Mindy J Fain

Interests

Research

High value models of care for frail eldersFrailty-Resilience

Teaching

Geriatric Education and TrainingInterprofessional Education and Collaborative Practice

Courses

Scholarly Contributions

Chapters

• Fain, M. J., Elfar, J. C., Joseph, B. A., & Parker, K. E. (2024). Management of Common Fractures in Older Adults. In Oxford Textbook of Geriatric Medicine 4th edition. Oxford University Press.
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  manuscript in preparation, for 2024 edition of the textbook

Journals/Publications

• Alpert, J., & Fain, M. (2025). Dementia and Its Common Comorbidities: A Multifaceted Challenge. American Journal of Medicine, 138(Issue 2). doi:10.1016/j.amjmed.2025.01.019
• Fain, M. J., Horne, B. D., Horwitz, L. I., Thaweethai, T., Greene, M., Hornig, M., Orkaby, A. R., Rosen, C., Ritchie, C. S., Ashktorab, H., Blachman, N., Brim, H., Emerson, S., Erdmann, N., Erlandson, K. M., de Erausquin, G., Fong, T., Geng, L. N., Gordon, H. S., , Gully, J. R., et al. (2025). Age-Related Changes in the Clinical Picture of Long COVID. Journal of the American Geriatrics Society, 73(Issue). doi:10.1111/jgs.70043
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  Background: This study evaluated the impact of aging on the frequency and prevalent symptoms of Long COVID, also termed post-acute sequelae of SARS-CoV-2, using a previously developed Long COVID research index (LCRI) of 41 self-reported symptoms in which those with 12 or more points were classified as likely to have Long COVID. Methods: We analyzed community-dwelling participants ≥ 60 years old (2662 with prior infection, 461 controls) compared to participants 18–59 years (7549 infected, 728 controls) in the Researching COVID to Enhance Recovery adult (RECOVER-Adult) cohort ≥ 135 days post-onset. Results: Compared to the Age 18–39 group, the adjusted odds of LCRI ≥ 12 were higher for the Age 40–49 group (odds ratio [OR] = 1.40, 95% confidence intervals [CI] = 1.21–1.61, p < 0.001) and 50–59 group (OR = 1.31, CI = 1.14–1.51, p < 0.001), similar for the Age 60–69 group (OR = 1.09, CI = 0.93–1.27, p = 0.299), and lower for the ≥ 70 group (OR = 0.68, CI = 0.54–0.85, p < 0.001). Participants ≥ 70 years had smaller adjusted differences between infected and uninfected symptom prevalence rates than those aged 18–39 for the following symptoms: hearing loss, fatigue, pain (including joint, back, chest pain and headache), post-exertional malaise, sleep disturbance, hair loss, palpitations, and sexual desire/capacity, making these symptoms less discriminating for Long COVID in older adults than in younger. Symptom clustering, as described in Thaweethai et al. (JAMA 2023) also exhibited age-related shifts: clusters 1 (anosmia and ageusia) and 2 (gastrointestinal, chronic cough and palpitations, without anosmia, ageusia or brain fog) were more likely, and clusters 3 (brain fog, but no loss of smell or taste) and 4 (a mix of symptoms) less likely to be found in older adults (relative risk ratios for clusters 3–4 ranging from 0.10–0.34, p < 0.001 vs. 18–39 year-olds). Conclusions: Within the limits of this observational study, we conclude that in community-dwelling older adults, aging alters the prevalence and pattern of reported Long COVID.
• Hu, S., Ackun, P., Zhang, X., Cao, S., Barton, J. B., Hector, M. G., Fain, M. J., & Toosizadeh, N. (2025). mmWave Radar for Sit-to-Stand Analysis: A Comparative Study with Wearables and Kinect. IEEE Transactions on Biomedical Engineering, 72(Issue 9). doi:10.1109/tbme.2025.3548092
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  This study investigates a novel approach for analyzing Sit-to-Stand (STS) movements using millimeterwave (mmWave) radar technology, aiming to develop a noncontact, privacy-preserving, and all-day operational solution for healthcare applications. A 60GHz mmWave radar system was employed to collect radar point cloud data from 45 participants performing STS motions. Using a deep learning-based pose estimation model and Inverse Kinematics (IK), we calculated joint angles, segmented STS motions, and extracted clinically relevant features for fall risk assessment. The extracted features were compared with those obtained from Kinect and wearable sensors. While Kinect provided a reference for motion capture, we acknowledge its limitations compared to the gold-standard VICON system, which is planned for future validation. The results demonstrated that mmWave radar effectively captures general motion patterns and large joint movements (e.g., trunk), though challenges remain for more finegrained motion analysis. This study highlights the unique advantages and limitations of mmWave radar and other sensors, emphasizing the potential of integrated sensor technologies to enhance the accuracy and reliability of motion analysis in clinical and biomedical research. Future work will expand the scope to more complex movements and incorporate high-precision motion capture systems to further validate the findings
• Ille, M., Adamopoulos, I. E., Fain, M. J., & Nikolich, J. (2025). Osteoimmunology and aging — a frontier to explore. GeroScience. doi:10.1007/s11357-025-01744-0
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  Osteoimmunology is an interdisciplinary branch of immunology which studies the interplay of skeletal and immune systems. Both spatial and functional connections exist between the two systems, as most immune cells are generated in the bone marrow microenvironment, which facilitates the communication between the two systems. Moreover, immune cytokines such as RANKL (receptor activating Nf-kB ligand) and non-immune soluble mediators such as osteoprotegrin (OPG), made by immune and bone cells, respectively, interact to influence differentiation and activation of each other. The above interactions become of particular importance in the old age, when dysregulation of both systems yields changes affecting both length and quality of life. This perspective paper will outline both our current understanding as well as general gaps in knowledge, on geriatric osteoimmunology. We will also specifically address two highly prevalent diseases of aging, osteoarthritis and osteoporosis, as major sources of disability, loss of independence and increased morbidity and mortality in older adults, because cellular senescence appears to play a substantial pathogenetic role in both conditions, potentially opening new avenues for diagnosis and treatment.
• Lee, C., Park, J., Fain, M., Galvin, J. E., Park, L., & Ahn, H. (2025). Immediate and long-term effects of transcranial direct current stimulation on pain relief in older adults with Alzheimer's disease and related dementias: A pilot study. Geriatric Nursing, 63. doi:10.1016/j.gerinurse.2025.03.025
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  We simultaneously assessed the impact of transcranial direct current stimulation (tDCS) on mitigating both self-reported pain and pain behaviors to more objectively explore its effects in older adults with Alzheimer's disease and related dementias. The analysis investigated 40 participants randomly (1:1) subjected to active and sham tDCS for 20 min on 5 consecutive days. Multi-group latent transition analysis enabled the simultaneous evaluation of both pain domains in a single model and analysis of their changes as a function of intervention exposure by modeling the transition probabilities of latent classes and comparing these changes between groups. Two pain categories (“high pain” and “low pain”) were identified based on the numeric rating scale and mobilization–observation–behavior–intensity–dementia scale scores. Overall, tDCS demonstrated better effects in helping participants transition to a “low pain” status during and after the intervention (∼3 months) compared with sham stimulation, demonstrating its immediate and enduring effects.
• Lee, C., Park, J., Kwoh, C. K., Fain, M., Park, L., & Ahn, H. (2025). Home-Based, Remotely Supervised Transcranial Direct Current Stimulation Improves the Overall Pain Experience of Older Adults With Knee Osteoarthritis. Pain research & management, 2025(Issue 1). doi:10.1155/prm/1783171
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  Objective: Chronic pain in knee osteoarthritis (OA) is a multidimensional phenomenon requiring thorough assessment and appropriate treatment. We assessed the impact of home-based, remotely supervised transcranial direct current stimulation (tDCS) on the overall pain experience of older adults with knee OA by simultaneously examining its effects on multiple pain domains-pain intensity, pain interference, and pain catastrophizing-using multigroup latent transition analysis (LTA). Methods: This secondary analysis of a randomized clinical trial involved 120 participants with knee OA pain, randomly assigned in a 1:1 ratio to receive 15 daily sessions of 2-mA tDCS or sham tDCS (20 min per session) over three weeks, with real-time remote supervision. Pain intensity was measured using the Numeric Rating Scale (NRS) and the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Pain interference was measured using the WOMAC functional scale. Pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). All the measures were assessed at baseline and at the end of each week (weeks 1, 2, and 3), after the participants had completed five tDCS sessions per week. Multigroup LTA enabled the simultaneous measurement of multiple pain domains and analysis of their changes as a function of intervention exposure by modeling the transition probabilities of latent classes and comparing these changes between the groups. Results: Based on the NRS, WOMAC, and PCS scores, three latent categories were identified: "high pain (all scores high)," "moderate pain (all scores moderate)," and "low pain (all scores low)." Active group participants with "moderate pain" at baseline had a 24.2% probability of transitioning to "low pain" after Week 1, whereas sham group participants remained stagnant during this interval. Notably, 37.6% of active group participants with "high pain" at Week 1 transitioned to "moderate pain," while 35.8% of those with "moderate pain" at Week 1 transitioned to "low pain" by Week 2 (after an additional five sessions). Nevertheless, no noticeable changes were observed in the sham group during this period. No pronounced intervention effects were noted by Week 3. Conclusions: Simultaneously modeling pain-related measures enriches our understanding of the efficacy of tDCS in improving the overall pain experience among older adults with knee OA. Trial Registration: ClinicalTrials.gov identifier: NCT04016272.
• Rittel, C. M., Borg, B. A., Hanessian, A. V., Kuhar, A., Fain, M. J., & Bime, C. (2025). Longitudinal Assessment of Mobility and Self-care Among Critically Ill Older Adults. An Age-Friendly Health Systems Initiative Quality Improvement Study. Dimensions of critical care nursing : DCCN, 42(4), 234-239.
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  Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options.
• Alpert, J. S., & Fain, M. (2024). Frailty: The Sixth and Seventh Ages of Man: Disability and Dementia. The American journal of medicine.
• Fain, M. (2024). Foreword. Geriatric Home-Based Medical Care: Principles and Practice: Second Edition.
• Hu, S., Cao, S., Toosizadeh, N., Barton, J., Hector, M. G., & Fain, M. J. (2024). Radar-Based Fall Detection: A Survey [Survey]. IEEE Robotics and Automation Magazine, 31(Issue 3). doi:10.1109/mra.2024.3352851
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  Fall detection, particularly critical for high-risk demographics like the elderly, is a key public health concern, where timely detection can greatly minimize harm. With the advancements in radio frequency (RF) technology, radar has emerged as a powerful tool for human fall detection. Traditional machine learning (ML) algorithms, such as support vector machines (SVM) and k-nearest neighbors (kNN), have shown promising outcomes. However, deep learning (DL) approaches, notably convolutional neural networks (CNNs) and recurrent neural networks (RNNs), have outperformed in learning intricate features and managing large, unstructured datasets. This survey offers an in-depth analysis of radar-based fall detection, with emphasis on micro-Doppler, range-Doppler, and range-Doppler-angles techniques. We discuss the intricacies and challenges in fall detection and emphasize the necessity for a clear definition of falls and appropriate detection criteria, informed by diverse influencing factors. We present an overview of radar signal-processing principles and the underlying technology of radar-based fall detection, providing an accessible insight into ML and DL algorithms. After examining 74 research articles on radar-based fall detection published since 2000, we aim to bridge current research gaps and underscore the potential future research strategies, emphasizing the real-world applications possibility and the unexplored potential of DL in improving radar-based fall detection.
• Hu, S., Cao, S., Toosizadeh, N., Barton, J., Hector, M. G., & Fain, M. J. (2024). Radar-Based Fall Detection: A Survey. IEEE robotics & automation magazine, 31(3), 170-185.
