The Center for Transformative Geriatric Research
The Center for Transformative Geriatric Research envisions a world in which all older adults thrive. Our mission is to perform and advance research that transforms healthcare and the lives of older adults.
To achieve our mission, our faculty employ a wide range of research approaches and techniques. Our major areas of person-oriented research focus on health service delivery for people with complex care needs, the care of people with multiple chronic conditions, person-oriented research on issues related to late-life memory disorders, and health information technology.
We value collaborative research that is innovative, interdisciplinary, patient, caregiver, and family-centered, and which can be translated into practice or health policy.
We believe firmly that performing and publishing research findings is insufficient for the 21st century academicians; it is critical for us to disseminate research findings into the real world to help people.
Our Faculty
Halima Amjad, M.D., M.P.H.
Alicia Ines Arbaje, M.D., Ph.D., M.P.H.
Associate Professor of Medicine
Cynthia Melinda Boyd, M.D., M.P.H.
Professor of Medicine
Ariel Ruth Green, M.D., Ph.D., M.P.H.
Bruce Allen Leff, M.D.
Professor of Medicine
Matthew Kendall McNabney, M.D.
Chair, Mosaic Initiative Workgroup to Promote Diversity and Inclusion
Professor of Medicine
Esther Seunghee Oh, M.D., Ph.D.
Associate Professor of Medicine
Assistant Professor of Pathology
Joint Appointment in Psychiatry and Behavioral Sciences
Nancy Li Schoenborn, M.D.
Associate Professor of Oncology
Sevil Yasar, M.D., Ph.D.
Associate Professor of Neurology
Health Service Delivery for People with Complex Care Needs
As the U.S. population ages, the number of Americans who have chronic health conditions will greatly increase. These demographic and epidemiologic dynamics will strain the capacity and the sustainability of the acute care-oriented U.S. health care system, which now provides chronic care ineffectively and inefficiently. New health service delivery systems will need to be developed, evaluated, and disseminated into widespread practice in order to deliver high-quality, cost-effective care for older adults.
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In recent work that includes partnerships with other health care institutions and agencies, researchers from the Center for Transformative Geriatric Research have explored the development of geriatrics health service delivery at all levels of the health system, from the patient and their family or caregivers to providers, hospital and health system. Using a wide array of qualitative and quantitative research techniques, investigators are finding new and better ways to care for older adults.
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Hopkins investigators have been at the forefront of developing, evaluating, and disseminating into practice new models of geriatric health service delivery to care for an aging population. Current research studies are focused on:
- Clinical interventions to improve transitions of older adults across the continuum of care
- Community-based long-term care
- Program of All-inclusive Care for the Elderly (PACE)
- Hospital at Home
- Home-based primary care
- Home-based palliative care
- Skilled home health care, assisted living, and long-term care
- Guided care
- Models of multidisiplinary care for people with dementia
- CAPABLE
- Assisted living facilities
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Faculty Investigators
Alicia Ines Arbaje, M.D., Ph.D., M.P.H.
Director of Transitional Care Research
Associate Professor of Medicine
Cynthia Melinda Boyd, M.D., M.P.H.
Director, Division of Geriatric Medicine and Gerontology
Professor of Medicine
Ariel Ruth Green, M.D., Ph.D., M.P.H.
Associate Professor of Medicine
Bruce Allen Leff, M.D.
Director, The Center for Transformative Geriatric Research
Professor of Medicine
Matthew Kendall McNabney, M.D.
Medical Director, Program for All-Inclusive Care of the Elderly (PACE)
Chair, Mosaic Initiative Workgroup to Promote Diversity and Inclusion
Professor of Medicine
Esther Seunghee Oh, M.D., Ph.D.
Co-Director, Johns Hopkins Memory and Alzheimer's Treatment Center
Associate Professor of Medicine
Assistant Professor of Pathology
Joint Appointment in Psychiatry and Behavioral Sciences
Nancy Li Schoenborn, M.D.
Associate Professor of Medicine
Associate Professor of Oncology
Sevil Yasar, M.D., Ph.D.
Associate Professor of Medicine
Associate Professor of NeurologyCollaborators
- Susannah Cafardi
- Ayse Gurses, PhD
- Nicole Werner, PhD
- Sara Szanton, RN, PhD
- Albert Wu, MD, MPH
- Kitty Chan, PhD
- Qilu Y, PhD (Westat)
- Armstrong Institute for Patient Safety and Quality
- Johns Hopkins Home Care Group
- Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging
- Johns Hopkins School of Nursing, Department of Community and Public Health
- National PACE Association Research Committee
- University of Maryland Department of Pharmaceutical Health Services Research
Multimorbidity
Forty-eight percent of older adults have three or more chronic conditions, and the number of older adults with multiple chronic conditions will continue to increase dramatically. The presence of multiple chronic conditions independently predicts adverse outcomes, including quality of life, mortality, disability, and complications of treatment beyond the effects of the individual conditions. Currently, there is a significant gap in our understanding of how best to provide care for patients with multiple chronic conditions.
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In recent work, Johns Hopkins researchers, led by Dr. Cynthia Boyd, have shown that implementing multiple single-disease clinical practice guidelines in older adults with multiple chronic conditions may result in polypharmacy and nonadherence, both of which detrimentally influence patient safety and clinical outcomes. Additional work has demonstrated how the entire process of clinical practice guideline development will need to be modified in order to develop appropriate clinical practice guidelines for patients with multiple chronic conditions.
