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| ### GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTER                 |
|                                                                       |
| ### *Annual Report: Fiscal Year [2004]{.underline}*                   |
|                                                                       |
| ######## Part II: Accomplishments                                     |
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| **NOTE:** The **GRECC Annual Report** reflects status and             |
| accomplishments of **[GRECC Core Staff]{.underline}** (as defined     |
| below) [only]{.underline}. Report year is from [October 1 through     |
| September 30]{.underline}. [This Accomplishments report should be no  |
| more than a [total of ten pages]{.underline}.]{.mark}                 |
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| **GRECC Core Staff** includes **Primary Core**, **Affiliated Core,**  |
| and **Research Core.** **Primary Core =** positions authorized by the |
| original GRECC allocation plus any addition in ceiling from VA        |
| Central Office specifically designated for GRECC. **Affiliated Core** |
| = Staff who work full- or part-time in [direct support]{.underline}   |
| of the GRECC's research, education or clinical activity. May be       |
| either "contributed" by the VA Medical Center or acquired through     |
| centralized enhancements/awards for programs such as Home-Based       |
| Primary Care, Geriatric Evaluation and Management Program, etc. To be |
| considered Affiliated Core, staff must be organizationally aligned    |
| under the GRECC or specifically identified by the Medical Center as   |
| GRECC-affiliated staff. **Research Core** = Full-or part-time staff   |
| who devote 51% or more of their total time to GRECC research and      |
| whose salaries are supported by research funds (either VA or non-VA). |
| Includes all GRECC staff whose salaries are paid from research funds  |
| (e.g., Associate Investigator, Assistant Research Scientist, Senior   |
| Research Career Scientist; Research Career Scientist, Advanced        |
| Research Career Scientist).                                           |
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| **1. GRECC NAME/LOCATION**                                            |
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| a.  **GRECC Name:** Wm. S. Middleton Memorial VAH -- GRECC            |
|                                                                       |
| b.  **Location** *(facility, VISN)*: Madison, WI; VISN 12             |
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| **2. CONTACT PERSON**                                                 |
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| a.  **Name:** Ce Doskocil                                             |
|                                                                       |
| b.  **Position:** Administrative Officer                              |
|                                                                       |
| c.  **Phone, e-mail:** 608-280-7000; cecilia.doskocil@med.va.gov      |
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| **3. GRECC FOCUS AREA(S)**                                            |
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| **NOTE:** Each problem area should ideally be approached from the     |
| basic biomedical, clinical [and]{.underline} health services research |
| perspectives, as well as from the rehabilitation research perspective |
| where that expertise exists. The number of problem areas should be    |
| limited to one or two. If the focus of research is different for      |
| basic biomedical, clinical, health services and/or rehabilitation     |
| research, there should be no more than a [total]{.underline} of 4     |
| major areas of investigation. [Changes to GRECC focus area(s) must be |
| approved by VACO (114).]{.mark}                                       |
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| a.  **Basic Biomedical**: 1) Nutrition/Oxidative Stress               |
|                                                                       |
| 2\) Bone & Mineral Metabolism                                         |
|                                                                       |
| b.  **Applied Clinical**: 3) Alzheimer's Disease and Related          |
|     Dementias                                                         |
|                                                                       |
| c.  **Health Services**: None                                         |
|                                                                       |
| d.  **Rehabilitation**: 4) Dysphagia                                  |
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| **4. ADMINISTRATION**                                                 |
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| a.  **GRECC Impact on Host VAMC in Current Year** *([list up to       |
|     five]{.mark} most important ways in which the GRECC has had       |
|     specific impact on host VAMC research, staff education, program   |
|     evaluation, or clinical care improvements for elderly veteran,    |