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  Fall detection, particularly critical for high-risk demographics like the elderly, is a key public health concern where timely detection can greatly minimize harm. With the advancements in radio frequency technology, radar has emerged as a powerful tool for human detection and tracking. Traditional machine learning algorithms, such as Support Vector Machines (SVM) and k-Nearest Neighbors (kNN), have shown promising outcomes. However, deep learning approaches, notably Convolutional Neural Networks (CNN) and Recurrent Neural Networks (RNN), have outperformed in learning intricate features and managing large, unstructured datasets. This survey offers an in-depth analysis of radar-based fall detection, with emphasis on Micro-Doppler, Range-Doppler, and Range-Doppler-Angles techniques. We discuss the intricacies and challenges in fall detection and emphasize the necessity for a clear definition of falls and appropriate detection criteria, informed by diverse influencing factors. We present an overview of radar signal processing principles and the underlying technology of radar-based fall detection, providing an accessible insight into machine learning and deep learning algorithms. After examining 74 research articles on radar-based fall detection published since 2000, we aim to bridge current research gaps and underscore the potential future research strategies, emphasizing the real-world applications possibility and the unexplored potential of deep learning in improving radar-based fall detection.
• Hu, S., Cao, S., Toosizadeh, N., Barton, J., Hector, M. G., & Fain, M. J. (2024). mmPose-FK: A Forward Kinematics Approach to Dynamic Skeletal Pose Estimation Using mmWave Radars. IEEE sensors journal, 24(5), 6469-6481.
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  In this paper, we propose mmPose-FK, a novel millimeter wave (mmWave) radar-based pose estimation method that employs a dynamic forward kinematics (FK) approach to address the challenges posed by low resolution, specularity, and noise artifacts commonly associated with mmWave radars. These issues often result in unstable joint poses that vibrate over time, reducing the effectiveness of traditional pose estimation techniques. To overcome these limitations, we integrate the FK mechanism into the deep learning model and develop an end-to-end solution driven by data. Our comprehensive experiments using various matrices and benchmarks highlight the superior performance of mmPose-FK, especially when compared to our previous research methods. The proposed method provides more accurate pose estimation and ensures increased stability and consistency, which underscores the continuous improvement of our methodology, showcasing superior capabilities over its antecedents. Moreover, the model can output joint rotations and human bone lengths, which could be further utilized for various applications such as gait parameter analysis and height estimation. This makes mmPose-FK a highly promising solution for a wide range of applications in the field of human pose estimation and beyond.
• Park, J., Lee, C., Lin, L., Galvin, J., Fain, M. J., Allen, A., Park, L., & Ahn, H. (2024). Efficacy of Home-Based Remotely Supervised Transcranial Direct Current Stimulation for Managing Neuropsychiatric Symptoms in Older Adults With Alzheimer’s Disease and Related Dementias. Integrative and Complementary Therapies, 30(Issue 5). doi:10.1089/ict.2024.21943.jp
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  Background: Neuropsychiatric symptoms (NPS) are prevalent among persons with Alzheimer’s disease and related dementias (ADRD). However, there are limited safe and effective nonpharmacological treatments for controlling NPS. Transcranial direct current stimulation (tDCS) is a promising noninvasive and safe treatment. Materials and Methods: This study investigated the effects of remotely supervised tDCS in managing NPS in older adults with mild to moderate ADRD. Forty older adults diagnosed with early-stage ADRD were randomly assigned in a 1:1 ratio to receive home-based active tDCS (n = 20) or sham tDCS (n = 20). Results: Results showed a significantly greater improvement in the following NPS: scratching (P = 0.052, Hedges’ g = −0.60 [confidence interval {CI}: −1.24, 0.04], Cliff’s δ = −0.41 [CI: −0.67, −0.06]), nighttime behaviors (P = 0.041; Hedges’ g = −0.62 [CI: −1.26, 0.03]; Cliff’s δ = −0.41 [CI: −0.67, −0.06], and appetite/eating changes (P = 0.010; Hedges’ g = −0.78 [CI: −1.43, −0.13]; Cliff’s δ = −0.41 [CI: — 0.56, −0.10]). Conclusion: This study shows promising initial results for using home-based, remotely supervised tDCS to manage NPS, such as nighttime behaviors, changes in eating and appetite, and scratching. Larger studies with more participants are needed to explore various tDCS doses and their long-term effects on NPS.
• Russell, S. J., Parker, K., Lehoczki, A., Lieberman, D., Partha, I. S., Scott, S. J., Phillips, L. R., Fain, M. J., & Nikolich, J. Ž. (2024). Post-acute sequelae of SARS-CoV-2 infection (Long COVID) in older adults. GeroScience, 46(6), 6563-6581.
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  Long COVID, also known as PASC (post-acute sequelae of SARS-CoV-2), is a complex infection-associated chronic condition affecting tens of millions of people worldwide. Many aspects of this condition are incompletely understood. Among them is how this condition may manifest itself in older adults and how it might impact the older population. Here, we briefly review the current understanding of PASC in the adult population and examine what is known on its features with aging. Finally, we outline the major gaps and areas for research most germane to older adults.
• Lee, J. K., Fain, M. J., Ladziak, N. A., Zerr, B., Howe, C. L., & Vadiei, N. (2019). Psychotropic medication use patterns in home-based primary care: a scoping review. Drugs & Aging.
• Miller, G., Miller, C., Marrone, N. L., Howe, C. L., Fain, M. J., & Jacob, A. (2014). The impact of cochlear implantation on cognition in older adults: A review of clinical evidence. BMC Geriatrics.
• Vadiei, N., Howe, C. L., Zerr, B., Ladziak, N. A., Fain, M. J., & Lee, J. K. (2019). Psychotropic medication use patterns in home-based primary care: a scoping review. Aging and Mental Health.
• Browne, R., Fain, M., & Boyer, L. (2022). John T. (Jack) Boyer, MD: Reflections of an aging geriatrician. Journal of the American Geriatrics Society, 70(12), 3362-3365.
• Eskandari, M., Parvaneh, S., Ehsani, H., Fain, M., & Toosizadeh, N. (2022). Frailty Identification Using Heart Rate Dynamics: A Deep Learning Approach. IEEE journal of biomedical and health informatics, 26(7), 3409-3417.
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  Previous research showed that frailty can influence autonomic nervous system and consequently heart rate response to physical activities, which can ultimately influence the homeostatic state among older adults. While most studies have focused on resting state heart rate characteristics or heart rate monitoring without controlling for physical activities, the objective of the current study was to classify pre-frail/frail vs non-frail older adults using heart rate response to physical activity (heart rate dynamics). Eighty-eight older adults (≥65 years) were recruited and stratified into frailty groups based on the five-component Fried frailty phenotype. Groups consisted of 27 non-frail (age = 78.80±7.23) and 61 pre-frail/frail (age = 80.63±8.07) individuals. Participants performed a normal speed walking as the physical task, while heart rate was measured using a wearable electrocardiogram recorder. After creating heart rate time series, a long short-term memory model was used to classify participants into frailty groups. In 5-fold cross validation evaluation, the long short-term memory model could classify the two above-mentioned frailty classes with a sensitivity, specificity, F1-score, and accuracy of 83.0%, 80.0%, 87.0%, and 82.0%, respectively. These findings showed that heart rate dynamics classification using long short-term memory without any feature engineering may provide an accurate and objective marker for frailty screening.
• Joseph, B., Saljuqi, A., Phuong, J., Shipper, E., Braverman, M., Bixby, P., Price, M., Barraco, R., Cooper, Z., Jarman, M., Lack, W., Lueckel, S., Pivalizza, E., Bulger, E., Adams, S., Arbabi, S., Cryer, H., Ditillo, M., Dutton, R., , Fain, M., et al. (2022). Developing a National Trauma Research Action Plan: Results from the geriatric research gap Delphi survey. Journal of Trauma and Acute Care Surgery, 93(2). doi:10.1097/TA.0000000000003626
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  BACKGROUND Treating older trauma patients requires a focus on the confluence of age-related physiological changes and the impact of the injury itself. Therefore, the primary way to improve the care of geriatric trauma patients is through the development of universal, systematic multidisciplinary research. To achieve this, the Coalition for National Trauma Research has developed the National Trauma Research Action Plan that has generated a comprehensive research agenda spanning the continuum of geriatric trauma care from prehospital to rehabilitation. METHODS Experts in geriatric trauma care and research were recruited to identify current gaps in clinical geriatric research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines ensuring heterogeneity and generalizability. On subsequent surveys, participants were asked to rank the priority of each research question on a nine-point Likert scale, categorized to represent low-, medium-, and high-priority items. The consensus was defined as more than 60% of panelists agreeing on the priority category. RESULTS A total of 24 subject matter experts generated questions in 109 key topic areas. After editing for duplication, 514 questions were included in the priority ranking. By round 3, 362 questions (70%) reached 60% consensus. Of these, 161 (44%) were high, 198 (55%) medium, and 3 (1%) low priority. CONCLUSION Among the questions prioritized as high priority, questions related to three types of injuries (i.e., rib fracture, traumatic brain injury, and lower extremity injury) occurred with the greatest frequency. Among the 25 highest priority questions, the key topics with the highest frequency were pain management, frailty, and anticoagulation-related interventions. The most common types of research proposed were interventional clinical trials and comparative effectiveness studies, outcome research, and health care systems research.
• Peña, M., Petrillo, K., Bosset, M., Fain, M., Chou, Y. H., Rapcsak, S., & Toosizadeh, N. (2022). Brain function complexity during dual-tasking is associated with cognitive impairment and age. Journal of neuroimaging : official journal of the American Society of Neuroimaging, 32(6), 1211-1223.
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  Early diagnosis of cognitive impairment is important because symptoms can be delayed through therapies. Synaptic disconnections are the key characteristics of dementia, and through nonlinear complexity analysis of brain function, it is possible to identify long-range synaptic disconnections in the brain.
• Ruberto, K., Ehsani, H., Parvaneh, S., Mohler, J., Fain, M., Sweitzer, N. K., & Toosizadeh, N. (2022). The association between heart rate behavior and gait performance: The moderating effect of frailty. PloS one, 17(2), e0264013.
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  Research suggests that frailty not only influence individual systems, but also it affects the interconnection between them. However, no study exists to show how the interplay between cardiovascular and motor performance is compromised with frailty.
• Chen, Z., Fain, M., Harwood, J., Insel, K., Phillips, L., & Sokan, A. (2021). Measuring Covid-related Ageism. Innovation in Aging, 5(Supplement_1), 1011-1012. doi:10.1093/geroni/igab046.3625
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  Abstract Prejudice, discrimination, and negative stereotypes based on age (ageism) are long-standing and strongly implicated in poor health outcomes and limited access to health care for older adults. Recent writings suggest the COVID-19 pandemic raised the specter of ageism to an entirely new level. Do these observations reflect an exaggeration of “usual” ageism or a unique manifestation of intergenerational tension rooted in resentments of younger people concerning COVID-related disruptions in their lives believed to be primarily a function of older people’s vulnerability to the disease phenomenon? To address this question, the purpose of this study was to develop and test an instrument to measure ageist tendencies associated with the COVID-19 pandemic. Scale items, written to reflect attitudes about paternalism, inconvenience, and sacrifice, were assessed for content validity. Then the 12-item scale was administered to 227 undergraduate and graduate students in the health and social sciences. Analysis showed items have strong internal consistency and concurrent and discriminant validity. Importantly the scale explained unique variance over and above other standard measures of ageism. Ageism is deeply embedded in global and U.S. culture and strongly related to negative outcomes. This scale will assist researchers investigating the ageist consequences of the current pandemic and help us to monitor what could be long-term residual ageist effects of the COVID pandemic.
