Herpes Zoster and Medications in the Elderly

Summary

Principal Investigator: Kenneth Schmader
Abstract: DESCRIPTION: (Applicant s abstract) The overall purpose of this award application is to support the patient-oriented research and mentoring program of an academic geriatrician in order to further develop his research and mentoring skills, generate new knowledge in clinical geriatrics and develop other clinical investigators in geriatrics. The candidate is a mid-career clinician and investigator at Duke University and Durham VA Medical Centers with a strong commitment, funding and publication record in patient-oriented research in herpes zoster and medications in the elderly and a history of mentoring house staff and junior faculty in clinical research. The research plan is structured along two complementary areas of investigation involving zoster and medications in the elderly. The objectives of his zoster research program are the optimal management of zoster and postherpetic neuralgia in the elderly. A series of studies is proposed that is centered around his work in the Shingles Prevention Study, a large multicenter clinical trial to determine whether immunization with live attenuated varicella-zoster vaccine can reduce the incidence and/or severity of zoster and PHN in the elderly. Additional research opportunities are available in treatment trials of zoster and studies of genetics and zoster. The objectives of his drug-related research program is to optimize pharmacotherapy in the elderly by reducing polypharmacy, inappropriate prescribing and adverse drug reactions. The basis for a program of drug-related studies is the GEM Drug Study, a multicenter trial to determine if Geriatric Evaluation and Management (GEM) care reduces adverse drug reactions and inappropriate prescribing in the elderly compared to usual care. The candidate will recruit and select advisees from a rich pool of beginning clinical investigators at Duke University Medical Center and mentor them in the context of the above research projects using one-one teaching, the Duke Clinical Research Training Program (CRTP) and other research educational experiences at Duke. The Duke CRTP and Faculty Development Programs will provide opportunities for the candidate s research, mentoring and leadership career development. The award will allow the candidate to devote additional time to patient-oriented research and mentoring by relieving the candidate of clinical and administrative responsibilities in the Division of Geriatrics, the Duke Geriatric Evaluation and Treatment Clinic and Durham VAMC. The award fits into past and future career development by providing a bridge from earlier academic activities to the expansion of mentoring and research skills and to program leadership in geriatrics.
Funding Period: 2001-09-01 - 2007-05-31
more information: NIH RePORT

Top Publications

  1. ncbi Herpes zoster and postherpetic neuralgia in older adults
    Kenneth Schmader
    Center for the Study of Aging and Human Development and Division of Geriatrics, Department of Medicine, Duke University Medical Center, Box 3469, Durham, NC 27710, USA
    Clin Geriatr Med 23:615-32, vii-viii. 2007
  2. ncbi The effect of increasing age on the risk of surgical site infection
    Keith S Kaye
    Division of Infectious Diseases, Department of Medicine, School of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina 27710, USA
    J Infect Dis 191:1056-62. 2005
  3. pmc The effect of surgical site infection on older operative patients
    Keith S Kaye
    Duke University Medical Center, Durham, North Carolina, USA
    J Am Geriatr Soc 57:46-54. 2009
  4. ncbi Frequency and predictors of adverse health outcomes in older Medicare beneficiaries discharged from the emergency department
    S Nicole Hastings
    Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, NC 27710, USA
    Med Care 46:771-7. 2008
  5. ncbi The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine
    Kenneth Schmader
    Center for the Study of Aging and Human Development and Division of Geriatrics, Department of Medicine, Duke University Medical Center, North Carolina, USA
    J Infect Dis 197:S207-15. 2008
  6. ncbi Does lack of social support lead to more ED visits for older adults?
    S Nicole Hastings
    Geriatrics Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC 27710, USA
    Am J Emerg Med 26:454-61. 2008
  7. ncbi Quality of pharmacotherapy and outcomes for older veterans discharged from the emergency department
    S Nicole Hastings
    Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina, USA
    J Am Geriatr Soc 56:875-80. 2008
  8. pmc Adverse health outcomes after discharge from the emergency department--incidence and risk factors in a veteran population
    S Nicole Hastings
    Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
    J Gen Intern Med 22:1527-31. 2007
  9. ncbi The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic
    S Nicole Hastings
    Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina 27710, USA
    J Am Geriatr Soc 55:1339-48. 2007
  10. ncbi Appropriate prescribing in elderly people: how well can it be measured and optimised?
    Anne Spinewine
    Center for Clinical Pharmacy, School of Pharmacy, Universite Catholique de Louvain, Brussels, Belgium
    Lancet 370:173-84. 2007

