RESEARCH

Aligning Clinical and Research Phenotypes to Advance Research in Alzheimer’s Disease and Related Dementias

Authors: Dr. Emily Trittschuh and Dr. Debby Tsuang

In a groundbreaking collaboration between the VA and National Institute on Aging (NIA), Drs. Debby Tsuang and Emily Trittschuh are partnering with Dr. Mark Logue at VA Boston to harmonize VA clinical phenotypes for Alzheimer’s disease and related dementias (ADRD) with research phenotypic data from the NIA Alzheimer’s Disease Sequencing Project led by Tim Hohman, PhD, MPI, of Vanderbilt University Medical Center. The VA's electronic medical record system is one of the largest potential data sources for ADRD research, yet the relevant data about diagnoses and other markers of ADRD – collectively referred to as phenotypes – are challenging to integrate into ongoing research. By making these ADRD diagnoses and phenotypes comparable, investigators in this consortium aim to create a resource for interagency collaborations that will help scientists better understand ADRD risks, improve the timely diagnosis of ADRD, and discover new ADRD treatments.

In future efforts, data from the VA's Million Veteran Program will be leveraged to facilitate genetic analyses. This work is an extension of Dr. Tsuang’s machine learning studies to find undiagnosed ADRD using VA medical records and Dr. Trittschuh’s harmonization of psychometric data for Dr. Homan’s investigation, as well as in the AD Neuroimaging Initiative, a study of protective genetic factors for Alzheimer’s Disease, and other associated work.

Dr. Tsuang is also the principal investigator of an NIH grant-funded study that seeks digital biomarkers for the early detection of dementia with Lewy bodies (DLB). Nearly half of patients with DLB experience delays in diagnosis of nearly 18 months after first reporting symptoms to physicians. Such underdiagnosis delays early treatment efforts, exacerbate caretaker stress, and likely result in high health care utilization. To address this, Dr. Tsuang is monitoring activity and sleep longitudinally in individuals with DLB and mild cognitive impairment (MCI). Her research portfolio focuses on the early diagnosis of dementia, using two separate approaches that include mobile health devices and existing electronic health records. Through these efforts, she hopes to bring cognitive health of aging Veterans to the forefront of Veterans Health Administration.

 
Contact: Emily.TrittSchuh@va.gov 

Benzodiazepine/Z-drug Discontinuation in Older Adults: A Combined Tapering and Behavioral Approach That Addresses Placebo Mechanisms

Author: Constance Fung, MD, MSHS

Benzodiazepines and z-drugs (e.g., zolpidem) are commonly prescribed for insomnia, particularly among older Veterans. However, long-term use in this population is associated with adverse effects, including cognitive impairment and increased risk of falls and hip fractures. A recent randomized clinical trial published in JAMA Internal Medicine examined the efficacy of a combined approach –  masked drug tapering plus augmented cognitive behavioral therapy for insomnia (CBT-I) – in facilitating successful discontinuation among older adults.

The study involved older adults, including Veterans, who had been using benzodiazepines or z-drugs for extended periods. Participants were divided into groups: the “MTcap” group received a masked or blinded taper prepared by a compounding pharmacist along with augmented CBT-I, while the “SGT” group received their medication in a traditional container with a pill cutter and paper taper schedule along with CBT-I. The augmented CBT-I in the MTcap group included exercises aimed at disrupting placebo mechanisms.

Results indicated that participants in the MTcap group were more successful in discontinuing benzodiazepine/z-drug use 6 months after finishing the program compared to the SGT group. Additionally, improvements in insomnia severity were observed in both groups, suggesting that CBT-I effectively managed insomnia symptoms during the tapering process.

The innovative approach used in this trial has potential to be used in tapering or up titrating other medications. The combination of a masked tapering protocol with augmented CBT-I offers a promising strategy for reducing long-term benzodiazepine/z-drug use among older Veterans. Implementing such approaches within the VA healthcare system aligns with ongoing efforts to promote safe prescribing practices and improve the overall well-being of our aging Veteran population.

