Policy Perspectives: Dementia
Dementia diagnoses will increase dramatically over the next years, according to a recent New York Times article. The article discusses new research suggesting the number of people in the United States who develop dementia each year will double over the next 35 years to about one million annually by 2060, with the number of new cases per year among Black Americans tripling. The increase will primarily be due to the growing aging population, as many Americans are living longer than previous generations. Increasing numbers of patients with dementia will also impact how care to these patients is delivered.
Many IHPS faculty research dementia care. Alissa Sideman, PhD, MPH, MA, Alma Hernandez de Jesus, and colleagues have a recent paper sharing the dissemination results of the Care Ecosystem, an effective collaborative care model that bridges medical and social care needs for individuals with dementia. Michael Steinman, MD, Leah Karliner, MD, MAS, Elena Portacolone, MBA, MPH, PhD, Kristine Yaffe, MD, John Boscardin, PhD, and Krista Harrison, PhD, along with their colleagues look at the use of high-risk medications by adults with cognitive impairment living alone. More than one-fourth of older adults with cognitive impairment live alone; these individuals often lack support for medication management and face a high risk of adverse drug events. The findings in their research findings can inform medication optimization interventions supporting this vulnerable population.
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"One thing that interests me right now is the role of AI (artificial intelligence) in both our clinical care models and research and what implications this has for all of us in both the communication and transparency of how AI is already integrating into our clinical care and research pipeline and what we anticipate the future will look like."
Dr. Farrand is an Assistant Professor in the Division of Pulmonary, Critical Care, Sleep, Allergy and Sleep Medicine and affiliated faculty at IHPS. Dr. Farrand's scholarship focuses on defining, assessing and improving the health care quality, safety and outcomes for individuals with interstitial lung disease.
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What are you currently working on? I’m conducting a pilot study to assess how well older adults tolerate sedation with oral benzodiazepines as an alternative approach to routine anesthesia care for cataract surgery.
What drew you to work on this? I’ve always been interested in patient safety and healthcare value. The ongoing shortage of anesthesia providers within the context of an aging US population motivates me to try and find alternative sedation options for cataract surgery that help allocate limited anesthesia resources more effectively. While routine anesthesia care has been the standard of care for cataract surgery sedation for decades, technological innovation has made it feasible for cataract surgery to be performed safely under local/topical anesthesia with light intravenous sedation. For selected patients, offering oral sedation for this procedure would potentially allow cataract surgery to be performed without the routine presence of anesthesia-trained clinicians. The demand for all surgical procedures (including cataract surgery) will continue to increase with the aging population, and many procedures cannot be performed without the expertise of anesthesiologists. My goal is to ensure that everyone who needs surgical care can have timely access to critical anesthesia services while preserving safe models of cataract surgery sedation that are acceptable to both patients and ophthalmologists.
What's next? Building on our pilot results, I plan to continue this line of inquiry with a full-scale RCT.
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What are you currently working on? I am currently working on several health education projects co-developed with youth. One of the most recent is a study integrating a behavioral health intervention into sports-based programming with colleagues at Soccer without Borders.
What drew you to work on this? Working directly with youth and community-based partners is inspiring and informative. It helps ensure that my research is relevant. For example, when developing “booster” sexual health education with older teens in the Central Valley, the teens really prioritized learning more about healthy relationships and communication.
What's next? We are about to launch an RCT of a fully online sexual health education program for youth in rural communities throughout the US. In some places, this information is no longer taught in schools. We are interested in seeing if the program improves health outcomes as well as learning how to best engage youth in online programming.
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What are you currently working on? My work leverages clinical informatics to accelerate the adoption of evidence-based practices that improve the quality of healthcare delivered within the VA's national learning health system.
