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| ### GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTER    |   |   |   |   |
|                                                          |   |   |   |   |
| ### *Annual Report: Fiscal Year [2006]{.underline}*      |   |   |   |   |
|                                                          |   |   |   |   |
| ######## Part II: Accomplishments                        |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **NOTE:** The **GRECC Annual Report** reflects status    |   |   |   |   |
| and accomplishments of **[GRECC Core Staff]{.underline}  |   |   |   |   |
| \*** (as defined below) [only]{.underline}. The          |   |   |   |   |
| **"Report Year"** is from [October 1, 2005 through       |   |   |   |   |
| September 30, 2006]{.underline}.                         |   |   |   |   |
|                                                          |   |   |   |   |
| You are welcome to use this report format for your own   |   |   |   |   |
| internal reporting purposes,                             |   |   |   |   |
|                                                          |   |   |   |   |
| in which case you may exceed the recommended limits of   |   |   |   |   |
| numbers of responses and their length                    |   |   |   |   |
|                                                          |   |   |   |   |
| ("list no more than..." "Describe the three most         |   |   |   |   |
| important..." "limit your response to five lines or      |   |   |   |   |
| fewer")                                                  |   |   |   |   |
|                                                          |   |   |   |   |
| ***\-\--BUT\--***                                        |   |   |   |   |
|                                                          |   |   |   |   |
| [Please limit **to ten pages or fewer** the version      |   |   |   |   |
| **SUBMITTED TO VACO** **.**]{.mark}                      |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **\*[GRECC Core Staff ]{.underline}**is limited to       |   |   |   |   |
| either **Primary Core**, **Affiliated Core**, or         |   |   |   |   |
| **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                                        |   |   |   |   |
|                                                          |   |   |   |   |
|     -   May have been acquired through centralized       |   |   |   |   |
|         enhancements/awards for programs\                |   |   |   |   |
|         (e.g., 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.              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **[IMPORTANT:]{.underline} Throughout this report,       |   |   |   |   |
| please AVOID/MINIMIZE JARGON. Each response is much more |   |   |   |   |
| likely to be included in secondary communications        |   |   |   |   |
| derived from the Annual Reports if it can be readily     |   |   |   |   |
| understood by a non-technical readership.**              |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **1. GRECC NAME/LOCATION**                               |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **GRECC Name:** Birmingham / Atlanta Geriatric       |   |   |   |   |
|     Research, Education and Clinical Center              |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Location** *(facility, VISN)*: Birmingham VAMC &   |   |   |   |   |
|     Atlanta VAMC, VISN 7                                 |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **2. CONTACT PERSON**                                    |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| a.  **Name:** Lesa L. Woodby, PhD, MPH                   |   |   |   |   |
|                                                          |   |   |   |   |
| b.  **Position:** Associate Director for Education and   |   |   |   |   |
|     Evaluation                                           |   |   |   |   |
|                                                          |   |   |   |   |
| c.  **Phone, e-mail:** 205-558-7064, Lesa.Woodby@va.gov  |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **3. GRECC FOCUS AREA(S)**                               |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **NOTE:** Please succinctly list your GRECC's Focus      |   |   |   |   |
| Area(s), one per line below. After each focus area       |   |   |   |   |
| listed, please indicate with a check mark () which of    |   |   |   |   |
| the research type(s) suitably describes the work         |   |   |   |   |
| conducted (including planning, implementation, analysis, |   |   |   |   |
| and dissemination/publication) within that focus during  |   |   |   |   |
| the Report Year. Add additional lines by positioning     |   |   |   |   |
| your cursor at the lower right side of the table and     |   |   |   |   |
| striking the "Tab" key.                                  |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+
| **GRECC Focus Area**                                     | * |   |   |   |
|                                                          | * |   |   |   |
|                                                          | R |   |   |   |
|                                                          | e |   |   |   |
|                                                          | s |   |   |   |
|                                                          | e |   |   |   |
|                                                          | a |   |   |   |
|                                                          | r |   |   |   |
|                                                          | c |   |   |   |
|                                                          | h |   |   |   |
|                                                          | T |   |   |   |
|                                                          | y |   |   |   |
|                                                          | p |   |   |   |
|                                                          | e |   |   |   |
|                                                          | * |   |   |   |
|                                                          | * |   |   |   |
+----------------------------------------------------------+---+---+---+---+
|                                                          | > | > | > | > |
|                                                          |   |   |   |   |
|                                                          | * | * | * | * |
|                                                          | * | * | * | * |
|                                                          | B | A | H | R |
