviews with caregivers (informal or paid) involved in supporting the care of 60% of participants. In LitCog IV, we will create a parallel caregiver cohort, with the secondary aims to 2) investigate associations between the presence of an involved caregiver with treatment adherence, chronic disease outcomes, and functional health status among older adults; 3) identify factors influencing associations between caregiver involvement and patient outcomes
  Leader(s): LINDQUIST, LEE A
    NIH R01AG058777 / ( 2019 - 2024 )
  The goal of this research is to better understand how older adult aging-in-place decision making and implementation is impacted by cognitive changes seen with Alzheimer s disease, functional loss, social influences, and environmental factors. Remaining in one s own home is a priority for many older adults. Decision making and planning is critical to ensure successful aging-in-place, especially when older adults are diagnosed with Alzheimer s disease. The most important decision that many adults navigate is how to balance progressively worsening cognition, seen in Alzheimer s disease, and increasing disability with their support needs. Although a great number of older adults will need support, prior research has shown that many may dismiss planning for their home support needs outright (e.g. I plan to die in my sleep before I ever need help). Most older adults do not want to leave their home and yet very few people plan for their home-based needs that they will require to age-in-place safely, as their cognition and function worsens. Through our previously PCORI-funded research, we developed a tool, PlanYourLifespan (PYL), which facilitates making decisions and planning to age-in-place, specifically with Alzheimer s disease. Through education about future health and home-based needs as well as access to these resources, older adults can make choices and share them with loved ones for their future needs. PYL was tested in a multi-site randomized controlled trial of 385 community-dwelling older adults with 3 month follow-up and found to be significantly efficacious in improving decision making behaviors towards aging-in-place options among older adults. With the short follow-up, we were limited in determining how these decision making plans of older adults translated into goal concordance towards aging-in-place. A gap exists in how decision making for aging-in-place is impacted by older adults changes in cognition, functional loss, social factors, and environments. How these plans translate into timely adoption as well as the impact that loved ones have on goal concordance have also been unexplored. Through this research, we aim to: Aim 1. Determine how decision making and planning for aging-in-place is impacted by older adults cognition changes (e.g. as experienced with Alzheimer s disease), functional changes, multi-chronic conditions, social influences (e.g. adult offspring, spouses), and environments (e.g. rural/urban, home type). Aim 2. Examine the mediating/ moderating interactions between older adult cognition, function, social influences, and environments in decision making for aging-in-place choices. Aim 3. Assess whether decision making and planning for aging-in-place translates into timely adoption and goal concordance for older adults and their surrogate/caregiver decision makers. To achieve these aims, we will leverage both an NIA-funded cohort (LitCog, n=700) with extensive cognitive testing and a PCORI-funded intervention: We will conduct a 42 month longitudinal study of older adults from the LitCog cohort who will receive the PYL intervention on Day 1. Surveys will be conducted every 6 months in conjunction with the active LitCog research, where cognitive, social, functional, health literacy data is being collected. Additionally, data will be collected on decision changes, resource use, timing of plan implementation, and goal concordance.
4. Project Title: Novel gastrocnemius muscle characteristics in peripheral artery disease patients associated with impaired functional performance
    NIH R01AG066724 / ( 2021 - 2025 )
  Lower extremity peripheral artery disease (PAD) significantly affects aging populations and results in functional impairment. Although the clinical importance of finding efficacious interventions for PAD is well-recognized, few medical therapies are currently available. PAD is diagnosed using the ankle brachial index (ABI), a measure of blood flow to the lower extremities. Lower ABI is associated with worse function; however, low ABI alone cannot fully explain functional impairments in PAD. Small studies have reported oxidative stress, mitochondrial dysfunction and/or fiber damage in gastrocnemius muscle biopsies from PAD patients, suggesting skeletal muscle perturbations may contribute to functional decline. We reported highly variable fiber type composition and fiber type grouping in a small cohort of PAD patients, and observed lack of intermyofibrillar mitochondria (IMFM-) in oxidative, myosin heavy chain (MyHC) type I fibers. We have provocative new preliminary data suggesting variability in response to ongoing denervation, and in fiber type and mitochondrial adaptations, with PAD. The purpose of this study is to define specific characteristics of muscle in PAD associated with impaired walking performance through detailed immunohistochemical analyses of 400 baseline gastrocnemius muscle biopsies stored in the Northwestern biorepository, collected from 9 different clinical trials. This biorepository of muscle from PAD patients is one-of-a-kind and is associated with detailed clinical and functional characteristics of the donors. We hypothesize that variability in fiber size, fiber type and mitochondrial adaptations in response to ischemia-reperfusion damage and denervation in individuals with PAD will have value in predicting walking impairment. In Aim 1, we will quantify the proportion of IMFM- areas in type I fibers with normal type I MyHC abundance, or accumulation of type IIX MyHC and/or LC3, a marker of autophagy, and determine associations with fiber type composition and fiber size, as well as relationships of muscle features to walking performance in PAD. We hypothesize that LC3 will co-localize with IIX MyHC in IMFM- areas, suggesting both incomplete autophagic clearance of IIX MyHC and mitochondrial biogenesis during fiber transition from type IIX to type I as a result of denervation and reinnervation. In Aim 2 we will quantify denervated, NCAM+ fibers and fibers with elevated oxidative damage markers by fiber type. We hypothesize that denervation in PAD will preferentially affect fibers expressing IIX MyHC and that only IMFM- areas that accumulate IIX MyHC will be NCAM+. In Aim 3 we will perform predictive modeling of PAD disease severity and functional impairment using morphological characteristics of muscle quantified in Aims 1 and 2 as biomarkers in conjunction with supervised classification approaches. In Aim 4 we will test the hypothesis that baseline muscle characteristics will predict longitudinal functional outcomes at 6-month follow up. This model will provide a powerful tool to aide in identifying biologic processes for targeted interventions and to assess the mechanism of action and effectiveness of current pharmacological and exercise interventions in ongoing PAD clinical trials.
  Leader(s): MROCZEK, DANIEL K.
    NIH R01AG067622 / ( 2019 - 2024 )
  This project will evaluate the role of personality and other non-cognitive risk factors (e.g., affect, resilience) that impact and moderate the pattern and progression of Alzheimer s disease (AD) and AD-related dementia, as well as change in physical and cognitive impairment. The impact of an individual s personality, their affect, and resilience are critical factors to take into account in the context of individual changes in onset and progression of Alzheimer s disease, AD-related dementia, general cognitive impairment, and physical health status. We embrace the concept of precision medicine, in the sense of understanding individual differences factors that underlie risk and resilience to health changes, including Alzheimer s disease and AD-related dementia.Individual differences in risk factors are at the heart of this project. An important aspect of this multi-study project is the potential to focus on explanations for variation in findings across independent studies of Alzheimer s disease, AD-related dementia, and physical and cognitive impairment. . We have found that in previous coordinated analyses there is often wide variation in effect sizes across studies that utilize identical measures of personality and have been analyzed using identical models, hence we propose systematic meta-regression analyses to evaluate better these individual and study-level differences. This approach promises a more in- depth understanding of lifestyle factors related to Alzheimer s disease and AD-related dementia, as well as general cognitive impairment and physical health. Impact: This project addresses NIA research goals supporting the examination of the interplay between psychological and social factors and their role in Alzheimer s disease and AD-related dementia, as well as more general cognitive impairment and physical health declines. It also promotes robustness, replicability and reproducibility, particularly in the context of Alzheimer s disease and AD-related dementia research, through the very nature of our multi-study coordinated analysis format.
