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Junève Toche, MD, partners with families at UNC Eastowne’s Geriatric Specialty Clinic to care for patients and promote health and quality of life.

June is the nationally recognized month to raise awareness about Alzheimer’s and other dementias that affect memory, and behavior, conditions that affect the majority of people who are 65 and older. It’s also a great time to spotlight Geriatric Medicine and the work our geriatricians are doing in education and research, to serve the aging and help them age well. Following is a look at recent activities from the Division of Geriatric Medicine along with some of the providers at the new UNC Eastowne Geriatric Specialty Clinic.

IHI Participating Age Friendly Hospital

The interprofessional team at UNC Hospitals Hillsborough Campus, as part of its work as an IHI Age Friendly Participating Hospital, has implemented an initiative to increase mobilization during hospitalization for older adults on the geriatric unit. The team includes Geriatric Medicine fellows Andrew de la Paz, MD, Carissa Lau, MD, and David Lynch, MD, and Internal Medicine Resident Kim Mournighan, MD, along with a team of nurses, nursing assistants, physical therapists, and occupational therapists.  The team has implemented a number of strategies to mobilize older adults multiple times per day and document this in each patient’s chart.

Andrew De La Paz, MD, Clarissa Lau, MD, and David Lynch, MD, are fellows in Geriatric Medicine.

“Collaborating with members from each discipline within the interprofessional team has been both rewarding and educational,” Lynch said. “As Geriatric Fellows, it has provided us with the opportunity to gain a greater appreciation of the wonderful work being carried out by our colleagues. All members of our team believe that close collaboration is essential in providing outstanding patient centered care. The mobility project has provided us with a roadmap for how we can continue to do this in the future.”

Mournighan presented the project at a poster session during the American Geriatrics Society Annual Meeting in May, 2021.

UNC Faculty and Trainees Participate in the American Geriatrics Society Annual Meeting.

Mitzi Rivera, LPN, (left) and Lilia Flores, LPN, (right) work with Meredith Gilliam, MD, MPH, (center) to communicate patient status and record medical history at the Geriatric Specialty Clinic.

The UNC Division of Geriatrics and Center for Aging and Health was well-represented at the annual meeting of the American Geriatrics Society, which was held virtually in May 2021. More than 30 presentations at this year’s meeting were given by UNC faculty and trainees. Nine rising MS3 students from the UNC MSTAR program presented research on a variety of topics that intersect with aging including ophthalmology, osteoarthritis, cardiology, emergency medicine, and critical care. Additionally, four UNC MSTAR students were selected to present in the Presidential Poster session, which features the highest rated abstracts submitted to the meeting. Several students were also selected to present at the John B. Graham Medical Student Research Society and Brian Wood (MSTAR 2020 cohort) was awarded the Harold C. Pillsbury, MD Student Research Award for Excellent Oral Presentation. The UNC MSTAR Program has been funded by the National Institutes on Aging to support medical student trainees in aging research since 2010.

Maureen Dale
Maureen Dale, MD

The UNC Internal Medicine Residency Program also had a strong showing at the American Geriatric Society Annual Meeting this year, with 12 residents presenting clinical vignettes, quality improvement projects, and educational programs.

“We are fortunate to have the opportunity to work with our internal medicine residents both on the inpatient geriatric service and in our geriatric primary care clinic, and I am pleased that so many of them presented posters this year at AGS,” said Maureen Dale, MD, program director for the Geriatric Medicine Fellowship. “The residency program’s focus on patient-centered care and medical education make the residents in many ways natural geriatricians, and I am thrilled that several of them are considering a fellowship and career in geriatrics.”

When Less is More: Deprescribing Finds its Home in UNC Geriatrics.

As adults age, it is important to reconsider the risks and benefits of medications. Many medications that were once appropriate no longer hold the same benefit as the risk for side effects increases. Deprescribing, the gradual reduction of medications when the benefits no longer outweigh the potential harms, is a cornerstone of geriatrics clinical practice to optimize care for older adults. Deprescribing is a rapidly growing area of research and the Division of Geriatrics, and the Center for Aging and Health is quickly becoming a hub these projects. Fall-risk increasing drugs (FRIDs) are one major target for deprescribing in older adults. These can include a variety of commonly prescribed medication classes such as antidepressants, antihistamines, and opioids.

