Geriatric Research Education and Clinical Center (GRECC)

Fall 2025 GRECC Forum on Aging

 Editor’s Message

Welcome to the Fall 2026 issue of the GRECC Forum on Aging. You may notice the absence of our former director, Dr. Marianne Shaughnessy, from this issue. She retired last spring after an impressive tenure during which she capably led our 20 Geriatrics Research, Education, and Clinical Centers (GRECCs) to uphold the GRECC mission by continuously improving scientific knowledge, teaching, and care of older Veterans. As I reflect on her legacy, it called to mind the so-called “campsite rule” – that is, to leave the place better than you found it. I have no doubts that Dr. Shaughnessy, in concert with our GRECC colleagues, did just that. If you have not yet read her farewell message in our last issue, I encourage you to do so. The publication of that issue was delayed but is now available for review. In addition to Dr. Shaughnessy’s message, you will also find several examples of great work by our GRECCs to leave the VHA a better place for our older Veterans.

As we venture forward, our GRECCs remain committed to this ideal. Our feature article describes the novel approach that Palo Alto GRECC staff have taken to help Veterans make and sustain lifestyle modifications that promote brain health. Veterans have praised the six-week, virtual “Balanced Brain” course as safe space to discuss cognitive concerns and pursue meaningful changes. Our Age Friendly item highlights the success of the Eastern Colorado GRECC in achieving the first ever Age Friendly Health System designation for a virtual clinic and how it serves older, rural Veterans with complex care needs better by addressing the Geriatrics 4Ms. The other pieces in this issue showcase many other GRECC-led efforts to better serve our Veterans, from novel approaches to the care of people with Parkinson’s disease to enhanced systems to address challenges of dementia care.

I, like my counterparts, have said goodbye to numerous revered colleagues in the past several months – Dr. Shaughnessy and many other people who have left the VHA better than they found it. While we feel that loss, the work of our colleagues highlighted in this issue gives me great optimism that our GRECCs will continue to carry the spark of the campsite rule forward. We can all seek opportunities to do better for our older Veterans, and I hope you will find inspiration in these stories just as I have.

Elizabeth Chapman, MD
Editor, GRECC Forum on Aging
Associate Director, Education and Evaluation
Madison VA GRECC        
                                 

FEATURE ARTICLE

Helping Veterans Take Charge of Their Brain Health

Authors: Carter H. Davis, PhD; Lawrence Ma, MD; Christine E. Gould, PhD
GRECC Location: Palo Alto

The topic of brain health and preventing cognitive decline has received much attention lately. Many new medications and tests for Alzheimer's disease are coming onto the market. Additionally, various diets, supplements, exercise regimens, and brain games marketed directly to consumers purport to stave off declines in thinking and memory. It can be difficult to sift through the noise and know which strategies are evidence-based and can make a difference.

At the VA Palo Alto GRECC, we noticed that suggestions made to Veterans during a clinic visit, such as increasing their physical activity or socializing more, can be difficult to integrate into their daily life in a sustainable way. Veterans might be overwhelmed managing other health concerns, have a limited social support network, or simply struggle with motivation. Additionally, many older Veterans wrestle with difficult feelings around aging and cognitive changes, such as coping with losses in their lives or worrying about what the future holds, all of which can serve as impediments to engaging with a brain-healthy lifestyle.

To address these barriers to brain health promotion, our team has been developing a new program called Balanced Brain, supported by the GRECC Clinical Innovations program. Balanced Brain is a six-week class, delivered via VA Video Connect, that combines education about health and lifestyle factors that contribute to brain health along with psychological coping tools to overcome barriers to implementing healthy changes. The figure below shows the key “ingredients” of Balanced Brain, which are Healthy, Resilient, and Engaged.

Key components of Balanced Brain that are covered in the six-week curriculum.

The practices we teach in Balanced Brain are derived from acceptance and commitment therapy (ACT, said like the verb, not the letters), an evidence-based mental health intervention that teaches individuals how to embrace and accept difficult thoughts and feelings instead of fighting or avoiding them, all in the service of living a more authentic and values-based life. For example, a Veteran who struggles with the thought “I wish my mind could just work like it used to,” can learn ways of making more space for this thought while also engaging in brain-healthy activities they care about, such as taking more walks or searching for volunteer opportunities in their community. In addition to a weekly class in which we help Veterans design their own brain health plan and practice coping skills to address emotional and motivational barriers, we provide all participants with a set of handouts and worksheets we designed just for this program (see example below).

Worksheet included in Balanced Brain program to help Veterans create specific, values-based brain health goals.