• Cioltan, H., Dermody, M., Fain, M. J., Goldsmith, P. N., Heasley, B., Lee, J. K., & Mohler, J. (2021). An assisted living interprofessional education and practice geriatric screening clinic (IPEP-GSC): a description and evaluation.. Gerontology & geriatrics education, 42(2), 166-177. doi:10.1080/02701960.2018.1463222
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  As the U.S. population ages and lives longer, we need to assure that future providers are prepared to work in highly functioning interprofessional teams to deliver person-centered care for older adults with complex chronic conditions. Assisted living facilities are ideal venues in which to train interprofessional health sciences students in providing such care. After monthly clinics involving interprofessional students (from the colleges of medicine, nursing, pharmacy, public health, and school of social work) providing team-based care to older adults, students' post-clinic evaluations indicated perceived improvements in knowledge, attitudes, and perceptions about aging and care of older adults. In addition, participating older adults reported improved self-worth and enjoyment. The curriculum, evaluation outcomes, and lessons learned are described to support program replication.
• Cohen, A., Ehsani, H., Fain, M., Joseph, B., Mohler, J., Pena, M., Ruiz, M., & Toosizadeh, N. (2021). Physical and Cognitive Function Assessment to Predict Postoperative Outcomes of Abdominal Surgery.. The Journal of surgical research, 267(Issue), 495-505. doi:10.1016/j.jss.2021.05.018
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  Current evaluation methods to assess physical and cognitive function are limited and often not feasible in emergency settings. The upper-extremity function (UEF) test to assess physical and cognitive performance using wearable sensors. The purpose of this study was to examine the (1) relationship between preoperative UEF scores with in-hospital outcomes; and (2) association between postoperative UEF scores with 30-d adverse outcomes among adults undergoing emergent abdominal surgery..We performed an observational, longitudinal study among adults older than 40 y who presented with intra-abdominal symptoms. The UEF tests included a 20-sec rapid repetitive elbow flexion (physical function), and a 60-sec repetitive elbow flexion at a self-selected pace while counting backwards by threes (cognitive function), administered within 24-h of admission and within 24-h prior to discharge. Multiple logistic regression models assessed the association between UEF and outcomes. Each model consisted of the in-hospital or 30-d post-discharge outcome as the dependent variable, preoperative UEF physical and cognitive scores as hypothesis covariates, and age and sex as adjuster covariates..Using UEF physical and cognitive scores to predict in-hospital outcomes, an area under curve (AUC) of 0.76 was achieved, which was 17% more sensitive when compared to age independently. For 30-d outcomes, the AUC increased to 0.89 when UEF physical and cognitive scores were included in the model with age and sex..Sensor-based measures of physical and cognitive function enhance outcome prediction providing an objective practicable tool for risk stratification in emergency surgery settings among aging adults presenting with intra-abdominal symptoms.
• Fain, M., Kenning, H., O'Neill, L., Sokan, A., Wager, M., & Yang, Y. (2021). Caregiver Challenges of Older University Employees During the COVID-19 Pandemic. Innovation in Aging, 5(Supplement_1), 65-65. doi:10.1093/geroni/igab046.250
• Jergović, M., Thompson, H. L., Bradshaw, C. M., Sonar, S. A., Ashgar, A., Mohty, N., Joseph, B., Fain, M. J., Cleveland, K., Schnellman, R. G., & Nikolich-Žugich, J. (2021). IL-6 can singlehandedly drive many features of frailty in mice. GeroScience.
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  Frailty is a geriatric syndrome characterized by age-related declines in function and reserve resulting in increased vulnerability to stressors. The most consistent laboratory finding in frail subjects is elevation of serum IL-6, but it is unclear whether IL-6 is a causal driver of frailty. Here, we characterize a new mouse model of inducible IL-6 expression (IL-6 mice) following administration of doxycycline (Dox) in food. In this model, IL-6 induction was Dox dose-dependent. The Dox dose that increased IL-6 levels to those observed in frail old mice directly led to an increase in frailty index, decrease in grip strength, and disrupted muscle mitochondrial homeostasis. Littermate mice lacking the knock-in construct failed to exhibit frailty after Dox feeding. Both naturally old mice and young Dox-induced IL-6 mice exhibited increased IL-6 levels in sera and spleen homogenates but not in other tissues. Moreover, Dox-induced IL-6 mice exhibited selective elevation in IL-6 but not in other cytokines. Finally, bone marrow chimera and splenectomy experiments demonstrated that non-hematopoietic cells are the key source of IL-6 in our model. We conclude that elevated IL-6 serum levels directly drive age-related frailty, possibly via mitochondrial mechanisms.
• Peterson, R. L., Butler, E. A., Ehiri, J. E., Fain, M. J., & Carvajal, S. C. (2021). Mechanisms of Racial Disparities in Cognitive Aging: An Examination of Material and Psychosocial Well-Being. The journals of gerontology. Series B, Psychological sciences and social sciences, 76(3), 574-582.
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  We tested the hypothesis that education's effect on cognitive aging operates in part through measures of material and psychosocial well-being.
• Black, M. A., Abidov, M., Fain, M. J., Mohler, J., & Samlan, R. A. (2020). Frailty Syndrome, Cognition, and Dysphonia in the Elderly.. Journal of voice : official journal of the Voice Foundation, 34(1), 160.e15-160.e23. doi:10.1016/j.jvoice.2018.06.001
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  The purpose of the current study is to determine the relation of frailty syndrome to acoustic measures of voice quality and voice-related handicap..Seventy-three adults (52 community-dwelling participants and 21 assisted living residents) age 60 and older completed frailty screening, acoustic assessment, cognitive screening, and the Voice Handicap Index-10 (VHI-10). Factor analysis was used to consolidate acoustic measures. Statistical analysis included multiple regression, analysis of variance, and Tukey post-hoc tests with alfa of 0.05..Montreal Cognitive Assessment (MoCA) and exhaustion explained 28% of the variance in VHI-10. MoCA and sex explained 27% of the variance in factor 1 (spectral ratio), age and MoCA explained 13% of the variance in factor 2 (cepstral peak prominence for speech), and slowness explained 10% of the variance in factor 3 (cepstral peak prominence for sustained /a/). There were statistically significant differences in two measures across frailty groups: VHI-10 and MoCA. Acoustic factor scores did not differ significantly among frailty groups (P > 0.05)..Voice-related handicap and cognitive status differed among robust and frail older adults, yet vocal function measures did not. The components of frailty most related to VHI-10 were exhaustion and weight loss rather than slowness, weakness, or inactivity. Based on these findings, routine screening of physical frailty and cognition are recommended as part of a complete voice evaluation for older adults.
• Fain, M. J., Lieberman, D., Mcfadden, C., & Tirambulo, C. V. (2020). Low Serum Albumin in Patients With Coexisting Cognitive Impairment Predicts Surgical Complications. Innovation in Aging, 4(Supplement_1), 138-138. doi:10.1093/geroni/igaa057.452
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  Abstract Cognitive impairment (CI, ~15-20%) and malnutrition (~38.7%) are common concerns among older adults ≥65 years. CI and malnutrition may be used as predictive risk factors for poor surgical outcomes. The 2012 ACS NSQIP/AGS Best Practice Guidelines for the preoperative assessment of geriatric surgical patients classify severe nutritional risk as either having a BMI < 18.5 kg/m2, serum albumin (SA) < 3.0 g/dL and/or unintentional weight loss > 10%-15% within 6 months. Using SA as a surrogate marker for malnutrition, we evaluated the relationship between CI, malnutrition, and risk for poor surgical outcomes in a geriatric population. Electronic medical record chart reviews of patients (≥65 years old) undergoing elective intermediate or high-risk surgery (IHRS), between 2016 and 2019 in Tucson, AZ, were conducted. Pre-and-post assessment factors such as cognitive status via mini-cog, laboratory markers (SA), and hospital complications were examined. Multivariate regression analyses were performed to determine the association between cognitive status, SA levels, and hospital complications. Of the 173 patients undergoing IHRS included in this assessment (mean age: 75.5±7.4 years, [60-93 years], 54.9% male), 42.8% experienced hospital complications. Multivariate regression analysis revealed cognitive impairment and low SA levels were significantly associated with this outcome (p
• Fain, M. J., Lieberman, D., Mcfadden, C., & Tirambulo, C. V. (2020). The Relationship Between Race and Ethnicity in Post-Surgical Discharge Disposition. Innovation in Aging, 4(Supplement_1), 140-140. doi:10.1093/geroni/igaa057.459
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  Abstract Racial and ethnic disparities have been reported regarding outcomes of intermediate or high-risk surgical (IHRS) procedures. This study aimed to assess whether or not these disparities exist with respect to post-procedural discharge disposition (DD). EMR chart reviews of patients (≥65 years old) undergoing IHRS were conducted, 2016-2019 in Tucson, AZ. Race and ethnicity were reported as American Indian/Alaskan Native; Black or African American; More-Than-One-Race; Native Hawaiian/Pacific Islander; White/Caucasian; Unknown/Not Reported, Hispanic/Latino; Non-Hispanic/Latino; or Unknown/Not Reported. DD was reported as to home, home with home health, rehabilitation center, skilled nursing facility (SNF), death, or other. Kruskal-Wallis tests were performed to determine the association with DD. Of the 161 patients (mean age: 74.7±6.9, [60-91], 53.4% male) assessed, 15.4% were discharged to a facility other than home or home with home health. Ethnicity was significantly associated with discharge disposition (p
• Lee, J. K., Fain, M. J., Ladziak, N. A., Zerr, B., Howe, C. L., & Vadiei, N. (2020). Psychotropic medication use patterns in home-based primary care: a scoping review. Mental Health Clinician.
• Malone, M. L., & Fain, M. J. (2020). Building the Infrastructure for Rapid Implementation of High-Value Home-Care Delivery Models. Journal of the American Geriatrics Society, 68(7), 1400-1401.
• Nikolich-Zugich, J., Knox, K. S., Rios, C. T., Natt, B., Bhattacharya, D., & Fain, M. J. (2020). Correction to: SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience, 42(3), 1013.
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  The affiliation of the second author (Kenneth S. Knox) should have been Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA instead of Department of Medicine, University of Arizona-Phoenix, Phoenix, AZ 85004, USA.
• Nikolich-Zugich, J., Knox, K. S., Rios, C. T., Natt, B., Bhattacharya, D., & Fain, M. J. (2020). SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience, 42(2), 505-514.
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  SARS-CoV-2 virus, the causative agent of the coronavirus infectious disease-19 (COVID-19), is taking the globe by storm, approaching 500,000 confirmed cases and over 21,000 deaths as of March 25, 2020. While under control in some affected Asian countries (Taiwan, Singapore, Vietnam), the virus demonstrated an exponential phase of infectivity in several large countries (China in late January and February and many European countries and the USA in March), with cases exploding by 30-50,000/day in the third and fourth weeks of March, 2020. SARS-CoV-2 has proven to be particularly deadly to older adults and those with certain underlying medical conditions, many of whom are of advanced age. Here, we briefly review the virus, its structure and evolution, epidemiology and pathogenesis, immunogenicity and immune, and clinical response in older adults, using available knowledge on SARS-CoV-2 and its highly pathogenic relatives MERS-CoV and SARS-CoV-1. We conclude by discussing clinical and basic science approaches to protect older adults against this disease.
• Peterson, R. L., Fain, M. J., A Butler, E., Ehiri, J. E., & Carvajal, S. C. (2020). The role of social and behavioral risk factors in explaining racial disparities in age-related cognitive impairment: a structured narrative review. Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition, 27(2), 173-196.
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  Alzheimer's disease (AD) is a growing public health concern with large disparities in incidence and prevalence between African Americans (AAs) and non-Hispanic whites (NHWs). The aim of this review was to examine the evidence of association between six modifiable risk factors (education, smoking, physical inactivity, obesity, social isolation, and psychosocial stress) and Alzheimer's disease risk in AAs and NHWs. We identified 3,437 studies; 45 met inclusion criteria and were included in this review. Of the examined risks, education provided the strongest evidence of association with cognitive outcomes in AAs and NHWs. This factor may operate directly on Alzheimer's disease risk through the neurocognitive benefits of cognitive stimulation or indirectly through social status.
