The UW Division of Geriatrics and the Geriatric Research, Education and Clinical Center (GRECC) of the Madison VA Medical Center support extensive interdisciplinary, translational research programs involving the study of age-associated diseases, their treatment and prevention strategies, and care management plans targeted to improve the lives of millions of older adults. The UW and GRECC faculty sponsor several internationally renowned research programs in aging, including Alzheimer’s disease, cancer and aging, caloric restriction, falls, osteoporosis, sleep disorders in the elderly, older women’s health, transitional care and health services research. Each program is supported by numerous peer-reviewed grants from various resources, including the NIH (RO1, PO1, T32, Beeson Award, K23), the Department of Veterans Affairs (Merit Review grants), the State of Wisconsin, various philanthropic organizations (i.e., the Hartford Foundation, Alzheimer’s Association, Helen Bader Foundation) and the pharmaceutical industry. Currently, the total research funding for the Division of Geriatrics exceeds $59 million. Training and mentoring junior investigators in research methodology is a Division and GRECC priority enhanced by affiliation with the John A. Hartford Center of Excellence in Geriatric Education and several NIH training grants.
In addition to investigator-initiated grants, the Division sponsors several prestigious institutes and centers supporting aging research, including the Wisconsin Alzheimer's Disease Research Center (PI: Asthana), the John A. Hartford Foundation-funded Center of Excellence in Geriatric Medicine and Education (PI: Asthana), Center for Women's Health Research (Director: Carnes), the Osteoporosis Clinical Center and Research Program, and the Wisconsin Institute on Healthy Aging.
Below is a brief description of major research programs sponsored by the UW Division of Geriatrics and the Madison GRECC:
Under the leadership of Sanjay Asthana, MD, the Division sponsors a nationally-recognized, well-funded, translational research program in Alzheimer’s disease and related illnesses. The program is supported by numerous grants from the NIH, VA, philanthropic foundations, and the pharmaceutical industry, and formed the basis for a recently funded P50 ADRC. The major focus of numerous ongoing research studies in the WCMP relate to various aspects of Alzheimer’s disease, including its neurobiology (Drs. Atwood, Puglielli), preclinical diagnosis (Dr. Johnson), prevention (Dr. Carlsson), and treatment (Drs. Asthana, Gleason).
Under the leadership of Rozalyn Anderson, PhD, the major focus of this internationally-renowned laboratory-based research program is to investigate the mechanisms of delayed aging by caloric restriction including its ability to off-set age-associated illnesses. The program involves molecular biology studies on postmitotic tissues, including adipose tissue, liver, skeletal muscles and the brain. Dr. Anderson and collaborators have published several seminal research papers, and are at the forefront of caloric restriction research involving non-human primates and rodents. Research support for the program has been received from various resources, including the NIH, the Department of Veterans Affairs (VA), and philanthropic foundations.
Dissemination of Evidence-Based Prevention Programs:
Led by Dr. Jane Mahoney, this work centers on effective ways to get evidence based programs into practice. Dr. Mahoneyis the Director of the Community-Academic Aging Research Network, which facilitates community-based aging research by connecting research faculty from UW-Madison with community partners from Wisconsin’s Aging Network. She is also the Medical Director of the Wisconsin Institute for Healthy Aging, a non-profit organization that disseminates evidence-based prevention programs for older adults to community partners and health care systems in Wisconsin and nationally. Lastly, she is Co-Director of Dissemination and Implementation Resources for UW-Institute for Clinical and Translational Research. In this role, she works with faculty across SMPH and it's affiliates to help them develop dissemination and implementation research grants, conduct the research, and launch their interventions into widespread practice across the United States.
Nicole Pulia, PhD, CCC-SLP, is an Assistant Professor in the Departments of Medicine and Surgery and Affiliate faculty in the Department of Communication Sciences and Disorders at the University of Wisconsin-Madison. Additionally, she is the Director of the Swallowing Research Program in the Geriatric Research Education and Clinical Center (GRECC) at the William S. Middleton Memorial Veterans Hospital as well as Director of the multi-site Veteran Health Administration’s (VHA) Swallow STRONG clinical program. The goal of Dr. Rogus-Pulia’s research program is to systematically identify and characterize factors underlying dysphagia in older adults and translate these findings into novel, evidence-based treatments for prevention of pneumonia onset. Her specific research interests include the effects of tongue strengthening on swallow function and health status, the impact of altered salivary production on swallowing, and the design of interventional studies for dysphagia in patients with dementia. Dr. Rogus-Pulia has grant funding from the VHA, the American Speech-Language-Hearing Foundation, and the Wisconsin Alzheimer’s Disease Research Center (ADRC) to support this work.