So far, we have enrolled two cohorts of Veterans for Balanced Brain, ranging in age from mid 50s to early 90s. We are collecting data on how the program affects quality of life and well as psychological variables such as acceptance and mindfulness. We additionally interview each Veteran about their personal brain health goals at the beginning of the program (e.g., exercise more, change diet, socialize, engage in cognitively stimulating activities), and then again at the conclusion of the class to determine what tangible steps they took towards their goal and identify barriers. Lastly, we assess Veterans’ overall satisfaction with the program and any suggestions they have for improving it. The feedback we have received already suggests that Veterans have resonated with the message of accepting what they cannot change in life while taking meaningful steps towards what they can, namely, maintaining a healthy lifestyle and staying engaged in activities and relationships that give them purpose (and keep their brain active!). Importantly, many participants have also shared that they find it validating to talk openly with other Veterans about their cognitive concerns, a topic that continues to be stigmatized.

We are continuing to enroll Veterans in the Balanced Brain program at VA Palo Alto and are refining the program based on feedback received from participants. We are also developing a training curriculum for group facilitators so that Balanced Brain can be adopted by other clinics and at other VA sites. Our intention is for Balanced Brain to be an accessible and adaptable program that can help Veterans to design and pursue their personal brain health journey.

The Balanced Brain project team is composed of Carter H. Davis, PhD, Lawrence Ma, MD, Marika B. Humber, PhD, and Christine E. Gould, PhD at the VA Palo Alto GRECC, as well as Sherry A. Beaudreau, PhD at the VA Palo Alto MIRECC. We are additionally supported by psychology doctoral students Jas Chok, MS, and Namasvi Jariwala, MA, from Palo Alto University.

Contact: Carter.Davis2@va.gov

AGE FRIENDLY

Eastern Colorado GRECC Team Describes Journey to Recognition of First Age Friendly Health System-designated Telemedicine Clinic in Nation

Author: Elizabeth Chapman, MD

The John A. Hartford Foundation and Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association and the Catholic Health Association of the United States, launched the Age-Friendly Health Systems (AFHS) effort to improve care for older adults through best practices that center around consideration of the Geriatrics 4Ms: Mentation, Mobility, Medication, and Matters Most. The VA’s Office of Geriatrics and Extended Care (GEC) has embraced the AFHS movement with the goal of better serving older Veterans across the nation. Well over 150 VHA facilities have achieved AFHS designation since this effort began, with the VA Eastern Colorado Health System among them. What sets the Eastern Colorado AFHS-designated site apart is that the clinic is not a brick-and-mortar facility, but rather the virtual GRECC Connect tele-Palliative Care clinic. A paper published in the July 2025 edition of the journal, Inquiry, highlights the process that led to the Eastern Colorado GRECC becoming the first virtual clinic to achieve AFHS status.

The manuscript details how the Eastern Colorado GRECC Connect tele-Palliative Care clinic used the Geriatrics 4Ms to improve the care of rural Veterans with uncontrolled symptoms, frequent hospitalizations or emergency department visits, or a need for coordination to manage complex conditions. In the two years the authors analyzed, the AFHS-aligned tele-Palliative Care clinic conducted 192 visits for 108 unique Veterans, 81% of which resided in rural or highly rural locations. In addition to consistently addressing the Geriatrics 4Ms, the telemedicine clinic spared Veterans and their care partners from 23622 (FY23) and 18632 (FY24) miles of travel. Impressively, the site was able to do so without expanding staff or changing clinical workflows.

Prior to the success of the Eastern Colorado GRECC Connect tele-Palliative Care clinic in achieving AFHS status, virtual settings had not been recognized as Age-Friendly by the IHI. The achievement by the Eastern Colorado GRECC team shows that virtual clinical settings can effectively address the Geriatric 4Ms without in-person contact. The manuscript authors attributed the positive outcomes to multiple facilitators, including a high-functioning interprofessional team and readily available resources from existing AFHS sites within the VA health system.

Contact: AgeFriendly@va.gov

New Manuscript Details Five Years of VA Success in Implementing Age-Friendly Care Across the Health System

Author: Elizabeth Chapman, MD

Since 2020, the Veterans Health Affairs (VA)’s Office of Geriatrics and Extended Care (GEC), has sought for VA to be recognized as the largest age-friendly health system (AFHS) in the nation. Using a quality improvement framework, GEC leaders have taken intentional steps to make this goal a reality, and VA authors describe this effort and its outcomes in a recently published manuscript in the journal Inquiry. Dr. Andrea Wershof Schwartz from the New England GRECC is the lead author of the paper, which outlines the process, from assembly of a central office team to guide local VA sites in their AFHS journey, to creating a VA Age-Friendly National Steering Committee, developing a national VA Age-Friendly 4Ms Dashboard, and providing venues to share lessons learned during AFHS implementation and best practices among sites.  The manuscript also describes characteristics of the current VA facilities with AFHS recognition and future aims to measure meaningful impacts on older Veterans. 

