Mindy J Fain

Interests

Teaching

Geriatric Education and TrainingInterprofessional Education and Collaborative Practice

Research

High value models of care for frail eldersFrailty-Resilience

Courses

Scholarly Contributions

Journals/Publications

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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., & Fain, M. J. (2003). Should older drivers have to prove that they are able to drive?. Archives of internal medicine, 163(18).

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.

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