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Geriatric Medicine and Gerontology

The Center for Transformative Geriatric Research

The Center for Transformative Geriatric Research envisions a world in which all older adults thrive. Our mission is to perform and advance research that transforms healthcare and the lives of older adults.

To achieve our mission, our faculty employ a wide range of research approaches and techniques.  Our major areas of person-oriented research focus on health service delivery for people with complex care needs, the care of people with multiple chronic conditions, person-oriented research on issues related to late-life memory disorders, and health information technology.

We value collaborative research that is innovative, interdisciplinary, patient, caregiver, and family-centered, and which can be translated into practice or health policy.

We believe firmly that performing and publishing research findings is insufficient for the 21st century academicians; it is critical for us to disseminate research findings into the real world to help people.

Quick Links Our Research

 

Our Faculty

 

Our Research

Health Service Delivery for People with Complex Care Needs

As the U.S. population ages, the number of Americans who have chronic health conditions will greatly increase. These demographic and epidemiologic dynamics will strain the capacity and the sustainability of the acute care-oriented U.S. health care system, which now provides chronic care ineffectively and inefficiently. New health service delivery systems will need to be developed, evaluated, and disseminated into widespread practice in order to deliver high-quality, cost-effective care for older adults.

Multimorbidity

Forty-eight percent of older adults have three or more chronic conditions, and the number of older adults with multiple chronic conditions will continue to increase dramatically. The presence of multiple chronic conditions independently predicts adverse outcomes, including quality of life, mortality, disability, and complications of treatment beyond the effects of the individual conditions. Currently, there is a significant gap in our understanding of how best to provide care for patients with multiple chronic conditions.

  • In recent work, Johns Hopkins researchers, led by Dr. Cynthia Boyd, have shown that implementing multiple single-disease clinical practice guidelines in older adults with multiple chronic conditions may result in polypharmacy and nonadherence, both of which detrimentally influence patient safety and clinical outcomes. Additional work has demonstrated how the entire process of clinical practice guideline development will need to be modified in order to develop appropriate clinical practice guidelines for patients with multiple chronic conditions.

    • Treatment burden in multiple chronic conditions
    • Development of clinical practice guidelines for patients with multiple chronic conditions
    • Clinical preventive services for patients with multiple chronic conditions
    • Improving patient-clinician communication and shared decision making in patients with multiple chronic conditions
    • Patterns of multiple chronic conditions
    • Performance measurement for patients with multiple chronic conditions
    • Methodological approaches to assess the balance of benefits and harms
    • Incorporating prognosis into the care of older adults
    • Reducing use of potentially inappropriate therapies in older adults

  • Faculty investigators

    Cynthia Melinda BoydCynthia Melinda Boyd, M.D., M.P.H.
    Director, Division of Geriatric Medicine and Gerontology
    Professor of Medicine

    Ariel Ruth GreenAriel Ruth Green, M.D., Ph.D., M.P.H.
    Associate Professor of Medicine
     

    Bruce Allen LeffBruce Allen Leff, M.D.
    Director, The Center for Transformative Geriatric Research
    Professor of Medicine
     

    Matthew Kendall McNabneyMatthew Kendall McNabney, M.D.
    Medical Director, Program for All-Inclusive Care of the Elderly (PACE)
    Chair, Mosaic Initiative Workgroup to Promote Diversity and Inclusion
    Professor of Medicine

    Nancy Li SchoenbornNancy Li Schoenborn, M.D.
    Associate Professor of Medicine
    Associate Professor of Oncology

    Collaborators

Cognitive Decline and Dementia

For aging populations in the United States and abroad, dementia is a major clinical and public health issue; it is a lengthy and costly condition that creates a large social and financial burden on society. Unless new discoveries are made in the prevention or treatment of dementia, specifically Alzheimer's disease, an estimated 13.2 million Americans will have dementia by 2050.  Identifying new and effective approaches to early detection of dementia is critical.

  • Research focus is on identification of new biomarkers, both fluid and imaging, and new pharmacological targets for prevention and treatment of late life memory disorders. Additional work focuses on understanding and improving care provided in dementia, including how timely diagnosis might link to improved outcomes. Recent studies by Johns Hopkins researchers showed that specific blood pressure medications can decrease dementia risk in healthy elderly people. Other studies include using oral glucose tolerance test (OGTT) to develop a biomarker of early stage Alzheimer’s disease. Research focus also extends to postoperative delirium, hearing and balance loss, and functional evaluation on the effect on dementia risk or progression.

    The knowledge gained by characterizing biological and cognitive changes that precedes clinical transition to dementia could allow the development of targeted treatments for dementia.

    • The effect of blood-pressure medications on the risk of developing dementia
    • The possible role of prescription and over the counter anticholinergic medication use and the risk of developing dementia
    • Plasma biomarkers for Alzheimer's disease using oral glucose tolerance test
    • Preclinical Alzheimer's disease as a risk factor for postoperative delirium and cognitive decline in hip fracture patients
    • Potentially unsafe activities and living conditions in older adults with dementia
    • Characteristics and longitudinal outcomes in undiagnosed dementia

  • Collaborators

    Ariel Ruth GreenAriel Ruth Green, M.D., Ph.D., M.P.H.
    Associate Professor of Medicine
     

    Esther Seunghee OhEsther Seunghee Oh, M.D., Ph.D.
    Co-Director, Johns Hopkins Memory and Alzheimer's Treatment Center
    Associate Professor of Medicine
    Assistant Professor of Pathology
    Joint Appointment in Psychiatry and Behavioral Sciences

    Sevil YasarSevil Yasar, M.D., Ph.D.
    Associate Professor of Medicine
    Associate Professor of Neurology
     

    Collaborators

Health Information Technology

Health information technology can improve the delivery and quality of care for older adults in every care setting and can help older adults (and their caregivers) better manage their own care. However, technology is only one of many important elements in health service delivery and it is critical that health information technology systems are carefully designed and evaluated.

  • Johns Hopkins researchers are designing computer-assisted education tools that can help teach older adults with chronic conditions how to self-manage their care more effectively. Our team is assessing the ability of technology to improve the care transitions associated with hospital discharges. These projects will provide important insight into the usability of various technology platforms by older adults, their caregivers, and their medical care providers.

    In addition, we are using large national datasets to clarify patterns of health-related Internet use among older adults in order to optimize the usability of a personal health record and to promote the use of a patient portal within an electronic health record by older adults with chronic conditions.

    • Use of personal health records and a patient portal in primary care geriatrics to support engagement of patients and caregivers
    • Use of home-based health information technology (including cell phone, iPod, tablet PC, PDA) for chronic disease self-management with a focus on diabetes
    • Use of technology during a medical office visit to improve visit satisfaction

  • Faculty Investigators

    Bruce Allen LeffBruce Allen Leff, M.D.
    Director, The Center for Transformative Geriatric Research
    Professor of Medicine
     

    Sevil YasarSevil Yasar, M.D., Ph.D.
    Associate Professor of Medicine
    Associate Professor of Neurology
     

    Collaborators

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