To learn more about the VA AFHS initiative, visit the AFHS page in the VA Diffusion Marketplace.

Contact: AgeFriendly@va.gov

RESEARCH

Behavioral Therapy for Bladder Symptoms Outperforms Medication in People with Parkinson's Disease

Author: E. Camille Vaughan, MD, MS
GRECC Location: Atlanta/Birmingham

People with Parkinson’s disease frequently suffer from overactive bladder and incontinence. These symptoms can result in a loss of independence, but treatment with medications can increase a Veteran’s risk for falls. VA researchers at the Birmingham/Atlanta GRECC  recently published a study showing that behavioral therapy worked just as well as medication to improve overactive bladder symptoms in patients with Parkinson's disease and with fewer side effects.

GRECC researchers randomly assigned 77 older adults with Parkinson's disease to one of two groups: a standard care group that received medications for bladder symptoms or an intervention group that received behavioral therapy, such as instruction in pelvic floor muscle exercises and urge-suppression strategies. After 12 weeks of treatment, both groups had similar bladder symptom improvements, suggesting that behavioral therapy is effective at reducing bladder symptoms in older patients with Parkinson's disease. In addition to similar efficacy, the behavioral therapy group had fewer falls and less difficulty with dry mouth compared to those taking medications for their symptoms. The work was published in JAMA Neurology on July 14, 2025, and was highlighted in a VA Research News Brief on 07/17/25.

Contact: Elizabeth.Vaughan2@va.gov  


Novel Robot-Led Exercise System Developed to Help People with Parkinson's Disease

Authors: Matthew D. Lamsey & Madeleine E. Hackney, PhD
GRECC Location: Atlanta/Birmingham

Can a robot help people with Parkinson’s disease exercise? VA researchers from the Atlanta/Birmingham GRECC have developed a novel robot-led exercise system to answer that question. After an initial study of people with Parkinson's disease noted positive responses to a robot-led exercise system, the investigators explored exercise specialists’ perception of the system. Participants included 11 exercise specialists, most of whom were physical therapists. They asked the participants to evaluate a robot-led exercise program called ZEST-E across multiple domains, including how well it performed exercise tasks, its benefits to their practice, and patient acceptance.

The participants felt the system was engaging for patients. They also thought it had potential to provide effective, personalized care in multiple settings, including clinics, homes, and nursing homes. While promising, participants identified additional improvements to make the ZEST-E more useful for people with Parkinson’s disease. They suggested creating more human-like feedback to the patient and simplifying the ZEST-E patient interface to enhance ease of use. The authors feel these findings highlight the potential of robot-assisted exercise to alleviate symptoms and improve the quality of life for people with Parkinson’s disease. A manuscript describing their results was featured in the July 3, 2025 issue of the journal Healthcare, and the study was recently featured in a VA Research News Brief on 7/24/25.

Contact: Madeleine.Hackney@va.gov and Lamsey@gatech.edu

GRECC Researchers Specializing in Treating Agitation in Dementia Contribute to Study Published in Nature Medicine

Authors: Kalpana Padala, MD and Prasad Padala, MD
GRECC Location: Little Rock

Kalpana Padala, Associate Director for Research, and Prasad Padala, Associate Director of Clinical Innovations at the Little Rock GRECC, are passionate about management of dementia and various behavioral problems associated with it. Driven by this passion, they recently participated in a large multi-site study of management of agitation in dementia via a repurposed FDA-approved medication, escitalopram.

The study aimed to determine whether escitalopram could significantly improve agitation in dementia given that the related drug, citalopram, has previously been found to be effective but has dose-limiting side effects. Investigators randomized participants with Alzheimer’s Disease and agitation who had failed initial non-pharmacologic interventions to continued non-pharmacologic treatments plus either placebo or escitalopram in this double-blinded trial. Over the course of 12 weeks, study teams collected data on the severity of agitation and monitored for side effects. They found that escitalopram was not effective for agitation and that cardiac conduction delays occurred more frequently among those on active treatment. The full manuscript can be found in the May 2025 issue of Nature Medicine.

Little Rock GRECC was the highest recruiting site among all US sites, thanks to the Veterans and their caregivers who graciously volunteered to take part. While the study results were negative, Drs. Kalpana and Prasad Padala continue to provide individualized, person-centered treatments for agitation to their Veterans with dementia. The photo at left was titled “Geriatric Caregivers” by a grateful daughter of a Veteran who the Padalas recently helped treat for agitation associated with dementia.