    NIH R01AG067781 / ( 2020 - 2025 )
  Memory complaints are widespread among the elderly and aging is a major risk factor for Alzheimer's disease (AD), leading to the impression that a gradual loss of memory ability, eventually culminating in dementia, may be a nearly universal consequence of getting old. Our studies explore an alternative aging trajectory by studying 80+ year olds, who have episodic memory performance that appears to have escaped age-related decline and that remains in the range that is at least normal for 50-60 year-olds and we have labelled `SuperAgers'. We enrolled a dedicated and unique cohort of SuperAgers and Controls committed to longitudinal assessment and brain donation at death. Our initial studies identified domain-specific biologic, psychosocial, and genetic features of the SuperAgers, including maintenance of cortical integrity (especially in the anterior cingulate), an abundance of anterior cingulate Von Economo neurons and sparse cortical Alzheimer pathology compared to their cognitively average peers. These features may contribute in part to maintenance of superior memory performance past the 8th decade of life. This Project plans to extend the characterization of the SuperAging phenotype through hypothesis-driven novel evaluations of functional brain network connectivity, regional distribution of gene expression, and integrity of dendritic, synaptic and axonal markers. The proposed project will allow us to expand our unique group of SuperAgers and cognitively average peers and address important questions related to the neurobiology of resilience and cognitive reserve. By identifying neurobiologic features that contribute to superior memory performance in old age, outcomes from this project will help isolate factors that promote successful cognitive aging and perhaps also prevent age- related brain diseases such as AD. The project's reliance on a cohort that has already been partially recruited, its longitudinal design, multidisciplinary structure, and collaboration-friendly organization increases the likelihood that consequential progress will be achieved.
  Leader(s): LINDQUIST, LEE A
    NIH R01AG068421 / ( 2020 - 2025 )
  The goals of this proposal are to adapt and test a negotiation and dispute resolutions (NDR) training program for caregivers of patients with Alzheimer s disease (AD), who experience conflicts when they act as patient advocates in the health system [Stage 1A and 1B]. Teaching NDR to family caregivers has the potential to improve caregiver communication, wellbeing, mood, and the care of the adult with AD. Alzheimer s disease (AD) affects more than 5 million older adults nationally, with the prevalence expected to increase as our population ages. An integral driver in the care of older adults with AD is the family caregiver. Our prior research has shown that family caregivers act as patient navigators for their loves ones with AD, often interacting with the health system for a multitude of conflicts (e.g. determining if a test/medication/hospitalization is necessary, responding to insurance denials, billing errors). A reoccurring theme is that family caregivers experience frustration, anxiety, and stress as they deal with these health system conflicts. Whether it is spending hours on the phone trying to get answers from a health care provider s team or navigating complex insurance hoops, these conflicts contribute to the burden experienced by a family caregiver. Unfortunately, family caregivers are vastly underprepared to effectively negotiate through these conflicts. Northwestern University s Kellogg School of Business is an innovator in the field of negotiations and dispute resolution training. Previously, we have tailored the negotiations training for health professionals with positive results. We hypothesize that teaching negotiation and dispute resolution tactics to family caregivers of patients with AD will help improve communication, caregiver stress, anxiety, and empowerment. To test this hypothesis, we aim to: Aim 1: Employ a caregiver (user)-centered design approach to modify and tailor a negotiations and dispute resolution (NDR) training intervention to support communication skills of family caregivers of adults with AD. Aim 2: Utilizing Multiphase Optimization Strategy (MOST), conduct a randomized pilot trial of the NDR intervention that targets better communication between caregivers and health teams, using a 2X3 full factorial design, to (2a) determine the feasibility of delivering the intervention, and (2b) derive estimates of the effect of 3 intervention components on changes in patient-centered outcomes at post-intervention and follow-up to inform a future RCT trial. Exploratory Aim 3: Explore if intervention components (lectures/exercises) interact to change communication between caregivers and health care teams at post-intervention and follow-up. The factorial design will enable testing if the effect of a component is moderated by another component, to ensure the optimized intervention retains components that directly or indirectly impact outcomes. We have partnered with community-based family caregivers who will provide feedback for tailoring the NDR and assist with recruiting family caregivers for the study. Our goal is to improve communication of family caregivers of adults with AD with healthcare providers and others through the negotiation and dispute resolution training.
8. Project Title: COCOA flavanols to improve walking performance in PAD: the COCOA-PAD II Trial
    NIH R01AG068458 / ( 2021 - 2026 )
  Lower extremity peripheral artery disease (PAD) affects 10-15% of people age 65 in the U.S. and will be increasingly common as the U.S. population lives longer with chronic disease. People with PAD have greater walking impairment and faster functional decline than those without PAD. Yet few therapies have been identified that improve walking impairment or prevent functional decline in people with PAD. In people with PAD, ischemia-reperfusion of calf muscle during walking activity causes pathophysiologic changes in calf skeletal muscle, including increased oxidative stress, myofiber injury, and reduced mitochondrial activity. These calf muscle abnormalities are associated with functional impairment and functional decline in PAD. Cocoa flavanols, from the seeds of theobroma cacao, the cocoa tree, have therapeutic properties that may improve calf muscle perfusion and reverse the calf muscle abnormalities in PAD. Pre-clinical evidence shows that cocoa flavanols increase nitric oxide (NO), capillary density, and limb perfusion and also reduce oxidative stress and improve mitochondrial activity in skeletal muscle. Consistent with this pre-clinical evidence, in our NIA-funded pilot clinical trial of 44 participants with PAD, cocoa flavanols significantly improved 6-minute walk distance by 42.6 meters at six-month follow-up, compared to placebo (P=0.005). Therefore, we now propose a Phase III double-blinded, multi-centered randomized trial in 190 participants with PAD, to definitively determine whether 6-months of cocoa flavanols significantly improves 6- minute walk distance at six-month follow-up, compared to placebo. In this revised application (original score: 36, percentile: 17), we will also assess the effects of cocoa flavanols on measures of nitric oxide (measured by brachial artery flow-mediated dilation, calf muscle endothelial nitric oxide synthase (eNOS) and calf muscle phosphorylated eNOS), calf muscle perfusion, whole body oxygen consumption, physical activity, maximal treadmill walking distance, and additional calf muscle biopsy measures at six-month follow-up. In response to reviewer comments, new analyses are proposed to delineate mechanisms and assess persistence of the cocoa flavanols effect on improved walking performance in PAD. If results from our pilot study of cocoa flavanols are confirmed in a definitive Phase III randomized trial, this inexpensive, safe, accessible, and well- tolerated therapy has the potential to meaningfully improve mobility in the large and growing number of older people disabled by PAD.
