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We are very pleased to share with you that COAH Core Faculty Dr. Thomas Cudjoe is our Winter 2023 COAH Champion. If you have an opportunity to bask in the presence of his warm smile and speak with him for a few minutes, surely you will recognize qualities such as his genuine concern and sincere compassion for people—particularly older adults, whose interests are at the heart of his life’s work. Known as an expert in social isolation and loneliness among older adults, Dr. Cudjoe was the lead author on two recent papers in this space that connect social isolation with an increased risk for dementia; Johns Hopkins Medicine story here, and NPR story here.

Assistant Professor of Medicine, Dr. Cudjoe is faculty in the Johns Hopkins University Division of Geriatric Medicine and Gerontology, where he is the Robert and Jane Meyerhoff Endowed Professor, and he is a Co-Director for Medicine for the Greater Good. In 2020, Dr. Cudjoe received the Division’s Junior Faculty Teaching Award, and in 2018 he was named one of 125 Hopkins Heroes “Living the Mission” in honor of Johns Hopkins University’s 125^th anniversary. Additionally, Dr. Cudjoe is a Center for Innovative Medicine Caryl & George Bernstein Scholar, which sponsors his involvement with the Johns Hopkins University Human Aging Project. And Dr. Cudjoe is the Stakeholder Engagement Core Leader for the university’s AI & Technology Collaboratory for Aging Research.

Beyond these accolades with Johns Hopkins, Dr. Cudjoe serves as a Major in the U.S. Army Reserves Medical Corps, where he was recognized with medals for Commendation, Achievement, and Humanitarian Service.  Plus, the Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity honored Dr. Cudjoe with an Achievers Award for his distinguished military service in 2020 in honor of Veterans Day.  (You may be interested in this story about US Army doctors fighting the coronavirus, which features a nice image of Major Cudjoe among Army colleagues and describes an effort to fight COVID-19.)     

Tony Teano: Tell us about your background, education, and path to COAH.

Dr. Cudjoe: I was born in Philadelphia, Pennsylvania, and I grew up in Macon, Georgia.  Experiences with grandparents in Georgia and also visiting grandparents in Ghana, were important to appreciating and being interested in what matters to older adults.  Also, I think my mother’s advocacy work was formative to my way of thinking early on.

When I went to college, I studied Biology, but I was planning to go to law school. One of my professors urged me to consider medicine. When I came home during the summer following my freshman year, I looked at programs that would expose me to medicine. To get ahead of this for my next summer, I started calling programs and asking about what I needed to do to be a successful applicant, and that’s how I stumbled upon an opening for a summer at Columbia College of Physicians and Surgeons in New York. They reviewed my information and accepted me that same summer.  After this program, I thought I would pursue medicine and law to merge my interest in caring, justice, and advocacy.  I later decided to pursue public health instead of law and did an MPH in Health Policy at Harvard School of Public Health after my 3^rd year of medical school at Robert Wood Johnson Medical School in New Jersey. A course on Issues of Aging exposed me to the complexities of aging policy and solutions. This fascinated me and helped me clarify that I wanted to dedicate my career to caring for and advancing issues related to the health and well-being of older adults. Following medical school, I did residency in internal medicine at Howard University Hospital in Washington, DC, and then came to Baltimore in 2015 to pursue clinical fellowship at Johns Hopkins.  Early on in my clinical fellowship, I met with Drs. David L. Roth and Cynthia Boyd and they helped me clarify my goals and obtain funding to support two additional years of research training. During this time, I was fortunate to receive excellent mentorship and sponsorship from Drs. David Roth, Deidra Crews, Roland Thorpe, Cynthia Boyd, Jennifer Wolff, Laura Gitlin, and Sarah Szanton.

 

Tony Teano: Why did you choose to go into this field of work?

