for Research and Education on Aging (PREA)
To improve the quality of life for older and disabled Ohioans
through research and education programming in the areas of acute, post
acute, long term, and palliative care that informs clinicians and policymakers
about cost effective innovations that are ripe for implementation.
LTC has been transformed in the past 20 years from a residential
service for the frail and cognitively impaired to a spectrum of services
serving residential, restorative, and palliative roles for many older
adults. Quality care remains a critical issue in many residential
care settings. Issues of quality of life, autonomy, and functional
restoration and maintenance however are increasingly important concerns
in LTC. How our society will support this rapidly growing segment
of health care is a challenge for providers and state and federal
Our ongoing LTC research projects include: 1) analysis of longitudinal
data for a recently completed randomized clinical trial testing a
care coordination model of "all-inclusive long term care programs
for frail elderly veterans (New Milennium Bill funded research "
2) an analysis of the clinical outcomes resulting from the 1997 Balanced
All-Inclusive Care for the Elderly
Long Term Care and Rehabilitation
Recent Publications on Long Term Care
||Bowman, K. M., Rose, J. H., & Kresevic,
D. (1998). Family caregiving of hospitalized older patients:
Caregiver and nurse perceptions at admission and discharge.
Journal of Gerontological Nursing,24,(8),2-10.
||Murray PK, Singer ME, Fortinsky R, Russo
L, Cebul RD (1999) Rapid Growth of Rehabilitation Services in
Traditional Nursing Homes, Arch Phys Med Rehabil. 80:372-378.
||Murray PK, Singer M, Dawson NV, Thomas
CL, Cebul RD. (2003) Outcomes of rehabilitation services for
nursing home residents. Arch Phys Med Rehabil. Aug;84(8):1129-36.
|| D'Eramo A, Papp K, & Rose, JH (2001)
Complementary therapies training for Nursing Assistants.
Geriatric Nursing . 22(4): 201-207.
||Rose JH, Bowman KF, & Kresevic D (2000))
Nurse versus family caregiver perspectives on hospitalized older
patients: An exploratory study of agreement at admission and
discharge. Health Communication. 12(1): 63-80.
in the Elderly
There is growing recognition of the need to examine age and cohort
differences in cancer care practices and patient outcomes from diagnosis
and treatment to long-term survivorship or end-of-life. Age is a key
consideration in testing interventions to improve care practices and
quality of life outcomes for patients over time. The incidence of
cancer is rising and occurs with greater frequency throughout the
middle years. It is already the leading cause of death among women
in their forties and fifties and is the second leading cause of death
for men in this age group. The prevalence of cancer is highest among
adults over age 60 and is now the leading cause of death among older
adults in their sixties and seventies, replacing heart disease. The
number of long term survivors of cancer is also on the increase, including
older long term survivors who may require assistance in follow up
over time. Studies to date suggest that patients' age is an important
factor in communication and medical decision making in both hospital
and community-based settings. Educational and training programs for
health professionals in cancer care must be expanded to include curricula
that enhance knowledge, attitudes and skills in evidence-based clinical
care of older cancer patients.
Our ongoing aging and cancer research projects include 1) a randomized
clinical trial to test a coping and communication support intervention
for middle-aged and older advanced cancer patients (NCI R01 and VA
HSR&D funded research) and 2) collaboration on a longitudinal study
of older long-term cancer survivors and their family members (NCI
R01 and R03 funded research). In addition, we are developing a program
for psychosocial and health services research on aging and cancer,
in collaboration with the Aging and Cancer Research Initiative (NCI-NIA
P-20) at the Case Comprehensive Cancer Center (CCCC). Education and
training initiatives also are planned in collaboration with the CCCC
Aging and Cancer Research Initiative and include developing, implementing
and evaluating a curriculum in geriatric oncology for geriatric fellows
and oncology fellows trained together, building on our conceptual
framework for shared care of older patients. The Western Reserve Geriatric
Education Center is taking a lead in developing and disseminating
continuing education programs for the health professions on topics
related to geriatric oncology and shared care.
