Research Projects

The Boston University Alzheimer’s Disease Center aims to reduce the human and economic costs of Alzheimer’s disease through the advancement of knowledge. The Boston University Alzheimer’s Disease Center was established in 1996 as one of 29 centers in the US funded by the National Institutes of Health to advance research on Alzheimer’s disease and related conditions. The Center is jointly based at the Boston University Medical Campus and Bedford VA Medical Center. In 2008, the Center began researching Chronic Traumatic Encephalopathy (CTE). We foster and support high-impact, innovative research on Chronic Traumatic Encephalopathy and other long-term consequences of repetitive brain trauma in athletes and military personnel.

The research in our lab focuses on examining memory across the age range in healthy younger and older adults and patients with Alzheimer’s disease. We study how the brain stores and retrieves memory. We focus on examining ways to help patients with Alzheimer’s disease improve their memory in side effect free, non-invasive ways.

The identification of early markers of cognitive impairment are needed to allow for timely diagnosis and greater opportunity for intervention. The goal of this project is to investigate the association of digitally captured neuropsychological test performance (via digital voice recorders and digital pens) with traditional test measures, dementia status, and neuroimaging markers in a healthy aging cohort. This has the potential to establish digital metrics as a sensitive measure of cognitive change in individuals with and without dementia leading to earlier detection and therefore earlier treatment of underlying brain pathology.

The impact of social determinants of health (SDOH) on health outcomes for older adults is being increasingly recognized. In 2021, the American Geriatrics Society updated their minimum competencies in geriatrics for medical students to include health equity, reflecting its importance. Despite this, there remains a gap in SDOH-focused teaching in geriatrics curricula at all learning levels.

As part of a required geriatrics clerkship, fourth year medical students at Boston University Chobanian & Avedisian School of Medicine join faculty preceptor for home visits. We aim to formally incorporate SDOH teaching into the medical student curriculum. During their geriatrics clerkship, fourth year medical students completed an exercise to assess how social determinants of health impacted care of patients enrolled in the Geriatrics Home Care practice. This exercise includes a structured observation of a patient’s home using a standardized worksheet. Students are then asked to match how identified SDOH affected the Geriatric 5Ms for their patients.

In this project, we are qualitatively evaluating the educational intervention and modifying the curriculum to ensure it is of utmost value to the students.

Funded by a HRSA grant, we are performing interdisciplinary comprehensive geriatric assessments for older adults with HIV. We work closely with pharmacy, nursing, case management, and psychiatry. We aim to create a bridge between the geriatric and ID clinics, and to come up with comprehensive, individualized plans for the patients seen in our consultative clinic. We are studying effects on polypharmacy, as well as patient satisfaction and quality of life.

The United States has the highest rate of incarceration in the world and this has impacted the number of older adults who are in jails and prisons. The number of persons incarcerated in state prisons aged 55 or older increased by 400% from 1993 to 2013, and it is predicted that by 2030, this age group will account for one-third of the US prison population (a number which is currently nearing 2 million people). People in prison are considered geriatric after age 55 because of a phenomenon known as “accelerated aging” and exhibit increased chronic health conditions and geriatric syndromes similar to people 10-15 years older in the community.

There are a variety of projects underway, supported by a HRSA Geriatric Academic Career Award, including projects which focus on education around this vulnerable population both to providers within carceral settings and in the community; a qualitative study which aims to better understand “what matters most” to this unique population; and advocacy via compassionate release and other avenues.

With new treatments available currently and more in development, finding patients at early stages of cognitive impairment is more critical than ever. Through several grants we are exploring how to improve screening for cognitive impairment in our General Internal Medicine and Family Medicine practices.

This new medical student quality improvement project aims to improve ambulation of hospitalized older adults. Hospitalized geriatric patients are at risk for physical deconditioning and functional decline due to prolonged bed rest. Hospitalized older adults can benefit both physically and psychologically from early mobilization.
Fourth year medical students on their 4-week required geriatrics rotation are trained in safe patient ambulation and assigned to educate and walk a patient. This educational program has been well received and showed student confidence in ambulating hospitalized older adults. Next steps include changes in student scheduling to increase student participation rates and number of patient walks and tracking impact on relevant geriatric patient outcomes such as length of stay and rate of discharge to skilled nursing facilities.

This project was selected for presentation during the Presidential Poster Session at the 2018 Annual Scientific Meeting of the American Geriatrics Society.

The Long Life Family Study is a longitudinal, observational study that has followed 5000 individuals from 550 families that demonstrate clustering for exceptional longevity since 2006. Out goal is to discover factors that help individuals remain healthy as they age by tracking participants’ morbidity, disability, cognitive decline, and eventually mortality. Analyses of genetic and non-genetic data hope to discover how people age, and why some people age more healthily than others. The Long Life Family Study is funded by and collaborates closely with The National Institute on Aging.

As with many other locations, Boston has a high number of residents who are aging, many of whom are experiencing cognitive decline. Working with the Boston Public Health Commission we are trying to enhance availability of resources for patients and caregivers, enhancing provider ability to identify patients with cognitive impairment, and training a broader workforce to care for and support adults with cognitive decline.

The New England Centenarian Study is an international survey of exceptional human longevity that has recruited almost 4,000 centenarians, as well as some of their siblings and offspring since 1994. Participants are carefully phenotyped at enrollment and are followed annually to track their health, and their changes in physical and cognitive functions. We examine potential genes they may have in common and other lifestyle and environmental factors that could influence the ability to live to very old age in good health. Our key findings include:

• Exceptional longevity runs strongly in families
• Among centenarians, disability is typically compressed towards at least their early- to mid-nineties
• With even older ages of survival, e.g., age 105+ years, morbidity is also compressed towards the end of these exceptionally long lives
• The genetic influence upon survival increases with older and older ages of survival beyond the nonagenarian years
• This genetic influence probably involves many genetic variants with individually modest effects, but as a group, they have a strong effectBut for some rare exceptions, centenarians have just as many disease-associated genetic variants as the average population. Thus, their genetic advantage is likely due to variants that slow aging and decrease risk for aging-related diseases such as heart disease, stroke, cancer, diabetes and Alzheimer’s disease.

The geriatric patient population is not well represented in studies regarding opioid use and misuse; none of the interventions that have been validated in the ambulatory setting have been implemented in the home-based primary care setting. This makes it difficult to prescribe controlled substances safely in older adults. This qualitative study includes a need-assessment survey among home care geriatrics providers in regards to prescribing and monitoring controlled substances in home care. The initial results of the study highlighted current attitudes and practices of geriatrics home-based primary care providers at out hospital. The study results will serve as a stepping stone in developing efficient and effective plans for prescribing and monitoring controlled substances in the geriatrics home care setting.

This project was selected for presentation during the Presidential Poster Session at the 2018 Annual Scientific Meeting of the American Geriatrics Society.

Each year not only do program fellows complete a group QI project, there are multiple other opportunities for scholarship ranging from increasing completion of healthcare proxies, enhancing rates of shingles vaccinations to deprescribing to name but a few.

This multi-site clinical trial aims to look at the efficacy, cost, and feasibility of delivering SNF-level care at home for patients requiring rehabilitation services after a hospitalization compared to traditional SNF care at a brick and mortar facility. Boston Medical Center is a recruitment site for this study.

Geriatricians encounter patients with substance use disorder in the hospital, in the clinic, at home, and in the post-acute and long-term care setting. This project aims to focus on improving transitions of care for older adults with substance use disorders to the post-acute care setting via educational curriculum for nursing and therapy staff in skilled nursing facilities.