• Toosizadeh, N., Wahlert, G., Fain, M., & Mohler, J. (2020). The effect of vibratory stimulation on the timed-up-and-go mobility test: a pilot study for sensory-related fall risk assessment. Physiological research, 69(4), 721-730.
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  Effects of localized lower-extremity vibration on postural balance have been reported. The purpose of the current study was to investigate the effect of low-frequency vibration of calf muscles on the instrumented Timed-Up-and-Go (iTUG) test among older adults. Older adults were recruited and classified to low (n=10, age=72.9±2.8 years) and high fall risk (n=10, age=83.6±9.6) using STEADI. Vibratory system (30Hz or 40Hz), was positioned on calves along with wearable motion sensors. Participants performed the iTUG test three times, under conditions of no-vibration, 30Hz, and 40Hz vibration. Percentage differences in duration of iTUG components were calculated comparing vibration vs no-vibration conditions. Significant between-group differences were observed in iTUG (p=0.03); high fall risk participants showed reduction in the duration of turning (-10 % with 30Hz; p=0.15 and -15 % with 40Hz; p=0.03) and turning and sitting (-18 % with 30Hz; p=0.02 and -10 % with 40Hz; p=0.08). However, vibration increased turning (+18 % with 30Hz; p=0.20 and +27 % with 40Hz; p=0.12) and turning and sitting duration (+27 % with 30Hz; p=0.11 and +47 % with 40Hz; p=0.12) in low fall risk participants. Findings suggest that lower-extremity vibration affects dynamic balance; however, the level of this influence may differ between low and high fall risk older adults, which can potentially be used for assessing aging-related sensory deficits.
• Vadiei, N., Howe, C. L., Zerr, B., Ladziak, N. A., Fain, M. J., & Lee, J. K. (2020). Psychotropic medication use patterns in home-based primary care: a scoping review. Mental Health Clinician, 10(5), 282-290.
• Vadiei, N., Howe, C. L., Zerr, B., Ladziak, N., Fain, M. J., & Lee, J. K. (2020). Psychotropic medication use patterns in home-based primary care: A scoping review. The mental health clinician, 10(5), 282-290.
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  Up to a third of patients seen by home-based primary care (HBPC) providers suffer from mental health problems. These conditions tend to be underrecognized and undertreated for patients receiving HBPC. The purpose of this scoping review is to evaluate current psychotropic use patterns for patients receiving HBPC services.
• Butler, E. A., Carvajal, S. C., Ehiri, J. E., Fain, M. J., & Peterson, R. (2019). P4-636: THE ROLE OF SOCIAL STATUS AND CHRONIC STRESS FOR RACIAL DISPARITIES IN COGNITIVE AGING. Alzheimers & Dementia, 15(7S_Part_30), P1571-P1571. doi:10.1016/j.jalz.2019.08.185
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  Racial disparities in cognitive aging are well established, with education hypothesized to play a key role via cognitive stimulation and the resulting contribution to cognitive reserve. In the broader health disparities literature, education is hypothesized to operate via its contribution to social status and association with discrimination, both of which influence experiences with chronic stress. We used structural equation modeling to test for mediational effects of subjective and objective measures of social status (household income; household wealth; perceived social status) and chronic stress (allostatic load, comprised of blood pressure, BMI, HbA1c, C-reactive protein and DHEA; perceived stress scale) in the relationships between race, education and cognitive function at two time points using data from the National Social Life Health and Aging Project. Household wealth mediated the relationships between race and time 2 cognition, and education and time 2 cognition at p
• Chang, A., Lundebjerg, N. E., Abrams, J., Barnes, D. E., Fain, M. J., Hall, W. J., Johnson, T. M., Michael Harper, G., Williams, B., & Ritchie, C. S. (2019). Leadership, Inside and Out: The Tideswell-AGS-ADGAP Emerging Leaders in Aging Program. Journal of the American Geriatrics Society.
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  To optimize health and well-being for all older people, we must collectively develop leaders to pioneer models of care, educate the healthcare workforce, advance research, and engage the community.
• Fain, M. J., O'neil, L., & Severance, J. J. (2019). FOSTERING DEMENTIA-FRIENDLY COMMUNITIES AND SUPPORTING CAREGIVERS THROUGH THE GWEP PROGRAMS. Innovation in Aging, 3(Supplement_1), S372-S373. doi:10.1093/geroni/igz038.1363
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  As the number of people affected by dementia increases, it is essential that caregivers are provided resources and communities educated on how to engage and support people living with dementia. Supporting caregivers and providing education about dementia-friendly communities are key components of the Geriatric Workforce Enhancement Programs. This symposium will provide examples of GWEP projects which foster dementia-friendly communities and support caregivers. Additionally, recent and current legislation targeting dementia and caregivers will be presented.
• Hamidi, M., Zeeshan, M., Leon-Risemberg, V., Nikolich-Zugich, J., Hanna, K., Kulvatunyou, N., Saljuqi, A. T., Fain, M., & Joseph, B. (2019). Frailty as a prognostic factor for the critically ill older adult trauma patients. American journal of surgery, 218(3), 484-489.
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  Frailty is highly prevalent in the elderly and confers high risk for adverse outcomes. We aimed to assess the impact of frailty on critically ill older adult trauma patients.
• Khan, M., Jehan, F., Zeeshan, M., Kulvatunyou, N., Fain, M. J., Saljuqi, A. T., O'Keeffe, T., & Joseph, B. (2019). Failure to Rescue After Emergency General Surgery in Geriatric Patients: Does Frailty Matter?. The Journal of surgical research, 233, 397-402.
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  Failure to rescue (FTR) is considered as an index of quality of care provided by a hospital. However, the role of frailty in FTR remains unclear. We hypothesized that the FTR rate is higher for frail geriatric emergency general surgery (EGS) patients than nonfrail geriatric EGS patients.
• Palmer, J., Pandit, V., Zeeshan, M., Kulvatunyou, N., Hamidi, M., Hanna, K., Fain, M., Nikolich-Zugich, J., Zakaria, E. R., & Joseph, B. (2019). The acute inflammatory response after trauma is heightened by frailty: A prospective evaluation of inflammatory and endocrine system alterations in frailty. The journal of trauma and acute care surgery, 87(1), 54-60.
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  Frailty is a geriatric syndrome characterized by decreased physiological reserves, increased inflammation, and decreased anabolic-endocrine response. The biomarkers associated with frailty are poorly understood in trauma. The aim of this study was to analyze the association between frailty and immune: IL-1β, IL-6, IL-2Rα, tumor necrosis factor (TNF)-α, and endocrine biomarkers: insulin-like growth factor-1 and growth hormone in trauma patients.
• Peterson, R. L., Carvajal, S. C., McGuire, L. C., Fain, M. J., & Bell, M. L. (2019). State inequality, socioeconomic position and subjective cognitive decline in the United States. SSM - population health, 7, 100357.
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  Social gradients in health have been observed for many health conditions and are suggested to operate through the effects of status anxiety. However, the gradient between education and Alzheimer's disease is presumed to operate through cognitive stimulation. We examined the possible role of status anxiety through testing for state-level income inequality and social gradients in markers of socioeconomic position (SEP) for Alzheimer's disease risk.
• Zerr, B., Ladziak, N., Fain, M. J., Howe, C. L., Lee, J. K., & Vadiei, N. (2019). PSYCHOTROPIC MEDICATION USE PATTERNS IN HOME-BASED PRIMARY CARE: A SYSTEMATIC REVIEW. American Journal of Geriatric Psychiatry, 27(3), S150. doi:10.1016/j.jagp.2019.01.058
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  Introduction Up to a third of patients seen by home-based primary care providers suffer from mental health problems, predominantly major depressive disorder. These conditions tend to be under-recognized and under-treated for patients receiving home-based care. This may be due to providers feeling inadequately trained on how to screen for various mental health disorders, and/or how to provide comprehensive mental health treatment. Given the high prevalence of patients suffering from mental health problems in this setting, the goal of this systematic review was to evaluate current psychotropic use patterns for patients receiving home-based primary care (HBPC). Methods Using controlled vocabulary terms (e.g. MeSH, Emtree) and keywords, a medical librarian conducted systematic literature searches in the following seven databases: Ovid/MEDLINE, Wiley/Cochrane Library, Elsevier/Embase, Elsevier/Scopus, Clarivate/Web of Science, EBSCO/CINAHL, and EBSCO/PsycInfo, limiting articles to those published between January 1, 2007 and January 5, 2018. Two independent reviewers screened all titles and abstracts and resolved differences by consensus. Two independent reviewers screened the full text of all publications selected in the screening phase. Differences were resolved by consensus with a third reviewer. Studies were selected if a) they were conducted in home-based primary care settings and b) identified psychotropic use/prescription patterns. We specifically did not include studies that were limited to patients in hospice care or nursing or rehabilitation facilities. Studies were excluded if they were: not in English; drug trials; limited to pediatric patients; or opinion pieces, case studies, case series, meeting abstracts, reviews, systematic reviews, or meta-analyses. Results Of the 2,675 publications identified through the seven database searches, 1,388 remained after duplicates were removed (Figure 1). Of these, 1,329 were eliminated because of irrelevance to the topic and 59 were selected for full text screening. Of these, four met full selection criteria and were included in the data extraction and analysis. Citation checking of these four, as well as of relevant review articles, resulted in the selection of an additional 15 articles for full text screening. None of these additional articles met the full selection criteria. Conclusions Pending ongoing investigation. This research was funded by This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.
• Hamidi, M., Zeeshan, M., O'Keeffe, T., Nisbet, B., Northcutt, A., Nikolich-Zugich, J., Khan, M., Kulvatunyou, N., Fain, M., & Joseph, B. (2018). Prospective evaluation of frailty and functional independence in older adult trauma patients. American journal of surgery, 216(6), 1070-1075.
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  The aim of our study was to assess the association between frailty and functional status in geriatric trauma patients.
• Lee, J., Cioltan, H., Goldsmith, P., Heasley, B., Dermody, M., Fain, M., & Mohler, J. (2018). An assisted living interprofessional education and practice geriatric screening clinic (IPEP-GSC): a description and evaluation. Gerontology & geriatrics education, 1-12.
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  As the U.S. population ages and lives longer, we need to assure that future providers are prepared to work in highly functioning interprofessional teams to deliver person-centered care for older adults with complex chronic conditions. Assisted living facilities are ideal venues in which to train interprofessional health sciences students in providing such care. After monthly clinics involving interprofessional students (from the colleges of medicine, nursing, pharmacy, public health, and school of social work) providing team-based care to older adults, students' post-clinic evaluations indicated perceived improvements in knowledge, attitudes, and perceptions about aging and care of older adults. In addition, participating older adults reported improved self-worth and enjoyment. The curriculum, evaluation outcomes, and lessons learned are described to support program replication.
• O'neill, L., Sukerji, R., Fain, M. J., Mohler, J., Morgan, H., Rapcsak, S. Z., & Tafich-rios, C. (2018). P2‐529: THE ALZHEIMER'S DISEASE AND RELATED DISORDERS (ADRD) PRIMARY CARE ENGAGEMENT CAMPAIGN: PHASE II. Alzheimers & Dementia, 14(7S_Part_17). doi:10.1016/j.jalz.2018.06.1223
