Geriatrics Newsletter Fall 2020

GERIATRICS NEWS

Fall 2020

Vol. 1, No. 1

LAUN C H O F

DAKOTA GERIATRICS As you might have heard, UND’s Department of Geriatrics was awarded a $3.75 million grant from HRSA to improve geriatrics education and transform primary care programs into Age Friendly Health Care. The grant is for a Geriatrics Workforce Enhancement

Interprofessional training in geriatrics assessment. Health

Program, one of 47 such programs across the nation. Dubbed Dakota

Ambassador Teams for Seniors (HATS) is an interprofessional

Geriatrics, this GWEP serves both North and South Dakota, two states

community service-learning experience for health profession students

with some of the highest rates of Alzheimer’s disease in the country.

to enhance their geriatrics knowledge through geriatric assessment

Both states also have a severe shortage of geriatricians with a gap of

with an older adult.

40 specialists in each state.

What Matters Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care Medication If medication is necessary, use age-friendly medication that does not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care Mentation Prevent, identify, treat, and manage delirium across settings of care Mobility Ensure that each older adult moves safely every day to maintain function and do What Matters

Key projects supported by Dakota Geriatrics are: Online curriculum. Gero-Champion online education is an interprofessional, faculty-led geriatrics multi-level curriculum. The

Age–friendly health care. Age-Friendly Health Systems is an initiative

three-level certification will cover 72 ACGME competencies for

of The John A. Hartford Foundation and the Institute for Healthcare

geriatric medicine, including the first level focusing on the 26 AAMC

Improvement (IHI) whose goal is expanding the 4Ms Framework to

competencies for medical students. Upon completion of each level,

20% of U.S. medical practices by the end of 2020. The 4Ms

the learner will receive a digital badge certificate of completion.

Framework is an essential set of evidence-based practices addressing: What Matters, Medication, Mentation, and Mobility.

Social media for improving geriatrics knowledge. “Art and Aging” social media combines evidence-based geriatric journal articles with artwork to bring engagement and enhance geriatrics knowledge. In collaboration with Nicole Derenne, professor in UND’s Department of

Dakota Geriatrics continues to work with a number of health systems across the state, including Indian Health Service and rural critical access clinics, in adopting the 4Ms Framework and becoming agefriendly recognized health systems.

Art & Design, Dakota Geriatrics utilizes multiple social media platforms such as Facebook, Instagram, and Twitter to ensure a broad reach of

Age–friendly conference. In our continuing efforts of disseminating

healthcare professionals and student trainees.

age-friendly healthcare education, Dakota Geriatrics is partnering with the National Indian Council on Aging (NICOA), Center for Rural Health

Learning senior population health through gaming. The serious game being developed in partnership with Drs. Richard Van Eck (SMHS Education Resources) and Scott Brewster (Triad Interactive Media, New York) combines evidence-based geriatrics education to vignette-guided pathways that allow learners to apply the concept of

(CRH), and Quality Health Associates (QHA) to present our first annual conference on Age-Friendly Health Care in the Great Plains, March 30-31, 2021. The two-day program will bring regional experts to discuss the geriatric 4Ms in patient care specific for American Indian populations.

age-friendly care to older adult population panels to impact health outcomes and healthcare costs. The healthcare trainees will

Dementia education. ADRD training is a crucial component of the

understand geriatric care's additive impact above and beyond

Dakota Geriatrics program, and includes multiple ongoing projects.

"business as usual practices" by utilizing the geriatric 4Ms: What

One project is the annual “Dementia Friendly Healthcare and

Matters, Medication, Mentation, and Mobility during older adult care.

...continued on next page

LAUNCH OF

DAKOTA GERIATRICS Community” symposium. This group’s second meeting is scheduled for June 21, 2021. In collaboration with the Saint Louis Geriatric Gateway’s Geriatric Education Center and the Wyoming Center on Aging, we will host national experts on dementia care for sessions directed towards providers, healthcare professionals, and community workers. A second aspect of ADRD education is the development of a caregiver curriculum. In partnership with the Alzheimer’s Association - ND/MN chapter, we are developing a curriculum for caregivers of dementia patients based on HRSA training modules. This curriculum will be provided to clinics and health systems across the region for group visits and patient education. Additionally, Dakota Geriatrics is a contributor to the Alzheimer’s State Plan coalition where we will be providing educational and survey content to create the ND Alzheimer’s State Plan.