|     i.e., how the GRECC has "made a difference" in these areas within |
|     the entire host VAMC; [up to five lines each]{.mark})*:           |
|                                                                       |
| -   VA research studies significantly enhanced VERA earnings due to   |
|     increased research dollars.                                       |
|                                                                       |
| -   The increase in research hires has strengthened local facility's  |
|     capacity to conduct memory research.                              |
|                                                                       |
| -   Palliative Care Consult Service mandate is being met due to GRECC |
|     faculty involvement.                                              |
|                                                                       |
| -   The GRECC Sleep Clinic is the first clinic to support the VISN    |
|     and local Sleep Program at the Madison VA.                        |
|                                                                       |
| -   The GRECC Core Topic Lecture Series has adapted its format so     |
|     that a large number of non-geriatric primary care providers are   |
|     attending.                                                        |
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| b.  **GRECC Impact on VISN in Current Year** *([list up to            |
|     five]{.mark} most important ways in which the GRECC has had       |
|     specific VISN-wide impact on research, education/training,        |
|     program evaluation, or clinical care improvements for elderly     |
|     veterans, i.e., how GRECC participation in VISN-wide activities   |
|     has "made a difference" in these areas within the entire VISN;    |
|     [up to five lines each]{.mark}.* NOTE: GRECCs are intended and    |
|     expected to serve as a [regional]{.underline}, and not merely     |
|     local resource*)*:                                                |
|                                                                       |
| -   Dr. Michael Siebers, GRECC GEM Director, continued his            |
|     involvement with the VISN Long-Term Care Committee.               |
|                                                                       |
| -   The GRECC Sleep Clinic is the first clinic to support the VISN    |
|     and local Sleep Program at the Madison VA.                        |
|                                                                       |
| -   GRECC Memory Clinic is unique within VISN 12 and supports         |
|     patients from several northern tier sites (Tomah; Iron Mountain;  |
|     Baraboo).                                                         |
|                                                                       |
| -   Madison GRECC research programs are conducting nationally         |
|     recognized work that has enhanced the reputation of VISN 12.      |
|                                                                       |
| -   Madison GRECC submitted an ORD invited proposal for a Clinical    |
|     Research Centers of Excellence (CRCoE) within VISN 12. Following  |
|     submission of the proposal, funding for the CRCoE were reduced    |
|     from 10 proposed sites to 2 approved sites.                       |
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| c.  **GRECC Trend-Setting Innovations since October 1,                |
|     [1999]{.underline}** *([list up to five]{.mark} most significant  |
|     GRECC research, education or clinical innovations in past five    |
|     years; for each item, provide date, GRECC staff responsible, and  |
|     [up to five line]{.mark} description)*:                           |
|                                                                       |
| -   Dr. Weindruch's research has employed microarrays ("gene chips")  |
|     to provide a global view of the effects of aging and caloric      |
|     restriction (CR, as state of aging retardation) on gene           |
|     expression in mice. Prior to the development of this technology,  |
|     the activities of genes were largely determined for one gene at a |
|     time. Microarrays allow one to monitor the activity of thousands  |
|     of genes in a single experiment. Work is now focused on using     |
|     this technology to determine critical shifts in the expression of |
|     genes underlying the retardation of aging by CR. (Weindruch, PhD) |
|                                                                       |
| -   Historically solutions used in video floroscopy swallowing were   |
|     not standardized. This GRECC has developed standard methods that  |
|     have lead to intellectual property that has been licensed through |
|     the Wisconsin Alumni Research Foundation (WARF) and has resulted  |
|     in diagnostic barium materials used nationally. (Robbins, PhD)    |
|                                                                       |
| -   As a result of the VA RR&D Grant received by the GRECC/UW         |
|     Swallowing Laboratory, an intra-oral exercise program has been    |
|     developed and disseminated to Speech and Language programs        |
|     throughout the country. (Robbins, PhD)                            |