Contact: Constance.Fung@va.gov 

EDUCATION

Applications to the Geriatric Scholars Program Continue to Outpace Available Enrollment Slots

Author: Josea Kramer, PhD

The Geriatric Scholars Program is a workforce development program to infuse geriatrics in interdisciplinary VA healthcare settings. The program, supported by the Offices of Rural Health and Geriatrics and Extended Care, operates as a collaboration among 11 GRECCs, with its Hub Site at the Greater Los Angeles GRECC. It has trained over 1750 clinical personnel to be ambassadors for change and champions in the healthcare of older Veterans. By training primary care providers (i.e., physicians, advance practice nurses and physician assistants), the program estimates that it has indirect impact on at least 466,000 Veterans enrolled in these primary care panels. Through webinars and team-based training, the Geriatric Scholars Program regularly provides continuing medical education and continuing education units to an additional 12,250 unique VA clinical personnel and staff.

The steady and growing interest in the Geriatric Scholars Program continues, even as funding from the Office of Rural Health is scheduled to end after fiscal year (FY) 2025. This year, as every year since its inception, there is a waitlist for enrollment in all educational activities. So far, for FY2025, the program enrolled 238 new Scholars in its core program and 308 alumni Scholars in clinical practicum and advanced courses.  New training opportunities have expanded to include registered nurses (RN) working in Geriatrics Patient Aligned Care Teams (GeriPACT) and in Home-Based Primary Care (HBPC). That component is enrolling over 350 nurses and has an extensive wait list as well.

For more information about courses for primary care providers, nurses, psychologists, psychiatrists, pharmacists, social workers and rehabilitation therapists, please contact Luis Melendez at or Josea Kramer.

 
Contacts: Luis.Melendez2@va.gov and BettyJo.Kramer@va.gov   

CLINICAL INNOVATION

Combining Age-Friendly Approaches and Geriatric Surgery Verification to Improve Surgical Outcomes of Older Veterans

Authors: Dr. Muralidhar Pallaki , Dr. Peijun Chen, Dr. Denise Kresevic, Dr. Jessie Jean-Claude

The Louis Stokes Cleveland VA Medical Center is among the first two sites piloting a new participation level in the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) Program. Called the Geriatric Surgery Verification (Age-Friendly) Level, the effort seeks to optimize the care of older adults undergoing surgical procedures by combining principles from the Institute of Healthcare Improvement Age Friendly Health Systems (AFHS) with the program standards set by the GSV Program. Dr. Jessie Jean-Claude, a vascular surgeon, Chief of Surgery, has partnered with staff from the VISN10 GRECC-Cleveland to pilot participation in the Geriatric Surgery Verification (Age-Friendly) Level at their site.

The Geriatric Surgery Verification (Age-Friendly) Level standards became available in January 2025 and feature six measures: Age-Friendly Leadership, Treatment and Overall Health Goals, Geriatric Vulnerability Screens, Management Plan for Patients with Positive Geriatric Vulnerability Screens, Age-Friendly Postoperative Protocol, and Data Review. Thus far, Dr. Jean-Claude and colleagues have established a core planning group and have been meeting regularly.  They are integrating Age-Friendly 4M concepts into care pathways to identify at-risk older Veterans and provide targeted interventions to enhance function in the preoperative period and reduce complications in postoperative periods. They plan to develop documentation templates, order sets, and a dashboard for tracking success.   

In addition to enhancing perioperative care and surgical outcomes among older Veterans, they will share their insights from the implementation process with the ACS. Their experiences will assist in the development and dissemination of an entry level to GSV that is both efficient and effective for hospitals across the nation.  

Contact: Denise.Kresevic@va.gov 

Innovation in Mobility: From Idea To Commercialization

Author: Edward Ratner, MD

The Mobility element of Age Friendly Health System’s 4M’s can be addressed in a variety of ways. Edward Ratner, MD of the Minneapolis VA GRECC has been on a 5-year journey to address this issue through an innovative mobility device. He and staff from the facility’s rehab engineering program, called RECOVER, have followed the VA’s Human Centered Design process to explore the problems of Veterans who can walk short distances but can’t ambulate as far or as fast as desired. The scope of this problem is vast, given that over 40% of Americans over 65 are unable or can’t easily walk 2 blocks.

For younger, more risk-taking populations, personal mobility is enhanced by devices such as e-bikes and two-wheeled scooters. For older people who can walk at home but with difficulty in the community, mobility aids include manual walkers or seated mobility scooters. None of these devices combine the three features reported to be important to Veterans interviewed by the project team: safety (avoiding falls), usability (indoors and outside while navigating bumps and curbs) and transportability (fits into a car). 