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  Most persons with dementia receive their medical care in primary care settings, but many receive suboptimal care. The goal of the initial campaign (Phase 1) was to improve the care that persons with dementia receive in primary care settings by increasing awareness of ADRD and related caregiver stress among primary care providers (PCPs), and connecting patients and families with Alzheimer's Association resources. Pilot data confirmed the campaign increased patient and caregiver support via referrals to the Alzheimer's Association; and many PCPs benefited from education on diagnosis and management of dementia. Phase 2 involves the development and implementation of a clinical practice model to assess and manage cognitive issues the primary care setting. Our clinical improvement process was developed by a multi-disciplinary team that focused on evidence-based practice and practice-based evidence to define, design and implement clinical practices, standing orders, and educational materials. Our team designed and developed a dementia clinical practice workflow that links to the Welcome to Medicare, and Medicare Annual Wellness Visits. The dementia clinical practice workflow was rolled out in an IM resident primary care clinic, with continuation of Phase 1 coordination with the Alzheimer's Association. Prior to activation, the IM primary care faculty, residents and staff received training in cognitive assessment and management. The workflow includes: 1) template embedded into the electronic health record, including orders; 2) access to printable instruments; 3) educational materials for primary care clinicians, staff and case managers including diagnosis, staging, treatment, communication of diagnosis, indications for specialty referral, care planning, and community support services; and 4) elements of the Medicare code for assessment and care planning to facilitate coding/billing of G0505 (e.g., functional assessment and advance-care planning). Conclusion: Phase 1 offers a low cost intervention that improved identification of patients with dementia and provided support for family caregivers. Phase 2 will add on a comprehensive program to improve clinical dementia assessment and management. The program has the potential to optimize health and quality of life and help reduce the annual acute and long term costs.
• Samlan, R. A., Black, M. A., Abidov, M., Mohler, J., & Fain, M. (2018). Frailty Syndrome, Cognition, and Dysphonia in the Elderly. Journal of voice : official journal of the Voice Foundation.
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  The purpose of the current study is to determine the relation of frailty syndrome to acoustic measures of voice quality and voice-related handicap.
• Schuchman, M., Fain, M., & Cornwell, T. (2018). The Resurgence of Home-Based Primary Care Models in the United States. Geriatrics (Basel, Switzerland), 3(3).
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  This article describes the forces behind the resurgence of home-based primary care (HBPC) in the United States and then details different HBPC models. Factors leading to the resurgence include an aging society, improved technology, an increased emphasis on home and community services, higher fee-for-service payments, and health care reform that rewards value over volume. The cost savings come principally from reduced institutional care in hospitals and skilled nursing facilities. HBPC targets the most complex and costliest patients in society. An interdisciplinary team best serves this high-need population. This remarkable care model provides immense provider satisfaction. HBPC models differ based on their mission, target population, geography, and revenue structure. Different missions include improved care, reduced costs, reduced readmissions, and teaching. Various payment structures include fee-for-service and value-based contracts such as Medicare Shared Savings Programs, Medicare capitation programs, or at-risk contracts. Future directions include home-based services such as hospital at home and the expansion of the home-based workforce. HBPC is an area that will continue to expand. In conclusion, HBPC has been shown to improve the quality of life of home-limited patients and their caregivers while reducing health care costs.
• Vandivort, M., Self, C., O'neill, L., Fain, M. J., Phillips, L. R., & Wendel, C. S. (2018). P1‐537: HOME‐BASED PRIMARY CARE SUPPORTS PATIENTS LIVING WITH DEMENTIA AND THEIR FAMILIES. Alzheimers & Dementia, 14(7S_Part_9). doi:10.1016/j.jalz.2018.06.548
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  Since multimorbidity is highly prevalent among community-dwelling persons living with dementia (PLWD), innovative models of care that include active management of multiple complex conditions are required to support patients and caregivers, reduce unnecessary healthcare costs and promote aging in place. Home-based Primary Care (HBPC) is a nationally recognized, evidence-based mobile, primary care program that provides team-based, goal-directed medical and social care at home for patients with severe and disabling chronic illness. The potential of HBPC to provide innovative, supportive and active medical and social care to PLWD is little emphasized. Our objective was to describe the clients served by HBPC at our health system to confirm its potential for delivering comprehensive care for PLWD and their families. Adults, aged 60+, currently receiving primary care from the HBPC program were stratified into three clinically confirmed groups: 1) Cognitively normal (CN); 2) Mild Cognitive Impairment (MCI); and 3) Dementia (probable ADRD). Co-variates included: site of care (home vs. assisted living facility); caregiver (yes or no); and presence or absence of multimorbidity, defined as the presence of two or more chronic conditions. 105 HBPC patients met the inclusion criteria: mean age was 84.1 (SD 9.8, range 60-99); 80 (76.2%) had dementia; 15 (14.3%) had MCI; and 10 (9.5%) were cognitively normal. Caregiver (formal or informal) was present in 93.1%. Most patients, 66 (62.9%) lived at home, while 39 (37.1%) resided in assisted living facilities. Of those living at home, 41 (62.1%) had dementia, 15 (22.7%) had MCI, and 10 (15.2%) had normal cognition. All 39 (100%) patients in assisted living had dementia. Of the 95 patients living with dementia or MCI, 94 (98.9%) had multimorbidity. Our results are consistent with national data that HBPC provides both dementia-focused care and active management of multiple chronic conditions. HBPC programs have proven success in delivering cost effective, high quality care which yield substantial reductions in unnecessary emergency room and hospital utilization, and long-term care admissions. These programs can fill the need for a high-value dementia care model for PLWD and should be expanded as a key component of our national strategy.
• Cioltan, H., Alshehri, S., Howe, C., Lee, J., Fain, M., Eng, H., Schachter, K., & Mohler, J. (2017). Variation in use of antipsychotic medications in nursing homes in the United States: A systematic review. BMC geriatrics, 17(1), 32.
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  The use of antipsychotic medications (APMs) in nursing home residents in the U.S. is an increasingly prominent issue and has been associated with increased risk of hospitalization, cardiovascular events, hip fractures, and mortality, among other adverse health events. The Food and Drug Administration has placed a black box warning on these drugs, specifying that they are not meant for residents with dementia, and has asked providers to review their treatment plans. The purpose of this systematic PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-based review was to summarize original research studies on facility level characteristics contributing to the use of antipsychotics in nursing homes across the United States, in order to investigate the variation of use.
• Fain, M. J., & Walston, J. D. (2017). THE MOLECULAR AND ORGANISMAL BASIS OF RESILIENCE AND FRAILTY. Innovation in Aging, 1(suppl_1), 664-664. doi:10.1093/geroni/igx004.2355
• Joseph, B., Orouji Jokar, T., Hassan, A., Azim, A., Mohler, M. J., Kulvatunyou, N., Siddiqi, S., Phelan, H., Fain, M., & Rhee, P. (2017). Redefining the association between old age and poor outcomes after trauma: The impact of frailty syndrome. The journal of trauma and acute care surgery, 82(3), 575-581.
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  Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months.
• Raoof, M., O'Neill, L., Neumayer, L., Fain, M., & Krouse, R. (2017). Prospective evaluation of surgical palliative care immersion training for general surgery residents. American journal of surgery, 214(2), 378-383.
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  Palliative care competencies in surgical training are recognized to improve the care of surgical patients with advanced or life-threatening illnesses. Formal programs to teach these competencies are lacking. The study aims to assess the feasibility and utility of a unique surgical palliative care immersion training program.
• Stocker, H. R., Fain, M. J., Mohler, J. J., Peterson, R., Stocker, H. R., Toosizadeh, N., & Wendel, C. S. (2017). BALANCE CHANGES ASSOCIATED WITH SIX-MONTH FRAILTY STATUS CHANGES. Innovation in Aging, 1(suppl_1), 1128-1128. doi:10.1093/geroni/igx004.4123
• Stocker, H. R., Fain, M. J., Mohler, J. J., Peterson, R., Stocker, H. R., Toosizadeh, N., & Wendel, C. S. (2017). FRAILTY TRANSITIONS AMONG OLDER ADULTS. Innovation in Aging, 1(suppl_1), 195-196. doi:10.1093/geroni/igx004.744
• Weiss, B. D., & Fain, M. J. (2017). Dementia Care: More Than Just Prescription Drugs. American family physician, 95(12), 766-767.
• Joseph, B., Zangbar, B., Pandit, V., Fain, M., Mohler, M. J., Kulvatunyou, N., Jokar, T. O., O'Keeffe, T., Friese, R. S., & Rhee, P. (2016). Emergency General Surgery in the Elderly: Too Old or Too Frail?. Journal of the American College of Surgeons, 222(5), 805-13.
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  Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in elective surgical cases. Emerging literature suggests the superiority of frailty measurements to chronological age in predicting outcomes. The aim of this study was to assess the outcomes in elderly patients undergoing EGS using an established Rockwood frailty index.
• Melville, D. M., Mohler, J., Fain, M., Muchna, A. E., Krupinski, E., Sharma, P., & Taljanovic, M. S. (2016). Multi-parametric MR imaging of quadriceps musculature in the setting of clinical frailty syndrome. Skeletal radiology, 45(5), 583-9.
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  Frailty is a common geriatric syndrome associated with loss of skeletal muscle mass (sarcopenia) conferring an increased risk of rapid decline in health and function with increased vulnerability to adverse outcomes. The purpose of this study was to investigate the correlation between diffusion tensor, T2 and intramuscular fat content values of the quadriceps muscle group and clinical frailty status using diffusion tensor MR imaging.
• Nikolich-Žugich, J., Goldman, D. P., Cohen, P. R., Cortese, D., Fontana, L., Kennedy, B. K., Mohler, M. J., Olshansky, S. J., Perls, T., Perry, D., Richardson, A., Ritchie, C., Wertheimer, A. M., Faragher, R. G., & Fain, M. J. (2016). Preparing for an Aging World: Engaging Biogerontologists, Geriatricians, and the Society. The journals of gerontology. Series A, Biological sciences and medical sciences, 71(4), 435-44.
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  Although the demographic revolution has produced hundreds of millions people aged 65 and older, a substantial segment of that population is not enjoying the benefits of extended healthspan. Many live with multiple chronic conditions and disabilities that erode the quality of life. The consequences are also costly for society. In the United States, the most costly 5% of Medicare beneficiaries account for approximately 50% of Medicare's expenditures. This perspective summarizes a recent workshop on biomedical approaches to best extend healthspan as way to reduce age-related dysfunction and disability. We further specify the action items necessary to unite health professionals, scientists, and the society to partner around the exciting and palpable opportunities to extend healthspan.
• O'keeffe, T., Fain, M. J., Hassan, A., Ibraheem, K., Jokar, T. O., Joseph, B., Kulvatunyou, N., Mohler, J., Rhee, P. M., & Tang, A. L. (2016). Functional Recovery in Elderly after Trauma: The Impact of Frailty. Journal of The American College of Surgeons, 223(4), S152. doi:10.1016/j.jamcollsurg.2016.06.329
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  Hassan, Ahmed MD; Rhee, Peter M. MD, MPH, FACS, FCCM; Ibraheem, Kareem MD; Jokar, Tahereh O. MD; Tang, Andrew L. MD, FACS; O’Keeffe, Terence MBChB, FACS; Kulvatunyou, Narong MD, FACS; Fain, Mindy J. MD; Mohler, Jane MPH; Joseph, Bellal MD, FACS Author Information
• Orouji Jokar, T., Ibraheem, K., Rhee, P., Kulavatunyou, N., Haider, A., Phelan, H. A., Fain, M., Mohler, M. J., & Joseph, B. (2016). Emergency general surgery specific frailty index: A validation study. The journal of trauma and acute care surgery, 81(2), 254-60.
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  Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in surgical cases. The aim of our study was to validate a modified 15-variable EGS-specific frailty index (EGSFI).
• Rhodes, S. M., Patanwala, A. E., Cremer, J. K., Marshburn, E. S., Herman, M., Shirazi, F. M., Harrison-Monroe, P., Wendel, C., Fain, M., Mohler, J., & Sanders, A. B. (2016). Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health-Related Emergency Department Visits: A Systematic Medical Record Review. The Journal of emergency medicine, 50(1), 143-52.
