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We are a scientific community of clinicians and researchers and we partner with the University of California, San Francisco (UCSF) and the San Francisco VA Health Care System (SFVAHCS) to bring the power of modern medicine to the health of our nation’s Veterans.

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Research News

Dr. Kristin Yaffe named 2022 Barnwell Awardee

NCIRE-supported researcher and Board member Kristine Yaffe, MD, has been named the 2022 John B. Barnwell Award recipient by the SF VA's Clinical Science Research and Development (CSR&D) service in recognition of her significant contributions as a leader in the field of Alzheimer's disease and related dementias (ADRD). She is the first woman to receive the award, which is CSR&D's highest honor given for scientific contributions that change clinical practice for veterans.

As an internationally recognized expert in the epidemiology of dementia and cognitive aging, Dr. Yaffe has served as the principal investigator on multiple grants from NIH, the U.S. Department of Defense, and several foundations, and delivered testimony as a subject expert to the U.S. Senate Special Committee on Aging. Her work focuses on the identification of modifiable risk factors—including cardiovascular and metabolic risk factors, sleep disturbances, and traumatic brain injury—and the critical role they play not just in late life, but across the entire lifespan. Her work has also provided important insight into the pathways that increase dementia risk.

The Barnwell Award recognizes senior VA Investigators who have achieved national and international acclaim for clinical research accomplishments in areas of prime importance to the VA’s research mission and who have also demonstrated a high level of clinical commitment to the patient population. More specifically, the award celebrates clinical researchers who have made notable sustained contributions resulting in better evaluation and treatment of conditions that are particularly important to veterans' health care.

Kristine Yaffe, MD, is the Roy and Marie Scola Endowed Chair and a professor of psychiatry, neurology, and epidemiology at UCSF, as well the Department of Psychiatry and Behavioral Sciences' vice chair for the Weill Institute for Neurosciences. She is also the chief of neuropsychiatry and director of the Memory Evaluation Clinic with the San Francisco VA Health Care System and director of the UCSF Center for Population Brain Health.

Join NCIRE in congratulating Dr. Yaffe for this remarkable achievement!

Smoking Prevalence Amongst Older Adults on the Decline

NCIRE-support investigators Drs. Ken Covinsky and John Boscardin co-published the article “The Epidemiology of Smoking in Older Adults: A National Cohort Study” in the Journal of General Internal Medicine. They found that smoking prevalence among older persons declined from 16% in 1998 to 11% in 2018 and over half of older smokers surviving to age 90 are able to successfully quit smoking. These findings highlight the need for continued aggressive efforts at tobacco cessation among older persons. This article was the last senior-authored article by Janine Cataldo, PhD, APRN-BC, FAAN, who died in 2021. Dr. Cataldo devoted her career to studying smoking and smoking cessation among older adults.

Ken Covinsky, MD, MPH is a clinician-researcher in the UCSF Division of Geriatrics. His research seeks to understand the factors that lead to disability in older persons and to improve the quality of life of those with older age disability and their caregivers. He holds the Edmund G. Brown, Sr Distinguished Professorship in Geriatrics and is Principal Investigator of the UCSF Older Americans Independence Center.

John Boscardin, PhD is a biostatistician with a joint appointment as Professor of Medicine and Epidemiology & Biostatistics. His primary roles with the Department of Medicine are as Director of the Statistical Laboratory in the UCSF Division of Geriatrics, Co-leader of the UCSF Pepper Center Data and Analysis Core, and Co-leader of the Analytics Core for the UCSF/Mount Sinai DEVELOP AD Research Program Project.

Learn More: https://pubmed.ncbi.nlm.nih.gov/36538157/

Functional and clinical needs of older hospice enrollees with coexisting dementia

NCIRE-supported researchers Drs. Alexander Smith and Kenneth Covinsky, along with colleagues at Mount Sinai, published a study in the Journal of American Geriatrics Society entitled: "Functional and clinical needs of older hospice enrollees with coexisting dementia." This study uses the National Health Aging and Trends Study (NHATS) linked to Medicare claims and finds that hospice enrollees with dementia coexisting with another terminal illness have high functional needs comparable to enrollees with principal hospice diagnoses of dementia, and high clinical needs comparable to hospice enrollees with no dementia.

Alexander Smith, MD, MPH, MS is a palliative medicine physician and Co-founder of the blog/podcast GeriPal.org and set of online prognosis calculators ePrognosis.org. His research is primarily focused on estimating and communicating prognosis for older adults with serious life limiting illnesses, including dementia.

Kenneth Covinsky, MD, MPH is a clinician-researcher in the UCSF Division of Geriatrics. His research seeks to understand the factors that lead to disability in older persons and to improve the quality of life of those with older age disability and their caregivers. He holds the Edmund G. Brown, Sr Distinguished Professorship in Geriatrics and is Principal Investigator of the UCSF Older Americans Independence Center.