Scientific Experts

Detail Information

Publications19

  1. ncbi Herpes zoster and postherpetic neuralgia in older adults
    Kenneth Schmader
    Center for the Study of Aging and Human Development and Division of Geriatrics, Department of Medicine, Duke University Medical Center, Box 3469, Durham, NC 27710, USA
    Clin Geriatr Med 23:615-32, vii-viii. 2007
    ..For PHN, evidence-based pharmacotherapy can reduce pain burden. The zoster vaccine is effective in reducing pain burden and preventing HZ and PHN in older adults...
  2. ncbi The effect of increasing age on the risk of surgical site infection
    Keith S Kaye
    Division of Infectious Diseases, Department of Medicine, School of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina 27710, USA
    J Infect Dis 191:1056-62. 2005
    ..The objective of the present study was to determine the relationship between increasing age and risk of SSI...
  3. pmc The effect of surgical site infection on older operative patients
    Keith S Kaye
    Duke University Medical Center, Durham, North Carolina, USA
    J Am Geriatr Soc 57:46-54. 2009
    ..To determine the effect of surgical site infection (SSI) on mortality, duration of hospitalization, and hospital cost in older operative patients...
  4. ncbi Frequency and predictors of adverse health outcomes in older Medicare beneficiaries discharged from the emergency department
    S Nicole Hastings
    Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, NC 27710, USA
    Med Care 46:771-7. 2008
    ..The goal of this study was to determine the frequency and predictors of adverse outcomes among older adults discharged from the ED...
  5. ncbi The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine
    Kenneth Schmader
    Center for the Study of Aging and Human Development and Division of Geriatrics, Department of Medicine, Duke University Medical Center, North Carolina, USA
    J Infect Dis 197:S207-15. 2008
    ..Given the central nervous system damage caused by HZ, the difficulty of adequately treating HZ to prevent PHN, and the intractability of PHN, the advent of the HZ vaccine appears to be a crucial innovation for preventing HZ and PHN...
  6. ncbi Does lack of social support lead to more ED visits for older adults?
    S Nicole Hastings
    Geriatrics Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC 27710, USA
    Am J Emerg Med 26:454-61. 2008
    ....
  7. ncbi Quality of pharmacotherapy and outcomes for older veterans discharged from the emergency department
    S Nicole Hastings
    Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina, USA
    J Am Geriatr Soc 56:875-80. 2008
    ..To determine whether suboptimal pharmacotherapy increases the risk of adverse outcomes in older adults discharged from the emergency department (ED)...
  8. pmc Adverse health outcomes after discharge from the emergency department--incidence and risk factors in a veteran population
    S Nicole Hastings
    Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
    J Gen Intern Med 22:1527-31. 2007
    ..An Emergency Department (ED) visit represents a time of significant risk for an older adult; however, little is known about adverse outcomes after an ED visit in the VA system...
  9. ncbi The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic
    S Nicole Hastings
    Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina 27710, USA
    J Am Geriatr Soc 55:1339-48. 2007
    ....
  10. ncbi Appropriate prescribing in elderly people: how well can it be measured and optimised?
    Anne Spinewine
    Center for Clinical Pharmacy, School of Pharmacy, Universite Catholique de Louvain, Brussels, Belgium
    Lancet 370:173-84. 2007
    ....
  11. ncbi The impact of acute herpes zoster pain and discomfort on functional status and quality of life in older adults
    Kenneth E Schmader
    Duke University, Durham, NC, USA
    Clin J Pain 23:490-6. 2007
    ....
  12. ncbi Clinically important drug-disease interactions and their prevalence in older adults
    Catherine I Lindblad
    Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455 0353, USA
    Clin Ther 28:1133-43. 2006
    ..Older adults may have decreased homeostatic reserve, have multiple chronic diseases, and take multiple medications. Therefore, they are at risk for adverse outcomes after receiving a drug that exacerbates a chronic disease...
  13. ncbi Therapeutic failure-related hospitalisations in the frail elderly
    Robert M Kaiser
    Miller School of Medicine, Division of Gerontology and Geriatric Medicine and Geriatrics Institute, University of Miami, Miami, Florida, USA
    Drugs Aging 23:579-86. 2006
    ....
  14. ncbi Surgical site infection in the elderly following orthopaedic surgery. Risk factors and outcomes
    Jeanne Lee
    Division of Infectious Diseases and Geriatrics, Department of Medicine, the Center for the Study of Aging, Duke University Medical Center, Box 3152, Durham, NC 27710, USA
    J Bone Joint Surg Am 88:1705-12. 2006
    ..The aim of this study was to identify risk factors for surgical site infections and to quantify the impact of these infections on health outcomes in elderly patients following orthopaedic surgery...
  15. ncbi Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay
    Joseph T Hanlon
    Department of Medicine Geriatrics, School of Medicine, University of Pittsburgh, and Center for Health Equity Research, Veterans Affairs Pittsburgh Healthcare System, PA 15213, USA
    J Gerontol A Biol Sci Med Sci 61:511-5. 2006
    ..This study examines the incidence and predictors of all and preventable ADRs in frail elderly persons after hospital discharge, a highly vulnerable but rarely studied population...
  16. ncbi Risk factors for surgical site infections in older people
    Keith S Kaye
    Duke University Medical Center, Durham, North Carolina 27710, USA
    J Am Geriatr Soc 54:391-6. 2006
    ..To identify risk factors for surgical site infection (SSI) in older people and to test a priori hypotheses regarding particular variables and SSI risk...
  17. ncbi Dementia and Alzheimer's disease in community-dwelling elders taking vitamin C and/or vitamin E
    Gerda G Fillenbaum
    Duke University Medical Center and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, NC 27710, USA
    Ann Pharmacother 39:2009-14. 2005
    ..Since increased oxidative stress may impair cognition and be a risk factor for dementia, there has been interest in determining whether use of antioxidants could protect against such events...
  18. ncbi Unnecessary drug use in frail older people at hospital discharge
    Emily R Hajjar
    Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Pennsylvania 19104, USA
    J Am Geriatr Soc 53:1518-23. 2005
    ..To determine the prevalence and predictors of unnecessary drug use at hospital discharge in frail elderly patients...
  19. pmc Underuse of indicated medications among physically frail older US veterans at the time of hospital discharge: results of a cross-sectional analysis of data from the Geriatric Evaluation and Management Drug Study
    Rollin M Wright
    Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Am J Geriatr Pharmacother 7:271-80. 2009
    ..Medication underutilization, or the omission of a potentially beneficial medication indicated for disease management, is common among older adults but poorly understood...