Geriatric Research Education and Clinical Center (GRECC)
Palo Alto GRECC
The Palo Alto GRECC has been serving older Veterans since 1975.
Research Focus Areas
Inflammatory mechanisms in degenerative disease: Alzheimer’s disease, and arthritis;
Endocrinology and metabolism of aging: impact of oxidative stress on aging;
Implementation and quality improvement research;Aging and mental health;
Care of older Veterans with Chronic Kidney Disease (CKD)/End-Stage Renal Disease (ESRD)/Mechanisms of cognitive impairment in CKD/ESRD
Our research focus includes three components: (1) Basic Biomedical where research emphasis is on cellular and molecular mechanisms involved in age-related decline in steroid hormone production (Azhar); delineate the mechanisms involved in age-induced alterations in cellular lipid metabolism and their relevance to obesity, metabolic syndrome, diabetes and cardiovascular disease (Azhar); to understand the mechanisms underpinning the initiation, natural remission, and progression of autoimmune disease particularly of rheumatoid arthritis and multiple sclerosis and develop targeted therapeutics that cure these diseases (Robinson); investigation of the role of metabolic disorders and oxidative stress-induced cellular damage in the development of neurodegenerative diseases and the aging process (Huang); understanding molecular processes that underlie aging and age-associated pathologies in mammals (Chua); investigation of the role of immune and injury responses in neurodegeneration and Alzheimer's disease and aging (Wyss-Coray); and research on stem cell biology, muscle stem cell aging, muscular dystrophies and tissue engineering (Rando); and 2) Applied Clinical with emphasis on using health information technology for quality improvement in clinical care (Goldstein); improving the quality of end-stage renal disease (ESRD) care among older adults (Tamura); develop and implement self-directed treatments for geriatric mental health problems that can be delivered using technology (Gould); and teaching older adults evidence based skills with minimum provider time can both promote self-management of mental issues and address the shortage of geriatrics metal health providers (Gould).
Education and Evaluation
The Education program includes both educational activities apart from specific clinical care sites and also clinical education of health professionals in conjunction with the clinical programs above. The educational activities include training in a range of different areas of aging, with special emphasis on interdisciplinary training opportunities, including training in areas of cognitive impairment/dementia and geriatric mental health. Our goal is to integrate new and existing geriatric knowledge and skills into clinical practice and providing training programs that develop future leaders in geriatric care and research. This is accomplished through programs provided to students, medical residents and fellows, allied health professionals, VA staff both at VA Palo Alto Health Care System and nationally, clinical faculty, VA patients, and members of the surrounding community. Palo Alto GRECC serves as a local, regional and national resource for geriatric education and training. Education and training programs include didactic, clinical and research training as well as staff development and continuing education programs. The content of educational programs focuses on state-of-the-art care of elderly veterans, and translating new knowledge from research and clinical demonstrations into educational experiences. Examples of continuing education programs include a national webinar series in geriatric mental health, and conferences on dementia and managing dementia related challenging behaviors.
The clinical care component of the VA Palo Alto GRECC includes interdisciplinary team (geriatrician, clinical nurse specialist, social worker, and psychology) primary care clinics and two consult clinics, one of which is a telehealth consult clinic which serves 4 rural or geographically distant CBOC. The primary care and consult clinics serve as teaching sites for the geriatric medicine fellows, internal medicine residents, medical students, advanced practice nurses, and trainees in psychology, social work, and other allied health professions. The clinical expertise of the VA Palo Alto GRECC is in the areas of cognitive impairment and mood disorders as well as geriatric medicine. The clinical programs include neuropsychological testing for suspected dementia or for capacity evaluations, which is provided by telehealth to several rural Community Based Outpatient Clinics (CBOCs); provision of E-consults for health professionals regarding management of behavioral issues in dementia and other geriatrics questions suited to E-consult; and provision of tailored phone-based socialization, educational, and recreational activities to older Veterans in rural settings.