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Other Links To expose medical students to a 8 to 12 week rotation in geriatric medicine and gerontologic research. back to top Located in the Johns Hopkins Geriatrics Center, the Beacham Ambulatory Care Center offers primary care for 3,000 elderly patients. In addition, the Beacham Center provides geriatric assessment and specialty care, e.g., geropsychiatry and continence clinic. back to top This program was founded in 1978 and is now operated in partnership with the Johns Hopkins Home Care Group. Regular physician housecalls as well as nursing and rehabilitative therapy are provided to approximately 200 home-bound elderly of southeast Baltimore City and County. In-the-home geriatric consultation requested by other physicians is available. back to top Hopkins ElderPlus replicates the PACE (Program of All-Inclusive Care for the Elderly) program which was pioneered in San Francisco, CA. PACE serves frail elderly individuals in need of comprehensive care to prevent or delay unnecessary institutionalization. The program provides a full array of services including comprehensive care, day care, and in-home services. The program is funded through Medicaid capitation payments and Medicare fee-for-service. back to top Located at the Johns Hopkins Hospital this program provides multi-dimensional and multi-disciplinary functional status assessment. back to top The center provides all levels of long-term care for 255 patients from the metropolitan area. Located in the facility are 195 comprehensive (skilled) nursing beds and sixty chronic hospital beds of which 12 form a chronic ventilator unit, and 25 are for rehabilitation in a Commission on Accredited Rehabilitation Facilities (CARF) accredited program. The staff of the Beacham Ambulatory Care Center includes full-time social workers, therapists, and physicians. Comprehensive, multi-dimensional, highly coordinated, and compassionate care is emphasized. Concentrated effort to discharge patients to their homes is made whenever possible. back to top Located in the Beacham Ambulatory Care Center, this program offers comprehensive evaluation and treatment of patients with osteoporosis and other metabolic bone diseases. back to top In the acute hospital, older adults who break their hip are treated by the geriatrician and orthopedic surgeon. The geriatrician treats the patient preoperatively and postoperatively. For more information - Please click the following http://www.jhbmc.jhu.edu/geriatrics/center/index.html back to top Basic Science:
Claude D. Pepper Older Americans' Independence Center (OAIC) to support institution-wide investigation of the etiology of frailty in older adults: The goals of the Pepper Center, over the long run, are to develop novel interventions to diagnose, prevent or treat frailty, or minimize adverse outcomes related to the presence of frailty. The Biology of Frailty program of the Division of Geriatric Medicine and Gerontology: The biology of frailty program assesses frailty via genetics and mouse models. At the meetings of the Biology of Frailty working group, they are working together to find the common link between the three (frailty, inflammation, and cancer). There are four major studies: A pilot study to evaluate genetic factors underlying chronic inflammation in frailty. A 5 year study to assess the genomic regions in older adults associated with declines in muscle strength. By assessing these regions, one will be able to define the molecular pathways associated with variations related to declines in muscle strength. This work is expected to provide a basis for development and testing of new interventions to slow the rate of decline in muscle strength. A 2 year study to assess the role of monotypic production and regulation of cytokine mediators in frail older adults. The assessment of the biological roles of a novel gene family termed SIBLINGs (for Small Integrin-Binding Ligand N-Linked Glycoproteins). Members of this gene family appear to play a role in certain pathologies such as cancer and inflammation through the binding and activation of matrix mealloproteinases (MMPs). MMPs are a group of enzymes critical for inflammation (e.g. MMP-9), as well as angiogenesis and metastasis (MMP-2, MMP-3 and MMP-9).
Division of NeuroPathology/Department of Pathology: Within the Division of NeuroPathology there are four main projects: The study of the selective dysfunction/death of populations of neurons in clinical and experimental neurological diseases in mouse models. The study of disease mechanisms of Alzheimer's Disease, and designing and testing of therapeutic strategies for Alzheimer's Disease. The study of mechanisms of neuronal cell death. The hypothesis that selective vulnerability is dictated by brain regional connectivity, mitochondrial function, and oxidative stress and is mediated by excitotoxic cell death resulting from abnormalities in excitatory, glutamatergic signal transduction pathways, including glutamate tranpsorters and glutamate receptors as well as their downstream intracellular signaling molecules. They are also investigating the contribution of neuronal/glial apoptosis and necrosis as cell death pathways in animal (including transgenic mice) models of acute and progressive neurodegeneration. The study of the potential pathogenic mechanisms contributing to neuronal degeneration, such as oxidative stress and programmed cell death.