Various programs designed to reduce incidence of falls in older adults are developed and researched in this area under the leadership of Dr. Jane Mahoney. Her current work includes developing a cultural and linguistic translation of a group program for the Hispanic community as well as an online maintenance program for graduates of the Stepping On fall prevention program.
Under the leadership of Molly Carnes, MD, MS, areas of training and research have focused on investigations aimed at increasing the diversity of the scientific and medical workforce as a way of improving women's health across the lifespan. Support for research and training includes grants from the NIH, NSF and the VA.
The major objective of this preeminent research program is to understand the pathophysiology and treatment of bone disease using various clinical investigative and basic science approaches. Under the leadership of Neil Binkley, MD, the major focus of numerous ongoing clinical studies in this program is to characterize the potential beneficial effects of alendronate, parathyroid hormone (PTH), and vitamin K on bone mineral density and markers of bone turnover. The basic science studies focus on the PHEX/Phex gene cloning, mutations, and tissue localization. Similar to others, this program is also supported by several peer-reviewed grants and those from the pharmaceutical industry.
Sleep Disorders in the Elderly:
Under the direction of Steven Barczi, MD, the Associate Director for Education and Evaluation at the Madison GRECC, this program investigates the potential adverse effects of sleep disorders on chronic disease, vascular status and cognitive function of older adults. Specific areas of investigation include sleep apnea, comorbid insomnia and sleep changes in dementia. Physiological research and clinical research occur in the setting of a nationally recognized VA respiratory physiology laboratory, two state-of-the-art clinical laboratories and geriatric-focused sleep clinics at both the UW (Wisconsin Sleep Center) and Madison VA. The GRECC and Madison VA hospital co-sponsor a clinical and research fellowship in Sleep Medicine that is jointly affiliated with the UW Center for Sleep Medicine and Sleep Research within the School of Medicine.
Research to Improve Care System Fragmentation for Disadvantaged Populations:
One of the emerging areas of novel research in the UW Division of Geriatrics relates to improving care system fragmentation for disadvantaged populations. Under the visionary leadership of Amy Kind, MD, PhD, an Associate Professor in the Geriatrics Division, Associate Director-Clinical for the VA Geriatrics Research Education and Clinical Center (GRECC) and a health services/implementation investigator, the major focus of this program is on assessing, understanding and improving care system fragmentation, particularly for highly vulnerable and disadvantaged older adult populations, especially those with Alzheimer’s Dementia. This program strives to develop novel ways to eliminate health disparities through innovative research in health policy and clinical programs, including performing studies to examine the role of neighborhood socioeconomic contextual disadvantage in the health of older adults. As part of this research, the program has designed and disseminated clinical interventions which improve care transitions and between-facility communication at the time of hospital discharge for high-risk older adult patients, including those with dementia and those in low-resource settings. One of these interventions, the Coordinated-Transitional Care (C-TraC) Program, is a low-cost, mostly phone-based intervention designed to improve hospital-to-home transitions for patients with dementia and other high-risk conditions. Originally developed at Madison VA Hospital, C-TraC was named a “VA Best Practice”, has disseminated to multiple VA and non-VA hospitals, and is the focus of a 5-year NIH-funded randomized controlled trial targeting patients with dementia and a 2-year CMS pilot to improve care within highly disadvantaged areas. Additionally, the program is sponsoring studies using Medicare-claims data to focus on issues of rehospitalization in high-risk populations, including the role of socioeconomic disadvantage in 30-day rehospitalization for older adults. This area of research is supported throughfunding from the NIH/National Institute on Aging, NIH/National Institute on Minority Health and Health Disparities, Department of Veterans Affairs and multiple non-profit foundations.
Overall, the UW Division of Geriatrics sponsors both laboratory-based and translational research studies of pivotal clinical significance and relevance. These studies are supported by numerous peer-reviewed grants from the NIH and the VA, and target enhanced care for millions of elderly patients suffering from chronic disabling illnesses. A substantial infrastructure exists to train and mentor junior investigators as they pursue their academic goals. The overarching mission of the Division of Geriatrics-sponsored research program is to better understand the pathobiology of age-associated diseases, and to reduce the cost and burden of illness as well as enhance the quality of life of older adults.