And last but not the least, there is an active effort in pursuit

Continued

IMPACT We are happy and excited to report that in its inaugural year, Dakota Geriatrics built partnerships with multiple academic programs, health systems and community organizations across North and South Dakota.

Education efforts with academic partnerships reached 1801 students from different health care professions, including MD programs, nursing programs, physical therapy students, Pharm D students, residents from internal medicine and family medicine programs, geriatric medicine fellows, multidisciplinary undergraduate students, and research fellows.

Including students, Year 1 training efforts reported engagement of 14,073 trainees across North and South Dakota for various activities.

These involved training sessions, conferences, presentations, lectures, and other activities organized by Dakota Geriatrics and partners, and covered a host of trainees from various disciplines:

to build partnerships between community organizations

Student Trainees

and health systems in order to include ADRD consults in

Social Workers

492

EHR for caregiver education for dementia patients.

Family Caregivers

322

For

further

information

check

out

the

website

www.Dakotageriatrics.com

EDUC AT IO N A L P R O G R A M S F O R

Older Adults Nursing Professionals

1801

1345 481

Faculty and Providers

349

Community Members

9632

MEDICAL STUDENTS

UNDERGRADUATES

MedSTAR program

Abby Lake is one of two undergraduate students assisting in the

UND Geriatrics, in collaboration with the University of Nebraska,

Department. She comes from Faribault, Minn., and is currently a

launched the summer program for medical students to conduct

freshman at the University of North Dakota majoring in biology with a

geriatrics research. Four rising second-year medical students

pre-med emphasis. She really loves to play softball and was, in fact,

inaugurated the program, pursuing various medical education

a two-time all-state athlete for her high school's softball team. She is

projects. Students received didactic presentations on biostatistics and

currently in her last year of eligibility for her club team.

geriatric principles of care. After the program, students gather their data and will submit abstracts to the Annual American Geriatrics Society meeting.

Ethlyn Voorhies is a French and molecular biology major who is also pre-medicine. She is a senior this year and is hoping to go to medical school within the next two years. She has lived in Grand Forks for the

Geriatric Special Interest Group A group of second-year students reactivated the Geriatrics Special Interest Group. One of the original plans was to have a “Geriatrics Fair” in which participants learn about late life disabilities through mock experiences that replicate visual, hearing, and physical impairments.

The pandemic put a crimp in that event, and students are organizing virtual sessions as well as helping with the geriatrics telehealth program.

past four years and has a two-year-old Aussie-doodle.

UND G ER IAT RI C S AWA R D E D

$400,000 AHRQ SUBCONTRACT UND Geriatrics was recently awarded a $400,000 AHRQ subcontract

to detail is so important, given that 25% of all COVID-19 deaths in the

to help deliver curriculum to regional nursing homes on ways to fight

U.S. are linked to nursing home staff and residents. Nearly 60,000

COVID-19. This project is support by the Institute for Healthcare

nursing home residents have died thus far.

Improvement and the National Education for Community Health Outreach (ECHO). Currently, 7,000 of 15,000 nursing homes across the country are enrolled in what is called ECHO COVID Action Network ECHO CAN). The idea of the network is to provide a series of 16 weekly training sessions focused on infection control and quality improvement for nursing home, which will train a team of up to four members (such as the Director of Nursing, Infection Control, Medical Director, and other representatives). The goal is to ramp up quality improvement through Plan Do Study Act cycles of change. For instance, one quality improvement study found that nursing home staff incorrectly took off their gloves 50% of the time after handling infected patients. This is why constant surveillance of how we do routine things is an important element of quality and infection control. This attention

UND Geriatrics has assembled a strong group of mentors for the ECHO CAN program. The faculty include two Geriatricians (Drs. Dahl and Jurivich), two quality improvement experts (Drs. Marx and Lauckner) and two infectious disease experts (Drs. Janson and Salzer).