Clinical and Population-Based Research: The Centers on Aging and Health: The COAH is the multi-disciplinary Center of Excellence for aging research and research training which is jointly sponsored by the Schools of Medicine, Public Health and Nursing of the Johns Hopkins Medical Institutions, and the Departments of Epidemiology, Biostatistics, Medicine, Health Policy and Management, Mental Hygiene, Psychiatry and Physical Medicine and Rehabilitation. COAH includes two physical Centers, one on each of the two major Johns Hopkins campuses. Both of the centers provide infrastructure for clinical and population-based aging research which can be utilized by the medical students, including a data management and analysis core, a medical record abstraction core, and research assistants with experience in recruitment and evaluation of older adults. The students have access to a large body of population-based research studies on older populations which our program faculty lead. These span a wide variety of content areas, including: the natural history, risk factors and prevention of chronic diseases, frailty, disability, falls, comorbidity, cognition and dementia; social and behavioral epidemiology; health promotion and prevention for older adults; and causes for health disparities in older populations; randomized trials of behavioral and pharmacologic therapies to prevent physical and cognitive disabilities, and social modes for prevention. Women's Health and Aging Studies (WHAS) I, II, III) - These are companion prospective, observational studies of the one-third most disabled women ages 65 and older (WHAS I), and the two-third most disabled women ages 70-79 (WHAS II), living in the community. WHAS III combines WHAS I & II to assess the biologic markers of frailty and disability. All three studies aim to determine the causes and course of physical disability, with the ultimate goal of preventing disability.
WHAS I is completed and is comprised of 1002 women at baseline, with nine rounds of follow-up data collection at six-month intervals. WHAS II is comprised of 436 women at baseline; with six follow up rounds, 18 months apart, with one more round of follow-up. WHAS III allows the assessment of biological basis of frailty and disability through banked blood and DNA from WHAS I & II.
Cardiovascular Health Study (CHS) - This is a 4-center, prospective observational study of risk factors and outcomes for coronary heart disease and stroke, in 6000 people 65 years and older at baseline. Initially funded in 1988 by NHLBI, CHS has evaluated participants longitudinally until the present. Extensive physical and laboratory evaluations have been performed at baseline and in annual examinations from 1989, assessing the presence and severity of CVD risk factors such as hypertension and glucose intolerence, as well as subclinical disease such as carotid artery atherosclerosis (by ultrasound), peripheral arterial disease (by ankle and arm blood pressures), transient ischemia (by ambulatory ECG), silent ischemia (by ECG and brain MRI), and clinically manifest CVD. Through collaboration among epidemiologist, biostatisticians, geriatricians, gerontologists, neurologists, cardiologists, and neuroradiologists, this study has exemplified the interdisciplinary nature of successful population-based studies on aging.
Dementia Outcome Study of the Cardiovascular Health Study, including cognitive Tests, ApoE, Brain MRI and Risk factors for Dementia - This ancillary study to the CHS is testing the hypothesis that subclinical MRI changes are associated with an increased risk of dementia, and therefore may provide insight into new approaches to prevention. The study comprises the 3660 CHS participants who had an initial brain MRI in 1992-3 and then a second MRI in 1997-8, who now average 87 years of age. The study has adjudicated the participants who developed clinical dementia, and is now evaluating the relationships among ApoE genotype, measures of inflammation, subclinical cardiovascular disease, and incident clinical disease (including stroke and myocardial infarction), cadiovascular risk factors such as hypertension and diabetes, and risk of dementia in relation to these MRI variables.
Experience Corps - This is a social model for health promotion in older adults. It is a uniquely designed senior services program which creates new generative roles for older adults, placing them in public elementary schools in a voluntary capacity. The results of this program for enhancing social, psychological, cognitive and physical function are now being evaluated in a pilot for a large randomized trial; the program is also in a national demonstration in 9 U.S. cities.
Howard/Hopkins Center for Asthma Disparities: This project seeks to decrease asthma disparities in underrepresented minority populations by improving patient/physician communication by developing a cultural competent setting. It is a joint project between the pulmonary divisions at Johns Hopkins and Howard University. Within the project, asthma in minority older adults is being evaluated. The project consists of focus groups of underrepresented minority older adults to understand their asthma descriptors as well as what the participants would prefer their physicians ask about their asthma. Focus groups in geriatricians to ascertain their views on asthma in older adults have also been conducted. From the qualitative analysis, a culturally competent asthma communication instrument senior will be developed that conveys the information the patients want their physicians to be cognizant of as well as feasible to use in a busy ambulatory medicine setting.