End-of-life health care use among socially isolated and cognitively impaired older adults

Social isolation is common in the last years of life, especially among individuals with cognitive impairment (CI), but it is unknown if social isolation is related to end-of-life health care use.

In a nationally-representative cohort of 2,380 older adults in the last years of life, NCIRE-supported investigators Drs. Kristine Yaffe and Alex Smith, and their research colleagues examined if patterns of end-of-life health care use differed by level of social isolation or social isolation subscales including lack of household contacts, low social network interaction, and low community engagement.

The Study concluded that individuals with fewer household contacts had lower hospice use, and cognitively impaired individuals with low social network interaction had fewer end-of-life ED visits, hospitalizations, and ICU stays. Clinicians should consider mobilizing external support services to ensure access to goal-concordant care for older adults with limited end-of-life social contact when needed.

The study was published in the Journal of American Geriatrics Society.

Kristine Yaffe, MD is a NCIRE Board Member and Chief of NeuroPsychiatry and Director of the Memory Evaluation Clinic at SFVAHCS. She is also the Scola Endowed Chair and Vice Chair, Professor of Psychiatry, Neurology, and Epidemiology, and Director of the Center for Population Brain Health at UCSF.

Return to community living and mortality after moving to a long-term care facility: A nationally representative cohort study

Recent long-term care facility (LTCF) policy has focused on transitioning nursing home (NH) residents back to community settings, yet there is a lack of recent descriptions of this phenomenon and how it compares in assisted living (AL). NCIRE-supported researcher, Dr. Kenneth Covinsky, co-published a study that sought shine a light on this policy and the outcome for older adults.

Using the National Health and Aging Trends Study, Dr. Covinsky and his colleagues studied adults over age 65 who had moved from community living into an LTCF between 2011 and 2018. Their primary outcome was cumulative incidence of return to community living, with death as co-primary outcome and modeled as a competing risk, stratified by NH versus AL entry. They identified covariates (age, gender, race/ethnicity, dementia, activity limitations, and prior living arrangement) associated with return to community living through bivariate and multivariable logistic regression.

The study was published in the Journal of American Geriatrics Society.

NCIRE-supported Investigators’ research paper receives the Journal of Geriatric Oncology's Dr. Arti Hurria Best Paper Award for 2021-2022

NCIRE-supported investigators Drs. Louise Walter, Alex Smith, Carling Ursem co-published a paper that received the Journal of Geriatric Oncology's Dr. Arti Hurria Best Paper Award for 2021-2022.

The paper, “You have to be sure that the patient has the full picture": Adaptation of the Best Case/Worst Case communication tool for geriatric oncology”, posited that shared decision making (SDM) is especially important for older adults with cancer given the risks of over- and undertreatment, uncertainty regarding benefits/harms worsened by research underrepresentation, and individual preferences. The research team aimed to adapt the Best Case/Worst Case (BC/WC) communication tool, which improves SDM in geriatric surgery, to geriatric oncology.

Congratulations to our supported investigators!

Louise Walter, MD is a NCIRE Board Member and Professor of Medicine and Chief of the Division of Geriatrics at SFVAHCS and UCSF. Dr. Walter is a practicing Geriatrician in the SFVAHCS Geriatrics Clinic, as well as a clinician-researcher who is an international leader in evaluating the real-world risks and benefits of cancer screening in older patients.

Carling Ursem, MD is an Assistant Professor with the UCSF Division Of Hematology and Oncology at the SF VA Medical Center, with an expert focus on Gastrointestinal & Genitourinary Oncology and Geriatric Oncology.

Post-traumatic stress disorder and risk for hospitalization and death following COVID-19 infection

Post-traumatic stress disorder (PTSD) is associated with an increased risk for physical illnesses and early mortality. However, it is not known if it also increases the risk for adverse outcomes of coronavirus disease 2019 (COVID-19).

In a retrospective cohort study, published in the medical journal Translational Psychiatry, NCIRE-supported researchers, Drs. Karen Seal and Thomas Neylan, examined associations of PTSD and other psychiatric disorders with risk for hospitalization and death in the 60 days following a COVID-19 infection in 228,367 U.S. Department of Veteran Affairs patients who tested positive for COVID-19 between February 2020 and August 2021 (age m = 60.6, 89.5% male).

In this large-scale study of VA patients, individuals with PTSD, and other psychiatric disorders, had heightened vulnerability to severe adverse outcomes of COVID-19; thus, individuals with PTSD should also be considered at higher risk for severe COVID-19 outcomes, and potentially prioritized for vaccination, screening, and early treatment intervention for COVID-19.