    NIH R01AG069762 / ( 2020 - 2025 )
  Our objective is to widely implement and evaluate a user-centered, scalable, electronic health record (EHR) - linked strategy for the routine detection of cognitive decline among diverse primary care settings. Cognitive impairment is most prevalent among adults 65 and older, yet less than half of cases are detected and/or diagnosed in primary care settings. It is now increasingly accepted that early detection is critically important to optimize care planning, sustained independence, management of chronic conditions and appropriate caregiver involvement. In 2011, Medicare initiated a covered, Annual Wellness Visit (AWV) that includes a cognitive assessment to detect impairment, Alzheimer s disease and related dementias (ADRD). While this has presented new opportunity for case finding, implementation of AWVs has been variable, including how cognitive function is assessed. Clinicians may rely on more basic, paper-based, interviewer-administered tests that may be less precise and more cumbersome to clinical workflow affecting the fidelity of an early detection strategy. Further, many practices lack a clear protocol for referral when impairment is determined, and a process for family involvement and establishing care goals. Practical, sustainable, scalable strategies are urgently needed to help primary care providers who are on the frontlines of healthcare routinely assess cognitive function as part of AWVs (or whenever a cognitive impairment is suspected), identify concerns and have a protocol for referrals and care management. This is especially true for resource-constrained clinical settings, such as Federally Qualified Health Centers (FQHCs) caring for more vulnerable patient populations. Northwestern developed and continues to innovate the NIH Toolbox for the Assessment of Neurological and Behavioral Function . Since 2017, our team has worked closely with primary care practices to develop a brief, technology-enabled, self-administered, EHR-linked cognitive assessment derived from the NIH Toolbox. We also devised a detailed protocol for its use and how results of our test, known as ToolboxDetect, can inform patient care. We propose a large-scale, primary care practice-randomized trial to implement and comprehensively evaluate ToolboxDetect as a standard of care with AWVs, linked to an EHR (Epic). Diverse, academic and community settings are included to optimize future dissemination efforts. Our primary aim is to evaluate the effectiveness of ToolboxDetect, compared to enhanced usual care, to promote timely detection of cognitive decline and its care management. Our secondary aims are to: 2) Disseminate and implement ToolboxDetect among a large Federally Qualified Health Center Network and assess its feasibility and acceptability for use; 3) Investigate the fidelity of ToolboxDetect, and identify any patient, caregiver, healthcare provider and/or system barriers to its optimal, sustained implementation; and 4) Determine costs associated with implementing ToolboxDetect from a primary care perspective.
    AHRQ R01HS026489 / ( 2019 - 2024 )
  Geriatric patients use the emergency department (ED) more than any other age group. Once in the ED, geriatric patients have longer stays, receive a greater number of diagnostic tests, and are more likely to be hospitalized than younger adults. ED visits for geriatric patients are sentinel health events. If geriatric patients are discharged, they often return to the ED or are hospitalized and experience declines in health-related quality of life (HRQoL) and disability. If they are hospitalized, they incur increased costs and greater risk for poor outcomes including infections, delirium, and falls. Suboptimal acute care for geriatric patients is a problem nationally, resulting in development of national geriatric emergency department guidelines and endorsement by prominent stakeholder groups. To improve acute care for geriatric patients, Northwestern Memorial Hospital implemented the Geriatric Emergency Department Innovations (GEDI) program. GEDI is an integrated, interdisciplinary approach to ED care for geriatric patients; it applies evidence-based protocols to improve ED care and improve transitions from the ED to the community. The program centers on geriatric nurse liaisons (GNLs) who are ED nurses with additional training in geriatrics and whose time is dedicated to GEDI rather than traditional bedside nursing. When consulted by the ED team, GNLs perform validated assessments and coordinate patient care in the ED, hospital, or outpatient setting. Through this assessment and coordination model, GEDI provides patient-centered care and aims to prevent unnecessary hospitalizations. Though GEDI was built on the best available evidence, and reflects the Geriatric Emergency Department guidelines supported by multiple national stakeholder groups, there are no prospective efficacy studies in the U.S. of ED- based programs for geriatric patients like GEDI. Therefore, GEDI's efficacy has not been tested prospectively. We propose a randomized controlled trial (RCT) to determine the efficacy of GEDI at a high- volume, urban hospital. Additionally, identifying patients most likely to benefit from GEDI is difficult. Available instruments have poor predictive validity for hospitalization, return to the ED, and functional decline. However, the Emergency Geriatric Review and Evaluation Tool (EGRET), which was developed with AHRQ funding, is a promising screener to identify older adults who may benefit from GEDI. A RCT of GEDI will be strengthened by using EGRET to screen geriatric patients at risk of poor outcomes. This study addresses several AHRQ priority populations: women, minorities, inner-city, End-of-Life, low income and the elderly.
11. Project Title: Technology Facilitated Behavioral Intervention for Depression among Diverse Patients in Ambulatory Oncology
  Leader(s): YANEZ, BETINA
    NIH R37CA255875 / ( 2021 - 2026 )
  Depressionis one of the most common psychological comorbidities experienced throughout the cancercontinuum. Elevated depressive symptoms in oncology patients is a major concern as unmanaged depressive symptoms in cancer patients is associated with poor health-related quality of life (HRQoL), poor adherence to cancer treatments, delayed return to work and baseline function, greater emergency department visits, greater risk of suicide, and higher all-cause mortality. Behavioral interventions for the management of depression are efficacious, but scalability and implementation of these evidence-based interventions in oncology is limited. Health interpretation capture behavioral populations. information technologies (HIT) provide an ideal opportunity t o expedite the administration, scoring, and of depression screening with well-validated, brief and precise measurement tools that can actionable data to screen for depression, and deliver pragmatic and scalable evidence-based interventions that are proven to reduce depressive symptomatology across various other Despite the benefits of these HITs,use of technology-based models to screen and deliver evidence-based behavioral treatments that address the depressive symptoms in cancer remains underdeveloped and poorly implemented. We will evaluate the effectiveness and the implementation of an evidence-based HIT behavioral treatment for cancer patients with elevated depressive symptoms. This HIT treatment combines systematic, electronic health record-integrated screening for depressive symptoms with an individually-tailored HIT interventions to address gaps in the treatment of depression among cancer patients. The study takes place across two distinct health systems in two major metropolitan areas Chicago and Miami (Northwestern Medicine and University of Miami Health System). We aim to conduct a pragmatic Type I effectiveness-implementation hybrid trial of My Cancer Support an evidence-based, tailored behavioral HIT program for the management of elevated depressive symptoms in ambulatory oncology care settings within two large health systems. We will establish the effectiveness of My Cancer Support on depressive symptoms(i.e., primary outcome) and anxiety, HRQoL, and health services use (i.e. secondary outcomes) compared to usual care. We will evaluate the process of implementing My Cancer Support and its impact on patient and system-level outcomes, including reach, adoption, maintenance, and acceptability. Next, we will identify facilitators and barriers to wide-scale implementation of My Cancer Support beyond Northwestern Medicine and University of Miami Health System. Finally, we will explore whether the effects of My Cancer Support vary across SES, language, disease severity, severity of depressive symptoms, recruitment sites, and other patient and clinical characteristics.
    NIH UH3HL141729 / ( 2019 - 2025 )
  More than 65% of people with lower extremity peripheral artery disease (PAD) are overweight or obese. People with PAD who are overweight or obese have greater functional impairment and faster functional decline than normal weight people with PAD. Walking exercise is first line therapy to improve functional performance in PAD. However, our observational longitudinal data show that overweight and obese PAD participants who combined weight loss with walking exercise had less functional decline than those who walked for exercise but did not lose weight. Therefore, we hypothesize that among people with PAD who are overweight or obese, a weight loss intervention combined with exercise (WL+EX) will improve walking ability more than EX alone. However, effects of intentional weight loss in overweight/obese people with PAD are unknown and may not be beneficial if weight loss exacerbates PAD-related sarcopenia. Behavior change that achieves sustained WL is challenging in older obese people with chronic disease. Therefore, among people with PAD and BMI>28 kg/m2, we will test the hypothesis that WL+EX achieves greater improvement in functional performance than EX alone. Our innovative weight loss intervention uses a group mediated cognitive behavioral framework, connective mobile technology, remote monitoring by a coach, and a calorie restricted DASH-derived OMNIHeart diet. In a seven week pilot study, our intervention achieved mean weight loss of 5.6 pounds and improved the 6-minute walk by 64.1 meters in eight PAD participants with BMI> 28 kg/m2. Preclinical evidence shows that obesity is associated with impaired limb perfusion. Human evidence shows that obesity is associated with reduced skeletal muscle mitochondrial biogenesis and activity. These obesity related changes exacerbate the pathophysiology of PAD. Therefore, we hypothesize that weight loss will improve walking ability in part by improving calf perfusion, and increasing calf mitochondrial activity. We will randomize 212 participants with PAD and BMI > 28 kg/m2 to one of two groups for 12 months: WL+ EX vs. EX alone. Participants will be randomized from Northwestern University, Tulane University, and the U. of Minnesota. Our primary outcome is change in six-minute walk distance at 12-month follow-up. Secondary outcomes are change in 6-minute walk distance at 6-month follow-up and change in exercise adherence, physical activity, patient-reported walking ability (measured by the Walking Impairment Questionnaire), and quality of life (measured by the SF12 Physical Component Score) at 12-month follow-up. Tertiary outcomes include MRI measured calf perfusion, MRI-measured calf muscle quantity and fat abundance, and diet quality. We will perform calf muscle biopsies in 50 participants to measure mitochondrial biogenesis and activity, capillary density, inflammation, and senescent cell abundance. If our hypotheses are correct, the PROVE Trial will have a major public health impact by preventing functional decline and mobility loss in the large and growing number of people with PAD who are overweight or obese.