|                                                          | a | p | e | e |
|                                                          | s | p | a | h |
|                                                          | i | l | l | a |
|                                                          | c | i | t | b |
|                                                          | > | e | h | i |
|                                                          |   | d | > | l |
|                                                          | B | > |   | i |
|                                                          | i |   | S | t |
|                                                          | o | C | e | a |
|                                                          | m | l | r | t |
|                                                          | e | i | v | i |
|                                                          | d | n | i | o |
|                                                          | i | i | c | n |
|                                                          | c | c | e | * |
|                                                          | a | a | s | * |
|                                                          | l | l | * |   |
|                                                          | * | * | * |   |
|                                                          | * | * |   |   |
+----------------------------------------------------------+---+---+---+---+
| Genitourinary Disorders                                  |   | * |   | * |
|                                                          |   | * |   | * |
|                                                          |   | x |   | x |
|                                                          |   | * |   | * |
|                                                          |   | * |   | * |
+----------------------------------------------------------+---+---+---+---+
| Mobility                                                 | * | * |   | * |
|                                                          | * | * |   | * |
|                                                          | x | x |   | x |
|                                                          | * | * |   | * |
|                                                          | * | * |   | * |
+----------------------------------------------------------+---+---+---+---+
| Palliative Care                                          |   |   | * |   |
|                                                          |   |   | * |   |
|                                                          |   |   | x |   |
|                                                          |   |   | * |   |
|                                                          |   |   | * |   |
+----------------------------------------------------------+---+---+---+---+
|                                                          |   |   |   |   |
+----------------------------------------------------------+---+---+---+---+

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| **4. ADMINISTRATION**                                                 |
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| a.  **GRECC Impact on Host VAMC in Report Year***: list **the**       |
|     **most important ways** in which the GRECC has had specific       |
|     impact on **host VAMC's** research, staff education, program      |
|     evaluation, or clinical care improvements for elderly veterans    |
|     (i.e., how the GRECC has "made a difference" in these areas       |
|     within the entire host VAMC) during the Report Year. **Please     |
|     limit your response to [5 or fewer]{.underline} "ways"; and       |
|     please limit your description of each of the five "ways" to [five |
|     lines or fewer]{.underline}. ***                                  |
|                                                                       |
| -   GRECC Continence Clinics in Birmingham and Atlanta continue to    |
|     provide state-of-the-art care for veterans with urinary and fecal |
|     incontinence. A Peri-operative Prostatectomy Pelvic Muscle        |
|     Training Clinical Demonstration Project, consisting of a          |
|     self-administered pelvic floor muscle training program (booklet)  |
|     suitable for cost-effective exportation if it proves successful,  |
|     was begun at the BVAMC in July 2006. The goal of the training is  |
|     to decrease the duration and severity of post-operative urinary   |
|     incontinence for veterans undergoing prostate cancer surgery.     |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   In Birmingham, the GRECC Fall Prevention and Mobility Clinic      |
|     provides assessment and treatment for veterans with mobility      |
|     impairments. Fall risk was reduced for more that 77 veterans.     |
|     Both the Continence and Fall Prevention and Mobility Clinics      |
|     provided opportunities for multidisciplinary trainees to          |
|     participate in the direct care of veterans.                       |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   The BVAMC Palliative Care Program experienced exponential growth  |
|     this past year. November 4, 2005 marked the opening of "Safe      |
|     Harbor," a new palliative care inpatient unit. Initially, five    |
|     beds were opened and staffed, with the unit expanding to eight    |
|     beds in July 2006 due to increased demand. Patients and families  |
|     have experienced the comfort care provided by the staff and the   |
|     protocols of the program. Adam Herman, MD, from the Atlanta       |
|     GRECC, began his in-house training at the Birmingham site.        |
|                                                                       |
| -   The GRECC continues to partner with the Deep South Center on      |
|     Effectiveness (REAP) at the Birmingham VA Medical Center and the  |
|     Atlanta HSR&D TREP. As a result, Patricia Parmelee, PhD received  |
|     two HSR&D Merit grants, one as PI and one as a co-investigator.   |
|     In May 2006, the REAP and the GRECC co-sponsored a VA Research    |
|     Week event, which was well-attended, provided continuing          |
|     education credit, and generated positive media coverage.          |
|                                                                       |
| -   The Aging Sensitivity Training offered by the GRECC during the    |
|     new employee orientation continues to be a well-received          |
|     educational opportunity in both Birmingham and Atlanta.           |
|     Collectively, more than 1,300 employees have been trained to      |