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  Behavioral health (BH)-related visits to the emergency department (ED) by older adults are increasing. This population has unique challenges to providing quality, timely care.
• Stocker, H., Wendel, C. S., Fain, M. J., Mohler, J., & Stocker, H. R. (2016). Student Presentation The Frailty Syndrome “eyeball Test” Fails: Geriatricians and Geriatric Fellows Guess Wrong: B68. Journal of the American Geriatrics Society, 64.
• Joseph, B., Pandit, V., Khalil, M., Kulvatunyou, N., Zangbar, B., Friese, R. S., Mohler, M. J., Fain, M. J., & Rhee, P. (2015). Managing older adults with ground-level falls admitted to a trauma service: the effect of frailty. Journal of the American Geriatrics Society, 63(4), 745-9.
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  To determine whether frail elderly adults are at greater risk of fracture after a ground-level fall (GLF) than those who are not frail.
• Miller, G., Miller, C., Marrone, N., Howe, C., Fain, M., & Jacob, A. (2015). The impact of cochlear implantation on cognition in older adults: a systematic review of clinical evidence. BMC geriatrics, 15, 16.
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  Hearing loss is the third most prevalent chronic condition faced by older adults and has been linked to difficulties in speech perception, activities of daily living, and social interaction. Recent studies have suggested a correlation between severity of hearing loss and an individual's cognitive function; however, a causative link has yet to be established. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation. We performed a review to determine the status of the literature on the potential influence of cochlear implantation on cognition in the older adult population.
• Mohler, J., Fain, M., Chen, Z., Lee, J. K., & Thienhaus, O. J. (2015). Depression, antidepressants, and bone health in older adults: a systematic review. Journal of the American Geriatrics Society, 63(3), 623-4.
• Mohler, J., Najafi, B., Fain, M., & Ramos, K. S. (2015). Precision Medicine: A Wider Definition. Journal of the American Geriatrics Society, 63(9), 1971-2.
• Mohler, M. J., Schachter, K. A., Eng, H. J., Fain, M. J., Lee, J. K., Howe, C. L., Alsheri, S., & Ciotan, H. S. (2017). Variation in use of antipsychotic medications in nursing homes in the United States: A systematic review. BMC Geriatrics, 17(1), 32-44. doi:10.1186/s12877-017-0428-1
• Oulton, J., Rhodes, S. M., Howe, C., Fain, M. J., & Mohler, M. J. (2015). Advance directives for older adults in the emergency department: a systematic review. Journal of palliative medicine, 18(6), 500-5.
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  It has been more than two decades since the passage of the Patient Self-Determination Act (PSDA) of 1991, an act that requires many medical points of care, including emergency departments (EDs), to provide information to patients about advance directives (ADs).
• Parvaneh, S., Howe, C. L., Toosizadeh, N., Honarvar, B., Slepian, M. J., Fain, M., Mohler, J., & Najafi, B. (2015). Regulation of Cardiac Autonomic Nervous System Control across Frailty Statuses: A Systematic Review. Gerontology, 62(1), 3-15.
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  Frailty is a geriatric syndrome that leads to impairment in interrelated physiological systems and progressive homeostatic dysregulation in physiological systems.
• Schwenk, M., Mohler, J., Wendel, C., D'Huyvetter, K., Fain, M., Taylor-Piliae, R., & Najafi, B. (2015). Wearable sensor-based in-home assessment of gait, balance, and physical activity for discrimination of frailty status: baseline results of the Arizona frailty cohort study. Gerontology, 61(3), 258-67.
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  Frailty is a geriatric syndrome resulting from age-related cumulative decline across multiple physiologic systems, impaired homeostatic reserve, and reduced capacity to resist stress. Based on recent estimates, 10% of community-dwelling older individuals are frail and another 41.6% are prefrail. Frail elders account for the highest health care costs in industrialized nations. Impaired physical function is a major indicator of frailty, and functional performance tests are useful for the identification of frailty. Objective instrumented assessments of physical functioning that are feasible for home frailty screening have not been adequately developed.
• Taleban, S., Colombel, J. F., Mohler, M. J., & Fain, M. J. (2015). Inflammatory bowel disease and the elderly: a review. Journal of Crohn's & colitis, 9(6), 507-15.
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  Inflammatory bowel disease among the elderly is common, with growing incident and prevalence rates. Compared with younger IBD patients, genetics contribute less to the pathogenesis of older-onset IBD, with dysbiosis and dysregulation of the immune system playing a more significant role. Diagnosis may be difficult in older individuals, as multiple other common diseases can mimic IBD in this population. The clinical manifestations in older-onset IBD are distinct, and patients tend to have less of a disease trajectory. Despite multiple effective medical and surgical treatment strategies for adults with Crohn's disease and ulcerative colitis, efficacy studies typically have excluded older subjects. A rapidly ageing population and increasing rates of Crohn's and ulcerative colitis make the paucity of data in older adults with IBD an increasingly important clinical issue.
• Gebara, M. A., Shea, M. L., Lipsey, K. L., Teitelbaum, S. L., Civitelli, R., Muller, D. J., Reynolds, C. F., Mulsant, B. H., Lenze, E. J., Chen, Z., Fain, M. J., Lee, J. K., Mohler, M. J., & Thienhaus, O. J. (2014). Depression, antidepressants, and bone health in older adults: a systematic review.. Journal of the American Geriatrics Society, 62(8), 1434-41. doi:10.1111/jgs.12945
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  To examine the association between depression, antidepressant use, and bone health in older adults and the implications for treatment..Systematic review..All studies that measured depression or antidepressant exposure and bone mineral density (BMD)..Adults aged 60 and older..Age, site of BMD measurement using dual-energy X-ray absorptiometry (DXA), measure of depression or depressive symptoms, association between BMD changes, and depression or antidepressant use..Nineteen observational studies met the final inclusion criteria; no experimental studies were found. Several cross-sectional and longitudinal studies found that depression or depressive symptoms were associated with a decrease in BMD. Few studies and only two longitudinal studies addressed the association between serotonin reuptake inhibitor (SRI) antidepressant use and a decrease in BMD and they had conflicting results..Depression and depressive symptoms are associated with low bone mass and accelerated bone loss in older adults; putative mechanisms underlying this relationship are discussed. There is insufficient evidence that SRI antidepressants adversely affect bone health. Thus, a change in current recommendations for the use of antidepressants in older adults is not justified at the present time. Given the high public health significance of this question, more studies are required to determine whether (and in whom) antidepressants may be deleterious for bone health.
• Hashmi, A., Ibrahim-Zada, I., Rhee, P., Aziz, H., Fain, M. J., Friese, R. S., & Joseph, B. (2014). Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. The journal of trauma and acute care surgery, 76(3), 894-901.
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  The rate of mortality and factors predicting worst outcomes in the geriatric population presenting with trauma are not well established. This study aimed to examine mortality rates in severe and extremely severe injured individuals 65 years or older and to identify the predictors of mortality based on available evidence in the literature.
• Joseph, B., Pandit, V., Sadoun, M., Zangbar, B., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Frailty in surgery. The journal of trauma and acute care surgery, 76(4), 1151-6.
• Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Hashmi, A., Green, D. J., O'Keeffe, T., Tang, A., Vercruysse, G., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA surgery, 149(8), 766-72.
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  The Frailty Index (FI) is a known predictor of adverse outcomes in geriatric patients. The usefulness of the FI as an outcome measure in geriatric trauma patients is unknown.
• Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Tang, A., O'Keeffe, T., Green, D. J., Vercruysse, G., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis. Journal of the American College of Surgeons, 219(1), 10-17.e1.
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  The Frailty Index has been shown to predict discharge disposition in geriatric patients. The aim of this study was to validate the modified 15-variable Trauma-Specific Frailty Index (TSFI) to predict discharge disposition in geriatric trauma patients. We hypothesized that TSFI can predict discharge disposition in geriatric trauma patients.
• Martinez, G. F., Fain, M. J., Knox, K. S., Lisse, J., Spear-ellinwood, K., Szerlip, H., & Vemulapalli, T. (2014). Finding a mentor: the complete examination of an online academic matchmaking tool for physician-faculty. Southwest Journal of Pulmonary and Critical Care, 9(6), 320-332. doi:10.13175/swjpcc138-14
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  Background: To have a successful career in academic medicine, finding a mentor is critical for physician-faculty. However, finding the most appropriate mentor can be challenging for junior faculty. As identifying a mentor pool and improving the search process are paramount to both a mentoring program’s success, and the academic medical community, innovative methods that optimize mentees’ searches are needed. This cross-sectional study examines the search and match process for just over 60 junior physician-faculty mentees participating in a department-based junior faculty mentoring program. To extend beyond traditional approaches to connect new faculty with mentors, we implement and examine an online matchmaking technology that aids their search and match process. Methods: We describe the software used and events leading to implementation. A concurrent mixed method design was applied wherein quantitative and qualitative data, collected via e-surveys, provide a comprehensive analysis of primary usage patterns, decision making, and participants’ satisfaction with the approach. Results: Mentees reported using the software to primarily search for potential mentors in and out of their department, followed by negotiating their primary mentor selection with their division chief’s recommendations with those of the software, and finally, using online recommendations for self-matching as appropriate. Mentees found the online service to be user-friendly while allowing for a non-threatening introduction to busy senior mentors. Conclusions: Our approach is a step toward examining the use of technology in the search and match process for junior physician-faculty. Findings underscore the complexity of the search and match process.
• Mohler, M. J., Fain, M. J., Wertheimer, A. M., Najafi, B., & Nikolich-Žugich, J. (2014). The Frailty syndrome: clinical measurements and basic underpinnings in humans and animals. Experimental gerontology, 54, 6-13.
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  Frailty is an increasingly recognized syndrome resulting in age-related decline in function and reserve across multiple physiologic systems. It presents as a hyperinflammable state, characterized by high vulnerability for adverse health outcomes, such as disability, falls, hospitalization, institutionalization, and mortality. The prevalence of Frailty Syndrome (FS) is of potentially enormous significance, as it potentially affects 20-30% of adults older than 75. Cellular and molecular basis of frailty has not been elucidated. The objective of this review is to discuss recent advances in: (i) the potential cellular and molecular basis of Frailty Syndrome, including development of new models to study it; (ii) the human and animal measures of Frailty Syndrome; and (iii) the development of objective cross-species correlates to aid the basic understanding, diagnosis, treatment and rehabilitation of Frailty Syndrome in older adults.
• O'neill, L., Began, V. D., Clemens, C. J., D'huyvetter, K., Fain, M. J., Mohler, J., Waer, A. L., & Wendel, C. S. (2014). Development of an Enhanced Interprofessional Chief Resident Immersion Training (IP-CRIT) Program.. Gerontology & geriatrics education, 35(4), 354-68. doi:10.1080/02701960.2013.858331