Contact: Prasad.Padala@va.gov

EDUCATION

Geriatric Scholars Program launches Virtual Learning Community

Authors: Josea Kramer, PhD
GRECC Location: Greater Los Angeles

The Geriatric Scholars Program is pleased to announce a new SharePoint site to serve as the program’s resource center and virtual learning community at: https://dvagov.sharepoint.com/sites/vagerischolarslearningcommunity.

The SharePoint site is open to all VA clinicians, staff, and trainees.

The SharePoint site replaces the web-based www.geroscholars.org. The site includes revised and updated Geriatric Scholars Program Toolkits for clinicians and for patients and family education on the following topics: Appropriate Prescribing, Delirium, Dementia, Depression, Elder Abuse, End of Life, Falls, Functional Assessment, Nutrition, Osteoporosis, Pain, PTSD, Rehabilitation, Sleep, Urinary Incontinence

The landing page includes a calendar of education events, enduring educational materials and archived recordings. There are also sections devoted to the Geriatric Scholars Program for prospective Scholars, new Scholars, and Alumni. The section on the 4Ms includes links to VA resources and examples of Scholars’ QI projects for each M.

The Geri Scholars Learning Community was a team effort. The site represents the overall vision and design by Eugenia Dorisca, Program Specialist, of the Bronx GRECC. Joe Douglas (contractor, Program Analyst) of the Greater Los Angeles GRECC managed the reviews of the toolkits in collaboration with VA subject matter experts. Josea Kramer, the Geriatric Scholars Program Director and ADEE of the GLA GRECC provided direction and collaboration in the team effort.  

GeriScholars Learning Community SharePoint site

Contact: BettyJo.Kramer@va.gov

Advanced Fellowship in Geriatrics (AFiG) Spotlight

Dr. Bolstad Seeks to Help Aging Veterans Rest Better through Innovative Sleep Research

Author: Courtney Bolstad, PhD, DBSM
GRECC Location: Birmingham/Atlanta

Dr. Courtney Bolstad is a first-year Advanced Fellow in Geriatrics with the Birmingham/Atlanta GRECC. The 2-year fellowship, funded by the Office of Academic Affiliations (OAA) is available at GRECCs across the nation and provides advanced career development training for future VHA clinician scientist leaders in Geriatrics. As a geropsychologist board certified in behavioral sleep medicine, Dr. Bolstad has provided mental health care to Veterans in the Birmingham VA’s Home-Based Primary Care program and Behavioral Sleep Medicine clinic. Dr. Bolstad has worked for the VA since 2022 and intends to make the VA her career home as an independent clinician-investigator conducting translational research on sleep and mental health problems in aging Veterans. Her current research focus is on parasomnias including REM sleep behavior disorder and nightmares.

Dr. Bolstad’s AFiG project aims to develop a non-pharmacological treatment for the management of REM sleep behavior disorder symptoms and related psychosocial concerns. Her project has been selected for funding support from the American Academy of Sleep Medicine (AASM) Foundation’s Focused Project Grant for Junior Investigators. Dr. Bolstad has published her work in the International Journal of Aging and Human Development [1] and the Journal of Sleep Research [2,3]. In 2024, she was awarded the Society of Behavioral Sleep Medicine’s Rising Star Fellow Award. Dr. Bolstad was recently selected for the competitive AASM Sleep Research Program for Advancing Careers (SOAR) Program, a structured grant writing course for early career sleep and circadian investigators. Dr. Bolstad is mentored by Dr. Connie Fung (Greater Los Angeles VA GRECC), Dr. Lori Davis (Birmingham VA), and Dr. Lisa Zubkoff (VA Birmingham/Atlanta GRECC). 

Contacts: Courtney.Bolstad@va.gov and Katharina.Echt@va.gov (Birmingham/Atlanta VA GRECC AFiG Program Director)

CLINICAL INNOVATION

CLC Workforce Joy in Work

Authors: Anna Mirk, MD; Katharina Echt, PhD; Michelle Hilgeman, PhD; Jennifer Smith, PsyD; Thuy Vi Dao, MD; Thomas Price, MD; Lynn Snow, PhD
GRECC Location: Atlanta/Birmingham GRECC

Community Living Center (CLC) staff are high-risk workforce for work-related stress and burnout. Work-related stress, low morale, and burnout are associated with individual-level and organization-level negative outcomes including employee illness; employee turnover; reduced organizational functioning; and negative impacts on patient care and safety. Team-based, patient-centered, Age-Friendly care is the goal for care provided in VA Community Living Centers (CLCs).

VHA implemented a program called REBOOT (Reduce Employee Burnout and Optimize Organizational Thriving; 2022) to address the primary drivers of burnout identified as unmanageable workload, perceived lack of fairness, lack of job control, low recognition or organizational support, interpersonal conflict, and mismatched values by improving the work environment and providing support for employe well-being.