|                                                                       |
| -   Performance-based evaluation of physical functions/skills of      |
|     older adults with Alzheimer's disease and cancer. (Asthana, MD)   |
|                                                                       |
| -   A three-volume compendium of key geriatrics reference articles    |
|     was developed and collated for geriatric medicine and geriatric   |
|     psychiatry fellows in May 2003. This included over 150 articles   |
|     organized using content areas adapted from the table of contents  |
|     of the American Geriatrics Society's (AGS) Geriatric Review       |
|     Syllabus. (Barczi, MD)                                            |
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| **5. RESEARCH**                                                       |
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| a.  **Key Findings Published in Current Year -- GRECC Core Staff as   |
|     PI or CO-PI** *([list up to five]{.mark}; for each item provide   |
|     GRECC Core Staff name(s), journal reference, and [up to five      |
|     line]{.mark} description of topic/method/ results/clinical        |
|     significance; use layperson language)*:                           |
|                                                                       |
| Baker LD, Sambamurti K, Craft S, Cherrier M, Stanczyk FZ, Raskind MA, |
| Plymate SR, **Asthana S:** Estrogen therapy improves plasma           |
| beta-amyloid for postmenopausal women with AD. *Am J Geriatr          |
| Psychiatry*, vol 11(2), pp 239-244, 2003.                             |
|                                                                       |
| The findings of this study, for the first time, indicated that        |
| treatment with transdermal estradiol favorably reduced plasma levels  |
| of Aβ-40 in postmenopausal women with Alzheimer's disease (AD). These |
| findings provide the first evidence that, similar to animal           |
| experiments, estrogen can favorably influence processing of amyloid   |
| precursor protein (APP) in subjects with AD.                          |
|                                                                       |
| Bowen, R.L. and **Atwood, C.S.** (2004). Living and Dying for Sex: A  |
| theory of aging based on the                                          |
|                                                                       |
| modulation of cell cycle signaling by reproductive hormones.          |
| *Gerontology* 50, 265-290.                                            |
|                                                                       |
| The basic premise behind this research program is that hormones that  |
| regulate reproduction in mammals                                      |
|                                                                       |
| act in an antagonistic pleiotrophic manner to control aging via cell  |
| cycle signaling; promoting growth and development early in life in    |
| order to achieve reproduction, but later in life, in a futile attempt |
| to maintain reproduction, become dysregulated and drive senescence.   |
| This premise forms the basis of a new theory                          |
|                                                                       |
| of aging that was published in Gerontology this year and that         |
| provides a plausible explanation of why                               |
|                                                                       |
| and how we age.                                                       |
|                                                                       |
| Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, DeLuca   |
| HF, **Drezner, MK**: Assay variation confounds the diagnosis of       |
| hypovitaminosis D: a call for standardization*. J Clin Endocrinol     |
| Metab* 89:3152-3157, 2004.                                            |
|                                                                       |
| Measurement of 25-hydroxyvitamin D, a metabolite of vitamin D, is     |
| essential to determine if a patient has adequate stores of this       |
| vitamin. We showed that conventional commercial assays of this        |
| metabolite do not correlate well with the gold standard for the       |
| measurement, high performance liquid chromatography, suggesting that  |
| alternative strategies should be developed to assess vitamin D stores |
| in humans.                                                            |
|                                                                       |
| The response of the hippocampus to repetition is sensitive to people  |
| with memory impairment:                                               |
|                                                                       |
| **Johnson, SC**, Baxter, LC, Susskind-Wilder, L, Connor, DJ, Sabbagh, |
| MN, Caselli, RJ. (2004). Hippocampal adaptation to face repetition in |
| healthy elderly and mild cognitive impairment. *Neuropsychologia,     |
| 42,* 980-989.                                                         |
|                                                                       |
| The purpose was to determine whether stimulus repetition can alter    |