Also helping the team is staff from the North Dakota Long Term Care Association. The overall intent is to standardize quality improvement to be better able to prevent and manage the pandemic as well as future infections. Rounding off the training program are sessions devoted to wellness, social isolation, and burn out–all factors that can contribute to lapses in infection control. If you are interested in these presentations, ECHO sessions are recorded and posted on the Dakota Geriatrics website: dakotageriatrics.org.

NEW FA C U LT Y

AND STAFF As one might imagine, a new Department is one of growth; so it comes

Bailey Knopf also joined the Department in

as no surprise that new faculty and staff joined the program this year.

June as a research technician for the

With great excitement, the Department on–boarded Ram Mathur,

geriatrics laboratory. She graduated from the

Ph.D., as a research scholar and tenure track faculty member. Dr.

University of Iowa, and after having visited

Mathur is an emerging immunologist who is interested in how aging

Grand Forks with her family decided to make

impacts gut immunity, gut inflammation, and colon cancer. Dr. Mathur

the move north! Her research is focused on

has a Crohns Foundation grant and quickly engaged research

the aging stress response and she is looking

education with both undergraduate and postgraduate research trainees recently joining his laboratory.

at ways to rejuvenate the age–dependent decline in the stress axis. Recently, Bailey adopted a poochon whom she keeps an eye on with a remote camera. Puppies can be

While she may not feel new to the

mischievous after all!

Department, Meghan Jeanotte is actually our the

Jitendra Kumar Tripathi (postdoctoral fellow) also joined our team!

associate.

Dr. Tripathi obtained his Ph.D. from Jawaharlal Nehru University in India,

Meghan spent seven years as an EPA

where his work was focused on “understanding the structure-function

manager at the Turtle Mountain tribe before

relationship in naturally occurring antimicrobial peptides and the

joining us. She is the engine that runs the

design of their novel analogues.” Dr. Tripathi joined UND’s Department

Department, managing personnel, budgets,

of Biomedical Sciences as a postdoctoral fellow and has explored the

grants, and educational efforts. Meghan is the mother of two lovely

molecular signaling of host-pathogen interaction, with special

children and is pursuing her BA degree in psychology at UND. Quite

attention to bacterial pneumonia (pneumosepsis). He has extensive

the go – getter, eh? If all her work and effort weren’t enough, Meghan

work experience with transgenic mouse strains as preclinical disease

will shortly oversee a new departmental educational program directed

mouse models. He joins the Department of Geriatrics in collaboration

towards nursing homes and their quality improvement.

with Dr. Nadeem Khan (Biomedical sciences), and is investigating the

relatively

recent

Department’s

new

addition

administrative

as

molecular mechanism of aging, immune/cellular senescence, and its relation to influenza-associated bacterial pneumonia. ...continued on next page

N EW FA C U LT Y

AND STAFF

Continued

Dr. Trishna Debnath is another new postdoctoral fellow. She

Marsha Waind, MOTR/L, CHT, CLT, is our most recent staff member

completed her Ph.D. in advanced applied life science from Konkuk

to join the Department as project director for Geriatrics Telehealth.

University in the Republic of Korea in 2014. She comes to UND with

Marsha recently retired from Altru Health System as director of their

an extensive research background that includes more than 50 research

telehealth and virtual care program, and with some gentle arm twisting

articles in peer-reviewed scientific journals. Her research interests

we were able to call Marsha out of retirement to activate our

include functional foods chemistry and immunology.

interprofessional telehealth training program. This program has two goals and is funded by HRSA as a COVID-19 response project. The

Upon activation of the HRSA–funded Dakota Geriatrics GWEP, we were fortunate to have Sarah Owens and Casey Morton join us as Project Director and Manager, respectively.

Sarah is an established UND staff member who transferred from the University Analytics & Planning office to join the Geriatrics

first goal is to teach older adults about how to successfully access telehealth services; the second goal is to teach health care trainees on how to optimally conduct a team–based telehealth encounter. We are particularly impressed with Marsha’s success in reaching out.