Bryan Godfrey, LCSW, offers services that help to improve the patient’s overall well-being, here with Jennifer Paris, RN, nurse manager for the clinic.

Jan Busby-Whitehead, MD, chief of the Division of Geriatrics, currently serves as co-PI  for a CDC-funded study to reduce falls in older adults through deprescribing alongside Stefanie Ferreri, PharmD, chair of the Eshelman School of Pharmacy. The study seeks to evaluate the impact of a consultant pharmacist model on deprescribing opioids and benzodiazepines in older adults, which have been shown to increase the risk for serious falls. The Division of Geriatrics and the Eshelman School of Pharmacy have partnered with the Carolina Assessment of Medications Program (CAMP) to develop an intervention to deliver deprescribing tools and recommendations to primary care providers. Seventeen clinics from the UNC Physicians’ Network have been enrolled in the study, which will continue through 2022.

Josh Niznik, PharmD, PhD
Joshua Niznik, PharmD, PhD

Deprescribing is also a key focus of one of the initiatives of the HRSA-funded Geriatric Workforce Enhancement Program (GWEP) in collaboration with the Department of Emergency Medicine. The project, led by Kathleen Davenport, MD, aims to reduce readmissions for older adults presenting to the emergency department for a fall by using clinical pharmacists to deprescribe medications that may have contributed to the event. Clinical pharmacists will identify patients at risk for medication-related falls, conduct a medication review, and send tailored recommendations to each patient’s primary care provider. Since August 2020, pharmacists have screened more than 300 patients and communicated nearly 200 recommendations medication recommendations to providers.

Josh Niznik, PharmD, PhD, was a featured presenter at the annual meeting of the US Deprescribing Research Network (USDeN) in May, 2021. An awardee of a pilot grant from USDeN, Niznik presented his study “Deprescribing of Bisphosphonates in Older Nursing Home Residents with Dementia: An Epidemologic Analysis.” Working with Carolyn Thorpe, PhD, MPH, and Laura Hanson, MD, in the Division of Geriatrics and Palliative Care, the study sought to validate definitions for deprescribing using prescription claims data and subsequently identify patient-level and systems-level factors that may be associated with deprescribing. Niznik was recently awarded a 5-year career development award from the National Institutes on Aging to continue this work.

UNC Geriatricians Support Nursing Homes through COVID-19

An interprofessional team of healthcare providers led by the Division of Geriatric Medicine, Center for Aging and Health, continues to mentor nursing homes in our state through the North Carolina COVID Action Network (NC CAN).  The weekly Zoom meeting began last November with support from the Agency for Healthcare Research and Quality, the Institute for Healthcare Improvement and the Project ECHO telementoring program (Extension for Community Healthcare Outcomes), developed at the University of New Mexico.

Jennifer Hubbard, Cristine Henage, Ed.D, Lisa Leatherwood (licensed nursing home administrator), Ben Blomberg, MD, Nicholas Layton, and Marvin McBride, MD, MPH, in a recent NC CAN ECHO meeting.

The program earned high marks from evaluators at Project ECHO and has been extended through August 31, 2021.  In addition to learning how to prevent the spread of the virus and treat nursing home residents with COVID-19, nursing home leaders put what they learn into practice.  Seventy-eight percent of UNC ECHO nursing homes have engaged their frontline staff in quality improvement projects to improve COVID-19 care.  A special training on how to best discuss vaccine hesitancy with their staff helped nursing home leaders to feel more confident. These conversations can be emotional and confrontational if they are not handled carefully according to Cristine Henage, MPS, EdD, The NC CAN Principal Investigator.

“After our ECHO training on boosting vaccine confidence, leaders who felt very confident talking with staff increased from 18% to 34%.” Henage said.  “Overall, 89% of our ECHO nursing homes report having access to geriatricians, infection control specialists and other nursing home leaders has helped them weather the pandemic.”

Read more about UNC Geriatricians and how they are helping skilled nursing facilities with collaborative problem solving and mentoring. More information can also be found in the Division of Geriatric Medicine and UNC’s Center for Aging and Health.