Dr. Cudjoe: My caregiving experience with my Grandpa was pivotal.  While visiting the doctor (Clement Nwosu, MD) with him when I was a freshman in college nurtured the interested that had been planted by one of my college mentors (Dr. Alfred McQueen at Hampton University).  These interactions as well as those during medical school and the course during my MPH helped me choose geriatrics.

Tony Teano: What paper are you most known for or most proud of?

Dr. Cudjoe: Epidemiology of social isolation. This was my first paper. It remains my most cited paper.  It helped establish me in the field.

Tony Teano: This feature will be published during Black History Month. Could you please tell us who your Black Hero is?

Dr. Cudjoe: Loretto Madeleine Grier-Cudjoe, DMD. My Mom is my hero. I have deep love and respect for her on so many levels. Her parenting and ongoing work has been critical for how I think and navigate life.

 

Tony Teano: What are the top items on your bucket list?

Dr. Cudjoe: To visit the Great Pyramids of Giza.

Tony Teano: Tell us about your hobbies… what renews you?

Dr. Cudjoe: I enjoy making pottery—engaging in ceramics!

 

 

 

Tony Teano: You recently published several articles that connected social isolation with dementia. Could you tell us more about your findings and how to intervene, please?

Dr. Cudjoe: Among older adults in the United States, social isolation is common. One in four adults experience isolation, and that is associated with a higher hazard of incident dementia over nine years. There were no observed differences in the association between social isolation and dementia by race and ethnic.  Social isolation may be a valuable and modifiable risk factor to target interventions for reducing dementia risk across diverse racial and ethnic groups.

Tony Teano: This is significant! And the good news is that the risk may be mitigated through social connection—wonderful insights everyone should know as they check in with the older adults in their sphere, near or far.  Dr. Cudjoe, thanks so much for taking the time to speak with me about your work and your world.

We thank Dr. Cudjoe for allowing us this opportunity to share this up-close and personal look into his personal and professional worlds. He is an amazing, thoughtful leader in geriatric medicine, and COAH is proud to celebrate his success! To keep up-to-date with Dr. Cudjoe, follow him on Twitter @tkmcudjoe.

 

By Anthony L. Teano, MLA
Communication Specialist

 

 

Thanks to our supporters who voted in the university-wide Diversity Innovation Grant (DIG) crowdsourcing competition, our proposal was funded!  We are deeply grateful for this opportunity to provide Diversity Equity and Inclusion training to research program coordinators and managers on best practices for enrolling older adults from minoritized populations who have been historically underrepresented in research (e.g., Blacks and LGBTQ+ people).

This training will be open to research staff members in all departments across the university where older adults are being recruited to research studies (Medicine, Nursing, Public Health, etc.). 

Specifically, the DIG funding will support training for 20 staff who are involved in recruiting older adults into ongoing clinical research studies—a goal we seek to achieve by June 30, 2023.  Here is the timeline to roll out this initiative:

• February: We will host a webinar to share information about this training program, and to recruit participants. Stay tuned for details—coming soon!
• March: We will select 20 research staff who will participate and ask each participant to complete a pre-training survey to self-rate their competencies for recruiting and engaging with diverse older adult populations.
• April: Training to start for all staff members. The curriculum includes two required courses: Faster Together, Enhancing the Recruitment of Minorities in Clinical Trials (Coursera); and Supporting LGBTQ+ Older Adults (SAGECare).
• May: Training to be completed by the end of the month.
• June: Participants will be asked to complete a post-training survey. We will also hold a meeting for participants to debrief, and to share ideas for incorporating the knowledge gained into their work.

If you would like to participate in this training program, or if you have any questions about it, please contact Brian Buta.  Again, many thanks to those who made funding this important proposal a priority in DIG’s crowdsourcing. It couldn’t have happened without your energetic support.