Marsha is married and is an empty-nester with three children and five grandchildren. In her spare time, she enjoys reading, lake time, and walks with the doggo.

Department. Sarah has previous experience Sarah Owens

with managing federal projects as part of her

Finally, Peni Rosten joined us as a project assistant for the

job with the Women’s Health initiative. Sarah

Department and GWEP. Peni recently received her bachelor’s degree

is concurrently pursuing a doctoral degree in

in digital marketing. Prior to coming to UND, Peni worked 13 years at

education at UND. Her organizational skills

Altru Health System in the clinical area. Originally from western North

and managerial finesse have accelerated gain

Dakota, Peni has spent the past 15 years in Grand Forks and is

in a Dakota Geriatrics program that has

married. She has two children: Brady (10) and Graham (8), as well as

multiple moving parts. Particularly adept at

and English cream golden retriever, Cruise (5). In her spare time, she

cultivating programmatic partnerships, Sarah

enjoys traveling, cooking, lake time, and baking with her boys.

is helping build academic, community, and Casey Morton

health

center

collaborations

towards

strengthening geriatrics education and age–friendly communities.

Sarah is married and is the mother of twin daughters, and enjoys spending time with family and friends. Casey Morton joined the Department with considerable experience in clinical management at the local community teaching hospital, Altru Health System. She is in charge of several complex and ambitious projects for Dakota Geriatrics, namely population health, social media, and our online curriculum. Casey was instrumental in working with medical students over the summer in compiling evidence-based geriatrics data for publication in our social media platforms. Uniquely, Casey has partnered with Assistant Professor Nicolle Derenne, Ph.D., from UND’s Department of Art & Design to create age–pertinent imagery to piggyback onto citations and annotated commentaries distributed to social media platforms. Research shows that people pay closer attention to social media posts linked to imagery than just script.

GERIAT R IC M E D I C I N E F E L L O WS HI P PROGRAM

UPDATED TO CONTINUED ACCREDITATION The relatively new Geriatric Medicine Fellowship celebrates its third

Anjandeep Hara, M.D.

class of Geriatric Fellows. Drs. Annie Hara and Carol Johnson joined

Dr. Hara grew up in Vancouver, British Columbia, and completed her

the fellowship program this past summer. Given the pandemic

family medicine residency at UND prior to starting her fellowship. She

situation, the fellowship had some challenges, but the program quickly

became interested in Geriatrics due to the complexity of the patients

adapted. Fellows are involved in telehealth and increased their

and the opportunity to use a variety of means to improve quality of life

homecare visitations. With great reluctance to visit the geriatric clinic,

and independence.

many older adults are missing their annual wellness exams and routine care for many of their chronic conditions. Similar to the national situation, this shortcoming has led to a spike in cancer and uncontrolled chronic conditions such as hypertension, heart failure,

Although geriatric medicine fellowships are typically undersubscribed across the country, and only 50% of the programs nationwide fill their programs, UND has been fortunate to have a steady stream of trainees with two of the past three years seeing the program 100 percent filled!

and chronic lung disease.

Additional good news regarding the fellowship is that the program was

Carol Johnson, M.D. Dr. Johnson is a UND alumna. She majored in biology and minored in women’s studies and english literature for her undergraduate studies.

She then graduated from the UND School of Medicine & Health Sciences in 2000. She did her family medicine residency in Tulsa, Oklahoma, and entered practice at Regina Medical Group in Hastings, Minnesota. She recently relocated to Fargo to be closer to family and

founded on an ACGME designation of “exceptional merit,” with a recent recertification of the program for 10 years. The program design is innovative, with fellows gaining experience in quality improvement, geriatric models of healthcare, and telehealth. Most gratifying is the fact that all three of our past fellows have become academic faculty at medical schools.

is pursuing further training in geriatrics, which has always been a strong interest for her.

GERIAT R IC S

RESEARCH Publications: One of our Department’s publications was highlighted

inflammatory conditions such as Alzheimer's disease and Parkinson's

as one of the “top five” articles published in the Journal of Gerontology

disease in late life, although the mechanism is not well understood.

in 2020!