|     appreciate the experience of potential sensory loss and physical  |
|     impairments associated with aging and to understand how to help   |
|     older adults accommodate to such limitations.                     |
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| b.  **GRECC Impact on VISN in the Report Year:** *list **the** **most |
|     important ways** in which the GRECC has had specific impact on    |
|     the **host** **VISN's** research, staff education, program        |
|     evaluation, or clinical care improvements for elderly veterans    |
|     (i.e., how the GRECC has "made a difference" in these areas       |
|     within the entire host VISN) during the rating period. **Please   |
|     limit your response to [5 or fewer]{.underline} "ways"; and       |
|     please limit your description of each of the five "ways" to [five |
|     lines or fewer]{.underline}. ***                                  |
|                                                                       |
| -   A VA Health Services Research and Development grant,              |
|     "Intervention to Improve Care at Life's End in VA Medical         |
|     Centers," Dr. Kathryn Burgio, PI, was launched. This 5-year,      |
|     multi-site trial is evaluating the Comfort Care Intervention      |
|     developed by Dr. Amos Bailey (BVAMC) in five VAMCs in VISN 7:     |
|     Atlanta and Augusta, GA; Charleston and Columbia, SC; and         |
|     Gainesville, FL. The intervention was conducted at Charleston and |
|     Atlanta VAMCs during this reporting period.                       |
|                                                                       |
| -   The GRECC in conjunction with the VISN 7 G&EC Service Line        |
|     developed, administered, and completed a pilot grant program to   |
|     support research, education and clinical demonstration projects   |
|     related to the health and well being of older veterans. A total   |
|     of nine projects were funded, each at a level of \$50,000, over a |
|     2-year period -- 6 research initiatives, 2 clinical demonstration |
|     projects and 1 education project. Thus far these projects have    |
|     yielded 8 peer reviewed publications, 3 abstracts and 1 VA RR&D   |
|     MERIT award (Connell, PI).                                        |
|                                                                       |
| -   Representing VISN 7, the GRECC has provided national leadership   |
|     for several initiatives, including: the Veterans Affairs Hospice  |
|     and Palliative Care Initiative; the Centers for Medicaid and      |
|     Medicare Services (CMS) validation of MDS quality indicators of   |
|     nursing home care for veterans; the VA/DoD National Stroke        |
|     Guidelines Committee; the National VA-Rehabilitation and          |
|     Geriatrics and Extended Care Workgroup -- Task Force on Outcome   |
|     and Quality Measures; and the VHA TeleRehabilitation/Telehealth   |
|     Field Work Group.                                                 |
|                                                                       |
| -   The GRECC represented VISN 7 in multiple leadership capacities    |
|     including: Drs Ouslander and Johnson provided leadership for the  |
|     development of the Health Plan Employer Data Information (HEDIS)  |
|     quality measure on urinary incontinence for the National          |
|     Committee for Quality Assurance; Lesa Woodby, PhD, MPH, served on |
|     the planning committee and participated in the VACO               |
|     G&EC/EES/GRECC Geriatric Education Series; and the VACO           |
|     EES/Consortium of Geriatric Education Centers/GRECC-sponsored     |
|     3-part satellite conference, entitled "The Older Driver."         |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Dr. Ted Johnson, GRECC Atlanta Program Director, was one of 2     |
|     individuals selected from the Atlanta VAMC as a participant in    |
|     the VA Network Executive Health Care Leadership Institute         |
|     (NEHCLI). NEHCLI is a cooperative venture for VISNs 1, 2, 3, 4,   |
|     and 7. Dr. Johnson was also named "Outstanding Manager of the     |
|     Year" by the Atlanta Federal Executive Board (FEB).               |
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| c.  **GRECC Trend-Setting Innovations since October 1,                |
|     [2001]{.underline}**: *list **the** **most significant** GRECC    |
|     research, education or clinical innovations in the past five      |
|     years. For each item, provide date or date range, GRECC core      |
|     staff responsible, and a description. **Please limit your         |
|     response to 5 or fewer innovations; and please limit each of the  |
|     five innovation descriptions to five lines or fewer. ***          |
|                                                                       |
| -   The Peri-operative Prostatectomy Pelvic Muscle Training Program   |
|     began at the BVAMC July 2005. This program is based on the        |
|     results of Dr. Burgio and Dr. Goode's NIH-funded research (*J     |
|     Urol 2006;175:196-201*) demonstrating that pre-operative training |
|     in pelvic floor muscle exercises decreased the duration and       |
|     severity of post-operative urinary incontinence. This health      |
|     services clinical demonstration program is now exploring the most |
|     cost-effective model for dissemination.                           |
|                                                                       |
| -   The Muscle Research Team led by Marcus Bamman, PhD, is using      |
|     novel analyses to identify key molecular processes driving the    |
|     rates of muscle "re-growth" accompanying strength training. By    |
|     revealing the specific signaling processes that drive muscle      |
|     protein synthesis and satellite cell recruitment, GRECC           |
|     investigators will develop methods to improve responsiveness to   |
|     strength training. (*J Appl Physiol* 2005; 98:211-20; *Am J       |
|     Physiol Endocrinol Metab 2005;* 288:1110-9; *Am J Physiol         |
|     Endocrinol Metab 2006; 291:E937-46)*                              |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   The Life-Space Assessment (LSA) instrument developed by Richard   |
|     Allman, MD and colleagues has been validated as a measure         |
|     reflecting the full continuum of mobility of older adults. (*J Am |
|     Geriatr Soc* 2003; 51:1610-1614; *Physical Therapy 2005; 85:      |
|     1008--1019*). It reflects important changes in life-style and has |
|     been used to identify modifiable risk factors for mobility        |