| the response of the hippocampus, a brain area for learning and        |
| memory. Functional MRI was used to show that the hippocampus responds |
| to repetition in healthy adults, but not in people with memory        |
| impairment. Results provide a strong link between function of the     |
| hippocampus and new learning; findings are applicable to early        |
| detection of AD.                                                      |
|                                                                       |
| **Puglielli, L.** The ACAT inhibitor CP-113,818 markedly reduces      |
| amyloid pathology in a mouse model of Alzheimer's disease. Journal:   |
| *Neuron* 2004; 44: 227-238.                                           |
|                                                                       |
| Here, we have assessed the efficacy of the ACAT inhibitor CP-113,818  |
| in reducing Alzheimer's disease-like pathology in the brains of       |
| transgenic mice. CP-113,818 treatment both brain amyloid plaque load  |
| (by 88-99%) and insoluble Aß levels (by 83-96%). CP-113,818 also      |
| improved spatial learning, which correlated with decreased Aß levels. |
| Our results suggest that ACAT inhibition may be effective in the      |
| prevention and treatment of Alzheimer's disease by inhibiting the     |
| generation of Aß peptide.                                             |
|                                                                       |
| Higami Y, Pugh TD, Page G, Allison DB, Prolla TA, **Weindruch R**:    |
| Adipose tissue energy metabolism: altered gene expression profile of  |
| mice subjected to long-term caloric restriction. *FASEB J.* 18:415-7, |
| 2004.                                                                 |
|                                                                       |
| We investigated the influences of short-term and long-term caloric    |
| restriction (LCR) on gene expression in white adipose tissue (WAT).   |
| Over 11,000 genes were examined in four groups of 10- to 11-month-old |
| male C57Bl6 mice: 1) fasted for 18 h before death (F); 2) short-term  |
| caloric restriction for 23 days (SCR); 3) LCR for 9 months; and 4)    |
| nonfasted control (CO). Only a few transcripts of F and SCR were      |
| differentially expressed compared with CO mice. In contrast, 345      |
| transcripts of 6,266 genes found to be expressed in WAT were altered  |
| significantly by LCR. These data provide new insights into the        |
| metabolic state associated with aging retardation by LCR.             |
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| b.  **Key Findings Published in Current Year -- GRECC Core Staff as   |
|     Co-Investigators on Projects with Non-GRECC PI (***[list up to    |
|     five]{.mark}; for each item provide GRECC Core Staff name(s),     |
|     journal reference, [and up to five line]{.mark} description of    |
|     topic/method/ results/clinical significance; use layperson        |
|     language)*:                                                       |
|                                                                       |
| Watson GS, Peskind ER, **Asthana S**, Purganan K, Wait C, Chapman D,  |
| Farris W, Selkoe DJ, Schwartz MW, Schellenberg GD, Plymate S, Craft   |
| S: Insulin increases CSF Aβ levels in normal older adults.            |
| *Neurology,* vol 60(12), pp 1899-1903, 2003.                          |
|                                                                       |
| The findings of this paper suggested that, similar to plasma,         |
| infusions of insulin increased CSF levels of amyloid protein,         |
| demonstrating a direct effect of insulin on APP processing. Insulin   |
| resistance is reportedly an important pathologic process in the       |
| pathobiology of AD, and the findings of this paper further support    |
| this concept.                                                         |
|                                                                       |
| Cherrier MM, Plymate S, Mohan S, **Asthana S**, Matsumoto A.M.,       |
| Bremner W.J., Peskind E, Raskind M, Latendresse, S, Haley AP, Craft   |
| S: Relationship between testosterone supplementation and insulin-like |
| growth factor-I levels and cognition in healthy older men.            |
| *Psychoneuroendocrinology*, vol Jan 29(1), pp 65-82, 2004.            |
|                                                                       |
| This paper characterized the effects of testosterone treatment on     |
| plasma levels of IGF-I. These findings indicate that                  |
| cognition-enhancing effects of testosterone in older healthy men may  |
| be partly mediated by changes in the IGF system.                      |
|                                                                       |
| Zhu, X., McShea, A., Harris, P.L.R., Raina, A.K., Castellani, R.J.,   |
| Funk, J.O., Shah, S., **Atwood, C.S.,**                               |
|                                                                       |
| Bowen, R., Bowser, R., Morelli, L., Perry, G. and Smith, M.A. (2004). |
| Elevated expression of a regulator                                    |
|                                                                       |