  1. The Role of BMI in Allostatic Load and Risk of Cancer Death.
    Andrzejak SE, Lewis-Thames MW, Langston ME, Han Y, Khan S, Nettles DA, Fuzzell LN, Tingen MS, Moore JX
    Am J Prev Med, 2023 Sep, 65(3): 417-426 | PMID: 36889531 | PMCID: PMC10440242
    Citations: NA | AltScore: NA
  2. Rural-urban differences in personality traits and well-being in adulthood.
    Atherton OE, Willroth EC, Graham EK, Luo J, Mroczek DK, Lewis-Thames MW
    J Pers, 2023 Feb 1 | PMID: 36725776 | PMCID: PMC10390645
    Citations: NA | AltScore: 346.56
  3. Development and Validation of the HL6: a Brief, Technology-Based Remote Measure of Health Literacy.
    Bailey SC, Griffith JW, Vuyyuru C, Batio S, Velazquez E, Carpenter DM, Davis TC, Parker RM, Taddeo M, Wolf MS
    J Gen Intern Med, 2023 Feb, 38(2): 421-427 | PMID: 35879534 | PMCID: PMC9311340
    Citations: NA | AltScore: 0.75
  4. Early serum ammonia variation in critically ill patients with cirrhosis: A multicentre cohort study.
    Cardoso FS, Kim M, Pereira R, Bagulho L, Fidalgo P, Pawlowski A, Wunderink R, Germano N, Bagshaw SM, Abraldes JG, Karvellas CJ
    Aliment Pharmacol Ther, 2023 Oct, 58(7): 715-724 | PMID: 37470277
    Citations: NA | AltScore: 90.45
  5. Post liver transplantation delirium assessment using the CAM-ICU-7 scale: A cohort analysis.
    Cardoso FS, Kok B, Dong V, Kim M, Karvellas CJ
    Can Liver J, 2023 Jul, 6(2): 261-268 | PMID: 37503525 | PMCID: PMC10370723
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  6. Editorial: Translational and clinical chronobiology.
    Facer-Childs ER, Kim M, Montagnese S
    Front Physiol, 2023, 14: 1191580 | PMID: 37064922 | PMCID: PMC10090657
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  7. Characterization of pre-operative anemia in patients undergoing surgery by a gynecologic oncologist and association with post-operative complications.
    Foley OW, Vega B, Roque D, Hinchcliff E, Marcus J, Tanner EJ, Barber EL
    Int J Gynecol Cancer, 2023 Jul 9
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  8. The impact of multidrug-resistant microorganisms on critically ill patients with cirrhosis in the intensive care unit: a cohort study.
    Kim M, Cardoso FS, Pawlowski A, Wunderink R, Ladner DP, Abraldes JG, Karvellas CJ
    Hepatol Commun, 2023 Feb 1, 7(2): e0038 | PMID: 36669500 | PMCID: PMC10019237
    Citations: 1 | AltScore: 15.05
  9. The association between light exposure before bedtime in pregnancy and the risk of developing gestational diabetes mellitus.
    Kim M, Facco FL, Braun RI, Wolf MS, Garcia-Canga B, Grobman WA, Zee PC, Reid KJ
    Am J Obstet Gynecol MFM, 2023 Aug, 5(8): 100922 | PMID: 36907513
    Citations: NA | AltScore: 53.43
  10. MidCog study: a prospective, observational cohort study investigating health literacy, self-management skills and cognitive function in middle-aged adults.
    Kim M, Kwasny MJ, Bailey SC, Benavente JY, Zheng P, Bonham M, Luu HQ, Cecil P, Agyare P, O'Conor R, Curtis LM, Hur S, Yeh F, Lovett RM, Russell A, Luo Y, Zee PC, Wolf MS
    BMJ Open, 2023 Feb 23, 13(2): e071899 | PMID: 36822802 | PMCID: PMC9950895
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  11. Light at night in older age is associated with obesity, diabetes, and hypertension.
    Kim M, Vu TH, Maas MB, Braun RI, Wolf MS, Roenneberg T, Daviglus ML, Reid KJ, Zee PC
    Sleep, 2023 Mar 9, 46(3): | PMID: 35729737 | PMCID: PMC9995772
    Citations: 10 | AltScore: 1313.068
  12. Distance and Transportation Barriers to Colorectal Cancer Screening in a Rural Community.
    Lee KMN, Hunleth J, Rolf L, Maki J, Lewis-Thames M, Oestmann K, James AS
    J Prim Care Community Health, 2023 Jan-Dec, 14: 2.15013E+16 | PMID: 36594346 | PMCID: PMC9829879
    Citations: 2 | AltScore: NA
  13. Adapting a Research and Community Capacity-Building Program to Address Rural Cancer Burden and Facilitate Partnership Development Between Rural Community Stakeholders and an Urban Comprehensive Cancer Center.
    Lewis-Thames MW, Leahy N, Kruse-Diehr AJ, Ackermann N, Maki J, Davis KL, Drake BF
    J Cancer Educ, 2023 Jan 3, 38(4): 1245-1255 | PMID: 36595213 | PMCID: PMC10315419
    Citations: NA | AltScore: 35.4
  14. Lack of geriatricians in aging-related national media talks.
    Liggett A, Medved D, Lindquist LA
    J Am Geriatr Soc, 2023 Mar 10, 71(7): 2328-2330 | PMID: 36898079 | PMCID: PMC10363224
    Citations: NA | AltScore: 35.55
  15. Early COVID-19 Attitudes and Behaviors and Their Associations With Later Infection: A Local Perspective From One U.S. City.
    Light SW, Opsasnick L, Bailey SC, Yoshino Benavente J, Eifler M, Lovett RM, Russell A, Yoon E, McCaffery K, Wolf MS
    Med Care, 2023 Jun 1, 61(6): 409-414 | PMID: 37068043 | PMCID: PMC10167936
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  16. Associations Between Cognitive Impairment Severity and Barriers to Healthcare Engagement Among Older Adults.
    Lovett RM, Benavente JY, Opsasnick LA, Weiner-Light S, Curtis LM, Wolf MS
    J Appl Gerontol, 2023 Jul, 42(7): 1387-1396 | PMID: 36987943 | PMCID: PMC10286119
    Citations: NA | AltScore: NA
  17. Association Between Metformin Use and Cognitive and Physical Function in Persons with HIV and Diabetes.
    Masters MC, Granche J, Yang J, Overton ET, Letendre S, Koletar SL, Rubin LH, Brown TT, Tassiopoulos K, Erlandson KM, Palella F
    AIDS Res Hum Retroviruses, 2023 Jun, 39(6): 302-309 | PMID: 36792952 | PMCID: PMC10278023
    Citations: NA | AltScore: 2.7
  18. Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic.