|     decline (*JGIM 2004; 19:1118-1126;Aging Health* 2006; 2:417-428). |
|     This practical measurement tool will facilitate studies of        |
|     interventions designed to enhance mobility.                       |
|                                                                       |
| -   Functional Incidental Training (FIT), a rehabilitative            |
|     intervention directed at continence, mobility, endurance, and     |
|     strength for older veterans in nursing homes, has been            |
|     demonstrated to have a significant effect on endurance, strength, |
|     and urinary incontinence. Translating these positive benefits     |
|     achieved under research conditions into practice will be          |
|     challenging because of the staff workload implications of the     |
|     intervention and the costs of care (*JAGS 2005; 53:1091-1100;     |
|     JAMDA 2005; 6: 121-127*).                                         |
|                                                                       |
| -   The Birmingham VAMC has become the model for Palliative Care in   |
|     VISN 7. GRECC investigators, Drs. Christine Ritchie, Amos Bailey  |
|     and Ted Johnson, crafted the VISN 7 Strategic Plan in Palliative  |
|     Care. Educational efforts have resulted in the VISN 7 Palliative  |
|     Care Summit, August 2006; a palliative care fellowship; and a     |
|     VISN-wide monthly journal club. And, in print in FY06 were the    |
|     results of new research on the ethics of conducting research with |
|     hospice patients and training recommendations for resident        |
|     physicians for death pronouncement (*J Palliative Med 2006;       |
|     9:968-74* and *Palliative and Supportive Care 2005; 3: 107-117)*  |
+-----------------------------------------------------------------------+
| **5. RESEARCH**                                                       |
+-----------------------------------------------------------------------+
| **a. Key Findings Published in the Report Year on projects for which  |
| GRECC Core Staff was PI or Co-PI:\                                    |
| ***list **five or fewer;** for each item provide GRECC Core Staff     |
| name(s), journal reference, and description of topic/                 |
| method/results/clinical significance.* *Please limit each response to |
| [5 lines or fewer]{.underline}.*                                      |
|                                                                       |
| -   ***Brown CJ**, **Roth DL**, Peel C, **Allman RM**. Predictors of  |
|     regaining ambulatory ability during hospitalization.  Journal of  |
|     Hospital Medicine 2006; 1:277-284.*                               |
|                                                                       |
| > This study examined a cohort of hospitalized patients who had       |
| > recently become nonambulatory. Recovery of ambulatory ability was   |
| > associated with not being married, higher life expectancy, absence  |
| > of restraints, having a urinary catheter, deep vein thrombosis, and |
| > higher bed mobility at admission. Early recognition of who will     |
| > recover ambulatory ability may help with discharge planning and     |
| > potential interventions, including addressing modifiable factors    |
| > such as low bed mobility and use of catheters and restraints.       |
|                                                                       |
| -   ***Burgio KL**, **Goode PS**, Urban DA, Umlauf MG, Locher JL,     |
|     Bueschen A, **Redden DT**. Preoperative Biofeedback Assisted      |
|     Behavioral Training to Decrease Post-Prostatectomy Incontinence:  |
|     A Randomized, Controlled Trial. The Journal of Urology 2006; 175, |
|     196-201.*                                                         |
|                                                                       |
| > This randomized controlled trial tested the effectiveness of        |
| > pre-operative biofeedback-assisted behavioral training for reducing |
| > the duration and severity of urinary leakage in the 6 months after  |
| > radical prostatectomy. Results indicated that preoperative training |
| > significantly reduced the time to continence after surgery and the  |
| > proportion of patients with severe leakage at 6-months. Thus, a     |
| > single preoperative session of biofeedback-assisted behavioral      |
| > training can hasten the recovery of urine control following radical |
| > prostatectomy.                                                      |
|                                                                       |
| -   *Kosek DJ, JS Kim, JK Petrella, JM Cross, and **MM Bamman**.      |
|     Efficacy of 3 d/wk resistance training on myofiber hypertrophy    |
|     and myogenic mechanisms in young versus older adults. Journal of  |
|     Applied Physiology 2006; 101:531-44.*                             |
|                                                                       |
| >                                                                     |
| >                                                                     |
| > In this 16-week resistance training project, investigators          |
| > quantified age differences in rates of muscle fiber hypertrophy and |
| > myogenic gene and protein expression. The results clearly show that |
| > resistance training-induced muscle growth is blunted in older vs.   |
| > young adults, and that the robust growth seen in young may be at    |
| > least partially mediated by enhanced satellite cell differentiation |
| > and fusion, as mRNA levels of key myogenic transcription factors    |
| > were markedly elevated with resistance training in young adults.    |
|                                                                       |
| -   *Lara-Castro C, Luo N, Wallace P, Klein RL, **Garvey WT**.        |
|     Adiponectin multimeric complexes and the metabolic syndrome trait |
|     cluster. Diabetes 2006; 55:249-259.*                              |
|                                                                       |
| > Low circulating levels of adiponectin are believed to play a        |
| > pathophysiological role in the development of the metabolic         |
| > syndrome. This study examined adiponectin multimeric forms and      |
| > showed that not only is serum adiponectin associated with increased |
| > insulin sensitivity, reduced abdominal fat, and high basal lipid    |
| > oxidation, but it is the high molecular weight adiponectin quantity |
| > that is primarily responsible for the syndrome complex that         |
| > comprises the metabolic syndrome.                                   |
