How do you motivate faculty, external colleagues, and curious undergraduates alike to brave the frigid cold to attend an 8:30am symposium?
Short answer: biscotti and coffee.
Of course, the breakfast delicacies are only a supplement to the strong, irresistible offerings of the annual Aging Center Research and Education Showcase, held Dec. 6 at the Trent Semans Center. As a first-semester undergraduate, I can attest to the captivating, inspiring nature of the speakers’ presentations; the research projects were interdisciplinary, comprehensive, and thought-provoking. What’s even more impressive is the intellectually stimulating questions prompted by the seasoned researchers in the audience. What an honor it was to listen to and learn from the legendary Dr. Harvey Cohen, Duke’s very own father of geriatrics, as he offered his advice to various presenters!
If I were to continue heaping praise on the symposium and narrate every detail of the 4-hour-long event, you would be bored to death. Instead, allow me to focus on the most impressive research undertakings (in my humble perspective): the PRISM Comparative Effectiveness Trial co-led by Dr. Cathleen Colon-Emeric, division chief of geriatrics, and the AI-driven clinical guidance project led by Dr. Juliessa Pavon.
The PRISM trial presentation from Colon-Emeric was the second talk listed in the symposium agenda, the first after the welcoming remarks from Dr. Heather Whitson, director of the aging center. And its headline placement was justified from the get-go: data on the prevalence of fall-related injuries is astonishing and concerning. For instance, did you know that two deaths occur from falls every hour in America? How about the fact that fractures are a more potent cause of death than breast or prostate cancers?
Having established the basis for her research, Colon-Emeric soon transitioned to her focus on post-acute care and the avenue by which she is investigating injury prevention mechanisms. Given that 90% of fracture patients take fall risk-increasing medications, with many taking up to three such medications simultaneously, Colon-Emeric and her co-investigators sought to design a randomized cluster crossover trial measuring injurious fall rates under three conditions. By assigning 3,780 patients in the study to deprescribing dangerous medications, treating osteoporosis, and both deprescription and treatment groups, the researchers hope to discern which model performs the best in preventing fall injuries.
After a few more invigorating lectures, the audience welcomed Dr. Juliessa Pavon for her remarks on her research on leveraging AI to personalize medication deprescribing for older adults. While Pavon’s project similarly aims to confront the issue of polypharmacy in seniors, especially the use of multiple central nervous system (CNS) acting drugs, she focuses on the process of deprescribing and how to improve decision-making. Noting that the current deprescribing tools such as STOPP and START are limited by their “one size fits all” nature, Pavon proposed that AI, the driving force behind individualized treatment rules (ITRs), could be used as a better alternative.
Beyond the complexity of models and algorithms used for this machine learning product and the behemoth dataset (containing information from 278,000 individuals) involved, I found Pavon’s explanation for the benefits of ITRs to be the most engrossing. Contrary to popular belief, ITRs don’t improve treatment outcomes for all patients, as portrayed in the depiction below. However, the strength of ITRs arises from their ability to achieve better outcomes for many patients beyond the baseline level, which is more desirable on a population level than applying the average treatment regimen. This realization was key for me to understand the rest of Pavon’s presentation.
Of course, I must address the other fascinating talks and poster presentations before I conclude. Dr. Cara McDermott’s seminar on improving medication and safety for rural residents featured another exciting research project; the selected data on the costs and difficulties surrounding dementia care was enlightening and underscores the grave realities confronting the support networks of dementia patients. Additionally, Dr. Maria Marquine’s address on research education in the Aging Center featured much celebratory applause as the audience congratulated undergraduate, graduate, and postgraduate scholars affiliated with the Aging Center’s various initiatives. Marquine’s passion and dedication to cultivating the next generation of aging and geriatric physician-leaders are evidenced by her involvement in all levels of the Aging Center’s education model, which warrants acclamation from the population at large. Lastly, I must mention the innovative research project spearheaded by Dr. Darina Petrovsky, assistant professor of nursing, examining the effect of music-based intervention for dementia patients. Her work, combined with her unique educational background of music studies and nursing, illustrates the multidisciplinary nature of medicine and how all skillsets could be applied to improving human health. Pre-med students: take this to heart!
While the weather outside was frightful, the fire of research and discovery inside the Trent Great Hall was surely delightful. As we celebrate another year of remarkable research progress at Duke Medicine and the Aging Center, let us congratulate our in-house experts on their work and together look forward to their exciting work in the coming year!