Research

The Gerontology Center is renowned for research in health services, aging, and chronic disease. Our research focuses on the health and well-being of older adults and other vulnerable populations (such as those with dementia, HIV/AIDS, MS, racial and gender minorities) and includes:

  • Analyses of policy and market effects
  • Pragmatic trials, including large-scale cluster-randomized trials
  • Large-scale observations of contemporary practice, quality of care, and outcomes
  • Short- and long-run evaluations of pharmaceutical risks and benefits
  • Intervention evaluations, including cost-effectiveness and cost-benefit analyses

Because of our existing big data, faculty expertise, and experience with both epidemiological and interventional research methods, key and emerging practice and policy questions can be addressed, often with rapid response.

We tackle topics within and across broad themes, such as:

 

Examples include HIV-related research, including measuring, monitoring, and improving adherence with HIV antiretroviral therapy (ART), and understanding the illness process from the patient perspective. Faculty are also involved in testing interventions to improve ART compliance through economic incentives and to improve physician-patient ART communication.

Current research includes:

  • Investigating the impact of the Affordable Care Act on racial and socioeconomic disparities among patients with end-stage renal disease
  • Applying the GOLD guidelines to assess lung function and chronic obstructive pulmonary disease management among nursing home residents
  • Lung function and management of COPD in NH residents:  application of the GOLD guidelines

We have a long history of research influencing end-of-life and palliative care policy and clinical practice, beginning with the original hospice study in the 1980s, which documented the clinical and cost benefits of hospice and led to making hospice a Medicare benefit.

More than a decade of our work documented the futility of feeding tube insertion for nursing home residents with advanced dementia, culminating in a major reduction in their use nationwide. We also documented that palliative care consultation for nursing home residents reduced invasive treatments and improved quality of life and articulated the concept of burdensome transitions at end of life, which is now a metric in evaluating care quality.

Current research includes:

  • Conducting a pragmatic trial evaluating the effectiveness of video-assisted advanced care planning among nursing home residents
  • Documenting regional variation in end-of-life transitions and the use of hospice and palliative care

We have a particular focus on pragmatic interventional research, with an embedded research center that partners with healthcare providers and others to identify, test, and disseminate innovative practices. The Center for Long-Term Care Quality & Innovation (Q&I Center) is unique in the nation as a result of its close collaborative relationship with a network of more than 14,000 assisted living communities and nursing homes and its mission to establish the evidence base for promising interventions to improve care for older adults. Q&I studies frequently involve cluster-randomized trials in the nursing home setting.

Current research includes:

  • Conducting multiple nursing home cluster-randomized trials, on topics including influenza vaccine, video-assisted advance care planning, and individualized music
  • Evaluating the impact of programmable, tunable LED lighting on nursing home residents’ sleep and dementia behaviors
  • Piloting nursing home decision support to improve antimicrobial stewardship

We are studying disabled and older adults living in the community, their unmet service needs, and health-related consequences. Examples include examining the benefits of long-term support services, meals on wheels, assistive technology, and home modifications as efficient home care resources in promoting independence.

Current research includes:

  • Enhancing social engagement among people with disabilities who live in the community
  • Studying the effect of home- and community-based services on outcomes in people with multiple sclerosis
  • Effect of home and community based services on outcomes in people with MS

Nursing home care

We are studying organizational behaviors of nursing homes, market demands and incentives, and state and federal policies affecting the provision of nursing home care and its quality. This includes a 10-year (to date) National Institute on Aging program project grant to better understand the impact of changing state Medicaid policies on long-term-care providers and the people they serve. Research under this grant has included documenting large regional variation in hospitalization rates, including end-of-life transitions and the use of hospice and palliative care. We also documented substantial disparities in the care and outcomes that minority nursing home residents experience, largely attributable to the fact that blacks and Hispanic residents  are more likely to reside in poor-quality facilities.

Current research includes:

  • Evaluating the impact of federal policy on antipsychotic (and other psychoactive) medication use in nursing home residents with dementia
  • Conducting multiple cluster-randomized trials on influenza vaccines and others
  • Analyzing the uptake and use of medications to ensure cost-effective care with consideration of drug prices
  • Evaluating medication adherence and exposures over time related to positive and negative (adverse) health effects for people with HIV/AIDs, multiple sclerosis, and gender identity issues