    Masters MC, Rivera J, Calamari M, Wright K, Janulis P, Rusie L, Bannon J, Milne P, Galvin SR, Molina EG, Hirschhorn LR, Palella FJ, Kumar R, Brown C, Hawkins C
    J Acquir Immune Defic Syndr, 2023 Sep 1, 94(1): 46-52 | PMID: 37368925 | PMCID: PMC10526734
    Citations: NA | AltScore: NA
  19. Subjective cognitive decline and missed aging-in-place/long-term care planning.
    Miller-Winder AP, Schierer A, Relerford RR, Murawski A, Opsasnick L, Olvera C, Curtis LM, Kim KY, Ramirez-Zohfeld V, Lindquist LA
    J Am Geriatr Soc, 2023 May 26, 71(10): 3314-3316 | PMID: 37235515
    Citations: NA | AltScore: NA
  20. Challenges and Opportunities in Academic Physiatry: An Environmental Scan.
    Morgenroth DC, Knowlton T, Apkon S, Blauwet CA, Burns AS, Vallejos CC, Frontera W, Hearn SL, Jayabalan P, Lim PA, Moroz A, Perret D, Powell D, Puderbaugh M, Rivers WE, Sowa G, Verduzco-Gutierrez M, Celnik PA
    Am J Phys Med Rehabil, 2023 Feb 1, 102(2): 159-165 | PMID: 36634238 | PMCID: PMC10233907
    Citations: NA | AltScore: 2.35
  21. Transforming a Negotiation Framework to Resolve Conflicts among Older Adults and Family Caregivers.
    Murawski A, Ramirez-Zohfeld V, Schierer A, Olvera C, Mell J, Gratch J, Brett J, Lindquist LA
    Geriatrics (Basel), 2023 Mar 8, 8(2): | PMID: 36960991 | PMCID: PMC10037562
    Citations: NA | AltScore: NA
  22. Development and Validation of COVID-19 Vaccine Messaging Materials for Latinx Communities.
    Pack A, Bailey SC, Light SW, Zuleta A, Batio S, Svoboda S, Cross MW, Wolf M
    J Health Commun, 2023 Apr 3, 28(4): 264-271 | PMID: 37038762 | PMCID: PMC10330455
    Citations: NA | AltScore: NA
  23. Current communication practices for biomarker testing in non-small cell lung cancer: Exploring patient and clinician perspectives.
    Pack A, Russell A, Kircher S, Weldon C, Bailey SC, Lockwood K, Marquart T, Afonso AS, Payakachat N, Wolf M
    Patient Educ Couns, 2023 Jun 7, 114: 107839 | PMID: 37321114 | PMCID: PMC10528088
    Citations: NA | AltScore: 5.25
  24. Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
    Patel D, Ng T, Madani LS, Persell SD, Greg M, Roemer PE, Oberoi SK, Linder JA
    Infect Control Hosp Epidemiol, 2023 May, 44(5): 736-745 | PMID: 35822429
    Citations: 4 | AltScore: 25.25
  25. Postoperative complications in women with ovarian cancer stratified by cytoreductive surgery outcome.
    Polan RM, Slota JM, Barber EL
    J Surg Oncol, 2023 Oct, 128(5): 891-901 | PMID: 37382209 | PMCID: PMC10529113
    Citations: NA | AltScore: NA
  26. Promoting Evidence-Based Practice: The Influence of Novel Structural Change to Accelerate Translational Rehabilitation.
    Rafferty M, Stoff L, Smith JD, Hansen P, Briody M, Diaz C, O'Donnell L, Heinemann AW, Brown CH, Lieber RL
    Arch Phys Med Rehabil, 2023 Aug, 104(8): 1289-1299 | PMID: 36924817 | PMCID: PMC10502191
    Citations: NA | AltScore: 7.4
  27. Development and pilot testing of EHR-nudges to reduce overuse in older primary care patients.
    Rowe TA, Brown T, Lee JY, Linder JA, Meeker D, Doctor JN, Goldstein NJ, Fox CR, Persell SD
    Arch Gerontol Geriatr, 2023 Jan, 104: 104794 | PMID: 36115068 | PMCID: PMC9682472
    Citations: 1 | AltScore: 2.75
  28. Fluctuating decision making about aging-in-place/long term care planning among older adults.
    Schierer A, Miller-Winder A, Murawski A, Relerford RR, Olvera C, Liggett A, Ramirez-Zohfeld V, Lindquist LA
    J Am Geriatr Soc, 2023 Aug 9 | PMID: 37555587
    Citations: NA | AltScore: NA
  29. Cognitive Impairment in Liver Transplant Recipients With a History of Cirrhosis: A Systematic Review.
    Siddiqui OM, Baskaran AB, Lin KA, Najam N, Shah T, Beestrum ML, Thuluvath A, Bonakdarpour B, Kim M, Dietch Z, Wolf M, Ladner DP
    Transplant Direct, 2023 May, 9(5): e1479 | PMID: 37096151 | PMCID: PMC10121435
    Citations: NA | AltScore: NA
  30. Patient Perspectives on the Drivers and Deterrents of Antibiotic Treatment of Acute Rhinosinusitis: a Qualitative Study.
    Smith SS, Caliendo A, Cheng BT, Kern RC, Holl J, Linder JA, Cameron KA
    J Gen Intern Med, 2023 Feb, 38(3): 683-690 | PMID: 36258155 | PMCID: PMC9971408
    Citations: 1 | AltScore: 0.25
  31. Effect of continuous post-operative lidocaine infusion in an enhanced recovery program on opioid use following gynecologic oncology surgery.
    Taiym D, Cowan M, Nakamura B, Azad H, Strohl A, Barber E
    J Gynecol Oncol, 2023 May 9, 34(5): e61 | PMID: 37232055 | PMCID: PMC10482581
    Citations: NA | AltScore: NA
  32. Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation.
    Young SR, Lattie EG, Berry ABL, Bui L, Byrne GJ, Yoshino Benavente JN, Bass M, Gershon RC, Wolf MS, Nowinski CJ
    JMIR Form Res, 2023 Jan 10, 7: e42416 | PMID: 36626223 | PMCID: PMC9875000
    Citations: NA | AltScore: 9.5
  33. Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop.
    Yu X, Lobo JD, Sundermann E, Baker DJ, Tracy RP, Kuchel GA, Stephenson KE, Letendre SL, Brew B, Cysique LA, Dale SK, Wallen C, Kunisaki KM, Guaraldi G, Milic J, Winston A, Moore DJ, Margolick JB, Erlandson KM
    AIDS Res Hum Retroviruses, 2023 Jan, 39(1): 12-Jan | PMID: 36322713 | PMCID: PMC9889016
    Citations: NA | AltScore: 3.75
  1. Feasibility and Prediction of Adverse Events in a Postoperative Monitoring Program of Patient-Reported Outcomes and a Wearable Device Among Gynecologic Oncology Patients.