| of the G2/M phase of the cell cycle, neuronal CIP-1-associated        |
| regulator of cyclin B, in Alzheimer's                                 |
|                                                                       |
| disease. *Journal of Neuroscience Research* 75, 698--703.             |
|                                                                       |
| Adult neurons are generally accepted to be in a quiescent,            |
| nonproliferative state. However, it is becoming                       |
|                                                                       |
| increasingly apparent that, in Alzheimer\'s disease (AD), alterations |
| in cell cycle machinery, suggesting an                                |
|                                                                       |
| attempt to reenter cell cycle, relate temporally and topographically  |
| to degenerating neurons. We found the                                 |
|                                                                       |
| cell cycle checkpoint protein, CIP-1-associated regulator of cyclin B |
| (CARB), a protein that associates                                     |
|                                                                       |
| with two key proteins, p21 and cyclin B, increased and localized to   |
| intraneuronal neurofibrillary tangles                                 |
|                                                                       |
| and granulovacuolar degeneration in susceptible hippocampal and       |
| cortical neurons in AD. Therefore,                                    |
|                                                                       |
| therapeutics targeted toward initiators of the cell cycle are likely  |
| to prove of great efficacy for the                                    |
|                                                                       |
| treatment of AD.                                                      |
|                                                                       |
| Rowe, PSN, Kumagai, Y, Guitierrez, G, Garrett, IR, Blacher, R, Rosen, |
| D, Cundy, J, Navvab, S, Chen, D, **Drezner, MK**, Quarles, LD, Mundy, |
| GR. MEPE has the properties of an osteoblastic phosphatonin and       |
| minhibin. *Bone* 34:303-319, 2004.                                    |
|                                                                       |
| Disorders in man characterized by excessive loss of phosphate in the  |
| urine and consequent poor bone mineralization are caused in many      |
| cases by the circulation in excessive amounts of proteins, which are  |
| called phosphatonins and/or minhibins. We showed that MEPE, a protein |
| found elevated in many of these diseases, has the ability to alter    |
| phosphate concentration in the urine and bone mineralization, as      |
| would be expected of a phosphatonin and minhibin.                     |
|                                                                       |
| Decline in learning abilities with age is related to the APOE gene:   |
|                                                                       |
| Baxter, LC, Caselli, RJ, **Johnson, SC**, Reiman, EM, Osborne, D.     |
| (2003). Apolipoprotein E ε4 affects new learning in cognitively       |
| normal individuals at risk for Alzheimer's Disease. *Neurobiology of  |
| Aging* *24,* 947-952.                                                 |
|                                                                       |
| In this study we showed that memory decline over a two year period is |
| related to the age of the subject, but only if the subject has a      |
| particular allele of the APOE gene. The results provide important     |
| evidence that this Alzheimer's risk gene is also important for        |
| memory. The finding sets the stage for much of the work we are now    |
| doing.                                                                |
|                                                                       |
| Wang C, Li Q, Redden DT, **Weindruch R**, Allison DB: Statistical     |
| methods for testing effects on \"maximum lifespan\". *Mech. Ageing    |
| Dev.* 125:629-632, 2004.                                              |
|                                                                       |
| It has been noted that certain interventions such as caloric          |
| restriction may increase maximum lifespan, whereas other              |
| interventions may increase mean or median lifespan but not maximum    |
| lifespan. This is of great interest because increasing maximum        |
| lifespan may be an indicator that an intervention is slowing the      |
| general process of aging and not merely retarding the development of  |
| specific diseases. This study shows that conditional t-test (CTT), a  |
| statistical method that is sometimes used, is invalid. We offer a new |
| method based on quantile regression and show this is conservative,    |
| powerful and valid.                                                   |
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| **6. EDUCATION**                                                      |
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| **NOTE**: Do not list trainee and conference data here. Those data    |