By Anthony L. Teano, MLA
Communications Specialist

 

We invite you to join us for our Center on Aging & Health Scientific Seminar on Monday, February 6, 2023 at 3:30pm with our featured speaker, Dr. Lindsay Kobayashi, Assistant Professor in the School of Public Health at the University of Michigan.  Dr. Kobayashi’s presentation is entitled “Socioeconomic conditions and cognitive aging in a rural, low-income setting: triangulating evidence across complementary study designs” and will be held in the Powe Room 1-500Q at 2024 E. Monument Street.  We encourage you to join us in person.  You may also attend via Zoom by registering at this link https://bit.ly/3XmacUz

 

 

Key Highlights about USDeN: 

• Pilot and Grant Planning Awards (Letter of Intent (LOI) due January 4, 2023)
• Junior Investigator Intensive Program (Application due February 1, 2023)
• USDeN Annual Meeting (May 3, 2023—Long Beach, CA)
• USDeN Webinars (Future schedule & Links to previously recorded)

 Cynthia M. Boyd, MD, MPH, the Mason F. Lord Professor of Medicine, is a Senior Associate with the Center on Aging and Health. Dr. Boyd’s primary appointment is with the School of Medicine, where she serves as the Director of the Division of Geriatric Medicine and Gerontology, and she has joint appointments with the Bloomberg School of Public Health in Health Policy and Management and in Epidemiology. Dr. Boyd’s research interests at Johns Hopkins include older people, person- and family-centered care multiple chronic conditions, multimorbidity, disability, functional recovery, quality of life, cognitive decline, polypharmacy, deprescribing, and guidelines. Also, Dr. Boyd is co-primary investigator for the US Deprescribing Research Network (USDeN) along with Dr. Michael Steinman with the University of California, San Francisco. Today, we will speak with her about USDeN.

Tony Teano:  Thanks for taking the time for this interview. You are a very well-respected national leader in the field of Geriatric Medicine and you are internationally known for your leadership in deprescribing research among older adults.  What is deprescribing and why is it important to older adults?

Dr. Boyd: My pleasure! I’m always happy to talk about the importance of deprescribing to older adults! Deprescribing refers to the thoughtful and systematic process of identifying high risk, low benefit, or unnecessary medications and either reducing the dose or stopping these medications in a manner that is safe, effective, and helps people maximize their wellness and goals of care. Deprescribing has the potential to avoid harms and to increase the quality of life.

Deprescribing is a collaborative effort between a patient and a health care professional to optimize medication usage in a way that puts what matters most to the patient as the goal, in tandem with reducing or eliminating potentially harmful medications. Medications may interact with each other in a way where the risks of harm outweigh the benefits. Some medications may no longer be needed because the condition may have resolved. Some medications may metabolize differently in an older adult compared to the way their body processed them when they were originally prescribed, and that may yield undesirable side-effects—so a medication may need to be decreased appropriately. Some medications, such as those prescribed in an emergency room or at hospital discharge, may have only been meant to be temporary. Plus, one medication may lead to a side-effect that causes a person to take yet another medication. This is especially important for older adults to consider, particularly if they are taking multiple prescriptions for multiple chronic conditions that may have been prescribed by multiple physicians over time.

Tony Teano:  What are a few common examples of medications that some older adults might be better off without?  Perhaps some medications that are red flags to check?

Dr. Boyd: Some medications, such as certain antihistamines and anti-anxiety drugs, may increase the risk of falls among older adults, and it may be more important for that individual to stop taking or cut back on such medications. Another example is that some medications may have side-effects that increase the risk of confusion or even delirium among older adults, such as opioids and some prescription sleep aids. Other commonly overly prescribed medications include proton pump inhibitors and gabapentin.

There are many drugs that may no longer be of benefit to a patient, and lists of medications should be reviewed for potential interactions and side-effects and whether they are still needed.  It is crucially important to mention that exploring tapering off or eliminating such medications should only be done under the close supervision of a doctor or other prescriber such as a nurse practitioner, physician assistant. Pharmacists are a great help in reviewing combinations of medications. Together with a patient, health care professionals should assess each person’s individual care plan and focus on what matters most to that person, and to deprescribe, with follow up and monitoring when appropriate.