What drew you to work on this? I like to fix things and optimize efficiency. If I had not gone to medical school, I would have become a systems engineer. Fortunately, the Veterans Health Administration healthcare system provides many opportunities to combine these interests! Our current work focuses on “Learning Health System” (Friedman et al, 2010) projects that identify quality gaps (data to knowledge), implement interventions to address those gaps (knowledge to performance), measure the impact of those interventions on healthcare outcomes (performance to data), and capture that data to identify further improvement opportunities (data to knowledge). During the past decade, for example, my mentees (a) found that guideline-recommended cardiac rehabilitation was vastly underutilized in patients with cardiovascular disease (Park et al, 2017; Beatty et al, 2018); (b) designed and implemented a novel home-based program at VA facilities (Rohrbach et al, 2017); (c) quadrupled participation in cardiac rehab (Schopfer et al, 2018; (d) reduced wait time from index event to enrollment by 2 months, with similar outcomes to traditional programs (Schopfer et al, 2020); and (e) demonstrated lower mortality in patients who did versus did not enroll (Krishnamurthi et al, 2023).
What's next? We recently launched a Learning Health System Embedded Scientist Training and Research (LHS E-STAR) Center Scholars Program at UCSF. Our goal is to train the next generation of Learning Health System scientists to improve healthcare delivery using this model.
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Leah Karliner, MD, MAS, Christina Mangurian, MD, MAS, and colleagues published Depression Treatment After a Positive Depression Screen Result in JAMA Internal Medicine. In this cohort study, moderate rates of initial treatment among patients with elevated depressive symptoms and/or suicidal ideation (SI) were found. Targeted interventions are needed for patients at risk of undertreatment, including patients with SI, African American or Black and Asian patients, and older adults.
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Chuan Mei Lee, MD,MA, Jayme Congdon, MD, MS, and colleagues published Practice-Based Models of Pediatric Mental Health Care
in the Pediatric Clinics of North America. Integrating behavioral health services in pediatric primary care can help address the growing mental health needs of children and adolescents in the US. Given the different approaches for integration, pediatric primary care practices may evaluate the features of each model and considering tailoring it to their unique practice environments.
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Elizabeth Dzeng, PhD, MD, MPH, and colleague, Sarah Rosenwhol-Mack, MD, published The Effects of Individual Ethical Frameworks on Clinician Moral Distress in the Journal of General Internal Medicine. Moral distress is often defined as the inability to act in accordance with one’s ethical beliefs because of institutional or other constraints. Moral distress was more frequently described among physician trainees with a best interest framework than those with an autonomy framework. This finding held true among both US and UK physician trainees.
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Tracey Woodruff:
(Yahoo News)
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Intimate Partner Violence Among Birthing People: Rural-Urban Differences and Implications for Safety and Equity
Katy Kozhimmanil, PhD, MPA
Vice Provost for Special Projects at Harvard University, Carol K. Pforzheimer Professor at Harvard Radcliffe Institute
Professor of Public Health Policy at the Harvard T.H. Chan School of Public Health
Harvard University
Intimate Partner Violence Among Birthing People: Rural-Urban Differences and Implications for Safety and Equity
Feb 5, 12 - 1 pm PT
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2025 Chancellor's Health Policy Lecture
Dave Chokshi, MD, MSc
Chair of the Common Health Coalition
Co-Chair of the Health and Political Economy Project
Sternberg Family Professor of Leadership
City College of New York
Mar 12, 2025, 12 - 1 pm PT
UCSF Nancy Friend Pritzker Psychiatry Building Auditorium
675 18th Street, San Francisco
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Follow IHPS on LinkedIn
IHPS has recently begun using LinkedIn. Please follow us at the link below! We will be sharing valuable updates regarding the work the IHPS community is engaged in, insights on current health policy-related matters, and information regarding IHPS-related events regularly.
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Philip R. Lee Fellowship Fund | |
Since its founding 50 years ago, IHPS has been dedicated to training the next generation of leaders in interdisciplinary research to solve our most important health policy issues. In celebration of our 50th anniversary and to honor our founders, Phil Lee and Lew Butler, we established an endowment fund for the Philip R. Lee Fellowship. We hope to continue to keep this fund and our fellowship program robust. | |
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Photo: Kim Felder Rhoads, MD, MS, MPH & Fellow for 2007-2008 with Philip R. Lee, MD, Founder of the Institute for Health Policy Studies | | | | |