|                                                                       |
| -   ***Ouslander JG,** Connell BR, Bliwise DL, Endeshaw Y, Griffiths  |
|     P, Schnelle JF: A Nonpharmacological Intervention to Improve      |
|     Sleep in Nursing Home Patients: Results of a Controlled Clinical  |
|     Trial. Journal of the American Geriatrics Society 2006;           |
|     54:38-47.*                                                        |
|                                                                       |
| > This controlled clinical trial tested a multicomponent              |
| > nonpharmacological intervention to improve nighttime sleep in       |
| > nursing home patients. The intervention included daytime physical   |
| > activity and attempts to keep subjects out of bed, evening bright   |
| > light exposure, consistent bedtime routine, nighttime care routines |
| > designed to minimize sleep disruption, and strategies to reduce     |
| > nighttime noise. The intervention had no effect on nighttime sleep  |
| > as measured by wrist actigraphy, polysomnography, or behavioral     |
| > observations.                                                       |
+-----------------------------------------------------------------------+
| **b. Key Findings Published in the Report Year on work in which GRECC |
| Core Staff served as Co-Investigators to a Non-GRECC PI:** *list      |
| **five or fewer**; for each item provide GRECC Core Staff name(s),    |
| journal reference, and description of topic/method/results/clinical   |
| significance. Please limit each response to [5 lines or               |
| fewer]{.underline}.*                                                  |
|                                                                       |
| -   *Ahmed A, Husain A, Love T, Gambassi G, Dell'Italia LJ, Francis   |
|     GS, Gheorghiade M, **Allman RM**, Meleth S, Bourge RC. Heart      |
|     failure, chronic diuretic use, and increase in mortality and      |
|     hospitalization: an observational study using propensity score    |
|     methods. European Heart Journal 2006; 27:1431-1439.*              |
|                                                                       |
| > This study examined the effects of diuretics on heart failure       |
| > outcomes by retrospective analysis of a large database on patients  |
| > treated with digitalis in the Digitalis Investigation Group study.  |
| > Analyses indicated that chronic diuretic use was associated with    |
| > increased long-term mortality and hospitalizations in a wide        |
| > spectrum of ambulatory chronic systolic and diastolic heart failure |
| > patients. The findings challenge the wisdom of routine chronic use  |
| > of diuretics in certain types of heart failure patients.            |
|                                                                       |
| -   *Ball, K. K., Roenker, D. L., Wadley, V. G., Edwards, J. D.,      |
|     **Roth, D. L.**, McGwin, G. Raleigh, R., Joyce, J. J.,            |
|     Cissell, G. M., & Dube, T. Can high-risk older drivers be         |
|     identified through performance-based measures in a Department of  |
|     Motor Vehicles setting? Journal of the American Geriatrics        |
|     Society 2006; 54: 77-84.*                                         |
|                                                                       |
| > This prospective cohort study evaluated the relationship between    |
| > performance-based risk factors and subsequent at-fault motor        |
| > vehicle collision involvement in older drivers with intact vision.  |
| > Older adults, men, and individuals with a history of falls were     |
| > more likely to be involved in at-fault collisions.                  |
| > Performance-based cognitive measures were also predictive of future |
| > at-fault collisions, indicating that high-risk older drivers can be |
| > identified through brief, performance-based testing administered in |
| > a Motor Vehicle Administration setting.                             |
|                                                                       |
| -   *Drentea P, Clay OJ, **Roth DL**, & Mittelman MS. Predictors of   |
|     improvement in social support: Five-year effects of a structured  |
|     intervention for caregivers of spouses with Alzheimer\'s disease. |
|     Social Science and Medicine 2006; 63: 957-967.*                   |
|                                                                       |
| > This study examined social support outcomes of a randomized         |
| > controlled trial of enhanced counseling and social support services |
| > in the USA, specifically the extent to which the intervention,      |
| > which helped spouse-caregivers mobilize their social support        |
| > network, helps them better adapt to the caregiving role. Findings   |
| > indicated that individuals in the intervention group reported       |
| > higher levels of satisfaction with their social support network     |
| > over the first 5 years of the intervention than those in the        |
| > support group.                                                      |
|                                                                       |
| -   *Wagner L, Capezuti E, Taylor JA, Sattin R, **Ouslander J.**      |
|     Impact of a falls menu-driven incident-reporting system on        |
|     documentation and quality improvement in nursing homes. The       |
|     Gerontologist 2005; 45: 835-842.*                                 |
|                                                                       |
| > This study tested the effect of a falls menu-driven                 |
| > incident-reporting system on quality-improvement efforts in nursing |
| > homes. Nursing homes that implemented the system had significantly  |
| > better documentation of fall characteristics on incident reports    |
| > than did the control nursing homes, indicating improvement in how   |
| > nursing staff assess residents following a fall incident. This      |
| > model has potential to enhance quality-improvement efforts and      |
| > augment the current system of adverse incident reporting in nursing |
| > homes.                                                              |
|                                                                       |
| -   *Head B, **Ritchie C,** Smoot T. Prognostication in Hospice Care: |
|     Can the Palliative Performance Scale help? Journal of Palliative  |
|     Medicine 2005; 8:492-502.*                                        |
|                                                                       |