The solution Dr. Ratner’s team has pursued is a stable upright mobility scooter, that can be driven at a variable speed, pushed in a tight or crowded space, and folded for transport or storage. Iteratively, they have developed a working prototype using a front hub motor, a four-wheeled, low to the ground standing platform, and tiltable stem and handlebars. The device can travel as slowly as 0.5 MPH or up to 15 MPH for over 10 miles using a lithium battery. Overall, it weighs about 20 kg, but the battery/controller can be separated from the base and steering column to ease lifting.

This project has been funded through the VA’s Innovation Ecosystem and Technology Transfer Program (TTP). The team presented the prototype at the national Design of Medical Device Conference in 2022 and published a paper in its conference proceeding. That year, the VA submitted a patent application, which was published in December of 2024. (US-2024/0409176-A1- approval is pending.) The intellectual property is licensable through VA TechLink and TTP. 

Project development continues. In December 2024, Dr. Ratner competed at a life sciences business competition, the Walleye Tank [based upon Shark Tank], sponsored by the University of Minnesota and Mayo Clinic, winning second place in its early-stage division. The project team is now participating in the Midwest regional National Science Foundation I Corps program, designed “to train researchers to extend their focus beyond the laboratory and accelerate the transfer of cutting-edge research into commercial success.” University of Minnesota funding has been requested to develop a usability/safety testing protocol and to complete detailed market research. The goal is to identify a business partner to make such a device available to Veterans and others, to enable independence in community activities, socialization and improved physical and emotional health.

Contact: Edward.Ratner@va.gov 

Minneapolis VA GRECC Staff Publish Manuscript Highlighting Clinical Demonstration Project Aimed at Supporting Caregivers

Authors: Sarah Garrett, MSN, RN and Allison Gustavson, PT, DPT, PhD

A team from the Minneapolis GRECC recently published a manuscript in the journal Geriatric Nursing that details the outcomes of a 2023 Clinical Demonstration project. The team included Darrick Idso, DNP, APRN, AGPCNP-BC, Amanda Johnson DNP, Emily Hudson, MA, Hannele Nicholson, PhD, CCC-SLP, Sarah Garrett, RN, MSN, Rebecca Brown, PhD, Med, RN, Kristine Talley, PhD, RN, GNP-BC, Edward Ratner, MD, Hilary Mosher, MD, MFA, Howard Fink, MD, MPH, and Allison Gustavson, PhD, DPT.  The publication describes the feasibility and acceptability of a caregiver-focused, nurse-led post-discharge call to caregivers of Veterans with dementia who were recently discharged from a single medical center.

During the intervention period, 30 caregivers met inclusion criteria, and 19 caregivers participated. Caregivers received calls focused on assessing their preparedness and identifying unmet needs.

Results suggested most caregivers of recently hospitalized Veterans with dementia can be identified, contacted, and interviewed to assess caregiving needs. However, sustainability was challenged by the significant time and resources required to screen and identify caregivers. Future iterations are focusing on deployment of an electronic health record tool to improve the efficiency by which caregiver information is located, documented, and used to inform clinical decisions and allow for conduct of caregiver-focused interventions.

This project was conducted in collaboration with the University of Minnesota Doctor of Nursing Program and provided a robust training experience for two DNP capstone projects. It also served as an opportunity for early career researchers invested in geriatrics to lead an interdisciplinary team in achieving project goals and expanding the work for sustainability.

Contact: Allison.Gustavson@va.gov 

An Interdisciplinary Partnership to Assess and Address Food Insecurity Among Hospitalized Older-adult Veterans at the Madison VA

Authors: Jennifer Orshak, PhD, RN, EBP-C; James Barnett; Lauren Christen, RD; Matthew Jones; Kayla Jacobsen, MSN, RN; Joseph Naylor; Ashley Olson, MS, RD, CD; Miriam Rivera Bodon, RDN, CDCES

Food insecurity is the “limited or uncertain availability of nutritionally adequate and safe foods” (Anderson, 1990). Rates of food insecurity among Veterans range from 6-24% Older-adult Veterans who experience food insecurity are at risk for social isolation as well as some physical (e.g., hypertension, diabetes) and cognitive conditions. They often eat nutrient poor, calorie dense foods, and endure the cyclic nature of food insecurity and poor health, which is costly to both Veterans and healthcare systems (Cohen et al., 2020). Clinical interventions designed to support Veterans with food insecurity are scarce (Orshak et al., 2025).