The Birmingham/Atlanta GRECC set out to explore the question of “Joy in Work” (IHI, Berwick, 2017) among VA staff working in Community Living Centers by considering REBOOT and complementary frameworks. Assembling experts in team dynamics and CLC environment, including CLC leaders, an interview guide was developed, and anonymous interviews were conducted with volunteer staff from all disciplines to explore barriers and facilitators to job satisfaction and team functioning.

Using rapid qualitative analysis to distill and map key thematic results to the REBOOT Framework, the team developed a CLC Leadership Resource Guide with existing VA programs/tools targeted to mitigate actionable barriers identified at the individual, team and system levels and to expand facilitators of job satisfaction and high functioning in CLC teams.

The CLC Joy Team is working to expand this program to CLCs in VISN 7. 

Contact: Anna.Mirk@va.gov

Sharing Health and Wellness Resources with Older Veterans in Rural Communities: The Gainesville VA GRECC VET-WISE Mobile Health Initiative

Authors: Sandra Citty, PhD, APRN; Josepha Cheong, MD; Kiara Jones, BS; Laurence Solberg, MD; Xinping Wang, PhD; Casey Bopp, RN; Connie Uphold, PhD, RN; Ronald Shorr, MD; Ivette M. Freytes, PhD, Travis Sheppard, MA; Kelli Crews, APRN; Tjuana Williams, BS; Carmen Fernandez, PsyD
GRECC Location: Gainesville

The Malcom Randall Veterans Affairs Medical Center (VAMC) Geriatric Research Education and Clinical Center (GRECC) in Gainesville Florida continued its VET-WISE (Veterans Education and Training for Wellness, Information, Support and Engagement) mobile health initiative reaching older Veterans in the north central Florida and South Georgia areas. Since November 2023, the Gainesville GRECC VET-WISE initiative has provided education, research, and clinical resources and services for over 5,000 Veterans, caregivers, VA staff, community members, and students. The VET-Wise program links VA and GRECC-affiliated staff nurses, physicians, pharmacists, psychologists, psychiatrists, and researchers with community events focused on Veterans.

These outreach events help to fill a need by sharing resources with Veterans out in the community and during their appointments when they are visiting VA hospitals and clinics. Veterans also have opportunities to talk to clinicians in a non-threatening environment and share their experiences. For example, while providing education about dental hygiene, the team found that many Veterans did not have dental insurance and had gaps in coverage for routine dental services. The GRECC VET-Wise program developed tips sheets that share free and reduced-rate dental care options within the regional community, which allowed Veterans to find the care they need at a discounted cost. At another outreach event, the team met a disabled Veteran who casually mentioned he had a leaking roof and was on the verge of homelessness. During interactions with him, VET-WISE staff were able to provide him with resources for his housing issues and link him with his VA social worker for follow-up.

In the 20 months since the program has been implemented, it has been a part of 25 outreach events in the VISN8 regional communities focusing on health promotion (tobacco cessation, nutrition, dental care, whole health, immunizations, and cognitive/brain health), VA healthcare registration services, suicide prevention, toxic exposure screening, mental health promotion, virtual delirium training, advanced care planning, and spreading awareness of VA services available to Veterans and their caregivers. Based on a needs assessment conducted at the start of the program, priority areas identified included Cognitive Decline Prevention, Brain health, Women Veteran Health, Homeless and Home Insecure Veterans, Food Insecure Veterans, Mental Health Awareness, Suicide Prevention, Toxic Exposure Screenings and Awareness, Veteran Outreach and VA Healthcare Registration Efforts, Dental Health, Promoting Whole Health, and Chronic Disease Prevention and Management. During outreach events the team provides Veterans with dental kits, medication pill boxes, hygiene supplies, and brain health resources (education pamphlets, word search/crosswords). All resources have the VA crisis hotline numbers to help spread the word about these resources for Veterans.

The Veteran and staff evaluations of these services have been overwhelmingly positive. As one Veteran reported “I have gratitude for this great service. It has opened my eyes greatly in how to utilize my benefits to help myself”.  The opportunity for sustainability of this program is high – it has sustained support from the North Florida South Georgia VA Transportation and Fleet services department to support the maintenance and use of the GRECC Mobile Health RV. The biggest challenge has been securing dedicated GRECC staff to organize, implement, and evaluate outreach events. Additionally, many Veterans are not aware of VA services and resources and not all veterans take advantage of VA healthcare services. Future focus will be on building internal/external stakeholder relationships, building sustainable program infrastructure, and targeting efforts to reach older Veterans to promote health, education, screenings, and resource sharing.