| > This study explored the application of the Palliative Performance   |
| > Scale (PPS) as a tool for projecting length of stay until death or  |
| > discharge in a home-based hospice program. PPS scores were          |
| > associated with length of survival. Negative change scores were     |
| > predictive of patient decline toward death, while stable PPS        |
| > ratings over time resulted in discharge consideration. Results      |
| > indicated that scores on the PPS are associated with patient length |
| > of survival in a hospice program and can be used in evaluating      |
| > hospice appropriateness.                                            |
+-----------------------------------------------------------------------+
| **6. EDUCATION**                                                      |
+-----------------------------------------------------------------------+
| **NOTE**: **DO NOT** list trainee and conference data                 |
| here**\--**those data are reported in the GRECC Electronic Database.  |
|                                                                       |
| **NOTE:** You may list educational activities here even if they were  |
| supported by funds that qualified for inclusion in the ePROMISE       |
| (RDIS) database if you wish.                                          |
+-----------------------------------------------------------------------+
| a.  **Innovations in Educational Activities Implemented during the    |
|     Report Year** *(list five or fewer. Please limit each item to [5  |
|     lines or fewer]{.underline} and include clarification of how each |
|     activity is innovative.)*                                         |
|                                                                       |
| -   The Birmingham VAMC received first-place honors for the VA        |
|     Teacher Ambassador Training program, "Heroes and Heroines: The    |
|     Faces of Freedom," in the Communications/Special Events category  |
|     in the 2005 VHA Excellence in Public Affairs Program. A VISN-wide |
|     train-the-trainer program conducted by BVAMC and GRECC staff      |
|     enabled classroom teachers across Alabama, Georgia, and South     |
|     Carolina to educate their students about the accomplishments of   |
|     American veterans and the role of the VA.                         |
|                                                                       |
| -   The GRECC participated in the conceptualization and               |
|     implementation of the VACO EES/G&EC/GRECC co-sponsored Geriatric  |
|     Education Series. This recurring monthly audio conference was     |
|     launched nationally in July 2006 to provide current information   |
|     on geriatric topics to the VA community. Hosted by Dr. Woodby and |
|     featuring Drs. Goode and Burgio, the inaugural presentation was   |
|     on "Assessment and Management of Urinary Incontinence in the      |
|     Clinic."                                                          |
|                                                                       |
| -   The GRECC has been approved as a site for a VA-funded Special     |
|     Advanced Fellowship Program in Geriatrics. Joseph Ouslander, MD,  |
|     and Kathryn Burgio, PhD, will provide leadership for this         |
|     program. Beginning in July 2007, the program will provide career  |
|     development training for physicians and postdoctoral level health |
|     professionals with clinical degrees who are committed to careers  |
|     in geriatric medicine or gerontology and demonstrate potential    |
|     for providing service to veterans receiving care from the VA.     |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   A monthly Palliative Care Journal Club with VANTS access was      |
|     begun in FY06 to increase knowledge across VA of innovations in   |
|     palliative care that can improve comfort for dying veterans. This |
|     enhances the monthly Continence and Mobility Journal Clubs that   |
|     have continued to present innovative publications to improve      |
|     research and clinical care for veterans.                          |
|                                                                       |
| -   GRECC staff collaborated with the University of Louisville to     |
|     evaluate the effect of a brief educational intervention regarding |
|     advance care planning discussions on resident behavior. Charts    |
|     were reviewed before and after a one time educational             |
|     intervention that included both didactic teaching and role        |
|     playing. No difference in documented DNR discussions were noted   |
|     pre and post intervention. (*J Palliative Medicine; 2006; 9:      |
|     964-967)*                                                         |
+-----------------------------------------------------------------------+
| b.  **Exportable Educational Products First Available for             |
|     Distribution in Report Year** *List five or fewer of the most     |
|     important products. For each item, limit the response to five     |
|     lines summarizing content, target audience, format, and product   |
|     evaluation plan and results. **Include educational products       |
|     developed in previous years ONLY if this is the [first            |
|     year]{.underline} they have been available for distribution.***   |
|                                                                       |
| -   The GRECC participated in planning and presenting a 3-part        |
|     satellite broadcast, "The Older Driver." This education series    |
|     focused on the functional assessment, psycho-social impact, legal |
|     issues, ethical issues, and rehabilitation of the elderly driver. |
|     Co-sponsors included the VA EES, Office of Geriatrics and         |
|     Extended Care, Consortia of Geriatric Education Centers, and      |
|     GRECCs at Birmingham/Atlanta, New England, and San Antonio.       |
|                                                                       |
| -   The EES/G&EC/GRECC Geriatric Audio Conference Series served as a  |
|     forum to export the GRECC Continence Clinical Demonstration       |
|     Project procedures for evaluation and treatment of urinary        |
|     incontinence. The seminar was presented by Drs. Patricia Goode    |
|     and Kathryn Burgio on July 27, 2006.                              |
|                                                                       |
| -   In June 2006, an updated full-text version of *The Palliative     |
|     Response* was posted on the website,                              |
|     [www.p                                                            |