In light of this, a team from the Madison VA led the “Ensuring Veteran Food Security Program,” a  GRECC Clinical Innovation during FY24 that had two goals in mind: 1) assess for food insecurity among hospitalized older adult Veterans at the Madison VA‘s Community Living Center (CLC) and inpatient units, and 2) address food insecurity by pilot testing an evidence-based clinical innovation designed to provide patient-centered, healthy non-perishable food items to Veterans prior to discharge.

The Nurse Scientist-led interdisciplinary team identified four objectives for the project: Objective 1: Educate 90% of CLC and inpatient nurses to identify Veterans with food insecurity using the VA’s 2-item Food Insecurity Screening tool embedded in the nursing admission note. Objective 2: Assess the clinical (e.g., hypertension, diabetes) and sociodemographic (e.g., age, race) factors associated with food insecurity among the Veterans in this innovation. Objective 3: pilot test the innovation among Veterans in the CLC over a three-month period prior to extending the innovation to the inpatient units. Objective 4: Assess the feasibility of implementing the pilot innovation.

The Nurse Scientist collaborated with a University of Wisconsin-Madison Doctor of Nursing Practice (DNP) student, nurse educators and leadership, and a clinical dietitian to provide multi-modal (e.g., in-person, via email) education to CLC and inpatient nurses to identify Veterans with food insecurity. As part of this education, the Nurse Scientist, student, and Education Department developed an evidence-based training module (TMS Module 4663558) and deployed it to nursing staff (n = 188) across 7 hospital units. The education increased nursing staff’s knowledge and confidence to screen Veterans for food insecurity and place appropriate consults. Additionally, food insecurity screening rates rose across all units. 

The Nurse Scientist conducted chart reviews to assess the frequency of factors associated with food insecurity among the Veterans included in the pilot innovation. Among participants, the average age was 65 years, and 83% (n = 15) self-identified as male. Seventy-eight percent (n = 14) were white and 100% (n = 18) were non-Hispanic. Forty-four percent (n = 8) served in the Vietnam Era. Seventy-eight percent (n = 14) reported tobacco use. Seventy-two percent (n = 13) reported a history of hypertension, and 61% (n = 11) reported alcohol use or abuse.

After three months of pilot testing the innovation among Veterans in the CLC, the team rolled it out to the remaining inpatient units. At three months, nurses across seven hospital units had screened over 700 Veterans for food insecurity and referred 33 Veterans to Nutrition & Food Services for the issue. Clinical dietitians re-screened Veterans and provided a total of 21 bags of healthy non-perishable food items to food insecure Veterans prior to discharge. This was a combined total of 358 healthy non-perishable food items weighing 271.7 pounds. At nine months, more than 1658 pounds of food were distributed to 89 food insecure Veterans across the CLC and inpatient units.

The team distributed a 20-item survey to assess the acceptability, appropriateness, and feasibility of implementation among healthcare staff involved in the pilot innovation, guided by the RE-AIM framework. Staff (N = 13) scores indicated high average ratings of acceptability (Mean = 4.52, SD = 0.50, range 4-5), appropriateness (Mean = 4.73, SD = 0.45, range 4-5), and feasibility (Mean = 4.27, SD = 0.60, Range 3-5).

Initial findings support assessing and addressing food insecurity among hospitalized, older adult Veterans prior to hospital discharge. Nurses in practice should assess all Veterans for food insecurity and refer them to appropriate resources as needed. To support Veterans prior to discharge, clinical dietitians can provide immediate short-term Nutrition Kits (i.e., bags of Veteran-centered, healthy, non-perishable food items) while consults to Nutrition and Social Work help establish intermediate and long-term support (e.g., Meals on Wheels, Supplemental Nutritional Assistance Program). The “Ensuring Veteran Food Security Program” offers a feasible, acceptable, and evidence-based model for addressing food insecurity among older hospitalized Veterans.