Reviewing medications to evaluate for the possibility of deprescribing should be a routine practice to support safety and personalized care: improve quality of life for patients, optimize the use of medications that are necessary, and putting what matters most to the patient and their health outcomes at the center of the conversation. For these reasons, deprescribing is not only a science backed by evidence and research, it is also an art in the sense that no two pictures of it may look quite the same because each person is unique and values different treatment priorities. Deprescribing is tailored care.

Reviewing medications periodically to screen for drug interactions and patient-centered care priorities should be a normal part of care but it doesn’t always actually happen. These conversations to are essential to high-quality care and in the best interest of older adults. Clinicians need more research, guidelines, and best practices about how to do this well. And that’s what the US Deprescribing Research Network (USDeN) is here for—providing rigorous, evidence-based research to support clinicians, patients, and their caregivers—all of whom are essential stakeholders in any deprescribing conversation.

Tony Teano: Please tell us more about USDeN and what it aims to do.

Dr. Boyd:  Funded by the US National Institute on Aging, USDeN’s goal is to develop and disseminate evidence about deprescribing for older adults, and in doing so to help improve medication use among older adults and the outcomes that matter.  USDeN is a community of people interested in mutual collaboration and learning about improving the body of impactful research on deprescribing for older adults. Overall, our activities are aimed at providing meaningful, helpful resources to catalyze expansion of the quality, quantity, and ultimate impact of deprescribing research.  To this purpose, USDeN has four robust, highly-engaged cores: Investigator Development Core; Pilot and Exploratory Studies Core; Stakeholder Engagement Core; and the Data and Resources Core.

I encourage anyone interested in USDeN to join us at our next annual meeting, which will be conveniently held just ahead of the American Geriatrics Society’s annual meeting, on Wednesday May 3^rd in Long Beach, California (more information here). This meeting will comprise a wide-ranging series of sessions and activities that are focused on:

1. Enhancing skills, providing multidisciplinary perspectives, and offering practical guidance on and opportunities for deprescribing research;
2. Communicating how the network can help an investigator advance deprescribing research interests;
3. Building collaborations and community among people interested in deprescribing research—and how it can be used to improve care for older adults.

The annual network meeting is open to all who are interested in research on deprescribing for older adults, including early-stage investigators, more experienced investigators, patients, caregivers, health system and other stakeholders, and policymakers who have a strong interest in advancing scholarship on deprescribing and translating research findings into everyday practice.  The meeting is designed to be interactive, so all attendees should be prepared to actively participate!

Tony Teano:  I noticed that USDeN offers grant awards. Tell us about them, please.

Dr. Boyd: Yes! USDeN has Pilot and Grant Planning award opportunities, and the Letter of Intent for this cycle is on January 4, 2023.  The LOI is really just a quick way to let USDeN know that you are interested and help us plan for our scientific review process—it doesn’t have to be a detailed plan.  The LOI is required, and the January 4, 2023 deadline is firm.  So I encourage anyone interested in this field to get it done soon! You can find examples of all the required documents and a webinar tutorial about it on USDeN’s website. The LOI is an easy first step to do.

All topics related to deprescribing research are welcome. Pilot awards are helpful to goals such as gathering preliminary data, proof of concept, or development work for a future, large-scale study.  Pilot awards also support career development, especially for junior investigators. Pilot awards are for 1 year with a maximum budget of $60,000 in total costs.  Grant Planning awards are intended to fund grant preparation activities that will lead to submission of large grant proposals, such as multisite clinical trials. For instance, a Grant Planning award might support funding for meetings and travel for study investigators to refine an intervention for different sites, and/or research costs to engage multiple clinical sites in a multisite research trial.  We are interested in stakeholder engagement being a robust force behind all the research we do.  You can find more information and resources on how to incorporate stakeholder engagement in the planning and conduct of your research here.