Clockwise, from Top Left: Dr. Sandra Citty, PhD, APRN, VA GRECC Clinical Nurse Investigator and UF College of Nursing Students sharing resources with Veterans on ways to stay healthy. Gainesville VAMC Pop-Up Health Fair in July 2025. North Florida/South Georgia Veterans Health System Women Veterans Appreciation Day 2025. Pictured: (from left to right) Theresa Wilson RN, MSN, CNOR, NEA-BC, Deputy Nurse Executive; Ilona Schmalfuss, MD, Chief of Staff; Tjuana Williams, BS (Veteran and VA Work Study Student); Shabnam Showell MD, Acting Deputy Chief of Staff; Ralph Atkinson, MD, Deputy Associate Chief of Staff, Primary Care & Outpatient Clinics North Florida/South Georgia Veterans Health System at the Jacksonville Outpatient Clinic Women Veterans Appreciation Day in June 2025. University of Florida Students sharing resources with Veterans on healthy nutrition and sharing electronic resources to improve health. Gainesville VAMC Pop-Up Health Fair in July 2025. Deanna Fernandez, PharmD, GRECC Geriatric Fellow and Mr. Kevin Davis, Gainesville VA Fleet Services manager sharing resources with Veterans at the Flagler Palm Coast VFW Post #8696, Health Fair in February 2024.

Contact: Sandra.Citty@va.gov

Pharmacist-led Deprescribing of Fall Risk Increasing Drugs (FRIDs) in a Veteran Population

Authors: Karl Brown, MS Michelle Paulsen, Pharm D Erica Martinez, BS, PMP Juliessa Pavon, MD, MHS Katherine Ritchey, DO, MPH
GRECC Locations: Puget Sound and Durham

Falls are the leading cause of injury in older adults and a significant contributor to morbidity and mortality. Falls risk-increasing drugs (FRIDs) have been associated with an increased odds of falling due to effects on balance, psychomotor functioning, and/or syncope. Dose-reduction or discontinuation of FRIDs can offer benefits, including lower risk of falls, decreased pill burden, and reduced out-of-pocket healthcare costs. Access to effective, systematic, FRID-focused deprescribing interventions were limited for veterans at VA Puget Sound. Therefore, we developed a chart review intervention built upon an existing local fall prevention education and exercise course. Our primary aim was to explore change in number of FRIDs over time when recommendations were accepted.

Cognitively intact, community-dwelling veterans who have a fear of falling, unsteady ambulation, or known fall(s) history are referred to the fall prevention program by VA primary care providers. All course participants received FRID-focused chart review by a clinical pharmacist; each review identified presence of any potentially hypotensive, hypoglycemic, and/or sedating drugs and assessed the apparent or potential detrimental effects posed by particular agents for the individual based on vitals, laboratory findings, or symptoms reported in recent progress notes. Sedating drugs included antidepressants, anticonvulsants, muscle-relaxants, anti-seizure, hypnotic, antipsychotic, and anticholinergic drugs, as well as any medication in an unlisted class with reported nervous system adverse effects. The pharmacist provided a prioritized list of recommendations to discontinue, adjust, or continue FRIDs with monitoring, and the primary care prescriber (PCP) was alerted through the electronic medical record. \

Changes to prescribed FRIDs and Drug Burden Index (DBI, a measure of total exposure to anticholinergic and sedative medications) score were assessed for all participants three months after initial medication review to help monitor changes in medications over time. Higher DBI scores indicate greater drug burden, with scores ≥1.0 considered high and are associated with a high risk of falling. Thirty minutes or more was dedicated to chart review and reporting for each participant.

Across the 112 study participants, the mean age was 75 years (standard deviation [SD] 12), 93 participants (83%) were male, and 89 participants (80%) were White. Medication-related recommendations were given to 72 (64%) of the 112 participants, with a mean of 1.9 [SD 1.2] recommendations per patient. The top three drug classes recommended to deprescribe most were antidepressants, anticonvulsants, and cardiovascular drugs. Compared to participants who received no recommendations from the pharmacist, those who received a recommendation had a higher DBI (mean DBI 1.2 [SD 1.0] for recommendation group and mean DBI 0.4 [SD 0.5] for no recommendation group, p < 0.01). Those who received a recommendation were also taking more FRIDs (mean FRIDs was 5.1 [SD 2.6] for recommendation group and 3.2 [SD 2.0] for no recommendation group, p < 0.01).

Of all participants who received at least one recommendation, 37 (51%) had at least one recommendation accepted by the PCP. Those who had a recommendation accepted experienced a greater decrease in DBI after 3 months of follow-up compared to the group who did not have a recommendation accepted (mean change in DBI of 0.3 [SD 0.6] for recommendation accepted group, mean change of 0 [SD 0.1] for recommendation not accepted group, p < 0.01, see Figure). Baseline DBI was slightly higher in those who did not have a recommendation accepted (mean [SD] DBI = 1.3 [1.0]) compared to the group that had a recommendation accepted (mean [SD] DBI = 1.1 [1.0]), suggesting that a more complex medication regimen may potentially make recommendations more difficult to accept (see Figure).

