Research
Faculty Research
Full-time Department faculty are involved with the research projects listed below. Click on the project's title to read a more detailed description.
John Agens, M.D.
Identifying Adverse Events After Discharge from a Community Hospital
Ken Brummel-Smith, M.D.
Outcomes of a HELP Intervention Using Hospitalists
Smartphone Application for Detecting Falls in Older Adults
Use of the “Go Wish” Card Game in Persons with Mild Cognitive Impairment
Lisa Granville, M.D.
Marshall Kapp, J.D., M.P.H.
Physician Orders for Life-Sustaining Treatment (POLST)
Alice Pomidor, M.D., M.P.H.
ElderQuest©: Video Game Fun with Geriatrics
Niharika Suchak, M.B.B.S., M.H.S., F.A.C.P.
Assessment of Baseline Characteristics of Older Adults at the Transition Center
Awareness of Vitamin D Deficiency States and Recommended Supplementation Doses: Survey of Faculty and Staff at a Southeastern United States Medical School
Adequate vitamin D has benefits beyond bone health. Supplements prevent falls in the elderly. Cholecalciferol (D3) is synthesized in skin and requires sunlight. D3 is converted to 25-hydroxyvitamin D (25OHD) in the liver. Deficiency occurs even in areas with plentiful sunshine.
We used email distribution lists to anonymously and confidentially survey physicians (MDs) and non-physicians (non-MDs) of a Southeastern US medical school in order to determine awareness of types and numbers of conditions associated with 25OHD deficiency, percentage of subjects with levels checked and low, MD-recommended doses, and MD factors associated with dose recommendations >800 IU/day.
MDs listed more conditions than non-MDs: 84% osteomalacia, 81% rickets, 65% osteoporosis, and <15% of any one of other conditions. 21% of all subjects had their vitamin D level checked and two thirds of those who knew their level reported it as low. 56% of MDs and 74% of non-MDs wanted 25OHD checked. Multivariate logistic regression showed: 1) having vitamin D checked and calcium supplementation were associated with personally taking vitamin D, 2) MDs were more likely to personally take vitamin D, and 3) a trend that physicians who had their vitamin D level checked recommended >800 IU/day for their patients.
For more information, email John Agens, M.D. at john.agens@med.fsu.edu.
Agens JE, Galasko GT, Purandare AV, Lin J. Awareness of vitamin D deficiency states and recommended supplementation doses: Survey of faculty and staff at a medical school. e-SPEN Journal. 2012;7(6):e215-e218.
Identifying Adverse Events After Discharge from a Community Hospital
Adverse events that occur after discharge from the hospital are a major public health concern that deserves much more attention, particularly for older adults. The only two studies that investigated adverse events after discharge from the hospital did not specifically examine an older population. We present preliminary results, from a recently funded R01 Agency for Healthcare Research and Quality grant, on the frequency of adverse events that occur after hospital discharge in patients age 65 and older and compare results with patients younger than age 65.
Although, preliminary results do not indicate statistically significant age differences for experiencing adverse events, the odds ratio seems to be in the direction that we expect patients age 65 and older to experience more adverse events after hospital discharge when compared to patients younger than age 65. We expect to have completed health record reviews and telephone interviews for 608 patients by May 2013.
Poster to be presented May 3, 2013 at the American Geriatrics Society Annual Meeting in Grapevine Texas (co-authors: J. E. Agens, D. Tsilimingras (PI), J. Bishop-Royse, J. L. Schnipper).
Medical Student Hospital Charting of Cognitive and Functional Status During Required Fourth Year Clerkship Rotations Both Before and After a Required Geriatric Clerkship
Part of the Florida State University College of Medicine Curriculum is a fourth-year Primary Care Geriatrics Clerkship (PCG) where students improve their ability to measure functional and cognitive status of elderly patients through presentations, shadow charts, and case studies. Documentation of how this experience translates into the hospital setting has been rare. We wished to learn more about these student’s abilities.
Our approach was to create a chart abstracting tool that measured the student’s documentation of cognitive status (acute and long term), and functional status (ADL and IADL). We compared students that have taken the PCG to those that have not yet. We took the sample from students in the Advanced Family Medicine and Advanced Internal Medicine Clerkships where trained assistants abstract on average five random charts of patients over the age of 65 whom they provided care for over their rotation. The chart tool was developed so that students would receive a score based on what information they recorded about cognitive and functional status, and how it compared to nurses and physician’s notes and also among other sources.