Tony Teano: This grant seems like a great opportunity, especially for those breaking into the field of deprescribing research. What additional ways does USDeN have to help investigators as they begin to enter this specialty?

Dr. Boyd: We love developing future deprescribing research investigators!  One of the USDeN programs of which I am most proud is the Junior Investigator Intensive (JII) Program in Deprescribing Research, and the 2023-2024 application cycle is open!  The applicant due date is February 1, 2023. (For details, click here.) The JII program will cultivate a cohort of emerging deprescribing research leaders.  The JII program has three main components:

1. Scholars will attend a special additional workshop at the 2023 US Deprescribing Research Network Annual Meeting that is focused on career development, networking, and collaborative research opportunities for early-stage investigators interested in deprescribing. 
2. Scholars will attend monthly “work-in-progress” meetings, a core curriculum, and other activities over the year that offer a mix of opportunities to get feedback on your research from colleagues and senior researchers and discussion of collaborative research projects in which scholars can participate (and help lead).
3. Scholars will have access to other aspects of USDeN, such as attendance at webinars, consultations, and engage with a robust community of other junior investigators in deprescribing research from around the world. Scholars will be expected to attend the USDeN Annual Meeting and most of the monthly web-based meetings during the year.

Additionally, we offer webinars with fabulous international leaders in deprescribing.  All of that is freely, publicly available to anyone interested in deprescribing research, and the recordings of the webinars are available from our website. Our next webinar is a prime example of a hot topic in deprescribing research with a leading expert; it will be on January 17^th and it is about the “Complex challenges in pain and opioid management: Relevance to deprescribing,” and presenting will be Dr. Jessica S. Merlin, MD, PhD, MBA.  Dr. Merlin is an Associate Professor of Medicine at the University of Pittsburgh School of Medicine, Director of CHAMPP (CHAllenges in Managing and Preventing Pain) Research Center, and Co-Director of TREETOP (Tailored Retention and Engagement in Equitable Treatment of Opioid use disorder and Pain) Research Center.  (Register here.)

Tony Teano:  The more you talk about deprescribing, the more I wonder why there’s any hesitation to it. It just seems to make sense! What are some of the obstacles to deprescribing?  Why is there any hesitancy?

Dr. Boyd:  This is a very important question, and we need more research around it. Essentially… Awareness. Trust. Communication. Teamwork. These are among the top key challenges to the art of deprescribing. Many people may not understand that as they age, their metabolism changes and their bodies no longer process the drugs the way they used to—and the chemicals stay in their systems longer than before.  Moreover, as people age and face new diagnoses over time, an increasing number of medications tend to be prescribed—and some of those may have negative interactions with each other, or cause serious side-effects.  Consequently, the patient may not know where to begin to make their medicine regime more simple and safe, or to understand any potential for harm—especially if they have several doctors acting in silos and prescribing medications without getting the bigger picture…. So, education is very important as a starting point—for clinicians as well as patients and their caregivers who may assist them with managing medications. Trust and communication go hand in hand as a foundation for sharing information and making smart decisions about an approach to deprescribing.  Sometimes, there’s a cultural disconnect between a patient and a provider.  Sometimes, a doctor may not have a history with a new patient and must establish a collaborative approach to care.  And deprescribing is a team effort that includes a lot of people in the support system of an individual’s care who also need to be aware of drug interactions—from the pharmacist filling prescriptions to the emergency department doctors who see a patient in an urgent situation, and nurses who may administer medications during a hospital admission, and so forth.

Tony Teano: Dr. Boyd, I appreciate your taking the time to give us a “Deprescribing 101” crash course!  This is a lot of great information to highlight why it is important for older adults to regularly review their medications with their doctor for optimal care and safety. Is there anything else you’d like to share with our readers?

Dr. Boyd: If you’d like more information about deprescribing research, please visit USDeN’s website or email us. We’re here to facilitate advancing research to optimize medication use among older adults. Let us know how we can support you in this cause.

By Anthony L. Teano, MLA
Communication Specialist