    Barber EL, Garg R, Strohl A, Roque D, Tanner E
    JCO Clin Cancer Inform, 2022 Mar, 6(1): e2100167 | PMID: 35427184 | PMCID: PMC9848580
    Citations: 5 | AltScore: 43.5
  2. Latent Class Analysis of Prescribing Behavior of Primary Care Physicians in the Veterans Health Administration.
    Barrett AK, Cashy JP, Thorpe CT, Hale JA, Suh K, Lambert BL, Galanter W, Linder JA, Schiff GD, Gellad WF
    J Gen Intern Med, 2022 Jan 6, 37(13): 3346-3354 | PMID: 34993865 | PMCID: PMC9550922
    Citations: 3 | AltScore: NA
  3. Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial.
    Behavioral Economics and eConsult Steering Committee, Meeker D, Friedberg MW, Knight TK, Doctor JN, Zein D, Cayasso-McIntosh N, Goldstein NJ, Fox CR, Linder JA, Persell SD, Dea S, Giboney P, Yee HF
    J Gen Intern Med, 2022 May, 37(6): 1400-1407 | PMID: 34505234 | PMCID: PMC8428492
    Citations: 2 | AltScore: 12
  4. Lessons from Detecting Cognitive Impairment Including Dementia (DetectCID) in Primary Care.
    Bernstein Sideman A, Chalmer R, Ayers E, Gershon R, Verghese J, Wolf M, Ansari A, Arvanitis M, Bui N, Chen P, Chodos A, Corriveau R, Curtis L, Ehrlich AR, Tomaszewski Farias SE, Goode C, Hill-Sakurai L, Nowinski CJ, Premkumar M, Rankin KP, Ritchie CS, Tsoy E, Weiss E, Possin KL
    J Alzheimers Dis, 2022, 86(2): 655-665 | PMID: 35124639 | PMCID: PMC9048609
    Citations: 4 | AltScore: 17.9
  5. Perceived facilitators and barriers to participation in golf for people with vision impairment: a qualitative study.
    Beukes EW, Hynes N, Mann DL, Hawkes R, Jayabalan P, Allen PM
    Am J Phys Med Rehabil, 2022 Sep 8, 102(9): 829-835 | PMID: 36076287
    Citations: NA | AltScore: 1
  6. A Qualitative Description of Clinician Free-Text Rationales Entered within Accountable Justification Interventions.
    Brown T, Zelch B, Lee JY, Doctor JN, Linder JA, Sullivan MD, Goldstein NJ, Rowe TA, Meeker D, Knight T, Friedberg MW, Persell SD
    Appl Clin Inform, 2022 Aug, 13(4): 820-827 | PMID: 36070799 | PMCID: PMC9451951
    Citations: NA | AltScore: 1.25
  7. Association of Primary Care Physician Compensation Incentives and Quality of Care in the United States, 2012-2016.
    Burstein DS, Liss DT, Linder JA
    J Gen Intern Med, 2022 Feb, 37(2): 359-366 | PMID: 33852143 | PMCID: PMC8811085
    Citations: 2 | AltScore: NA
  8. A Scoping Review on the Concept of Physician Caring.
    Burstein DS, Svigos F, Patel A, Reddy NK, Michelson KN, O'Dwyer LC, Linzer M, Linder JA, Victorson D
    J Gen Intern Med, 2022 Sep, 37(12): 3134-3146 | PMID: 35391622 | PMCID: PMC8989128
    Citations: 1 | AltScore: 1.6
  9. Trends in the Incidence of New-Onset Hypertensive Disorders of Pregnancy Among Rural and Urban Areas in the United States, 2007 to 2019.
    Cameron NA, Everitt I, Seegmiller LE, Yee LM, Grobman WA, Khan SS
    J Am Heart Assoc, 2022 Jan 18, 11(2): e023791 | PMID: 35014858 | PMCID: PMC9238536
    Citations: 22 | AltScore: 227.65
  10. Diabetes mellitus is associated with declines in physical function among men with and without HIV.
    Clare M, Yang J, Lake JE, Abraham AG, Kingsley L, Brown TT, Palella FJ, Erlandson KM
    AIDS, 2022 Jan 6, 36(5): 637-646 | PMID: 34999609 | PMCID: PMC8957604
    Citations: 1 | AltScore: NA
  11. Soothe the savage beast: Patient perceptions of the benefits of music therapy in an inpatient rehabilitation facility.
    Edwards ER, Jayabalan P
    PM R, 2022 Aug 18, 15(9): 1092-1097 | PMID: 36412009 | PMCID: PMC9938087
    Citations: NA | AltScore: 1
  12. Association of State Medicaid Expansion Status With Hypertensive Disorders of Pregnancy in a Singleton First Live Birth.
    Everitt IK, Freaney PM, Wang MC, Grobman WA, O'Brien MJ, Pool LR, Khan SS
    Circ Cardiovasc Qual Outcomes, 2022 Jan, 15(1): e008249 | PMID: 35041477 | PMCID: PMC8820292
    Citations: 3 | AltScore: 8.1
  13. Temporal Trends in Adverse Pregnancy Outcomes in Birthing Individuals Aged 15 to 44?Years in the United States, 2007 to 2019.
    Freaney PM, Harrington K, Molsberry R, Perak AM, Wang MC, Grobman W, Greenland P, Allen NB, Capewell S, O'Flaherty M, Lloyd-Jones DM, Khan SS
    J Am Heart Assoc, 2022 Jun 7, 11(11): e025050 | PMID: 35583146 | PMCID: PMC9238733
    Citations: 9 | AltScore: 444.1
  14. The Invisible Hand of Industry.
    Guo XM, Barber EL
    Clin Obstet Gynecol, 2022 Jun 1, 65(2): 260-267 | PMID: 35476619 | PMCID: PMC9060382
    Citations: 2 | AltScore: 2.6
  15. Rural-Urban Temporal Trends for Sudden Cardiac Death in the United States, 1999-2019.
    Hughes ZH, Shah NS, Tanaka Y, Hammond MM, Passman R, Khan SS
    JACC Clin Electrophysiol, 2022 Mar, 8(3): 382-384 | PMID: 35331435
    Citations: 2 | AltScore: 1.85
  16. Evidence-based classification in golf for athletes with a vision impairment: A Delphi study.
    Hynes NJ, Beukes EW, Hawkes R, Bennett HA, Hamilton C, Jayabalan P, Allen PM
    Ophthalmic Physiol Opt, 2022 Nov, 42(6): 1193-1203 | PMID: 36129728 | PMCID: PMC9547903
    Citations: 1 | AltScore: 1.85
  17. Multivitamins and Supplements-Benign Prevention or Potentially Harmful Distraction?
    Jia J, Cameron NA, Linder JA
    JAMA, 2022 Jun 21, 327(23): 2294-2295 | PMID: 35727292
    Citations: 1 | AltScore: 1049.78
  18. Validation of Heart Failure-Specific Risk Equations in 1.3 Million Israeli Adults and Usefulness of Combining Ambulatory and Hospitalization Data from a Large Integrated Health Care Organization.
    Khan SS, Barda N, Greenland P, Dagan N, Lloyd-Jones DM, Balicer R, Rasmussen-Torvik LJ
    Am J Cardiol, 2022 Apr 1, 168: 105-109 | PMID: 35031113 | PMCID: PMC8930701
    Citations: 3 | AltScore: NA
  19. Sex-Based Differences in Heart?Failure: JACC Focus Seminar 7/7.
    Khan SS, Beach LB, Yancy CW
    J Am Coll Cardiol, 2022 Apr 19, 79(15): 1530-1541 | PMID: 35422249
    Citations: 9 | AltScore: NA
  20. Association between county-level risk groups and COVID-19 outcomes in the United States: a socioecological study.
    Khan SS, Krefman AE, McCabe ME, Petito LC, Yang X, Kershaw KN, Pool LR, Allen NB
    BMC Public Health, 2022 Jan 13, 22(1): 81 | PMID: 35027022 | PMCID: PMC8756413
    Citations: 12 | AltScore: 9.25
  21. Association of Body Mass Index in Midlife With Morbidity Burden in Older Adulthood and Longevity.
    Khan SS, Krefman AE, Zhao L, Liu L, Chorniy A, Daviglus ML, Schiman C, Liu K, Shih T, Garside D, Vu TT, Lloyd-Jones DM, Allen NB
    JAMA Netw Open, 2022 Mar 1, 5(3): e222318 | PMID: 35289856 | PMCID: PMC8924714
    Citations: 5 | AltScore: 266.23
  22. Predictive Utility of a Validated Polygenic Risk Score for Long-Term Risk of Coronary Heart Disease in Young and Middle-Aged Adults.
