I am a geriatrician and epidemiologist at the Brigham and Women’s Hospital and Assistant Professor of Medicine at Harvard Medical School. I am also appointed at the Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Institute for Aging Research, Hebrew SeniorLife.
My long-term goal is to improve decisions about use of drug therapy and surgical procedures in older adults by incorporating frailty. The main areas of my research include frailty, geriatric pharmacoepidemiology, and preoperative geriatric assessment. My research has been supported by grants from the National Institute on Aging, Harvard Catalyst/Clinical and Translational Science Center, Medical Foundation, and John A. Hartford Foundation. Current research projects are outlined below:
Frailty Measurement for Database Research: I developed a frailty index for Medicare data that enables measurement of frailty at the population level (check out here). This index has been validated against deficit-accumulation frailty index and physical performance based on clinical assessment. The claims-based frailty index enables assessment of the effectiveness of health care intervention in frail older adults and better risk adjustment for frailty. Selected ongoing projects include:
- Frailty measurement in claims data (NIA K08AG051187)
- Comparing claims-based frailty indices
Geriatric Pharmacoepidemiology: I am evaluating the comparative effectiveness and safety of drug therapies that are commonly used in ambulatory and hospitalized older adults. This research includes applying geriatric syndromes (e.g., frailty, multimorbidity, delirium, dementia) to evaluate outcomes of drug therapy and improving methods to study outcomes relevant to geriatric populations. Selected ongoing projects include:
- Antipsychotic use in hospitalized older adults with delirium (NIA R01AG056368)
- Frailty and effectiveness and safety of drug therapy
- Restricted mean survival time and home time to interpret treatment effect
Incorporation of Frailty in Clinical Practice: I have conducted both prospective and retrospective observational studies on frailty as a key predictor of clinical and functional outcomes in older adults. To translate frailty assessment into clinical practice, my team has developed an online calculator of frailty index for clinicians (check out here). I am working to improve measurements and calibration in the frailty index calculation, and build outcome databases to inform prognosis and clinical decision-making. In addition, I am also conducting clinical trials to prevent or reverse frailty and improve functional outcomes in older adults. Selected ongoing projects include:
- Frailty and functional outcomes after transcatheter and surgical aortic valve replacement (Harvard Catalyst and NIH, KL2 TR001100)
- Home-based exercise program for recovery after transcatheter aortic valve replacement: a pilot randomized controlled trial (NIA, P30AG031679, P30AG048785)
- Multicomponent frailty intervention for socioeconomically vulnerable older adults: a designed-delay study
As a board-certified geriatrician, I provide primary and consultative care to older adults with multiple chronic conditions and preoperative evaluation in patients before transcatheter aortic valve replacement in the Senior Health Clinic at the Beth Israel Deaconess Medical Center.
Locally I participate in various clinical and research training activities for medical students, postgraduate trainees, and research fellows at Harvard Medical School and Harvard Geriatrics Fellowship, and doctoral students at Harvard T. H. Chan School of Public Health. I am a faculty in the Harvard Annual Review of Geriatric Medicine course, in which I teach peers about preoperative assessment and treatment of older surgical patients. In addition, I direct the geriatrics observership program for international clinicians and scholars at the Beth Israel Deaconess Medical Center. Finally, I am a consultant to Alosa Health, a non-profit education organization, to develop and review evidence materials for academic detailing.
I am a member of the American Geriatrics Society, Gerontological Society of America, International Society for Pharmacoepidemiology, and American Delirium Society. As a member of the American Geriatrics Society Research Methods Subcommittee, I work with other members to organize a research method workshop at the annual meeting. I also collaborate with the members of the American College of Cardiology Geriatric Cardiology section to educate geriatric principles to cardiologists.