Program for Research and Education on Aging (PREA)

Directors Patrick K. Murray, M.D., M.S.
Julia H. Rose, Ph.D., M.A.



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.

Research Themes

Long Term Care
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 governments alike.

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 Budget Amendment.

All-Inclusive Care for the Elderly Project
Long Term Care and Rehabilitation Project

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.
Cancer 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, S25-S32.
  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,
Enhancing Abilities
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 paradigm shift.

Shared 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 Neuropsychologist 14:13-17
  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
Geriatric 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, 28, 1103-1118.
  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.

Educational Programs

Western Reserve Geriatric Education Center (WRGEC) []
National Technical Advisory Center for Geriatric Education Centers (website under construction)
Division of Geriatrics and Palliative Care (website under construction)

Associated Faculty

Elizabeth O'Toole, MD
Mary Jo Roach, PhD

Aging Links

Geriatric Research Education & Clinical Care (GRECC)
Case Western Reserve University Center on Aging

Positions Available

Geriatrics/Palliative Care Health Services Researcher


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