    Khan SS, Page C, Wojdyla DM, Schwartz YY, Greenland P, Pencina MJ
    Circulation, 2022 Aug 23, 146(8): 587-596 | PMID: 35880530 | PMCID: PMC9398962
    Citations: 6 | AltScore: 90.78
  23. Differences in Cause-Specific Premature Mortality by Medicaid Expansion Status, 2010-2018.
    Khan SS, Seegmiller LE, Lloyd-Jones DM, Pool LR
    J Gen Intern Med, 2022 Jan 3, 37(11): 2873-2875 | PMID: 34981350 | PMCID: PMC9411337
    Citations: NA | AltScore: 0.5
  24. Prevalence and risk factors of sleep disturbance in adults with underlying health conditions during the ongoing COVID-19 pandemic.
    Kim M, Opsasnick L, Batio S, Benavente JY, Zheng P, Lovett RM, Bailey SC, Kwasny MJ, Ladner DP, Chou SHY, Linder JA, Weintraub S, Luo Y, Zee PC, Wolf MS
    Medicine (Baltimore), 2022 Sep 16, 101(37): e30637 | PMID: 36123887 | PMCID: PMC9477708
    Citations: 1 | AltScore: 0.75
  25. The Roles of Busyness and Daily Routine in Medication Management Behaviors Among Older Adults.
    Klinedinst TC, Opsasnick L, Benavente JY, Wolf M, O'Conor R
    J Appl Gerontol, 2022 Dec, 41(12): 2566-2573 | PMID: 35950560 | PMCID: PMC9671821
    Citations: 1 | AltScore: 2.25
  26. Persistent loneliness due to COVID-19 over 18 months of the pandemic: A prospective cohort study.
    Kotwal AA, Batio S, Wolf MS, Covinsky KE, Yoshino Benavente J, Perissinotto CM, O'Conor RM
    J Am Geriatr Soc, 2022 Dec, 70(12): 3469-3479 | PMID: 36054661 | PMCID: PMC9539351
    Citations: 5 | AltScore: 61.73
  27. Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016.
    Levine DM, Chalasani R, Linder JA, Landon BE
    JAMA Netw Open, 2022 Jun 1, 5(6): e2218167 | PMID: 35713900 | PMCID: PMC9206183
    Citations: 3 | AltScore: 19.35
  28. Consequences of Structural Urbanism: Urban-Rural Differences in Cancer Patients' Use and Perceived Importance of Supportive Care Services from a 2017-2018 Midwestern Survey.
    Lewis-Thames MW, Fank P, Gates M, Robinson K, Delfino K, Paquin Z, Seaman AT, Molina Y
    Int J Environ Res Public Health, 2022 Mar 14, 19(6):
    pii: 3405. | PMID: 35329094 | PMCID: PMC8955585
    Citations: 2 | AltScore: 9.1
  29. Racial and Ethnic Differences in Rural-Urban Trends in 5-Year Survival of Patients With Lung, Prostate, Breast, and Colorectal Cancers: 1975-2011 Surveillance, Epidemiology, and End Results (SEER).
    Lewis-Thames MW, Langston ME, Khan S, Han Y, Fuzzell L, Xu S, Moore JX
    JAMA Netw Open, 2022 May 2, 5(5): e2212246 | PMID: 35587350 | PMCID: PMC9121191
    Citations: 6 | AltScore: 38.98
  30. An examination of the implementation of a patient navigation program to improve breast and cervical cancer screening rates of Chinese immigrant women: a qualitative study.
    Lewis-Thames MW, Tom LS, Leung IS, Yang A, Simon MA
    BMC Womens Health, 2022 Feb 4, 22(1): 28 | PMID: 35120523 | PMCID: PMC8815179
    Citations: 2 | AltScore: 1.6
  31. What matters most to older adults in skilled nursing facilities.
    Liggett A, Petrakos A, Rusboldt M, Lindquist LA
    J Am Geriatr Soc, 2022 Dec 12, 71(4): 1332-1334 | PMID: 36504015 | PMCID: PMC10089948
    Citations: NA | AltScore: 14.95
  32. Aspects of cognition that impact aging-in-place and long-term care planning.
    Lindquist LA, Miller-Winder AP, Schierer A, Murawski A, Opsasnick L, Curtis LM, Kim KY, Ramirez-Zohfeld V
    J Am Geriatr Soc, 2022 Sep, 70(9): 2646-2652 | PMID: 35726136 | PMCID: PMC9489627
    Citations: 2 | AltScore: 11.55
  33. Improvement in self-efficacy among older adults aging-in-place during COVID-19.
    Lindquist LA, Miller-Winder AP, Schierer A, Murawski A, Opsasnick L, Kim KY, Ramirez-Zohfeld V
    J Am Geriatr Soc, 2022 Jul 15, 70(11): 3318-3321 | PMID: 35838195 | PMCID: PMC9349408
    Citations: 1 | AltScore: 5.6
  34. Dissemination of a long-term care planning tool,, through community-based stakeholder leaders.
    Lindquist LA, Wong N, Forcucci C, Rogers B, Ramirez A, Ramirez-Zohfeld V
    J Am Geriatr Soc, 2022 Jul 21, 70(11): 3195-3201 | PMID: 35860971 | PMCID: PMC9669168
    Citations: 1 | AltScore: 3.25
  35. Prevalence of anxiety and depressive symptoms and impact on self-management among adults with chronic conditions in Chicago, Illinois, USA, during the COVID-19 pandemic: a cross-sectional survey.
    Lovett RM, Opsasnick L, Russell A, Yoon E, Weiner-Light S, Serper M, Cooper Bailey S, Wolf MS
    BMJ Open, 2022 Jan 7, 12(1): e052495 | PMID: 34996790 | PMCID: PMC8743840
    Citations: 2 | AltScore: 1.5
  36. Chronic HIV Infection and Aging: Application of a Geroscience-Guided Approach.
    Masters MC, Landay AL, Robbins PD, Tchkonia T, Kirkland JL, Kuchel GA, Niedernhofer LJ, Palella FJ
    J Acquir Immune Defic Syndr, 2022 Feb 1, 89(Suppl 1): S34-S46 | PMID: 35015744 | PMCID: PMC8751288
    Citations: 3 | AltScore: 2.75
  37. Optimizing voice-controlled intelligent personal assistants for use by home-bound older adults.
    O'Brien K, Light SW, Bradley S, Lindquist L
    J Am Geriatr Soc, 2022 Jan 14, 70(5): 1504-1509 | PMID: 35029296 | PMCID: PMC9106816
    Citations: NA | AltScore: 4.75
  38. Trajectories of perceived susceptibility to COVID-19 over a year: The COVID-19 & chronic conditions (C3) cohort study.
