A5004973724- Bone health and osteoporosis research
- Geriatric Care and Nursing Homes
- Hip and Femur Fractures
- Frailty in Older Adults
- Bone health and treatments
- Health Systems, Economic Evaluations, Quality of Life
- Palliative Care and End-of-Life Issues
- Nutrition and Health in Aging
- Balance, Gait, and Falls Prevention
- Resilience and Mental Health
- Pharmaceutical Practices and Patient Outcomes
- Dialysis and Renal Disease Management
- Dementia and Cognitive Impairment Research
- Cardiac, Anesthesia and Surgical Outcomes
- Health Policy Implementation Science
- Interprofessional Education and Collaboration
- Emergency and Acute Care Studies
- Intensive Care Unit Cognitive Disorders
- Chronic Disease Management Strategies
- Vitamin D Research Studies
- Blood Pressure and Hypertension Studies
- Health disparities and outcomes
- Cerebral Palsy and Movement Disorders
- Bone and Joint Diseases
- Stroke Rehabilitation and Recovery
Duke University
2016-2025
Geriatric Research Education and Clinical Center
2016-2025
Durham VA Medical Center
2015-2024
Durham VA Health Care System
2018-2024
The University of Texas Southwestern Medical Center
2024
VA Pittsburgh Healthcare System
2023
University of Minnesota
2023
Stanford University
2023
VA Palo Alto Health Care System
2023
Duke Medical Center
2013-2022
Mortality is increased after a hip fracture, and strategies that improve outcomes are needed.In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at dose of 5 mg), 1062 placebo. The infusions first administered within 90 days surgical repair fracture. All (mean age, 74.5 years) received supplemental vitamin D calcium. median follow-up was 1.9 years. primary end point new clinical fracture.The rates any fracture...
Abstract Zoledronic acid reduces the risk of death by 28% after hip fracture, but mechanisms are not known. This exploratory analysis sought to identify potential pathways for reduction in mortality with zoledronic fracture. was a retrospective randomized, controlled trial. Patients recent fracture (n = 2111) were treated or placebo infusion yearly, as well calcium and vitamin D supplementation. Causes adjudicated blinded central review committee. Baseline comorbidities, events occurring...
Annual infusions of zoledronic acid (5 mg) significantly reduced the risk vertebral, hip, and nonvertebral fractures in a study postmenopausal women with osteoporosis clinical all-cause mortality another men who had recently undergone surgical repair hip fracture. In this analysis, we examined whether timing first infusion drug after fracture influenced antifracture efficacy benefit observed study. A total 2127 patients (1065 on active treatment 1062 placebo; mean age, 75 yr; 76% 24% men)...
Resilience, the ability to resist or recover from adverse effects of a stressor, is widespread interest in social, psychologic, biologic, and medical research particularly salient as capacity respond stressors becomes diminished with aging. To date, on human resilience responses factors influencing these has been limited.The National Institute Aging convened workshop August 2015 needs for improve measures predict assess Effects aging-related impairing homeostatic were developed examples...
To determine the efficacy of once-yearly intravenous zoledronic acid (ZOL) 5 mg in reducing risk clinical vertebral, nonvertebral, and any fractures elderly osteoporotic postmenopausal women.A post hoc subgroup analysis pooled data from Health Outcome Reduced Incidence with Zoledronic Acid One Yearly (HORIZON) Pivotal Fracture Trial HORIZON Recurrent Trial.Multicenter, randomized, double-blind, placebo-controlled trials.Postmenopausal women (aged > or =75) documented osteoporosis (T-score <...
Hospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital.To examine whether wearable hospital trackers can be used predict HAD.A prospective observational study between January 2016 March 2017.An academic medical center.Community-dwelling older adults, aged 60 years or older, enrolled within 24 hours of admission general medicine (n = 46).Primary outcome was HAD, defined as having one more new daily living deficits, decline four greater on...
To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. The study design was a qualitative, observational of nursing home staff perceptions the implementation in each 3 homes. We conducted 7 focus groups licensed unlicensed staff, medical care providers, administrators. Questions explored facilitators barriers change. Using template organizing style analysis with immersion/crystallization, themes were coded leadership. Six emerged,...
Older adults with advanced chronic kidney disease ( CKD ) experience functional impairment that can complicate management. Failure to recognize may put these individuals at risk of further decline, nursing home placement, and missed opportunities for timely goals‐of‐care conversations. Routine geriatric assessment could be a useful tool identifying older who are decline provide contextual information guide clinical decision‐making. Two innovative programs were implemented in the Veterans...
For older adults receiving dialysis, health-related quality of life is not often considered in prognostication death or future hospitalizations. To determine if routine measures may be useful for prognostication, the objective this study to extent association Kidney Disease Quality Life (KDQOL-36) subscales with adverse outcomes dialysis. This a longitudinal 3500 aged ≥75 years dialysis United States 2012 and 2013. We used Cox Fine Gray models evaluate KDQOL-36 risk hospitalization. adjusted...
Diabetes mellitus among older men has been associated with increased bone mineral density but paradoxically fracture risk. Given the interactions medication treatment, glycemic control, and diabetes-associated comorbidities, relative effects of each factor remains unclear. This retrospective study includes 652,901 male veterans aged ≥65 years diabetes baseline hemoglobin A1c (HbA1c) value. All subjects received primary care in Veterans Health Administration (VHA) from 2000 to 2010....
In a nursing home case study using observation and interview data, the authors described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule CNAs to respond residents as they would want someone do for them. Mother wit treat their own children. These engendered self-control affection but also led actions such infantilization misinterpretations about potentially undiagnosed conditions depression or pain. Furthermore, found were isolated from...
Abstract Bisphosphonates have been shown to reduce mortality in patients with osteoporotic fractures, but the mechanism is unclear. immunomodulatory effects that may influence development of vascular disease. We sought determine if bisphosphonate use associated a reduced risk myocardial infarction (MI) rheumatoid arthritis (RA) population high prevalence and Adult RA enrolled National Data Bank for Rheumatic Diseases, longitudinal study continuously from U.S. rheumatology practices between...
Objectives To assess the efficacy of once-yearly zoledronic acid (ZOL) 5 mg in increasing bone mineral density (BMD) men with a recent hip fracture participating Health Outcomes and Reduced Incidence Zoledronic Acid Once- Yearly Recurrent Fracture Trial to compare that women from same study. Design Randomized, placebo-controlled, double-blind trial. Setting International multicenter. Participants Five hundred eight 1,619 within 90 days surgical repair low-trauma study (for comparison)....
Objectives To describe the time to first acute care use (e.g., emergency department ( ED ) without hospitalization or rehospitalization) for older adults discharged home after receiving postacute in skilled nursing facilities SNF s); identify predictors of use. Design Retrospective cohort study using administrative claims data. Setting SNFs providing patients N orth and S outh C arolina = 1,474). Participants A Medicare beneficiaries aged 65 55,980) who were hospitalized then transferred a...
Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial an intervention to improve staff communication (CONNECT), we conducted focus groups direct and managers elicit their perceptions factors that enhance or reduce LTC setting. The overall aim was generate hypotheses how sustain complex LTC.In eight facilities, 15 with 83 who had participated at least one session. Where possible, separate were managers. An...
Abstract Purpose Patient priorities for quality of life change with age. We conducted a qualitative study to identify themes importance older adults receiving dialysis and the extent which these are represented in existing instruments. Methods semi-structured interviews 12 aged ≥ 75 years hemodialysis elicit participant perspectives on what matters most them life. used framework analysis methodology process interview transcripts (coding, charting, mapping), major themes, compare by frailty...