Contact: Jennifer.Orshak@va.gov 

GeroFit Empowers Veterans to Achieve their Functional Goals

Author: Troy Moore, Atlanta VAHCS Gerofit Program Manager, Birmingham/Atlanta GRECC

Emiko Lanier is a 71-year-old Gerofit participant warming up for her 3-year physical functioning assessment with the program where she will soon find out just how much progress she’s made in her functional journey this past year.

When she first joined, Emiko struggled with limited mobility, frequent joint pain, and fatigue, all of which affected her quality of life. These concerns come up quite regularly among Gerofit participants, but the nature of the program provides a safe opportunity to work on gaining strength, flexibility, and most importantly confidence.

On a normal day, Emiko would work up a sweat safely on the treadmill, but today she is preparing for her Gerofit physical functioning assessment at a leisurely pace to loosen up her legs and get mentally prepared.

After 3 years with Gerofit, Emiko has grown familiar with the assessments and sees them as a challenge to exceed her prior performance. “When I first started, sometimes my strength was low, sometimes not, so the exercises were tough” says Emiko. Like many others, Emiko found enjoyment in the Gerofit program after looking for a way to address recurrent pain in her back and legs.

Through consistent participation, she has noticed a marked decrease in joint pain, especially in her lower back and legs, which had previously been a barrier to daily activities. Perhaps just as important as the decrease in joint pain has been the understanding of just how much to push it when she’s feeling good and when to be a bit more conservative and take it easy.

Just how well did Emiko perform on her tests?

Depending on each Veterans preference, the testing battery changes slightly in number and time requirements. Of greatest concern for Emiko, she scored in the top 80th percentile for women in her age-group for the 2-minute step test and in the top 95th for the sit to stand, both highlighting the effort she has invested in addressing her lower body pain and stiffness.

Emiko’s journey highlights the transformative impact that senior-specific exercise programs like Gerofit can have on both physical health and emotional well-being. The Gerofit program remains cost-free for Veterans ages 65+ enrolled in the Atlanta VA Medical Center and is also available at other VA sites across the country. VA health care providers can refer individual Veterans with a Gerofit consult, and Veterans and providers alike can follow-up with any specific program questions with the Gerofit exercise physiologist.

 Contact: Troy.Moore@va.gov 

Captain Wally Dombrowski's Cross-Country Adventure: Staying Active with Gerofit

Author: Katie Althuis, MS, Ann Arbor Gerofit Program Coordinator

Captain Wally Dombrowski, a U.S. Army Veteran and licensed 100-Ton Master, has had countless adventures on the water throughout his life. Recently, however, he embarked on a new kind of adventure—traveling across the United States in his RV.

Alongside his wife, Kris, Captain Dombrowski journeyed from coast to coast, stopping at national parks, scenic highways, popular tourist destinations, and more remote locations. During these stops, the couple often took the opportunity to stretch their legs and explore the surroundings, either by hiking or biking. But Wally wasn’t always as confident about his ability to remain active as he aged.

Several years ago, pain and weakness in his legs had Wally concerned. He had less energy, felt weaker, and struggled with balance issues. The Veteran was aptly enthusiastic after finding a Gerofit brochure during an appointment at the Ann Arbor VA.

Gerofit, a free program for older veterans designed to improve strength, balance, and overall wellness, seemed like the perfect fit for Dombrowski. While the program offers both in-person and virtual classes, Wally chose to participate in the online sessions, allowing him to stay active no matter where his travels took him.

From October 2024 to January 2025, Captain Dombrowski took Gerofit on the road as he and Kris traveled from Michigan to California, with numerous stops along the way. Throughout the journey, Dombrowski remained committed to his daily workouts, logging into Gerofit’s live and recorded sessions no matter where he was parked. Whether in the middle of the New Mexico desert, along California’s rugged coastline, or at a campground in Arizona, Dombrowski's workout routine never skipped a beat—even when his RV broke down in Texas.

Along his travels, Dombrowski had the chance to explore some truly unforgettable locations. He biked 8 miles through Saguaro National Park in Arizona, 18 miles to the San Diego waterfront in California, and 14 miles along the rim of the Grand Canyon. Despite the challenges of long-distance travel, his dedication to Gerofit was key to staying healthy and injury-free.