Karen Seal, MD, is a Professor of Medicine and Psychiatry in Residence at the University of California, San Francisco (UCSF). Based at the San Francisco VA Health Care System (SFVAHCS), she serves as Chief of the Integrative Health Service.

Thomas Neylan, MD, is a Professor, In Residence in the Department of Psychiatry at the University of California, San Francisco. He is the Director of the Posttraumatic Stress Disorders (PTSD) Clinic and the Stress and Health Research Program at the San Francisco Veterans Affairs Medical Center.

Learn more: https://www.nature.com/articles/s41398-022-02156-w

Researchers Address Racial Imbalances in Alzheimer’s Study: $147M Grant Boosts Efforts to Recruit More Blacks, Latinx, Asians, American Indians

The Northern California Institute for Research and Education, which partners with UC San Francisco and the San Francisco VA Medical Center, has been awarded a five-year, $147 million grant that will expand diversity among Alzheimer’s disease research participants for the Alzheimer’s Disease Neuroimaging Initiative (ADNI).

In the fourth iteration of this study, ADNI4, researchers will focus on recruiting ethnoculturally diverse participants by using a community-engaged approach with recruiters in communities, digital marketing and social media campaigns. Approximately 50 percent to 60 percent of new enrollees will be from underrepresented groups, such as Black, Latinx, Asian, Pacific Islander, American Indian, as well as people with a high school education or less.

Funding for the upcoming phase of the study, ADNI4, is approximately double that of the study’s third phase, enabling researchers to expand their current participant pool from more than 1,000 to about 1,500 people. At least half of the participants will come from underrepresented populations, in an effort to make research findings more generalizable for all patients with Alzheimer’s disease.

ADNI was launched in 2004 to identify and validate the imaging, genetic and biochemical biomarkers in the early detection and tracking of Alzheimer’s disease -- the most common form of dementia -- as well as to support advances in preventing and treating the disorder through new diagnostic methods.

The project leader is Michael Weiner, MD, professor of radiology, medicine and neurology at UCSF and the principal investigator of ADNI, with 60 sites in the United States and Canada. ADNI is one of the first public-private partnerships funded in part by the National Institutes of Health’s National Institute on Aging to study the neurodegenerative disorder.

Association of Race and Ethnicity With Prescription of SGLT2 Inhibitors and GLP1 Receptor Agonists Among Patients With Type 2 Diabetes in the Veterans Health Administration System

Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney disease progression. The equitability of these agents' prescription across racial and ethnic groups has not been well-evaluated.

NCIRE-supported researchers, Drs. Michael Shlipak and Michelle Estrella, and their colleagues investigated the differences in the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with type 2 diabetes by racial and ethnic groups.

The study found that among patients with type 2 diabetes in the Veterans Health Administration system during 2019 and 2020, prescription rates of SGLT2i and GLP-1 RA medications were low, and individuals of several different racial groups and those of Hispanic ethnicity had statistically significantly lower odds of receiving prescriptions for these medications compared with individuals of White race and non-Hispanic ethnicity. Further research is needed to understand the mechanisms underlying these differences in rates of prescribing and the potential relationship with differences in clinical outcomes.

The study was published in The Journal of the American Medical Association (JAMA).

Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial

Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to the best of knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults.

NCIRE-supported investigator Michael Shlipak, MD, MPH co-published a study that sough to evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults.

The study, which included the analysis of a randomized clinical trial, showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC.

This study was published in The Journal of the American Medical Association (JAMA) Internal Medicine.

Michael Shlipak, MD, MPH is an Associate Chief of Medicine for Research Development at the SF VA Health Center System, Professor of Medicine, Epidemiology and Biostatistics at UC San Francisco, and co-founder and Scientific Director of the Kidney Health Research Collaborative.

Genetics professionals are key to the integration of genetic testing within the practice of frontline clinicians

With genetic tests have becoming more widely available, NCIRE-supported researchers sought to understand the use of genetic tests in the practice of frontline clinicians within the United States Department of Veterans Affairs (VA).

Drs. Maren Scheuner, Katherine Hoggatt, Mary Whooley and their colleagues administered a web-based survey to clinicians at 20 VA facilities. Physicians, nurse practitioners, physician assistants, and pharmacists were eligible. They excluded genetics providers and clinicians not seeing patients. The research team used multiple logistic regression to evaluate the associations between clinician characteristics and experience with genetics.

Their study revealed that most VA clinicians don't feel prepared to use genetic tests. Those with genetic testing experience are more likely to consult genetics providers. The demand for genetics providers should increase as frontline clinicians use genetic tests in their practice.

This study was published in Genetics in Medicine, a journal of the American College of Medical Genetics and Genomics.

