The AGS and the AGS Health in Aging Foundation conferred one of their newest honors, the Arti Hurria Memorial Award for Emerging Investigators in Internal Medicine Focused on the Care of Older Adults, on two experts:
- Rasheeda Hall, MD, a board-certified nephrologist and assistant professor of medicine at Duke University; and
- Kah Poh (Melissa) Loh, MBBCh, BAO, a board-certified internist, hematologist, and oncologist at the University of Rochester Medical Center.
Following the cancellation of the AGS 2020 Annual Scientific Meeting due to COVID-19, Dr. Hall and Dr. Loh both will be presented with the Arti Hurria Memorial Award for their innovative research at the AGS 2021 Annual Scientific Meeting (#AGS21; May 13-15 in Chicago, Ill.).
“Potentially Inappropriate Medications (PIMs) and Risk of Adverse Outcomes in Older Adults with Chronic Kidney Disease (CKD)” (Rasheeda Hall, MD)
For her research—now featured in a special supplement for the Journal of the American Geriatrics Society (JAGS), Dr. Hall and colleagues from Duke, the University of Pennsylvania, and the University of Maryland at Baltimore evaluated a concern long central to geriatrics expertise: The risk for adverse outcomes when using potentially inappropriate medications, especially for older adults with chronic kidney disease.
The kidneys play a key role in helping our bodies process medicines, and chronic kidney disease can impede their work and increase the risk for adverse effects (the medical term for serious issues or side effects associated with medication). In their study, Dr. Hall’s team looked at data from more than 3,900 adults enrolled in the Chronic Renal Insufficiency Cohort Study to determine whether potentially inappropriate medications—so named because they may have an improper balance of benefits and harms for certain groups, including older adults—were associated with mortality, falls, hospitalization, or worsening chronic kidney disease.
The use of potentially inappropriate medication increased considerably with age: 58.5 percent of patients under 65 used one or more such medication, with figures rising to 64.2 percent for those between the ages of 65 and 70 and 69.5 percent for those 71-years-old or older. In all age groups, the most common potentially inappropriate medications (identified using the AGS Beers Criteria®) were omeprazole, clonidine, and ibuprofen. In looking at patient data, Dr. Hall and her team also concluded that adults with chronic kidney disease taking multiple potentially inappropriate medications had increased risk for hospitalization, death, and falls irrespective of age.
A physician-scientist with expertise in geriatric nephrology, Dr. Hall has structured much of her career to design, test, and implement new models of care that target dialysis (a standard treatment for those with kidney failure). Dr. Hall has been awarded a Grant for Early Medical/Surgical Specialists’ Transition to Aging Research (GEMSSTAR) award and a Paul B. Beeson Career Development Award, both from the National Institute on Aging (NIA). She also received a 2019 AGS Health in Aging Foundation New Investigator Award for work presented at a past AGS Annual Scientific Meeting.
“Association Between Caregiver-Oncologist Discordance in Length-of-Life Estimates for Patient and Caregiver Satisfaction” (Kah Poh Loh, BMedSci, MBBCh, BAO)
In her work also published in the JAGS supplement, Dr. Loh and colleagues from the University of Rochester in N.Y., Rutgers University in N.J., and Alfred Health in Australia looked at the unique connections between caregiver optimism, health professional pragmatism, and satisfaction with care in geriatric oncology. Links between the three are important: Caregiver confidence often leads to overestimates for a patient’s length of life, which in turn can lead to frustration with the health system and dissatisfaction with the level of perceived support someone receives from a care team.
In their study, Dr. Loh and her team identified more than 380 pairs of caregivers and oncologists and asked them to estimate remaining lifespan for an older friend or family member receiving cancer care. Caregivers also completed a questionnaire regarding their satisfaction with the oncologist’s communication at periodic intervals between four weeks and six months after the study began.
More than 270 pairs of caregivers and oncologists disagreed about a patient’s estimated length of life. Interestingly, patient survival appeared to influence the effect discord had on caregiver satisfaction with an oncologist’s communication. For patients who survived cancer treatment, caregivers still rated oncologist communication favorably, even when both parties disagreed about lifespan. Conversely, for patients who died, caregivers tended to report greater frustration with provider communication when the caregiver’s lifespan estimate differed substantially from an oncologist’s prediction.
As an oncologist, Dr. Loh is no stranger to these conversations—but, as a geriatric oncologist, her training and expertise reflect the nuances of how those conversations can change as we age. With a long-term goal of developing behavioral interventions to improve outcomes for older adults living with cancer affecting the blood, Dr. Loh has received considerable support for her work from noteworthy influencers in the U.S. and abroad, including the U.S. National Cancer Institute (K99/R00 Pathway to Independence Award) and the prestigious Wilmot Cancer Institute (Wilmot Cancer Research Fellowship Award) at the University of Rochester.
Like Dr. Hall and Dr. Loh, Dr. Hurria—namesake of this award—championed AGS programs connecting colleagues outside geriatrics to the rewards of supporting health, safety, and independence for us all as we age. Dr. Hurria, who passed away in 2018, believed in the need to infuse geriatrics principles across all specialties. The Arti Hurria Memorial Award for Emerging Investigators in Internal Medicine Focused on the Care of Older Adults is one of several honors conferred by the AGS at its Annual Scientific Meetings. The award recognizes the accomplishments of junior and mid-career clinician-investigators in general internal medicine and its specialties. Chosen from hundreds of research presentations submitted to the AGS, the Hurria join our other award winners in representing healthcare leaders who champion care for older adults.
Past Recipients of the Arti Hurria Memorial Award for Emerging Investigators in Internal Medicine Who are Focused on the Care of Older Adults
2019 Lauren Ferrante, MD, MHS