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UAB’s Dr. Cynthia J. Brown, MD – Promoting a Vision of National Leadership in Geriatrics

Cynthia BrownAs Director of the Geriatric Medicine Section in the Division of Gerontology, Geriatrics, and Palliative Care, Associate Professor of Medicine Cynthia J. Brown, MD, MSPH, is providing experienced, insightful leadership focused on promoting UAB’s continued role as a national leader in geriatrics. Having recently completed her first year in this key role, Dr. Brown says that UAB is well-positioned to remain on the forefront of groundbreaking advances in geriatric medicine. “Our vision for geriatrics at UAB is that we will assume an increasingly important national leadership role in research, clinical care, and education,” she explains. Prior to beginning her tenure at UAB in 2003, Dr. Brown completed a three-year Geriatric Medicine fellowship at Yale University. Since her arrival at UAB, Dr. Brown has become nationally recognized for her research and expertise in the care of hospitalized older adults, particularly in the area of low mobility and fall prevention. “UAB is fortunate to have someone as talented and accomplished as Dr. Cynthia Brown providing leadership for the Geriatric Medicine Section,” observes the UAB Parrish Endowed Professor of Medicine Richard Allman, MD, who also serves as the director of the UAB Center for Aging and the Division of Gerontology, Geriatrics, and Palliative Care. “It is also rewarding for me to see her professional development not only as a researcher and clinician but also as a strong leader with an inspired vision for geriatrics at UAB.”

Setting the Standard for Innovative Models of Clinical Care

Dr. Brown stresses that a key strength of geriatrics at UAB is the interdisciplinary approach to clinical care. “An important hallmark of our program is that we are inter-professional, which enables us to provide a higher quality of care to our patients because we are better able to overcome difficult and complex challenges through collaboration,” she adds. Dr. Brown says that this interdisciplinary approach has been incorporated into an innovative model of hospital care – called the Acute Care for Elders (ACE) Unit – that serves as a specialized unit for geriatric patients at UAB Highlands Hospital. “The cornerstone of this program is an interdisciplinary team that meets daily to discuss the management of geriatric issues that often go unrecognized or unaddressed during an older adult’s hospitalization,” she explains. Dr. Brown – who currently serves as the Quality Improvement and Research Director for the ACE Unit – says this unique, innovative model of care can be utilized successfully in other units of the hospital to increase the recognition and management of geriatric issues. “The ACE interdisciplinary team is there to assist the attending physician in recognizing geriatric syndromes and other problems associated with older adults,” she explains. “An important goal for us is to assist in transferring this model of care to other units of UAB Hospital – as well as to other hospital units across the nation.”

Spearheading Groundbreaking Research in Low Mobility and Fall Prevention

Dr. Brown says her research interest in low mobility and fall prevention among hospitalized older adults is an extension of her 10-year career as a licensed physical therapist prior to beginning medical school. “Initially, my research in this area focused on whether it was a problem for hospitalized older adults to remain in bed,” she explains. “In fact, our research established that remaining in bed during a hospitalization resulted in a decline in function and increased rates of new nursing home admissions among older adults.” Next, Dr. Brown examined the amount of time older adults spend out of bed during a medical hospitalization using wireless mobility monitors attached to the thighs and ankles of study participants. “Participants, who received typical, routine hospital care, spent 83% of their hospital stay in bed and were on their feet less than 45 minutes a day,” Dr. Brown explains.

Building on her previous, nationally recognized research in this area, Dr. Brown and her colleagues recently completed a randomized controlled trial that examined the effects of a mobility intervention administered to a group of hospitalized older adults. All of the study participants could walk independently when they were admitted to the hospital and had no dementia. Participants in the control group received routine hospital care while participants in the mobility intervention group received visits twice a day from a hospital staff member who assisted patients in getting out of bed and walking for a short time. “The individuals who walked with patients in the mobility intervention group were not physical therapists but various members of the hospital staff who had been given a brief training in the proper ways to assist patients in walking,” says Dr. Brown. At the end of the four-week study period, the control group – which received routine hospital care with no specialized intervention – had a 10-point decline in its average life-space mobility score. “However, the mobility intervention group had only a one-point decline in its life-space mobility score, indicating that the twice-per-day walking intervention administered to this group was effective in preventing significant functional decline during hospitalization,” observes Dr. Brown. “The results of this study provide encouraging evidence that significant functional decline among hospitalized older adults can be prevented with a simple walking intervention that can be administered by hospital staff or family members who have been given a brief training.”

Advancing UAB’s Role as a Center of Excellence in Pain Education

Dr. Brown’s commitment to geriatric education at the national level is further expressed in her current role as co-principal investigator for UAB’s recently awarded designation as a Center of Excellence in Pain Education – one of 12 professional schools from across the nation that were awarded this prestigious distinction by the National Institutes of Health Pain Consortium in May, 2012. As part of this three-year initiative, UAB and the 11 other Centers – including Johns Hopkins School of Medicine and the University of Pennsylvania Perelman School of Medicine – will serve as sites for the development, evaluation, and distribution of pain management curriculum resources for medical, dental, nursing, and pharmacy schools to enhance and improve how healthcare professionals are taught about pain and its treatment. “Cynthia’s leadership role in this initiative is enhancing and supporting the UAB Comprehensive Center for Healthy Aging’s mission to promote interdisciplinary research and education, which is integral in helping UAB to provide the highest level of care available to older adults,” says Dr. Allman.

Dr. Brown explains that because pain is extremely prevalent in older adults, it’s important for members of the medical community to understand how to assess pain and manage it effectively. “The impact of untreated pain is quite significant and impacts every aspect of life, including mobility and social interaction,” she adds. UAB and the 11 other Centers of Excellence are charged with developing Web-based modules, targeted to early learners, that will be utilized by health professional schools across the nation as a method of teaching about pain assessment and management. The UAB modules will focus on four distinct patient groups: older adults with dementia; older adults with multi-morbidity; HIV patients; and cancer survivors. “This initiative is interdisciplinary, incorporating expertise from professionals in pharmacy, medicine, physical therapy, occupational therapy, psychology, and nursing,” says Dr. Brown. “Each of these disciplines has a role in pain management. For example, pharmacy provides information about pain medications and their side effects, while nursing is instrumental in helping to assess levels of pain in the patient. Psychology often incorporates imagery and relaxation techniques to assist patients in managing pain.” Dr. Brown emphasizes that the initiative is also inter-institutional, allowing the participating universities to collaborate in developing the Web-based modules. “Our goal is not to create new information but to combine information from the participating institutions in order to offer the most advanced, leading-edge instruction from the best pain experts in the nation.”

The Future Role of Geriatrics from a National Perspective

Dr. Brown emphasizes that geriatrics will play an increasingly important role in the U.S. healthcare system as the number of older adults in our nation is expected to reach 70 million by the year 2030. “Still, there will be challenges to recruiting medical students into geriatrics,” she observes. “This is primarily because geriatrics isn’t as high-profile or as highly paid as most of the surgical specialties, for example.” Dr. Brown says this challenge underscores the need for geriatric education in the medical school setting. “Family medicine and internal medicine practitioners are the primary groups taking care of older adults. That’s why it’s important to incorporate geriatric education into medical schools and residency programs so that other specialties can have the benefit of specialized training in taking care of older adults.” She stresses that our nation is currently in the midst of the “silver tsunami” we have been anticipating. “Geriatrics will have an integral role in informing every other area of medicine regarding how to provide care for this important population.”

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