For more information, email John Agens, M.D. at john.agens@med.fsu.edu.
View the A Tool for Audit of Hospital Charting of Functional and Cognitive Status by Year Four Medical Students: A Pilot Study [pdf] poster that Dr. Agens presented at the 39th North American Primary Care Research Group Annual Meeting in December 2012.
Effects of Exogenous Melatonin Administration and its Role in Cognitive Function Among Elderly Subjects
This is a double-blind, placebo-controlled, clinical trial, that was used to assess exogenous melatonin administration and its role in cognitive function among elderly subjects. Subjects suffering from mild cognitive impairment (MCI) were subjected to screening/baseline testing using the Montreal Cognitive Assessment (MoCA)©. Subjects were randomly assigned into either the experimental or control group and were provided with either 15 mg/day melatonin for six weeks or placebo capsules. Subjects took the provided melatonin or placebo nightly for six weeks and then completed the MoCA© for a second time. All data has been collected from the study and is in the process of being analyzed.
For more information, email the lead faculty member, James Olcese, Ph.D. (Department of Biomedical Sciences), at jolcese@fsu.edu.
Department of Geriatrics Collaborator: Ken Brummel-Smith, M.D., ken.brummel-smith@med.fsu.edu
Outcomes of a HELP Intervention Using Hospitalists
The Hospital Elder Life Program (HELP) is a hospital- based delirium prevention program for older adults developed at Yale University School for Medicine. The Florida State University College of Medicine and Tallahassee Memorial Hospital partnership fostered HELP’s introduction in Tallahassee with funding from a Donald W. Reynolds Foundation grant. The HELP program aims to reduce the incidence of delirium in patients 70 years or older who show certain risk factors upon admission to the hospital through improved geriatric-specific nursing care and using specially trained volunteers who have regular interaction with patients and conduct evidence-based prevention activities. Unlike other replications, our model uses hospitalists, rather than geriatricians, as the physician involved in the team.
For more information, email Ken Brummel-Smith, M.D., at ken.brummel-smith@med.fsu.edu.
Smartphone Application for Detecting Falls in Older Adults
Falls are a leading cause of injury and death in older persons. Many of the commercially available fall detection systems used in long-term care are not appropriate in community-dwelling elders. A large percentage of elders use cell phones, and smartphones are being increasingly used. Smartphones have a built-in accelerometer that can be programmed to detect a fall. Research is needed to determine whether the detection is reliable. If the smartphone detection system is determined to be reliable, then the phone can be programmed to call the "faller" and if no response is received, to automatically call for medical assistance.
For more information, email the lead faculty member, Gary Tyson, Ph.D. (FSU College of Arts and Sciences, Department of Computer Science), at gtyson@fsu.edu.
Department of Geriatrics Collaborator: Ken Brummel-Smith, M.D., ken.brummel-smith@med.fsu.edu.
Use of "Go Wish" Cards in Persons with Mild Cognitive Impairment
The concept that a discussion of the patient's goals and values should precede any discussion of specific treatment choices when considering end-of-life care is becoming increasing well accepted. Recently, a new device, the "Go Wish" cards, has been developed as a way for patients and their families to identify and record their goals and values. This project explores the use of "Go Wish" cards in a diverse older adults population.
For more information, email Ken Brummel-Smith, M.D., at ken.brummel-smith@med.fsu.edu.
Anatomy First Patient
On average medical cadavers at the College of Medicine have ranged in age from 50-102 years. This provides an overt opportunity to incorporate the age of the cadaver as a geriatric learning opportunity. A very successful curricular innovation and basic and clinical science collaboration occurred in the anatomy course where the doctoring-course clinical faculty provided a structured teaching session on the first day of anatomy class. This session was an introduction to the students’ first patient. Students used observational skills to identify physical abnormalities and applied clinical reasoning to associate findings with functional and therapeutic implications and then considered social support needs that existed at the end of life.