| alliative.uab.edu/response](http://www.palliative.uab.edu/response/). |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Also released this year was the new *Geriatric Review Syllabus: A |
|     Core Curriculum in Geriatric Medicine*, 6th ed., edited by Pompei |
|     P & Murphy JB, which included a chapter on Geriatric              |
|     Rehabilitation co authored by GRECC investigator, Dr. Cynthia     |
|     Brown. (*Studenski SA, **Brown CJ**, Duncan PW: Chapter 15:       |
|     Geriatric Rehabilitation. New York, NY: American Geriatric        |
|     Society, 2006*)                                                   |
+-----------------------------------------------------------------------+
| **7. CLINICAL DEMONSTRATION PROJECTS**                                |
+-----------------------------------------------------------------------+
| **NOTE:** A clinical demonstration [program]{.underline} is defined   |
| as:                                                                   |
|                                                                       |
| -   an ongoing, clinical, cooperative collaboration between the GRECC |
|     and host VA medical center;                                       |
|                                                                       |
| -   that carries out and evaluates assessment strategies, management  |
|     approaches and/or specialized investigations                      |
|                                                                       |
| -   of a targeted or focused group of elderly patients                |
|                                                                       |
| -   with the intention that findings will be disseminated for the     |
|     advancement of the field.                                         |
|                                                                       |
| A clinical demonstration program is comprised of one or more clinical |
| demonstration [projects]{.underline}, each of which is defined as     |
|                                                                       |
| -   a set of one or more clinical activities                          |
|                                                                       |
| -   integrated and coordinated under a specified protocol             |
|                                                                       |
| -   designed to permit evaluation(s) of processes and/or outcomes.    |
|                                                                       |
| Evaluation of a clinical demonstration program may be a comprehensive |
| assessment of the activity and/or the clinical                        |
| outcomes. Alternatively, evaluation may concentrate on a prioritized  |
| and feasible set of more focused or specific, project-related         |
| questions, e.g. related to improved diagnosis, quality of care,       |
| patient satisfaction, drug compliance, functional status,             |
| etc. Ongoing and subsequent modifications of the care model may also  |
| be evaluated as may be the practicability and outcomes of exporting   |
| new clinical models or variations of models to general care settings  |
| and/or smaller, more resource-limited VA medical centers or           |
| outpatient facilities.                                                |
+-----------------------------------------------------------------------+
| a.  **Clinical Demonstration Projects Underway in Report Year***:     |
|     list **all** GRECC Clinical Demonstration Projects underway. For  |
|     each item, indicate whether [N]{.underline}ew or                  |
|     [O]{.underline}ngoing in Report Year. You may include up to five  |
|     lines of descriptive text for each Project.*                      |
|                                                                       |
| > **NOTE:** The number of Projects listed should be equal to the      |
| > number of Clinical Demonstration Projects you have listed and named |
| > in the GRECC Electronic Database.                                   |
|                                                                       |
| -   The newest GRECC Continence Clinical Demonstration Project is a   |
|     **self-administered program of peri-operative training** in       |
|     pelvic muscle exercises (booklet) for men who are about to        |
|     undergo prostate cancer surgery at the BVAMC. This program, if    |
|     effective in this clinical demonstration project, will be the     |
|     basis for a randomized controlled trial to confirm the results    |
|     and explore potential cost-savings to the VA. *New*.              |
|                                                                       |
| -   The Atlanta VA Continence Clinic has initiated a **Telephone      |
|     Bronze Continence Clinic** to enhance compliance with             |
|     behaviorally-based therapies and to maximize clinic capacity.     |
|     *New.*                                                            |
|                                                                       |
| -   The GRECC Continence Clinics continued to provide evaluation and  |
|     treatment for increasing numbers of veterans with urinary and     |
|     fecal incontinence in Atlanta and Birmingham. In addition to      |
|     improving the health and quality of lives of veterans, these      |
|     clinics have been productive multidisciplinary training sites, as |
|     well as sources of pilot data for research projects. *Ongoing*.   |
|                                                                       |
| -   The GRECC Mobility Clinic continued to provide                    |
|     **multidisciplinary assessment and treatment of veterans at high  |
|     risk of falling.** The clinic has been a very productive          |
|     multidisciplinary training site, as well as providing clinical    |
|     care. *Ongoing*.                                                  |
|                                                                       |
| -   The BVAMC Palliative Medicine Program, with the support of the    |
|     GRECC, continued to provide consultative care for inpatients and  |
|     outpatients. A new **inpatient hospice unit**, "Safe Harbor,"     |
|     opened November 4, 2005. This program has already begun serving   |
|     as a training center for providers of end-of-life care throughout |
|     the VISN. *Ongoing*.                                              |
+-----------------------------------------------------------------------+
| b.  **Evaluation of Clinical Demonstration Projects:** *for each      |