Alzheimer's Disease Research Center: The overall goal of this Center, which has been funded by NIA for twenty years, is to accelerate the discovery of new treatments that are directed at the basic mechanisms of disease (e.g. Alzheimer's Disease), and to hasten the time when effective treatments for Alzheimer's Disease and related disorders become a reality. It is a collaborative effort between basic science and clinician researchers. All of the basic science investigators in neuropathology participate in research in the Center (see basic science neuropathology). In addition to the basic science projects (see basic science-neuropathology section), there are many clinical studies:
Progression of dementia: a population based study of the progression of cognitive, functional, and behavioral change in incident cases of dementia Treating Depression in Alzheimer's Disease; A randomized, placebo-controlled trial of sertraline for the treatment of major depression in Alzheimer's disease, which also explores the long-term benefits of depression reduction on Alzheimer outcomes Dementia and Psychiatric Disorders in Assisted Living: A study of the prevalence, treatment, and impact of dementia and other psychiatric disorders in a random sample of residents of assisted living facilities A Clinical Trial to Prevent Alzheimer's Disease with NSAIDs (ADAPT): A randomized, placebo controlled trial of naproxen and celecoxib for the primary prevention of Alzheimer type dementia in cognitively normal persons at risk of dementia based on age and family history The Evolution of Psychopathology in the Population: A follow-up study of the Baltimore Epidemiologic Catchment Area (ECA) project with a special emphasis on the epidemiology of dementia and depression in later life The Diffusion Tensor Imaging in Alzheimer's Disease Study: the study utilizes a new technique based on magnetic resonance imaging (MRI) which allows for measurement of the directionality of the water diffusion. The image allows researchers the ability to assess the integrity of white matter tracts then one may be able to improve the specificity and sensitivity of MRI-based diagnosis of Alzheimer's disease The Ethical Aspects of Dementia Research: the study assesses the instruments utilized by clinicains to assess dementia and obtain informed consent and compares the methods used to assess capacity to give informed consent.
Health Sevices Research: At the Center on Aging and Health East, the health services research team meets monthly for a health services Research in Progress seminar which provides an opportunity for students to hear about all ongoing research projects. The current studies that are ongoing or are in the process of development, include: Guided Care: The goal of this project is to measure the effects of "Guided Care" on the quality and outcomes of care for high-risk older persons, their unpaid caregivers, and their primary care physicians. Guided Care is defined as using evidence-based protocols for providing seven patient-centered services: comprehensive assessment and care planning, patient and family education, patient and family activation, proactive health monitoring, accessing community resources, coordination of care among all providers, and ad hoc around-the-clock advice and support. These services are provided by a nurse who has received training in all of the evidence-based protocols. In the guided care pilot, a specially trained Guided Care Nurse (GCN), based in a primary care practice, collaborates with two primary care physicians to implement the seven evidence-based protocols for a target of 40-60 high-risk patients. The overall goal of the study is to provide information such as descriptive data about the processes and the costs involved in provided Guided Care. It will hopefully provide the Centers for Medicare and Medicaid Services with the information it will need to cover Guided Care as a Medicare benefit in the future. Dr. Boult is the PI on this grant; Drs. Boyd and McNabney are co-investigators. Successful Aging and Disablement Process and Association with Health Care Utilization: This project is based on the premise that aging well is one of the best solutions to bridging the gap between the increasing need for care among elderly and the limited health care resources available. It will use a prospective cohort study to address the following; 1) to measure the validity, reliabilty, and feasibility of classifying older adults regarding successful aging, a multidimensional construct that integrates physiologic (e.g., diseases, impairments), psychologic (e.g., emotional vitality, depression), and sociologic (engaging with life) domains; 2) to describe sociodemographic, functional, and health-related charateristics of people who have aged successfully; 3) to examine the dynamic change over time after people have disablement process (i.e., impairment, functional limitation, and disability); and 4) to describe and compare formal care (e.g., hospitalization, physician visits) and informal care (e.g., spouse, children) utilized by groups that have aged successfully or unsuccessfully. The goal will be to create an instrument to see who is aging well and how it can be maintained. The latter could change how care is provided to older adults. Program for All Inclusive Care of the Elderly (PACE): PACE, a model for chronic care, is designed for those aged > 55 who are considered nursing home eligible and qualify for Medicaid and Medicare. The overall goal of the program is to keep seniors with chronic care needs in the community both for their own well being and their families as well. Within the PACE program at the Johns Hopkins Division of Geriatric Medicine and Gerontology, there are many research questions being addressed, including the factors which affect the medical care decisions utilized in the PACE program, the cost of PACE to Medicare programs, and quality assurance in the PACE model. Home Hospital: The program is designed to treat older adults with certain medical problems such as pneumonia at home to prevent poor outcomes from hospitalization such as immobility. The Johns Hopkins Division of Geriatric Medicine and Gerontology is the coordinating center for three other sites which are implementing the home hospital program in a randomized controlled trial. All of the data will be pooled to evaluate hypothesis that Home Hospital vs. traditional inpatient care will; 1) be acceptable to patients and providers; 2) result in higher patient satisfaction and comparable clinical outcomes and safety; 3) not increase caregiver burden; and 4) be less costly than traditional care. Robert Wood Johnson National Engagement Campaign to Improve Care for Chronic Disease - This project seeks to synthesize existing evidence as to the clinical care practices that optimize health outcomes for people with chronic disease, then to educate various relevant constituencies about overcoming obstacles to best achieve these practices. Component projects are devoted to Alzheimer's disease, diabetes, severe mental illness, and the frail elderly.