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- Treatment burden in multiple chronic conditions
- Development of clinical practice guidelines for patients with multiple chronic conditions
- Clinical preventive services for patients with multiple chronic conditions
- Improving patient-clinician communication and shared decision making in patients with multiple chronic conditions
- Patterns of multiple chronic conditions
- Performance measurement for patients with multiple chronic conditions
- Methodological approaches to assess the balance of benefits and harms
- Incorporating prognosis into the care of older adults
- Reducing use of potentially inappropriate therapies in older adults
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Faculty investigators
Cynthia Melinda Boyd, M.D., M.P.H.
Director, Division of Geriatric Medicine and Gerontology
Professor of Medicine
Ariel Ruth Green, M.D., Ph.D., M.P.H.
Associate Professor of MedicineBruce Allen Leff, M.D.
Director, The Center for Transformative Geriatric Research
Professor of MedicineMatthew Kendall McNabney, M.D.
Medical Director, Program for All-Inclusive Care of the Elderly (PACE)
Chair, Mosaic Initiative Workgroup to Promote Diversity and Inclusion
Professor of MedicineNancy Li Schoenborn, M.D.
Associate Professor of Medicine
Associate Professor of OncologyCollaborators
- Wendy Bennett, MD
- Kay Dickersin, PhD
- Sydney Dy, MD, MSc
- Tianjing Li, MD
- Milo Puhan, MD, PhD
- Cynthia Rand, PhD
- Jodi Segal, MD, MPH
- Orla Sheehan, MD, PhD
- David Roth, PhD
- Ravi Varadhan, PhD
- Renee Wilson
- Jennifer Wolff, PhD
- Tsung Yu, PhD
- Qian-li Xue, PhD
Cognitive Decline and Dementia
For aging populations in the United States and abroad, dementia is a major clinical and public health issue; it is a lengthy and costly condition that creates a large social and financial burden on society. Unless new discoveries are made in the prevention or treatment of dementia, specifically Alzheimer's disease, an estimated 13.2 million Americans will have dementia by 2050. Identifying new and effective approaches to early detection of dementia is critical.
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Research focus is on identification of new biomarkers, both fluid and imaging, and new pharmacological targets for prevention and treatment of late life memory disorders. Additional work focuses on understanding and improving care provided in dementia, including how timely diagnosis might link to improved outcomes. Recent studies by Johns Hopkins researchers showed that specific blood pressure medications can decrease dementia risk in healthy elderly people. Other studies include using oral glucose tolerance test (OGTT) to develop a biomarker of early stage Alzheimer’s disease. Research focus also extends to postoperative delirium, hearing and balance loss, and functional evaluation on the effect on dementia risk or progression.
The knowledge gained by characterizing biological and cognitive changes that precedes clinical transition to dementia could allow the development of targeted treatments for dementia.
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- The effect of blood-pressure medications on the risk of developing dementia
- The possible role of prescription and over the counter anticholinergic medication use and the risk of developing dementia
- Plasma biomarkers for Alzheimer's disease using oral glucose tolerance test
- Preclinical Alzheimer's disease as a risk factor for postoperative delirium and cognitive decline in hip fracture patients
- Potentially unsafe activities and living conditions in older adults with dementia
- Characteristics and longitudinal outcomes in undiagnosed dementia
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Collaborators
Ariel Ruth Green, M.D., Ph.D., M.P.H.
Associate Professor of Medicine
Esther Seunghee Oh, M.D., Ph.D.
Co-Director, Johns Hopkins Memory and Alzheimer's Treatment Center
Associate Professor of Medicine
Assistant Professor of Pathology
Joint Appointment in Psychiatry and Behavioral SciencesSevil Yasar, M.D., Ph.D.
Associate Professor of Medicine
Associate Professor of NeurologyCollaborators
- Suzanne Craft, PhD
- Michelle Carlson, PhD
- Neal Fedarko, PhD
- Sharon Inouye, MD, MPH
- Constantine Lyketsos, MD, MHS
- Edward Marcantonio, MD, SM
- Paul Rosenberg, MD
- Quincy Samus, PhD
- Frederick Sieber, MD
- Juan Troncoso, MD
Health Information Technology
Health information technology can improve the delivery and quality of care for older adults in every care setting and can help older adults (and their caregivers) better manage their own care. However, technology is only one of many important elements in health service delivery and it is critical that health information technology systems are carefully designed and evaluated.
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Johns Hopkins researchers are designing computer-assisted education tools that can help teach older adults with chronic conditions how to self-manage their care more effectively. Our team is assessing the ability of technology to improve the care transitions associated with hospital discharges. These projects will provide important insight into the usability of various technology platforms by older adults, their caregivers, and their medical care providers.
In addition, we are using large national datasets to clarify patterns of health-related Internet use among older adults in order to optimize the usability of a personal health record and to promote the use of a patient portal within an electronic health record by older adults with chronic conditions.
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- Use of personal health records and a patient portal in primary care geriatrics to support engagement of patients and caregivers
- Use of home-based health information technology (including cell phone, iPod, tablet PC, PDA) for chronic disease self-management with a focus on diabetes
- Use of technology during a medical office visit to improve visit satisfaction
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Faculty Investigators
Bruce Allen Leff, M.D.
Director, The Center for Transformative Geriatric Research
Professor of Medicine
Sevil Yasar, M.D., Ph.D.
Associate Professor of Medicine
Associate Professor of Neurology
Collaborators
Hospital-to-Home-Health Transition Quality (H3TQ) Index
Johns Hopkins geriatrician Alicia Arbaje recaps findings from two bodies of work that address transitions of care for older adults from hospital to home health services. She describes the development of the Hospital-to-Home-Health Transition Quality (H3TQ) Index and research performed to validate the tool.