Development and validation of novel multimorbidity indices for older adults

Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. NCIRE-supported researchers sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes.

In a study published in the Journal of the American Geriatrics Society, Drs. Michael Steinman, Sei Lee, Kenneth Covinsky, W. John Boscardin and their colleagues developed a new series of claims-based multimorbidity measures that were modestly better at predicting hospitalization and functional decline than several legacy indices, and death.

Incidence of Severe COVID-19 Illness Following Vaccination and Booster With BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines

A cohort of NCIRE-supported investigators posed the question: What is the incidence of severe COVID-19 illness following vaccination and booster with BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines?

The retrospective cohort study, published in the JAMA Network, included 1,610,719 participants receiving care at Veterans Health Administration facilities, followed up for 24 weeks (July 1, 2021, to May 30, 2022) after completing a COVID-19 vaccination series and booster. Overall, the incidence of hospitalization with COVID-19 pneumonia or death was 8.9 per 10, 000 persons. The meant that in a US cohort, there was a low incidence of hospitalization with COVID-19 pneumonia or death following vaccination and booster during a period of Delta and Omicron variant predominance.

The NCIRE-supported researchers involved in the study included Katherine Hoggatt, PhD; W. John Boscardin, PhD; Amy Byers, PhD; Phyllis C. Tien, MD; Salomeh Keyhani, MD, MPH; Joseph Wong, MD; and Tristin A. Moss-Vaszquesz, BA.

The study was published in the Journal of the American Medical Association (JAMA).

Improving multiparametric MR-transrectal ultrasound guided fusion prostate biopsies with hyperpolarized 13 C pyruvate metabolic imaging: A technical development study

NCIRE-supported investigator Matthew Cooperberg, MD, MPH co-published a study that sought to develop techniques and establish a workflow using hyperpolarized carbon-13 (13 C) MRI and the pyruvate-to-lactate conversion rate (kPL ) biomarker to guide MR-transrectal ultrasound fusion prostate biopsies.

The study demonstrated the safety and technical feasibility of integrating hyperpolarized 13 C metabolic targeting into routine 1 H-mpMRI and transrectal ultrasound fusion biopsy workflows, evaluated via 5 men (median age 71 years, prostate-specific antigen 8.4 ng/mL, Cancer of the Prostate Risk Assessment score 2) on active surveillance undergoing integrated scan and subsequent biopsies.

The study was published in the medical journal, Magnetic Resonance in Medicine.

Dr. Cooperberg is a Professor of Urology and Epidemiology & Biostatistics; Helen Diller Family Chair in Urology; Chief of Urology at San Francisco VA Health Center System.

Dr. Michelle Estrella receives ASN Distinguished Mentor Award

The American Society of Nephrology (ASN) recognized NCIRE-supported scientist Michelle Estrella, MD with its Distinguished Mentor Award.

The award recognizes individuals who have made contributions to the kidney community through the mentorship and development of other clinicians or researchers; and those who inspire trainees to pursue nephrology and become leaders in the transformation of healthcare through innovations in research, education, and practice.

Dr. Karen M. Warburton, MD of UVA Health was also recognized with this year’s award.

Michelle Estrella, MD, MHS is a Professor of Medicine and the Renal Section Chief at the San Francisco VA Medical Center.

Dr. Judith M. Ford Named 2022 Middleton Awardee

We are proud to announce that NCIRE-supported researcher Dr. Judith M. Ford has been named a 2022 Middleton Awardee! The William S. Middleton Award is the highest honor conferred by the VA Biomedical Laboratory Research and Development service, recognizing outstanding achievement in biomedical research.

Dr. Ford is recognized for her translational research in psychiatry, which has transformed the understanding of psychotic illnesses in Veterans. She is credited with explaining the basic neural mechanism that enables animals to distinguish between "self-generated" and "other-generated" sensations. This finding facilitated groundbreaking research that found people with schizophrenia demonstrate altered responses to self-generated sensations like sound and speech, due to an inability to predict these sensations.

Sensations that are not predicted may be attributed to external sources. In this way, thoughts may become audible. Her work has reassured patients and their families that their symptoms have a neuro-biological basis. Dr. Ford's research has provided fundamental insights into the pathophysiology of schizophrenia-spectrum disorders. She is a visionary scientist whose discoveries have assisted Veterans and others diagnosed with mental health disorders.

Dr. Ford is a research career scientist at the San Francisco VA Medical Center and codirects the Brain Imaging and Electroencephalography (EEG) Laboratory at the University of California in San Francisco. She was the former director of the Schizophrenia Biological Research Center at the VA Connecticut Healthcare System in West Haven.

Join NCIRE in congratulating Dr. Ford for this remarkable achievement!

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