Research & Evaluation


Scientific research has historically not focused on the needs and concerns of older adults or their caregivers. Older adults, especially those with multiple chronic conditions and those who are aging at home, are routinely excluded from large research trials of medicines and clinical innovations, even though the interventions being tested are used most frequently among this population. Evidenced based, novel approaches to care for older patients often are not put into practice because there is inadequate knowledge to support practical dissemination and implementation of these care approaches.

Since 2011, Tideswell has invested in a portfolio of high-impact pilot projects that were designed to: 1) provide insight on an understudied area in the care of older adults; 2) test successful models of care in new populations or settings; or 3) evaluate educational innovations that improve the lives of older adults and their caregivers.

Highlighted Projects:

Developing a toolkit to empower IHSS workers to engage disenfranchised older adults in advance care planning

Dr. Rebecca Sudore
Millions of older adults require in home care support in order to remain in their homes, yet most are unprepared to face the complex medical decisions over the course of advanced illness. Lack of preparation can lead to uninformed choices, receipt of care inconsistent with personal goals, and lack of patient empowerment during clinical decision making.  Dr. Sudore’s paradigm of advance care planning (ACP) focuses on preparing patients to communicate their wishes and to participate with clinicians in making real-time, complex medical decisions over the course of illness. In this project, her team will develop a toolkit for In Home Support Services (IHSS) workers to engage their medically frail clients in ACP and advance directives.

Video-based urinary incontinence care guidance for caregivers of older adults with dementia

Dr. Amy Hsu
Urinary incontinence affects up to a third of older adults with dementia who live at home, and is a major source of burden to their caregivers. One important contributor to this burden is the lack of education and instruction about incontinence care. Dr. Hsu’s project will address the gap in readily available, evidence-based, objective information for caregivers managing urinary incontinence in patients with dementia by creating three short animated videos focusing on areas previously reported to be important to caregivers: a) causes and contributors of incontinence in older adults with dementia, b) appropriate and effective use of medications and behavioral therapies for incontinence at home, and c) factors to consider when selecting incontinence absorption products. The long-term goals are to decrease stress, improve quality of life and empower caregivers of older adults with dementia.

Improving Palliative Care Access Through Technology (ImPacTT): A Pilot Study

Dr. Caroline Stephens
Nursing homes are increasingly becoming the place of care and site of death for frail older adults dying from multiple chronic illnesses. Unfortunately, little is known about nursing home residents and family experiences with symptom management and advanced care planning, particularly in an ethnically and racially diverse, palliative care-eligible population. This pilot study builds on focus group data and hospital/nursing home partnerships to assess the feasibility, cost and resident/family outcomes of a technology-enhanced hospital-based palliative care team. The goal of this project is to evaluate how telehealth can extend the reach of palliative care consult service and improve access to palliative care through technology.
Caroline Stephens

Paired Integrative Home Exercise for Seniors With Dementia And Their Caregivers: A Pilot Study

Dr. Wolf Mehling
Alzheimer’s dementia is a major public health challenge, and with the absence of disease-altering medications, it is critically important to study alternative strategies. There is also a huge need for innovative programs that assist both individuals with dementia and their caregivers in the community. In an effort to address both of these needs, Dr. Wolf Mehling is conducting a pilot study that consists of a brief series of progressive interactive exercises from sit to stand to be practiced in dyads. The paired exercise intervention shows the potential to ameliorate the impact of dementia for patients and caregivers and has the potential to be widely implemented, thereby addressing the impending dementia epidemic.

The Social Isolation of Older Americans Living in High-Crime Neighborhoods: Root Causes and Possible Solutions

Dr. Elena Portacolone
Despite the fact that living in high crime neighborhoods is likely to increase isolation and therefore have poor health outcomes, very little is known about the subjective experience of isolated older adults living in these areas. Furthermore, only partial knowledge is available on the formal and informal support available to isolated older residents of high-crime neighborhoods and any gaps in services they may perceive. This study aims to address these knowledge gaps by examining the experience of older adults living in high-crime neighborhoods and understanding the relationships between these individuals and their support networks.

Validation of Functional Measures in the Veterans Health Administration

Dr. Rebecca Brown
We are increasingly beginning to appreciate the role of functional status on cost of care and quality of life.  Although large clinical and administrative databases have been used extensively for research, these databases seldom include systematically-collected data on functional status and disability. For this reason, studies of late-life disability have been unable to take advantage of these large-scale data sources. However, over the past several years VA medical centers have started collecting functional status data from older veterans during patient triage before primary care appointments. The goal of this project is to assess the validity of these data compared to a gold standard of structured self-report.
2. Validation of Functional_ Brown

Analysis of Trends in Older Adults’ Primary Care Utilization in Safety Net Settings

Dr. Anna Chodos
The health care safety net provides primary care to medically and socially complex patients, but there is little data describing the population of older adults with complex needs who receive care in these settings, as there are rarely geriatrics specialists available.  Because of the swelling tide of older adults, Dr. Anna Chodos is reviewing national data to look at recent trends in primary care utilization by older adults in safety net settings.
 3. Analysis of Trends_Chodos

Evaluation of a Registry to Improve Quality of Home-Based Primary and Palliative Care

Dr. Christine Ritchie, Dr. Bruce Leff, and Sarah Garrigues
For the growing number of functionally limited, seriously ill adults, home-based primary and palliative care has been shown to be effective in improving quality of life and supporting person-centered care in the home. However, currently no quality measures exist for this field.  The National Home-Based Primary Care and Palliative Care Network, co-directed by Dr. Ritchie (UCSF) and Dr. Leff (Johns Hopkins University), was chartered to optimize care quality provided by home-centered practices by creating a quality of care registry and performing formative and field testing of the registry and the quality of care measures used in the registry.  With Tideswell’s support, the Network is developing the technical aspects of the registry, educational training materials, and registry evaluation strategies. This registry will raise the bar for home-centered practices in California and nationally. To learn more about the National Home-Based Primary Care and Palliative Care Network and the status of home-based healthcare in the United States, read “The Invisible Homebound: Setting Quality-Of-Care Standards for Home-Based Primary and Palliative Care“.

Development of a Mobile Health Tool to Understand Effects of Pain Medications on Older Adults with Chronic Pain

Dr. Christine Ritchie, Nicole Thompson, and Ingrid Maravilla
A growing number of Americans over the age of 65 experience chronic pain. While research has looked at individuals experiencing pain and the use of pain assessment tools, very little research exists on the best ways to manage pain in older adults. The Cognition-activity Assessment in Response to Rx Interventions (CARRI) project aims to develop a mobile health (“mHealth”) tool that combines the information from an application on an iPad and from an activity monitor worn on the wrist to measure brain function and physical activity, to improve our understanding of the effects of pain medications on older adults with chronic pain. The tool will eliminate recall bias, enable better evaluation of fluctuations in medication effectiveness and harms (for example pain intensity or cognitive effects) over the course of the day, and ultimately provide faster turn-around time for accurate assessments that could be useful for guiding therapy in real time.
Read about educational innovations aiming to improve training for those caring for older adults here.