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  Using interprofessional faculty, the authors reviewed and enhanced the nationally renowned Chief Resident Immersion Training (CRIT) in the Care of Older Adults Program to include Triple Aim objectives and interprofessional competency-based content and developed the Interprofessional CRIT. Evaluations were positive and sustained. The authors educated chief residents about value-based care, linking them to key interprofessional staff to build team-based care. The authors addressed quality improvement issues identified by the Institute of Medicine and our health network. Chief residents are now better prepared to train medical students and residents using a team-based, patient-centered approach, and a culture of continual quality improvement toward improved care of older patients.
• Sanguineti, V. A., Wild, J. R., & Fain, M. J. (2014). Management of postoperative complications: general approach. Clinics in geriatric medicine, 30(2), 261-70.
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  The goal of postoperative management is to promote early mobility and avoid postoperative complications, recognizing the potentially devastating impact of complications on elderly patients with hip fracture. The recommended approach involves early mobilization; freedom from tethers (indwelling urinary catheters and other devices); effective pain control; treating malnutrition; preventing pressure ulcers; reducing risk for pulmonary, urinary, and wound infections; and managing cognition. This carefully structured and patient-centered management provides older, vulnerable patients their best chance of returning to their previous level of functioning as quickly and safety as possible.
• Fain, M., Mohler, M. J., O'Neill, L., D'Huyvetter, K., Clemens, C. J., Waer, A., Began, V. D., & Fain, M. J. (2013). Supporting the triple aim: interprofessional chief resident in training program. Journal of the American Geriatrics Society, 61(10).
• Fain, M., Phan, H. M., Alpert, J. S., & Fain, M. J. (0). Frailty, inflammation, and cardiovascular disease: evidence of a connection. The American journal of geriatric cardiology, 17(2).
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  Frailty is a progressive physiologic decline in multiple body systems marked by loss of function, loss of physiologic reserve, and increased vulnerability to disease and death. Until recently, frailty has been poorly defined in the medical literature. One currently accepted definition of frailty is having 3 of the following 5 attributes: unintentional weight loss, muscle weakness, slow walking speed, easy exhaustion, and low physical activity. The mechanisms that underline frailty remain unclear. Significantly higher levels of markers of inflammation and the clotting cascade have been found in frail persons compared with nonfrail persons. These markers are also risk factors for the development of coronary heart disease. Recent research has indicated that frailty is a clinical manifestation of cardiovascular disease, especially of heart failure. Thus, understanding the connection between frailty and cardiovascular disease may lead to development of new interventions that will prevent and reverse the associated morbidity and mortality.
• Weiss, B. D., Fain, M. J., & Mohler, M. J. (2011). Geriatrics in Taiwan: What is the solution?. Journal of Clinical Gerontology and Geriatrics, 2(4), 93-95. doi:10.1016/j.jcgg.2011.11.011
• Wendel, C. S., Bobrow, B. J., Clark, L., Fain, M. J., Itty, A., Mohler, M. J., Mosier, J., & Sanders, A. B. (2011). Cardiocerebral resuscitation improves out-of-hospital survival in older adults.. Journal of the American Geriatrics Society, 59(5), 822-6. doi:10.1111/j.1532-5415.2011.03400.x
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  To compare the survival and neurological status of people aged 65 and older receiving cardiocerebral resuscitation (CCR) with that of those receiving standard advanced life support (Std-ALS), as well as predictors of survival..Historical prospective cohort study..The Save Hearts in Arizona Registry (SHARE)..Persons who had experienced cardiac arrest receiving CCR or Std-ALS..Patient demographics, emergency medical service events, survival to hospital discharge, and out-of-hospital cardiac arrest (OHCA) outcomes were obtained from Arizona hospital records and Bureau of Public Health Statistics from 2005 to 2008..People receiving CCR were twice as likely to survive as those receiving Std-ALS (adjusted odds ratio=2.0, P=.005). An additional 20 per 1,000 older adults would survive, above the background survival rate of Std-ALS, if given CCR. More than 96% of those receiving CCR had good or moderate neurological outcomes, compared with 89% of those receiving Std.-ALS (P=.41)..CCR is associated with superior survival outcomes than Std-ALS for OHCAs in people aged 65 and older. Use of CCR in older adults without known do-not-resuscitate status is warranted. These findings should be understood within the broader context of the essential role of comprehensive advance care planning in providing care consistent with patient goals and values.
• Fain, M., Mohler, M. J., D'Huyvetter, K., Tomasa, L., O'Neill, L., & Fain, M. J. (2010). Healthy aging rounds: using healthy-aging mentors to teach medical students about physical activity and social support assessment, interviewing, and prescription. Journal of the American Geriatrics Society, 58(12).
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  Medical students underestimate the health and functional status of community-dwelling older adults and have little experience in health promotion interviewing or prescribing physical activity. The goal was to provide third-year University of Arizona medical students with an opportunity to gain a broader and evidence-based understanding of healthy aging, with specific focus on physical activity and social engagement. Students engaged in one-on-one conversations with healthy older adult mentors and practiced assessment, interviewing and prescription counseling for physical activity and social support. This 2-hour mandatory interactive educational offering improved student attitudes and knowledge about healthy aging and provided hands-on health promotion counseling experience.
• Fain, M., Weiss, B. D., & Fain, M. J. (2009). Geriatric education for the physicians of tomorrow. Archives of gerontology and geriatrics, 49 Suppl 2.
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  The world's population is aging and there is need for more geriatricians. Current training programs, however, are not producing a sufficient number of geriatricians to meet that need, largely because students and residents lack interest in a career in geriatrics. A variety of reasons have been suggested to explain that lack of interest, and several changes in geriatrics training might increase the number of medical trainees who choose a career in geriatrics. These changes include recruiting medical students who are predisposed to geriatrics, loan forgiveness programs for those who enter careers in geriatrics, increased reimbursement for geriatric care, providing geriatric education to physicians in all specialties throughout their training, and refocusing geriatrics training so it includes the care of healthy vigorous older adults, rather than an exclusive focus on those with debility and chronic or fatal illnesses.
• Shanmugasundaram, M., Fain, M. J., Mohler, J., Wendel, C. S., & Alpert, J. S. (2009). Predictors of Recurrent Cardiovascular hospitalizations in Patients with Diastolic Heart Failure. Journal of Cardiac Failure, 15(6), S 121.
• Ahmed, N., Mandel, R., & Fain, M. (2008). The Reply. American Journal of Medicine, 121(2). doi:10.1016/j.amjmed.2007.10.018
• Alpert, J. S., Fain, M. J., & Phan, H. M. (2008). Frailty, inflammation, and cardiovascular disease: evidence of a connection.. The American journal of geriatric cardiology, 17(2), 101-7.
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  Frailty is a progressive physiologic decline in multiple body systems marked by loss of function, loss of physiologic reserve, and increased vulnerability to disease and death. Until recently, frailty has been poorly defined in the medical literature. One currently accepted definition of frailty is having 3 of the following 5 attributes: unintentional weight loss, muscle weakness, slow walking speed, easy exhaustion, and low physical activity. The mechanisms that underline frailty remain unclear. Significantly higher levels of markers of inflammation and the clotting cascade have been found in frail persons compared with nonfrail persons. These markers are also risk factors for the development of coronary heart disease. Recent research has indicated that frailty is a clinical manifestation of cardiovascular disease, especially of heart failure. Thus, understanding the connection between frailty and cardiovascular disease may lead to development of new interventions that will prevent and reverse the associated morbidity and mortality.
• Fain, M. J., Klotz, S. A., & Martin, C. P. (2008). The older HIV-positive adult: a critical review of the medical literature.. The American journal of medicine, 121(12), 1032-7. doi:10.1016/j.amjmed.2008.08.009
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  Older adults make up an ever-growing proportion of human immunodeficiency virus (HIV) cases in the United States, with approximately 25% of infections occurring in adults over the age of 50 years. Although there is a preliminary body of literature addressing the socioeconomic and prognostic issues of HIV infection in older adults, very little rigorous scientific research has looked at the significant clinical issues relevant to this growing population. Treatment of older adults is complicated by an increased prevalence of medical comorbidities, but little is known about the effects of complicated medication regimens in this group, as they are routinely excluded from clinical trials of newer HIV medications. The delay in diagnosis and treatment of HIV in older adults has led to poorer outcomes, including lower baseline CD4 counts, decreased time to acquired immune deficiency syndrome diagnosis, and increased mortality. Despite these facts, there is mounting evidence that timely diagnosis and treatment of HIV in older adults leads to improved outcomes, similar to younger patients. This review evaluates the literature focusing on HIV and older adults.
• Ahmed, N. N., Fain, M. J., Mandel, R. M., & Mandel, R. (2007). Frailty: an emerging geriatric syndrome.. The American journal of medicine, 120(9), 748-53. doi:10.1016/j.amjmed.2006.10.018
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  Frailty is a new and emerging syndrome in the field of geriatrics. The study of frailty may provide an explanation for the downward spiral of many elderly patients after an acute illness and hospitalization. The fact that frailty is not present in all elderly persons suggests that it is associated with aging but not an inevitable process of aging and may be prevented or treated. The purpose of this article is to review what is known about frailty, including the definition, epidemiology, and pathophysiology, and to examine potential areas of future research.
• Fain, M., Demeure, M. J., & Fain, M. J. (2006). The elderly surgical patient and postoperative delirium. Journal of the American College of Surgeons, 203(5).
• Fain, M. J. (2003). Rebuttal by Dr Fain. JAMA Internal Medicine, 163(18), 2131-2131. doi:10.1001/archinte.163.18.2131
• Fain, M., & Fain, M. J. (2003). Should older drivers have to prove that they are able to drive?. Archives of internal medicine, 163(18).
• Spagnuolo, P., Fain, M., & Bass, S. (1987). Dissociation of neutrophil aggregation, adhesiveness, and Fc receptor activity. American Journal of Hematology, 26(3). doi:10.1002/ajh.2830260303
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  Neutrophils that bear receptors for the Fc portion of immunoglobulin G have been demonstrated to be more active in assays of adherence, aggregation, and chemotaxis compared to Fc receptor‐negative cells. We examined the relationship of neutrophil Fc receptor activity and cell–cell adherence or aggregation induced by phorbol myristate acetate. In contrast to 1‐isoproterenol, isobutyl‐methyl‐xanthine, and dibutyryl cAMP, each of which inhibited Fc receptor activity and neutrophil aggregation, theophylline significantly impaired aggregation without affecting Fc receptor activity. The selective beta‐2 agonist, metaproterenol, and 8‐Bromo cAMP failed to inhibit Fc receptor activity or neutrophil aggregation. Three known inducers of neutrophil intracellular cyclic AMP, PGE1, PGE2, and cholera toxin, also did not inhibit Fc receptor activity. Inhibition of Fc receptor activity by 95% in the presence of purified Fc fragments did not affect neutrophil aggregation. Similarly suppression of Fc receptor activity by purified Fc fragments did not inhibit neutrophil adhesion to nylon fiber columns. These data demonstrate that the Fc receptor does not mediate phorbol myristate acetate‐induced cell–cell adhesion and is not necessary for optimal neutrophil adhesion to nylon fibers. Our results are consistent with the possibility that the reversible inhibitory activity of beta‐adrenergic agonists on rosette formation may be a steric effect rather than a metabolic effect. These data tend to dissociate Fc receptor activity, neutrophil aggregation, and adhesion and support the hypothesis that the Fc receptor may be a marker of neutrophil heterogeneity rather than a component necessary for optimal neutrophil aggregation or adhesion. Copyright © 1987 Wiley‐Liss, Inc., A Wiley Company