| are reported in the GRECC Electronic Database.                        |
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| a.  **Innovations in Educational Activities Implemented During        |
|     Current Year** (*[list up to five]{.mark}; for each item, [up to  |
|     three lines]{.mark} on how it is innovative)*:                    |
|                                                                       |
| -   A second Geriatric Objective Structured Clinical Exercise (OSCE)  |
|     was developed for the University of Wisconsin Medical School in   |
|     January 2004. (Barczi, MD)                                        |
|                                                                       |
| -   A Pocket Guide to Dementia and Associated Behavioral Symptoms:    |
|     Diagnosis, Assessment, and Management. S. Gravenstein, H.E.       |
|     Davidson, eds. Arlington Heights, IL: ACCESS Medical Group,       |
|     October 2003 (2^nd^ Edition). (Howell, MD)                        |
|                                                                       |
| -   A Geriatrics ambulatory curriculum and primer was refined. This   |
|     is unique across the UW campus and has been adapted for medical   |
|     students and residents.                                           |
|                                                                       |
| -   An orientation to the older driver workshop was developed and     |
|     given three times in FY04. This was presented to GRECC trainees,  |
|     local VA physicians and nurses, and to local VA Ethics Committee  |
|     members. It includes interactive presentations by Geriatric MD    |
|     (Dr. Barczi) and Geriatric OT (Ms. Farrell-Holtan)                |
|                                                                       |
| -   GRECC developed a community-based program to screen for cognitive |
|     impairment in adults residing in a retirement community. This     |
|     enlisted the expertise of the GRECC Memory Research Program. The  |
|     battery of tests was evidence-based with adequate depth to have   |
|     greater sensitivity than simple screening approaches. This        |
|     program included public education, screening and primary MD       |
|     education. This activity is being sought by retirement            |
|     communities throughout Madison. Generalizability to VISN sties is |
|     being explored.                                                   |
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| b.  **Exportable Educational Products First Available for             |
|     Distribution in Current Year** *([list up to five]{.mark} most    |
|     important products; for each item, [up to three lines]{.mark}     |
|     summarizing content, target audience, format, product evaluation  |
|     results. Include educational products developed in previous years |
|     ONLY if this is the [first year]{.underline} they have been       |
|     available for distribution)*:                                     |
|                                                                       |
| -   A novel memory battery of studies was developed for screening in  |
|     the retirement community. (Barczi/Gleason)                        |
|                                                                       |
| -   The GRECC Pocket Cards with ready reference instruments/screeners |
|     for medical students, residents, and practicing VA physicians was |
|     developed in 2004. (Barczi)                                       |
|                                                                       |
| -   The Memory Research Program developed and disseminated numerous   |
|     educational pamphlets/guides: Alzheimer's Disease: The Complete   |
|     Picture; Be A Part of the Solution; Evaluating Simvastatin's      |
|     Potential Role in Therapy; Cognitive Brain Imaging of Normal      |
|     Aging and Early Detection of Alzheimer's Disease; Wisconsin       |
|     Comprehensive Memory Program; Is It Alzheimer's?; An Overview of  |
|     Alzheimer's Disease and Related Dementias; Alzheimer's Disease    |
|     Fact Sheet; and Alzheimer's Disease Medications Fact Sheet.       |
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| **7. NEW CLINICAL MODELS**                                            |
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| **NOTE:** These are new models of care for elderly veterans that the  |
| GRECC is developing and evaluating, in relation to its area(s) of     |
| focus. This is NOT a list of all Geriatrics & Extended Care clinical  |
| programs at the host VAMC.                                            |
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| a.  **New Clinical Models Implemented in Current Year** *(list all    |
|     new clinical models or significant modifications of existing      |
|     models that the GRECC is developing and evaluating. For each      |
|     item, indicate whether [N]{.underline}ew or [O]{.underline}ngoing |
|     in current year; provide [up to five line]{.mark} description)*:  |
|                                                                       |
| -   GRECC Geropsych Clinic (New) began in July 2004. This geriatric   |