Each year, the activity has been positively evaluated by both participating students and faculty. Dissemination of this innovative activity has occurred through Donald W. Reynolds Foundation grantees meetings, the American Geriatrics Society annual meeting, and posting on the Portal of Geriatric Online Education (POGOe) http://www.pogoe.org/productid/20308, where it won "Editor’s Choice" in 2009.
The development of this educational innovation was supported by funding from the Donald W. Reynolds Foundation.
For more information, email Lisa Granville, M.D. at lisa.granville@med.fsu.edu.
Senior Mentor Program
During this activity medical student pairs made at least three "house calls" to active older adults. Examples of learning content included understanding of historical influences on health perceptions, the existence of "wellness" in the face of chronic disease, and health promotion and disease prevention practices that exist in the community.
Unique to this program was the student requirement to make at least two "house calls" to a much younger developmentally challenged population. Students were encouraged to compare and contrast these divergent "house-call" experiences, to explore their biases regarding functional ability and age associations, and to explore the value of applying geriatric-care principles across the lifespan.
A performance by the "Pyramid Players" was included as another exposure to the developmentally challenged population beginning in 2007. The performance group is made up of 10 to 20 performing artists who demonstrate a variety of skills such as singing, dancing, poetry reading, and playing musical instruments. At the conclusion of the performance, M1 students and artists had an interactive question and answer session.
Annually, students and senior mentors participating in the program complete evaluation surveys. The development of this educational innovation was supported by funding from the Donald W. Reynolds Foundation. Ongoing funding for this project is provided by the Mina Jo Powell Endowed Fund for Study of Health Issues in Aging.
For more information, email Lisa Granville, M.D. at lisa.granville@med.fsu.edu.
Physician Orders for Life-Sustaining Treatment (POLST)
The Center for Innovative Collaboration in Medicine & Law is the central coordinating body for the POLST (Physician Orders for Life-Sustaining Treatment) Paradigm in Florida. Professor Kapp has mentored College of Medicine and College of Law students for the Charles R. Mathews Geriatric Education and Research Scholarships regarding this topic. For more information on the students' projects view the Charles R. Mathews webpage.
For information on the Florida POLST Paradigm visit the Center for Innovative Collaboration in Medicine and Law website or email Marshall Kapp, J.D., M.P.H. at marshall.kapp@med.fsu.edu.
ElderQuest©: Video Game Fun with Geriatrics
ElderQuest© is a 3D video game aimed at helping medical students learn geriatric-care principles while having fun. The game is played from a medical student’s perspective, and key members of the geriatrics team are integrated into the game and storyline in order to illustrate the interprofessional team-based model for geriatric care. Learner game play is being tracked during a pilot study to see if there is an association with student performance on their year four geriatrics clerkship. Game development was done in collaboration with Brainstorm Rising, L.L.C. through initial funding under a Donald W. Reynolds Foundation grant, and is continuing under support from the College of Medicine.
For more information, email the lead faculty member, Alice Pomidor, M.D., M.P.H., at alice.pomidor@med.fsu.edu or Ken Brummel-Smith, M.D., at ken.brummel-smith@med.fsu.edu.
View the ElderQuest© Enhancing Learning with Video Games poster [pdf] that Dr. Pomidor presented at the 2012 American Geriatrics Society annual meeting.
Assessment of Baseline Characteristics of Older Adults at the Transition Center
Patients discharged from a hospital setting may be referred to the Transition Center at Tallahassee Memorial Hospital. The concept of transitional care ensures adequate follow up after a patient is discharged from the hospital. The rate of rehospitalization, especially among frail older adults, is often high and costly and can lead to preventable poor outcomes. The goal of this study is to assess the baseline characteristics, which may include medical history, functional status, and current medical conditions of individual patients seen at the Transition Center.
The InterRAI™ Contact Assessment (CA) provides the minimum clinical information to identify patients that need short-term services, as well as identify patients that may need longer term services. It was developed to support decision-making about the urgency of providing patients with immediate service and also identifying patients that need assistance outside of the medical center.
Because this is a preliminary study and the InterRAI™ CA has never been used in a Transition Center, we are unsure of what we expect to find; however, we hope to gather enough information to see the value of this tool in the Transition Center and to identify patients who might need further assistance.
For more information, email Niharika Suchak, M.B.B.S, M.H.S., F.A.C.P. at niharika.suchak@med.fsu.edu.