|     GRECC Clinical Demonstration Project listed in 7a above,          |
|     summarize the evaluation activity. If no evaluation results are   |
|     available, be explicit as to the focus of the planned evaluation, |
|     and when it is anticipated to occur. If the project has been      |
|     completed during the Report Year, provide key findings and their  |
|     significance.*\                                                   |
|     \                                                                 |
|     **NOTE:** Do not list patient service use data here. Those data   |
|     are reported in the GRECC Electronic Database.                    |
|                                                                       |
| -   Continence Clinic: Only 6 men have been enrolled in the           |
|     Self-Administered Pre-operative Prostatectomy Pelvic Muscle       |
|     Training Clinical Demonstration Project since its initiation      |
|     August 2006. Outcome data are available on the first two          |
|     participants and 1 of the 2 was continent 6 weeks                 |
|     post-operatively. This compares favorably to the men who were     |
|     taught pre-operative pelvic floor muscle exercises by a nurse     |
|     practitioner in last year's clinical demonstration project with   |
|     25% continent at 6 weeks, 37.5% at 3 months, 40% at 6 months, and |
|     50% at 9- months.                                                 |
|                                                                       |
| -   Mobility Clinic: The veterans seen in the Fall Prevention clinic  |
|     have a mean age of 77 years (± 8.2 yrs), mean gait speed of 4.9   |
|     seconds (± 2.0 sec.) and mean score on the of 48/120 (± 21.5) on  |
|     the UAB Life Space Assessment. These data demonstrate, not        |
|     surprisingly, that our patients are frail and at high risk for    |
|     additional falls. Our prior assessments have demonstrated that    |
|     veterans fall less after assessment and treatment in our clinic.  |
|     Future plans include pre-post assessments of several measures in  |
|     an effort to determine which components of our fall interventions |
|     are most successful for our veteran population.                   |
|                                                                       |
| -   The Palliative Care Program evaluation was presented by Dr. Amos  |
|     Bailey at the American Academy of Hospice and Palliative Medicine |
|     Annual Assembly, February 2006, in Nashville, TN. Results showed  |
|     that, as a result of the use of the Comfort Care Order Set in the |
|     CPRS system, more patients received morphine, the preferred       |
|     medication for pain relief at end of life.                        |
+-----------------------------------------------------------------------+
| c.  **New Clinical Models developed at your GRECC that were exported  |
|     in the Report Year** *(list up to five examples, up to two lines  |
|     each; provide name of new clinical model, name of VA or non-VA    |
|     facility to which it was exported, and method of export, such as  |
|     "Falls Clinic protocol sent to [X]{.underline} VAMC"):*           |
|                                                                       |
| -   The Comfort Care Intervention developed by Dr. Bailey was         |
|     implemented at the Charleston and Atlanta VAMCs through our       |
|     HSR&D-funded grant to study this intervention to improve          |
|     end-of-life care (PI: Dr. Kathryn Burgio)                         |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Drs. Kathryn Burgio and Patricia Goode's national training        |
|     program in behavioral therapy for stress incontinence was         |
|     repeated in Sept 2006 for nurses and physical therapists from 5   |
|     sites in the NICHD Pelvic Floor Disorders Network.                |
|                                                                       |
| -   The procedures for evaluation and treatment of incontinence from  |
|     the Continence Clinical Demonstration Project were exported       |
|     nationally through the Geriatric Audio Conference Series. (Drs.   |
|     Goode & Burgio, July, 2006)                                       |
+-----------------------------------------------------------------------+
| **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.              |
+-----------------------------------------------------------------------+
| b.  **Current Year Activity Outcomes** *(list up to five examples, up |
|     to two lines each; 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):*     |
|                                                                       |
| -   The Palliative Care Service facilitated the adoption of "Five     |
|     Wishes" as the Advance Directive used for patients in the         |
|     Birmingham VA Medical Center.                                     |
|                                                                       |
| -   The BVAMC hosted the VISN 7 Leadership Board (all Quad/Pentad     |
|     members from VISN 7). The educational focus of the meeting was    |
|     palliative and end-of-life care and included a tour of the Safe   |
|     Harbor Unit.                                                      |
|                                                                       |
| -   VISN 7 sponsored, and the Birmingham facility held a VISN 7       |
|     Summit Retreat in Palliative Care and Hospice Care. (August 2006) |
|                                                                       |
| -   Dr. Patricia Goode presented "Medical Interventions for Urinary   |
|     Incontinence in Older Men and Women" at the well-attended Annual  |
|     GRECC Conference in Little Rock, Arkansas.                        |
|                                                                       |
| -   Dr. Richard Alllman met with investigators at the Gainesville     |
|     GRECC and with G&EC leaders in Lake City, FL on June 15, 2006 to  |
|     discuss research, education, and clinical programs in geriatrics. |
+-----------------------------------------------------------------------+
| b.  **Previous Years' Activities Outcomes** *(list up to five         |
|     examples, up to two lines each; 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.)*                                                   |
|                                                                       |
| -                                                                     |
+-----------------------------------------------------------------------+