|     medicine and geriatric psychiatry collaborative blends the        |
|     medical and mental health model using Dr. Howell's STAR Method (a |
|     five-point ecological method of tracking multiple problems in     |
|     older adults) as a mechanism to care for frail, older people and  |
|     teach GRECC trainees.                                             |
|                                                                       |
| -   The GRECC Geriatric Sleep Clinic (New) was implemented in         |
|     July 2004. This clinic has developed CPRS consult templates and   |
|     computer templates. An educational packet of readings was created |
|     for rotating trainees. Methodology is being developed to use      |
|     actigraphy as a routine screening method.                         |
|                                                                       |
| -   The GRECC began its involvement in the local VA Palliative Care   |
|     Consult Team in September 2003. Its focus has been providing pain |
|     management, palliative and transitional care for older veterans   |
|     with non-cancer diagnoses. A major emphasis of this model is      |
|     education for GRECC trainees. Academic foci will be employed      |
|     given the GRECC's new Cancer and Aging Grant.                     |
|                                                                       |
| -   GRECC Memory Clinic (ongoing) has a truly integrative approach    |
|     with equal input of geriatric medicine, geriatric psychiatry, and |
|     neuropsychology during assessment. Treatment and follow-up data   |
|     is collected on all patients served. New as of 2004,              |
|     speech/swallow is being conducted on all new patients.            |
|                                                                       |
| -   The GRECC's research-based clinical program focused on dysphagia  |
|     has implemented a lingual strengthening protocol for geriatric    |
|     veterans. A major emphasis of this multiple-disciplinary model is |
|     providing interactive, patient-focused lingual resistant excise   |
|     to treat dysphagia caused by sarcopenia and other age-related     |
|     diseases.                                                         |
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| b.  **Current Year Evaluation Results of New Clinical Models** *([for |
|     each clinical model listed in 7-a above]{.mark}, indicate whether |
|     evaluated by [R]{.underline}esearch or [Q]{.underline}uality      |
|     [I]{.underline}mprovement project; [up to five lines]{.mark}      |
|     summarizing evaluation outcomes, such as changes in access to     |
|     care, patient functioning, satisfaction, cost-effectiveness,      |
|     organizational changes, etc. Note if no evaluation results in     |
|     current year for a particular model)*:                            |
|                                                                       |
| **NOTE:** Do not list patient service utilization data here. Those    |
| data are reported in the GRECC Electronic Database.                   |
|                                                                       |
| -   The GRECC Geropsychiatry Clinic has not yet employed evaluation   |
|     methods since it began in July 2004.                              |
|                                                                       |
| -   The GRECC Sleep Clinic has only monitored process and logistical  |
|     outcomes since its inception in July 2004. Plans are to establish |
|     and maintain a database for sleep architecture variables,         |
|     sleepiness scale measures, cognitive measures, medical illness,   |
|     medication, and driving information.                              |
|                                                                       |
| -   The GRECC Memory Clinic made substantial organizational changes   |
|     in grids and time allotments based on Quality Improvement data.   |
|     These changes addressed access to care, patient/family            |
|     satisfaction, and cost-effectiveness (patients seen per           |
|     half-day).                                                        |
|                                                                       |
| -   The Palliative Care Consult Team is evaluating its outcomes and   |
|     service using Quality Improvement methodology. Data on all        |
|     patients consulted, terminal diagnosis, time in hospital before   |
|     consult, disposition, veteran/family's perception on              |
|     hospital/hospice transition, and pain measurement data is being   |
|     tracked.                                                          |
|                                                                       |
| -   The GRECC's research-based clinical program focused on dysphagia  |
|     uses SWAL-QOL, a dysphagia specific quality of life questionnaire |
|     developed at this VA, to monitor the impact of treatment. In      |
|     addition, dietary intake and biomechanical and bolus flow are     |
|     measured throughout the course of treatment.                      |
+-----------------------------------------------------------------------+
| c.  **New Clinical Models Exported in Current Year** *([list up to    |