Figure: 72 veterans received a recommendation by pharmacist to change, decrease, or stop at least one FRIM. Boxplots show DBI at baseline and 3-month follow-up for the group that had at least one recommendation accepted by prescriber and the group that did not.

This analysis demonstrates that the acceptance of pharmacist FRID deprescribing recommendations led to a reduction in the number of FRIDs and DBI. Future studies should explore factors influencing PCP acceptance of recommendations to maximize the positive impact of this pharmacist intervention or a control group to determine if the program improves outcomes beyond usual care.  

Contact: Katherine.Ritchey2@va.gov

Supporting Age-Friendly, Supported Housing for Aging and Physically Disabled Veterans

Authors: Anushka Sista MS, Jennifer Palmer PhD, Deborah Lee MSW, Jack Tsai PhD, Nathan A. Boucher DrPH
GRECC Locations: Durham and New England

This national quality improvement initiative seeks to enhance housing stability for older and physically disabled Veterans who are experiencing or at risk of homelessness. The Veterans Health Administration (VHA), in partnership with the U.S. Department of Housing and Urban Development, operates the HUD-VASH program to provide rental assistance and case management services. With a dramatic 150% rise in homelessness among Veterans aged 55 and older from 2010 to 2023, the VHA is advancing age-friendly and least restrictive care settings that promote independence and dignity. Special programs, including the Homeless Aging and Disabled Veterans Initiative, aim to provide comprehensive support through permanent supportive housing, community collaboration, and expanded home-based care.

To inform the development of an implementation blueprint for Veterans Affairs Medical Centers (VAMCs), the project employed two qualitative methods: in-depth interviews with Geriatric Specialists (GSs) across all 18 VHA regional networks, and user-centered design (UCD) sessions with HUD-VASH, Geriatrics and Extended Care (GEC) staff, and community partners in North Carolina and Massachusetts. These methods identified barriers and facilitators to effective VA-community collaboration, using the Shepherd and Meehan (2012) framework.

Findings revealed recurring challenges in multiple domains. Memoranda of Understanding (MOUs) were essential but administratively burdensome, with delays impacting care coordination. Shared goals were often misaligned due to regional diversity and institutional silos, yet in-person meetings were seen as a crucial step toward mutual understanding. Policy fragmentation and lack of standardized procedures further impeded collaboration, especially in emerging programs for aging Veterans.

Role ambiguity and turnover undermined service consistency, while information sharing was hampered by privacy constraints and a lack of centralized databases. Geographic disparities and limited staff awareness of available services added to the inefficiencies. Regular meetings, although valued, were inconsistently held due to staff shortages. Participants emphasized the need for formal role definitions, clear points of contact, resource databases, and routine communication as foundational improvements.

These insights led to the creation of a strategic implementation blueprint structured around five components: Partnership Strategies, Communication Strategy, Implementation, Monitoring & Evaluation, and Sustainability & Growth. It is designed as a practical tool for HUD-VASH teams to assess and improve local collaborations. Each component includes guiding questions on actions needed at the VHA and community levels, and on how to incorporate Veterans’ input.

In conclusion, this initiative highlights systemic challenges and proposes actionable solutions to improve cross-sector collaboration in the delivery of housing and care for vulnerable Veterans. The blueprint offers a path forward for VHA teams to build more effective, Veteran-centered partnerships, and future research is needed to assess its impact. The project underscores the importance of coordinated efforts to ensure that aging and disabled Veterans can thrive in least restrictive, supportive settings aligned with their needs and preferences

Contact: Nathan.Boucher@va.gov

Implementation of a Virtual Dementia System of Care in a VA Health Setting

Author: James S. Powers MD
GRECC Location: Tennessee Valley

The number of persons living with dementia over age 65 is estimated at 6.9 million and is expected to rise to 13.8 million by 2060. There is an inadequate number of specialty providers to evaluate and manage this population and primary care providers are increasingly in need of assistance for dementia care due to the complexities involved in management. James Powers MD affiliated with TVHS GRECC recently reported on a 7-year study implementing a virtual dementia system of care directly supporting primary care providers (PCP’s) in the journal BMC Geriatrics.

Between 2018-2024, 1176 patients referred by primary care were evaluated by e-consult (93%), telephone or (veterans video connect VVC) or in-person (2%), and for follow-up management questions (5%) by PCP’s. Educational consultation provided diagnostic information including functional assessment staging (FAST) and management recommendations including further diagnostic testing as indicated, medication recommendations and deprescribing, referral for formal neuropsychological testing when appropriate, psychiatric referral for severe behavioral concerns, and individualized primary care management, safety considerations, home and community-based resources and caregiver support. The program was additionally linked to a virtual Caregivers First support series. Acceptance of the virtual consultation by PCP's was high and included appreciation of the immediate access and education by the consultation. Caregivers voiced appreciation for the accessibility and support provided by the Caregivers First program.