In addition to maintaining his own fitness routine, Captain Dombrowski also supported his wife, Kris, as she participated in the Susan G. Komen 60-mile breast cancer walk in both Dallas and San Diego. This marked Kris’s 15th year walking the 60-mile route. While cheering on the participants, Dombrowski walked and biked along the courses, all while sticking to his Gerofit schedule.

“Doing Gerofit every day gives me more energy and physical ability to meet life's demands—whether it's walking, reaching, sitting for long periods, bending to pick something up, or even tying my shoes,” Dombrowski shared. “All the things that were easy when we were kids are still possible!”

Captain Dombrowski’s experience highlights the growing impact of the Gerofit program, which has become an essential resource for veterans and older adults across the nation. Many of these individuals struggle to maintain fitness after retirement or after transitioning to civilian life, but Gerofit provides a practical and accessible way to stay healthy.

As Dombrowski’s journey proves, fitness is a lifelong commitment. Whether traveling across the country or simply managing daily activities, Gerofit’s flexible virtual program offers older adults and veterans a crucial tool to maintain strength, mobility, and overall wellness.  Now that Dombrowski’s cross-country journey has come to an end, he remains a testament to the power of perseverance, adaptability, and the importance of prioritizing health at every stage of life. With Gerofit by his side, he’s not just crossing state lines—he’s also crossing personal milestones in his fitness journey.

Contact: Katie.Althuis@va.gov 

KEEPING CURRENT

Networking Event Planned For 2025 American Geriatrics Society Annual Scientific Meeting

The National Coordinating Center for the VA’s Advanced Fellowship in Geriatrics invites our VA and GRECC colleagues to join us for a networking event at the annual scientific meeting of the American Geriatrics Society (AGS) in May. We’d love to see you there!

Contact: Colleen.Hursh@va.gov 

Join GRECC Staff for Symposium on Artificial Intelligence in Geriatrics

 

Dr. Juliessa Pavon of the Durham GRECC will join Drs. Jeremy Walston and Ravishankar Ramaswamy to present a symposium at the upcoming American Geriatrics Society Annual Scientific Meeting in Chicago on May 8, 2025, at 1:30 p.m. local time. The session, hosted by Dr. Amit Shah and titled “Artificial Intelligence and Geriatric Medicine: Innovative Uses of AI to Improve Clinical Care and Health Professions Education,” will cover a range of topics regarding artificial intelligence applications for clinical and educational settings in Geriatric Medicine.  

Contact: Juliessa.Pavon@va.gov 

New Enduring Educational Activity Available from Bronx GRECC

The Bronx GRECC is pleased to announce that the 4th Annual VISN 2 GRECC Virtual Conference: Updates in Geriatrics and Palliative Care - The 4Ms of the Age-Friendly Health System is now available as an enduring educational activity. The conference originally took place on September 19, 2024 and has been converted to a course on the VA Talent Management System (TMS). It offers continuing education credits for clinicians from numerous backgrounds and familiarizes participants with the 4Ms framework and how to apply it to the care of Veterans. Those interested can access the activity through TMS (Course ID 131015180) or via this link.

Contact: Eugenia.Dorisca@va.gov 

Connect Faculty and Trainees to Leaders in Aging Research with Funding from Clin-STAR

If your institution is seeking experts in Geriatrics and Gerontology to provide education, training, and mentoring for clinician scientists, faculty, and/or trainees, consider the Clin-STAR Visiting Professor Program.  Clin-STAR offers a searchable database of researchers and has a curated roster of experts in aging research from a variety of professions and specialties who have expressed interest in traveling to give Grand Rounds or engage in other training activities. The program prioritizes sites without robust aging or geriatrics research programs. Clin-STAR will provide up to $3000 to cover travel, room and board, and honorarium for the visit and accepts applications on a rolling basis. More information on the program can be found at the Clin-STAR Visiting Professor Travel Fund webpage.