Recent Publications on Cancer in the Elderly:
||Rose, J. H., O'Toole, E. E., Dawson, N.
V., Thomas, C. Connors, A. F., Wenger, N., Phillips, R. S.,
Hamel, M.B., Cohen, H. J., & Lynn, J. (2000). Age differences
in care practices and outcomes for hospitalized patients with
cancer. Journal of the American Geriatrics Society, 48,
||Rose, J. H., O'Toole, E. E., Dawson, N.
V., Lawrence R., Gurley D., Thomas C., Hamel, M.B., Cohen, H.
J., & Lynn, J. (2004). Perspectives, preferences, care practices,
and outcomes among older and middle-aged patients with late-stage
cancer. J Clin Oncol, 15;22(24):4907-17.
||Rose JH, Bowman KF, Deimling G, Stoller
E (2004). Health maintenance activities and lay decision-making
support: A comparison of young-old and old-old long-term survivors.
Journal of Psychosocial Oncology, 22: 3.
||Bowman KF, Rose, J. H., Deimling, G. (in
press). Predicting health maintenance of families in long-term
care survivorship: Advocacy and practice. Journal of Psycho-Oncology,
The paradigm through which policymakers, clinicians, researchers
consider disability has undergone a major revision in recent years.
Using technological, policy, and educational tools to enable abilities
has supplanted a focus on lessening impairment as a major direction.
Our currently funded development and research project designs and
evaluates a shared decision making program that meshes with this new
Decision Making Project
Recent Pulications on Enhancing Abilities:
||Jain N, Layton BS, Murray PK.(2000) Are
aphasic patients who fail the GOAT in PTA? A modified Galveston
orientation and amnesia test for persons with aphasia. Clinical
||Wuolle KS, Bryden AM, Peckham PH, Murray PK,Keith
M.(2003) Satisfaction with upper-extremity surgery in individuals
with tetraplegia. Arch Phys Med Rehabil 84(8):1145-9
Palliative and End of Life Care
There is a clearly demonstrated need for research and education
to improve care for older adults during chronic illness and at end
of life. This is evidenced by such recent publications as: The American
Geriatrics Society Position Statement on the Care of Dying Patients
(2002), Clinical Practice Guidelines for Quality Palliative Care (2004),
Recommended Competencies and Curricular Guidelines for End of Life
Nursing Care (2004), National Association of Social Workers Standards
for Palliative and End of Life Care (2004), and the NIH Consensus
on the State of the Science on Improving End-of-Life Care (2004).
America's elders often confront the challenges of living and dying
with acute and chronic illness, impairments and suffering. Improved
education and training that merges state of the art knowledge and
skills in palliative care and geriatrics to better serve the geriatric
palliative care needs of this population will be a focus of our efforts.
Our ongoing geriatric palliative and end of life care research includes
1) collaboration on a new intervention study to examine intensive
communication in the chronically critically ill (NINR R01 funded project).
In addition, we are developing White Paper recommendations for education
and training in the new field of geriatric palliative care (HRSA BHPr
funded project). Mentorship for junior faculty and students in medicine,
nursing and social work is recognized as a high priority in advancing
this new field. The new Institute for Palliative and End-of-Life Care
will collaborate with the Western Reserve Geriatric Education Center
to develop, implement and evaluate a new interdisciplinary faculty
development curriculum on Geriatric Palliative Care at Case.
Research and Education programs are closely tied to the development,
implementation and evaluation of our clinical programs, e.g., Residency
Training and the Palliative Care program (including consultation and
direct care) across the MetroHealth System.
Recent Publications on End of Life Care:
||Rose, J. H., O'Toole, E. E., Dawson, N.
V., Thomas, C., Conners, A. F., Wenger, N., Phillips, R. S.,
Hamel, M.B., Reding, D. T., Cohen, H. J., Lynn, J. (2000). Generalists
and oncologists show similar care practices and outcomes with
hospitalized late stage adult cancer patients. Medical Care,
||Daly BJ, Douglas SL, Kelly CG, O'Toole E,
Montegro HD (in press). Trial of a disease management program
reduced readmissions in the chronically critically ill. Chest.