He says: “The overarching goal overarching goal of my laboratory research is to understand the regulatory mechanism of low-grade

The study reveals that heat shock (HS) response declines with age.

The attenuated response entails changes in HSF1–protein interactions potentially driven by loss of HSF1 protein levels and gain of negatively regulating heat shock proteins, thus emphasizing the inhibitory

loop

of

HSF1–DNA

binding.

Age-dependent

posttranslational modifications of HSF1 also appear to affect its transactivating

properties,

including

loss

of

the

activating

phosphoserine 326 residue as well as accumulation of HSF1 acetylation, which is known to block HSF1–DNA binding. Thus, age affects the heat shock axis at multiple levels. Our recently published review from the Journal of Experimental Gerontology explains the key features of the HS response that are likely targets of aging processes and then examines evidence of a multifactorial mechanism that renders a sub-optimal stress response. Additionally, the review summarizes how the stress response is further altered by late-life diseases and the potential for therapeutically manipulating the stress.

Dr. Ram Mathur is actively publishing on: age-dependent chronic inflammation, which is linked to colon cancer and other neuro-

inflammation and identify drug candidates to alleviate aging pathology.

Our recent findings suggest that autophagy protects gut epithelial damage, and impaired autophagy results in severe colitis in the atg7 ablated CX3Cr1Atg7f/f TNBS mouse. Autophagy describes as a highly conserved catabolic pathway that assists in the sequestration and removal of unwanted cellular debris. A decline in autophagy function reported in aging people, and induction of autophagy, has been shown to alleviate longevity. To determine autophagy and mitophagy function in regulating mucosal inflammaging, we created a series of knockout mouse lines ablating autophagy and mitophagy function in Villin epithelial CX3Cr1 resident macrophage cells. We are now interested in investigating the underlying regulatory cellular, molecular, and epigenetic factors utilizing pharmaceutical, epigenetic, functional assay, and mouse genetic tools. Given the autophagy and the mitophagy process involved in mucosal inflammation, further understanding of the regulatory mechanisms would be indispensable to the prevention of aging pathologies.”

Non Profit Org US Postage Paid

Department of Geriatrics 1301 N Columbia Rd Stop 9037 Grand Forks, ND 58202 Phone: 701.777.6949 med.UND.edu/geriatrics

Grand Forks ND

Permit #10

NEW

FACULTY With great excitement and anticipation, we are pleased to announce

Dr. Syed Haris Ali is currently our newest

the successful recruitment of Jeremy Holloway, Ph.D., who will

community faculty member as a physician

become an educational scholar-track, assistant professor in the

and scholar. He trained in anatomy and

Department of Geriatrics. Jeremy wowed the faculty search committee

carried out doctoral-level research in medical

with his charisma, eloquence, and commitment to diversity. He is a

education at the UND School of Medicine &

freshly minted Ph.D., and has already created an educational program

Health Sciences. Thereafter, he trained in

that links undergraduate students with older adults in assisted living

UND’s Internal Medicine Residency as well as

through video chat encounters with the intention of creating a booklet

our own Geriatrics Fellowship programs.

for older adults that recount their life’s milestones. This timely project

Since then, he has been working in hospital medicine and devoting

addresses social isolation and loneliness looming in congregate senior

time to the new Geriatrics Workforce Enhancement Program by

housing due to the COVID–19 pandemic. Jeremy is married to Kayla,

participating in undergraduate geriatrics curriculum development,

who works in the cardiac unit at the Toledo Promedica Hospital. They

knowledge dissemination via social networking platforms, and

are the proud parents of three children (Anaya, Asher, Grace) and are

assessment of knowledge via multiple-choice questions. Dr. Ali finds

expecting a fourth child in Nov. 2020 as of this writing. Dr. Holloway

his scholarly work to be highly relevant to day-to-day clinical practice.

will provide faculty oversite of the Dakota Geriatrics program, assuring effective educational design and programming, especially online, and curricular assessment. Equally importantly, Dr. Holloway will work with UND’s Diversity and Inclusion office to advance under-resourced and under-represented trainees. Dr. Holloway developed a program to optimize academic performance of minority students.