|     five examples, up to two lines each]{.mark}; provide name of new  |
|     clinical model, name of VA or non-VA facility to which it was     |
|     exported, and method of export, such as*                          |
|                                                                       |
| d.  *"Falls Clinic protocol sent to [X]{.underline} VAMC")*:          |
|                                                                       |
| -   The GRECC Memory Research Program protocol was exported to        |
|     Oakwood Village Retirement Community, Madison, WI, in 2004.       |
|                                                                       |
| -   The GRECC Sleep Clinic exported its added battery of cognitive    |
|     tests and driver outcomes relevant to older adults to the         |
|     University of Wisconsin Sleep Clinic in 2004.                     |
|                                                                       |
| -   The GRECC Geropsychiatry STAR assessment tool was exported to     |
|     Milwaukee Department of Aging, Wisconsin state family care        |
|     programs, and ElderCare of Wisconsin by Dr. Timothy Howell in     |
|     2004.                                                             |
+-----------------------------------------------------------------------+
| **8. CONSULTATION AND OUTREACH**                                      |
+-----------------------------------------------------------------------+
| NOTE: **Consultation** = GRECC staff going to sites **[within host    |
| VAMC]{.underline}** or having those staff come to the GRECC, to       |
| assist in development of research, education or clinical programs at  |
| those sites. **Outreach** = GRECC staff going to **[non-host VAMC     |
| facilities]{.underline}** or having those staff come to the GRECC (in |
| person or by video or other technology) to assist in development of   |
| research, education or clinical programs at those sites.              |
+-----------------------------------------------------------------------+
| **Current Year Activity Outcomes** *([list up to five                 |
| examples]{.mark}, [up to two lines each]{.mark}; summarize specific   |
| outcomes realized from current year **consultation**, e.g., "Host     |
| VAMC instituted a Falls Clinic after consultation from GRECC staff;"  |
| or **outreach**, e.g., [X]{.underline} VAMC instituted a Falls Clinic |
| after GRECC outreach via series of videoconferences)*:                |
|                                                                       |
| -   (Consultation) The GRECC Memory Research Program conducted        |
|     educational seminars for the host VAMC in its "Alzheimer's        |
|     Disease: The Complete Picture" in November 2003.                  |
|                                                                       |
| -   (Consultation) The host VAMC is at the forefront of osteoporosis  |
|     recognition among men. This disease is classically viewed as a    |
|     "woman's disease"; however approximately 25% of men will sustain  |
|     an osteoporotic fracture in their lifetime. The recent            |
|     availability of densitometric vertebral fracture assessment       |
|     (technology) VFA has allowed detection of                         |
|     clinically-unappreciated vertebral compression fractures in       |
|     women. However, this technology had heretofore not been evaluated |
|     in men. A recent study conducted by geriatric faculty, Dr. N.     |
|     Binkley and Ms. N. Vallarta-Ast and reported at the American      |
|     Society for Bone and Mineral Research Annual Meeting indicates    |
|     that this technology performs equally well in men and women. This |
|     assessment has become part of routine assessment in the GRECC     |
|     Osteoporosis Clinic with dual-energy x-ray absorptiometry.        |
|                                                                       |
| -   (Consultation and Outreach) Dr. Barczi and newly-hired GRECC      |
|     affiliate staff, Dr. Timothy Juergens, (Geropsychiatry) interpret |
|     50% of all sleep studies conducted at host VA for northern tier   |
|     for VISN 12.                                                      |
|                                                                       |
| -   Host VAMC instituted a lingual strengthening program for          |
|     treatment of dysphagia secondary to sarcopenia and age-related    |
|     disease after consultation from GRECC staff.                      |
+-----------------------------------------------------------------------+
| b.  **Previous Years' Activities Outcomes** (*[list up to five        |
|     examples]{.mark}, [up to two lines each]{.mark}; summarize        |
|     specific outcomes realized from previous years' [**consultation** |
|     to host VAMC]{.underline} or [**outreach** to non-host            |
|     facilities]{.underline}, where results were first realized in the |
|     current year.)*                                                   |
|                                                                       |
| -                                                                     |
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