The Geriatric Research Education and Clinical Center (GRECC) is funded by the Department of Veterans Affairs Geriatric Research Education and Clinical Center (GRECC) and provides an integrated program of basic biomedical, clinical and health services research, education of trainees and practitioners, and clinical demonstration projects designed to advance knowledge regarding care of the elderly, with an emphasis on stroke.
The research component of the GRECC consists of four elements:
- Basic science
- Applied clinical
- Health services
- Rehabilitation research
The basic science component is focused on the identification of novel genes whose products play a role in regulating cell death after ischemia, the development of strategies to reduce expression of neurotoxic response genes or enhance expression of neuroprotective gene products in response to stroke. Health services research is directed at addressing inappropriate prescribing and the overuse of medications in the elderly VA population (geriatric polypharmacy). Rehabilitation research includes studies designed to determine the optimal parameters for rehabilitation of aphasia resulting from stroke, to determine the degree that hearing impairment contributes to cognitive dysfunction in the elderly, to develop a quality-of-life instrument for stroke survivors, develop innovative cardiac rehabilitation strategies and to address pain assessment and treatment in the elderly. The GRECC faculty expended over $3.5M in direct costs from federally funded research during the federal Fiscal Year (FY) 2018 in addition to the GRECC’s $2M VA core funding.
The education component of the GRECC is designed to ensure that existing knowledge in geriatrics and new research findings are integrated into clinical practice and disseminated locally, regionally and nationally, and consists of two elements:
- postgraduate fellowship training in geriatrics for physicians, clinical rotations for internal medicine residents and medical students, and clinical and didactic offerings for trainees in associated health science fields, and
- continuing medical education in geriatrics for physicians and other health service practitioners. There were 86 GRECC trainees (including fellows, residents, medical students, and associated health trainees) during FY2018 and approximately 1731 attendees at GRECC CME activities.
There were six active GRECC clinical demonstration projects:
- The Pittsburgh Intensive Residential Aphasia Treatment and Educational program (PIRATE) is a novel residential outpatient aphasia rehabilitation program. PIRATE provides a 21-day program of intensive aphasia treatment for veterans who reside at the John Heinz Community Living Center in Aspinwall during treatment.
- The Dementia Telemedicine Clinic that provides comprehensive geriatric, neurological, psychiatric and social work services for Veterans with dementia including telehealth services for patients at regional VA Medical Centers and Community Based Outpatient Clinics. These clinical demonstration projects are intended to pilot novel ways of delivering care to elderly veterans.
- Both an inpatient and outpatient cardiac rehabilitation (CR) program was developed that employs a large multi-disciplinary team consisting of a cardiologist, geriatrician, nutritionist, psychologist, social worker, pulmonologist, nurse, physical therapist, pharmacist, and specialists in sleep, pain management, smoking cessation, diabetes care, yoga, and tai chi. The CR program stands out as a model of care that is able to accommodate patients with a range of medical complexities as well as the logistic challenges associated with living far from the VA campus.
- The Geriatric Polypharmacy E-consult program was developed that consists of a team of a geriatric pharmacist, geriatrician, and project coordinator to provide e-consults to rural primary care providers at multiple Community Based Outpatient Clinics (CBOCs) affiliated with the VAPHS for Veterans >65 and taking 10 or more regularly scheduled prescriptions and non-prescription medications or who were taking any high-risk medications.
- A tele-dementia caregiver support group that was developed to assist caregivers of Veterans receiving care in the Tele-dementia clinic.