back to top Weekly Discussions with Faculty from different racial/ethnic backgrounds Readings: The Spirit Catches You and You Fall Down The Scalpel and the Silver Bear
back to top The first 9 chapters of Epidemiology by Leon Gordis are reviewed. back to top Weekly review of questions and techniques to prepare you for the USMLE Step 1. back to top Please feel free to email any of the students listed below to ask about the program. Thomasina Bailey - After finishing the program she won the Doris Duke Medical Fellowship Award, National Medical Fellowship Award, and the Edward Henderson Medical Student Award baileytc@upstate.edu Hasra Phillip - She presented her summer research as a paper presentation at the Gerontologic Society of America Meeting. She has also won a National Medical Fellowship Award and RPS/American Federation of Aging Research Award hphillip@jhsph.edu Aleicia Mack - She presented her summer research as a poster presentation at the American Geriatric Society Meeting and she also won a RPS/American Federation of Aging Research Award. cutedoc5000@yahoo.com Maxwell Adu-Lartey - He used his summer research as an application and won a National Medical Fellowship Award smal_tee@hotmail.com back to top You must be expected to successfully complete your first year of medical school at an accredited medical school. Women and underrepresented minority groups are encouraged to apply. To apply please click on this link http://www.afar.org/medstu.html
back to top http://www.afar.org/medstu.html
back to top http://www.baltimore.org/
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Stethoscope Short White Coat Attire for Students Male: In all clinics gentleman should wear ties,
collared shirts and dress slacks.
Female: In all clinics ladies can wear dresses,
skirts, blouses and tailored pants. Johns Hopkins HIPPA Compliance for Visiting Students
In addition to the required HIPPA training please complete the online portion of the course on research ethics. If you are participating in Basic Science Research please complete the Animal Care and Use course. If you are participating in Clinical/Population Based on Health Services Research please complete the Human Subjects Research course.
Section 1 - Epidemiology of Aging:
Implications of the Aging Society Section 2 - Prevention in Geriatric Medicine Section 3 - Rehabilitation Section 4 - Dementia Section 5 - Urinary Incontinence Section 6 - Falls Section 7 - Osteoporosis and Osteomalacia Section 8 - Pressure Ulcers Section 9 - Activities of Daily Living Section 10 - Articles 10.1 Frailty in Older Adults
10.2 Untangling the Concepts of
Disability, Frailty,
and Comorbidity
10.3 Epidemiology of Aging
Section 11 - Statistics For additional infomation on Geriatric Medicine and Gerontology please see the following: http://www.americangeriatrics.org/education/geristudents
http://www.geron.org http://www.afar.org/medstu.html
back to top If you have any questions, please do not hesitate to contact us: back to top The Johns Hopkins Geriatric Summer Scholars Program: A Model to Increase Diversity in Geriatric Medicine The Road to Diversity
For infomation on visiting minority medical student clerkships for 3rd and 4th year students at Johns Hopkins Department of Medicine http://diversitycouncil.med.som.jhmi.edu/clerkship/index.html
Johns Hopkins Geriatric Education Center (JHGEC) is an education initiative of the Division of Geriatric Medicine and Gerontology of the Department of Medicine, Johns Hopkins University School of Medicine http://hopkinsmedicine.org/gec
http://www.snma.org http://www.aaip.org/programs/anams/anams.htm http://www.amsa.org/ http://www.amwa-doc.org http://www.lmsa.net/
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