Contact: Andrea@afar.org 

Staff News

 Awards

Dr. Betz Elected into National Academy of Medicine

Emmy Betz, MD, MPH, was elected as a member of the National Academy of Medicine. Dr. Betz is a research physician in the Eastern Colorado GRECC, and Director of the University of Colorado (CU) Firearm Injury Prevention Initiative and Professor of Emergency Medicine in the University of Colorado School of Medicine. She is a nationally recognized pioneer in injury and suicide prevention research, with a focus on firearm injury prevention research, including among older adults. In 2023, she launched the CU Firearm Injury Prevention Initiative to serve as a trusted community and national resource for firearm-related research and solutions. She was inducted into the National Academy of Medicine in a ceremony in October 2024.

New Hires

Dr. Juliessa Pavon Named Associate Director of Clinical Innovation for the Durham VA GRECC

The Durham VA GRECC is pleased to announce that Dr. Pavon has been appointed as the Associate Director of Clinical Innovation for the Durham VA GRECC. A hospital-based geriatrician and clinical investigator, Dr. Pavon is an Associate Professor of Medicine, Biostatistics and Bioinformatics, and Head and Neck Surgery and Communication Sciences at Duke University. She also serves as the Associate Scientific Director of Informatics and Artificial Intelligence for the Duke Aging Center and Division of Geriatrics & Palliative Care, and is a co-investigator in the Duke Pepper Center, where she leads data science initiatives.

Dr. Pavon’s research focuses on leveraging artificial intelligence (AI), informatics, and wearable technology to improve medication safety, mobility, and functional outcomes in older adults. She has led pioneering efforts in developing machine learning models to predict physical activity and functional decline, as well as AI-driven tools for deprescribing high-risk medications. Her expertise in applied informatics and digital health has also been instrumental in optimizing electronic health records (EHRs) for clinical decision-making, including the development of inpatient Age-Friendly 4Ms dashboards, mobility and delirium screening, medication safety alerts, and piloting AI-enhanced EHR documentation tools, and computer vision AI technology to enhance monitoring of ICU delirium. 

Currently, Dr. Pavon co-leads two clinical innovation programs for the Durham VA GRECC, funded as part of the VA Patient Safety Center of Inquiry and Deprescribing Collaborative:

The Falls Assessment of Medications in the Elderly (FAME) program is an interdisciplinary program at the Durham VAHCS designed to improve medication safety in Veterans aged 65 years and up at high risk for falls. The program utilizes EHR-based case finding and interdisciplinary medication case reviews to provide evidence-based deprescribing recommendations, which are forwarded electronically to prescribers for approval, then implemented through follow-up telephone visits.

The Caregiver Help to Improve Medication Safety (CHIMES) program extends FAME by supporting medication safety for Veterans with dementia through a caregiver-focused approach. To enhance sustainability, CHIMES will evaluate the safety, appropriateness, and acceptability of generative AI in producing deprescribing recommendations, comparing AI-generated outputs with clinician-derived ones. The goal is to identify AI’s limitations and ensure its safe integration into medication management, with findings informing responsible AI use in deprescribing.

In addition to her research, Dr. Pavon plays a national leadership role in advancing geriatrics and hospital medicine through her service on the National Epic Geriatrics Steering Board, the Society of Hospital Medicine Research Committee, and the U.S. Deprescribing Network’s Data Harmonization Core. She has been the recipient of multiple National Institute of Health awards, including an National Institute of Aging (NIA) K23 Career Development Award and a recently funded NIA R01 grant focused on personalizing deprescribing decision-making using machine learning and multi-site EHR data.

Dr. Pavon’s work at the Durham VA GRECC will continue to shape the future of AI in geriatrics, bridging clinical innovation with data-driven insights to improve outcomes for older veterans.

SUBMIT TO FORUM ON AGING

 We welcome submissions from GRECCs for this news magazine, including:

• Updates and results about research, education, and evaluation efforts and clinical innovations
• Notices of awards, grants, training opportunities
• Staff news
• Photos or images to accompany your submission

GRECC Forum on Aging is published by the VA William S. Middleton Memorial Veterans Hospital and Clinics – Madison Geriatrics Research, Education, and Clinical Center.

Elizabeth Chapman, MD, Editor

For inquiries, please contact:

Madison VA GRECC

2500 Overlook Terrace

Madison, WI 53705

Phone: 608-280-7000

Fax: 608-280-7291

Elizabeth.Chapman3@va.gov

To provide feedback about Forum on Aging, please contact: Elizabeth.Chapman3@va.gov

Sponsored by the Office of Geriatrics and Extended Care, VACO