Poster Presentations

• Sokan, A. E., Fain, M. J., Phillips, L. R., Harwood, J. T., & et., a. (2021, November). Measuring Covid-related Ageism.. Gerontological Society of America annual conference. November, 2021. Virtual: GSA.
• Stocker, H., Mohler, M. J., Wendel, C. S., & Fain, M. J. (2016, May 2016). The Frailty Syndrome “Eyeball Test” Fails: Geriatricians and Geriatric Fellows Guess Wrong.. Presidential Poster Session, American Geriatrics Society Annual Scientific Meeting. Long Beach, CA.: American Geriatrics Society.
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  Stocker H., Mohler J., Wendel C., Fain M. The Frailty Syndrome “Eyeball Test” Fails: Geriatricians and Geriatric Fellows Guess Wrong. Accepted for Presidential Poster Session, American Geriatrics Society Annual Scientific Meeting, Long Beach, CA. May 19-21, 2016.
• Bannis, K., Bhargava, R. K., Mandel, R., Weiss, B. D., O'Neill, L., Mohler, J., Wang, J., Cheng, K., Ananth, A., & Fain, M. J. (2015, April). Elder Care. A Novel Application-Based Medical Database. Arizona Geriatric Society.

Reviews

• Cegledi, A., Cegledi, A., Russell, S., Russell, S., Phillips, L. R., Phillips, L. R., Scott, S., Scott, S., Fain, M. J., Fain, M. J., Lieberman, D., Lieberman, D., Partha, I., Partha, I., Nikolich, J. Z., Nikolich, J. Z., Parker, K., & Parker, K. (2024. Post-Acute Sequelae of SARS-CoV-2 Infection (Long COVID) in Older Adults.
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  Invited review article in preparation for publication 2024

Others

• Jason, K., Wager, M., Robles, D., Insel, K. C., Verhougstraete, M., O'Neill, L. M., Phillips, L. R., Fain, M. J., Yuan, N. P., Yang, Y., Kenning, H., Butt, H., Sokan, A. E., & Chen, Z. (2021, November). Impact of COVID-19 on Older Employees of a Large State University: Findings From a Mixed-Methods Study.. Symposium - Gerontological Society of America annual conference.
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  Symposium