    Opsasnick LA, Curtis LM, Kwasny MJ, O'Conor R, Wismer GA, Benavente JY, Lovett RM, Eifler MR, Zuleta AM, Bailey SC, Wolf MS
    Medicine (Baltimore), 2022 Jun 17, 101(24): e29376 | PMID: 35713441 | PMCID: PMC9276380
    Citations: 1 | AltScore: 1.85
  39. Development of High-Risk Geriatric Polypharmacy Electronic Clinical Quality Measures and a Pilot Test of EHR Nudges Based on These Measures.
    Persell SD, Brown T, Doctor JN, Fox CR, Goldstein NJ, Handler SM, Hanlon JT, Lee JY, Linder JA, Meeker D, Rowe TA, Sullivan MD, Friedberg MW
    J Gen Intern Med, 2022 Aug, 37(11): 2777-2785 | PMID: 34993860 | PMCID: PMC9411452
    Citations: 2 | AltScore: 17.25
  40. Survival and Surgical Approach among Women with Advanced Ovarian Cancer Treated with Neoadjuvant Chemotherapy.
    Persenaire C, Pyrzak A, Barber EL
    J Minim Invasive Gynecol, 2022 Mar, 29(3): 375-384 | PMID: 34648931 | PMCID: PMC8918010
    Citations: NA | AltScore: 5.45
  41. Key recommendations from the 2021 \inclusion of older adults in clinical research\" workshop."
    Petrovsky DV, ?o?n LN, Loizos M, O'Conor R, Prochaska M, Tsang M, Hopman-Droste R, Klinedinst TC, Mathur A, Bandeen-Roche K, van der Willik O, Kritchevsky SB
    J Clin Transl Sci, 2022, 6(1): e55 | PMID: 35754432 | PMCID: PMC9161040
    Citations: 3 | AltScore: 43.75
  42. Association between cystoscopy at the time of hysterectomy performed by a gynecologic oncologist and delayed urinary tract injury.
    Polan RM, Barber EL
    Int J Gynecol Cancer, 2022 Jan, 32(1): 62-68 | PMID: 34732516 | PMCID: PMC9087478
    Citations: NA | AltScore: 10.15
  43. Variation in Operative Time and Work Relative Value Units in Gynecologic Surgery.
    Polan RM, Barber EL
    Obstet Gynecol, 2022 Jun 1, 139(6): 1145-1148 | PMID: 35675612 | PMCID: PMC9199588
    Citations: NA | AltScore: 0.5
  44. The Motherhood Penalty in Obstetrics and Gynecology Training.
    Polan RM, Mattei LH, Barber EL
    Obstet Gynecol, 2022 Jan 1, 139(1): 13-Sep | PMID: 34856581 | PMCID: PMC8830705
    Citations: 4 | AltScore: 34.15
  45. Blood Pressure and Glycemic Control Among Ambulatory US Adults With Heart Failure: National Health and Nutrition Examination Survey 2001 to 2018.
    Rethy L, Vu TT, Shah NS, Carnethon MR, Lagu T, Huffman MD, Yancy CW, Lloyd-Jones DM, Khan SS
    Circ Heart Fail, 2022 May, 15(5): e009229 | PMID: 35477292 | PMCID: PMC9179200
    Citations: 2 | AltScore: 37.65
  46. Associations of Clinical and Social Risk Factors With Racial Differences in Premature Cardiovascular Disease.
    Shah NS, Ning H, Petito LC, Kershaw KN, Bancks MP, Reis JP, Rana JS, Sidney S, Jacobs DR Jr, Kiefe CI, Carnethon MR, Lloyd-Jones DM, Allen NB, Khan SS
    Circulation, 2022 Jul 19, 146(3): 201-210 | PMID: 35607988 | PMCID: PMC9308688
    Citations: 13 | AltScore: 112.25
  47. Managing Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art Review.
    Stone NJ, Smith SC Jr, Orringer CE, Rigotti NA, Navar AM, Khan SS, Jones DW, Goldberg R, Mora S, Blaha M, Pencina MJ, Grundy SM
    J Am Coll Cardiol, 2022 Mar 1, 79(8): 819-836 | PMID: 35210038
    Citations: 36 | AltScore: 29.9
  48. Longitudinal Sedentary Time and Symptoms in Breast Cancer Patients during Chemotherapy Using Ecological Momentary Assessment.
    Welch WA, Solk P, Auster-Gussman L, Whitaker M, Siddique J, Fanning J, Mishory A, Khan S, Santa-Maria C, Kulkarni S, Phillips SM
    Med Sci Sports Exerc, 2022 Dec 28, 55(5): 966-974 | PMID: 36574735 | PMCID: PMC10106380
    Citations: 1 | AltScore: 1
  49. Sleep and gynecological cancer outcomes: opportunities to improve quality of life and survival.
    Zhao C, Grubbs A, Barber EL
    Int J Gynecol Cancer, 2022 May 3, 32(5): 669-675 | PMID: 35331996 | PMCID: PMC9064983
    Citations: 3 | AltScore: 9.1


Albert Siu, MD
Mount Sinai Medical Center
Serving since 2021 (2 years)

Catherine Sarkisian, MD, MSHS
University of California – Los Angeles
Serving since 2021 (2 years)

Cynthia Boyd, MD, MPH
Johns Hopkins University
Serving since 2021 (2 years)

Kenneth Covinsky, MD, MPH
University of California – San Francisco
Serving since 2021 (2 years)

Lona Mody, MD, MSc
University of Michigan
Serving since 2021 (2 years)

MInjee Kim, MD (2023)
  • RCCN Scholar Award
  • Nulliparous Pregnancy Outcome Study – Monitoring Mothers-to-be Heart Health Study 2 (nuMoM2b-HHS2) Scholars’ Award


General Brief Description of Minority Activities:
Not defined.

Minority Trainee(s):
  • Diana Chirinos, PhD, Assistant Professor, Department of Preventive Medicine (Epidemiology)
    Pepper Scholars Program: Differential Associations Between Spousal Bereavement, Physical Functioning, and Health Outcomes Among White and Latino Older Adults
  • Emi C. Bretschneider, MD, Assistant Professor, Department of Obstetrics and Gynecology (Female Pelvic Medicine and Reconstructive Surgery (Urogynecology))
    Pepper Scholars Program: Ready for Advances in Bladder health for Older Women (The RAInBOW Study)
  • Marquita Lewis-Thames, PhD, Research Assistant Professor, Department of Medical Social Sciences
    Pepper Scholars Program: Designing a Telehealth-Based Tool for Rural Older Adults with Cancer and Cancer-Related Distress: Testing for Usability and Acceptability
  • Minjee Kim, MD, Assistant Professor, Department of Neurology
    Pepper Scholars Program: Technology-Enabled Screening Strategy for Obstructive Sleep Apnea (TEST-OSA) in Primary Care Older Patients with Multiple Chronic Conditions
  • Prakash Jayabalan, MD, Assistant Professor, Department of Physical Medicine & Rehabilitation
    Pepper Scholars Program: The Development of Novel Therapeutic Walking Exercise Strategies in Sedentary Individuals with Knee Osteoarthritis
  • Sadiya Khan, MD MSc, Assistant Professor, Department of Medicine (Cardiology) and Department of Preventive Medicine (Epidemiology)
    Pepper Scholars Program: Prevalence of microvascular dysfunction and association with functional limitation in older adults with chronic obstructive pulmonary disease
  • Whitney Welch, PhD, Research Assistant Professor, Department of Preventive Medicine (Behavioral Medicine)
    Pepper Scholars Program: Remote Sensor-Based Frailty Detection in Older Adults

No minority grant information specified.