Limitations of virtual dementia consultation include severe behavioral disturbances, patients with psychiatric co-morbidities or requiring formal neuropsychological testing, and those for him the goals of care include consideration of anti-amyloid treatment. Virtual educational consultation for dementia care may facilitate PCP delivery of supportive care for persons living with dementia, dementia care navigation, and caregiver support.

Contact: James.Powers2@va.gov

KEEPING CURRENT

Contact: Colleen.Hursh@va.gov

VA Boston Research Week Celebrates 100 years of VA Research with theme “Using Implementation and Health Systems Science to Improve Care for Veterans.”

Author: Chelsea Lam, MD
GRECC Location: New England

VA Boston Researchers celebrated its annual Research Week with a Speakers’ Session and Poster Session May 15, 2025. Among the presenters were New England GRECC representatives, including Dr. Chelsea Lam (advanced fellow), Dr. Julia Boyle (research psychologist), and Dr. Saadia Qazi (clinical scientist).

Said Vincent, Ng, Director of the VA Boston Healthcare System, “The theme — ‘Using Implementation and Health Systems Science to Improve Care for Veterans’ — could not be more timely or more relevant. It reflects not only the direction of modern health care but the very heart of what we do here at VA Boston. VA Research is also celebrating 100 years of work, innovation, and relentless pursuit of solutions that have had a profound impact on the care we provide Veterans, and, through their contributions, on healthcare delivery across the nation and around the world.”  To learn more about the work presented, including that of Drs. Lam, Boyle, and Qazi, you can review a photo gallery from the event here.

Contact: Chelsea.Lam@va.gov

STAFF NEWS

Awards and Honors

New England GRECC Nurse Scientists Participate in Research Training Program

Authors: Katie Fitzgerald Jones PhD, APN and Caroline Madrigal PhD, RN
GRECC Location: New England

Drs. Katie Fitzgerald Jones, PhD, APN and Caroline Madrigal, PhD, RN, who are Nurse Scientists at the New England GRECC, were selected to participate in the 2025-2026 Society of General Internal Medicine VA Partnered Research Training Program. The program aims to equip early-stage investigators with skills to conduct high-quality research in partnership with healthcare teams and systems.

Dr. Madrigal's program of research focuses on developing and implementing person-centered interventions across the care continuum, especially during transitional care periods. She serves as the national program coordinator for VA's Coordinated Transitional Care (CTraC) program with the goal of facilitating high quality care transitions for Veterans at high risk of readmission and long-term care placement. Clinically, she works as a registered nurse with experience in acute and long-term care. She is passionate about bridging the gap between research and practice. Dr. Jones is a Palliative and Addiction Nurse Practitioner who focuses on older adults with cancer, chronic pain, and substance use disorder. Her research interests are a direct result of her clinical work with GRECC that is focused on the intersection between chronic pain, serious illness, aging, substance use, and opioid therapy.

Contact: Katie.Jones4@va.gov

Dr. Prasad Padala Elected to Board of Directors for the American Association for Geriatric Psychiatry (AAGP)

Author: Dr. Prasad Padala
GRECC Location: Little Rock

Colleagues have elected Dr. Prasad Padala of the Little Rock GRECC to the AAGP Board of Directors. Dr. Padala has served in various capacities in AAGP over the last two decades, including as the co-chair for the research committee, chair of the poster and oral sessions, and a consummate cheerleader for trainees and young faculty. He has chaired the "Building Your Research Career" symposium at the AAGP annual meetings for over a decade and has had many Office of Research and Development program officers participate. His longstanding mentorship efforts have been recently recognized by the establishment of a travel fellowship under his name to encourage interest in geriatric psychiatry training.

Contact: Prasad.Padala@va.gov

GRECC Physician Scientist’s Manuscript Selected as Best Research Paper of the Year

Author: Constance Fung, MD, MSHS
GRECC Location: Greater Los Angeles

In December 2024, Dr. Constance Fung published a study that found a combined approach of masked medication tapering plus augmented cognitive behavioral therapy for insomnia (CBT-I) effectively helped Veterans discontinue benzodiazepines and z-drugs like zolpidem. More information about the program, titled “Switch to Sleep” is available in the Spring 2025 Issue of the GRECC Forum on Aging. This practice-changing approach led the VA Health Systems Research to select her manuscript as the winner of the “Best Research Paper of the Year Award”.

Contact: Constance.Fung@va.gov  

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

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