Ongoing research projects at the Jewish Home

Jewish Home Grants and Contracts Information

Entity Name: Hebrew Home for Aged Disabled; dba Jewish Home, San Francisco

Address: 302 Silver Ave, San Francisco CA 94112

Type of organization: Skilled Nursing (D/P), Acute Psychiatric Hospital

Tax exempt status: 501c(3) corporation

Date of incorporation: 10/16/1889

Interim Chief Financial Officer
Vic Meinke
Phone: 415.562.2690

Entity Identification Number (EIN) #94-0545320

DUNS No.: 020004693

Congressional District: CA-008

FWA#: 00009027

DHHS F&A Agreement date: 6/05/2012

DHHS site: Division of Cost Allocation
Dept. of Health & Human Services
90 7th Street, Suite 4-600
San Francisco, CA 94103-6705

Older Persons and Drugs:
Race, Gender, and Age Effects

—Janice B. Schwartz, M.D.

The goal of this project is to determine how age, gender, or ethnicity can affect the removal of medications from the body. Among the highlights of Dr. Schwartz’s findings are that women metabolize some, but not all, drugs faster than men; women and men require different doses of medicine; and hormone replacement therapy in women does not affect drug metabolism or responses.

Genetic Determinants of Drug Responses

—Janice B. Schwartz, M.D.

The overall hypothesis is that use of genetic information in combination with demographic and concomitant medication administration information will provide better estimates of drug dosing requirements than consideration of demographic and concomitant medication administration information alone in very old patients. Warfarin is the first medication to be studied. It is hoped that this would allow improved dosing during initiation of warfarin to older patients and decrease unwanted bleeding complications and that the time to reach a desired anticoagulation level will be reduced.

Maintaining Relationships and Quality of Life After Institutionalization for Dementia

—Theresa A. Allison, M.D. and Kenneth Covinsky, M.D.

This project seeks to identify moments of meaningful connection between caregivers and nursing home residents and to explore the underlying processes that foster relationships and social connections. An understanding of these processes may contribute to the development of clinical care models that enhance the quality of life of institutionalized adults with dementia.

Effects of Vitamin D on CYP3A Substrate Clearance

—Janice B. Schwartz, M.D.

This study will determine the effects of vitamin D supplements on how quickly the body clears a commonly prescribed cholesterol medication, Lipitor (atorvastatin). Levels of Lipitor will be measured in the blood, and the levels of blood lipids will also be evaluated. Identification of agents that may alter drug metabolism is important for optimizing drug therapy, especially in individuals who take multiple medications and supplements.

Effects of Vitamin D on Lipids

—Janice B. Schwartz, M.D.

Preliminary research data suggest that vitamin D supplements lower blood LDL-cholesterol and total cholesterol levels. If further investigation supports its effectiveness in lowering blood cholesterol levels, vitamin D administration could serve as a valuable addition or alternative to existing treatments for hyperlipidemia. The aim of this research is to detail the effects of vitamin D supplementation on blood lipid levels.

Etiological Roles of the Functional Anti-T Cell Auto-Antibodies and Th17 Cell Cytokine Abnormalities in Immunosenescence

—Edward Goetzl, M.D.

The overall hypothesis is that two critical causes of immunosenescence (aging-associated changes in immunity) are dysregulated generation of inflammatory interleukins (immune proteins) by T lymphocytes and production of anti-lymphocyte autoantibodies; that both are susceptible to correction by existing forms of therapy. This investigation is designed to study in the laboratory T lymphocytes from the blood of healthy aged patients in comparison to those of healthy young matched controls. The numbers of different types of T lymphocytes will be quantified and their functions assessed in vitro, including generation of a range of interleukins. Subject plasma will be studied for the presence and characteristics of anti-lymphocyte autoantibodies.

Proxy Decision-Making for Alzheimer’s Disease Research

—Laura Dunn, M.D.

Hopes for developing effective treatments for Alzheimer disease (AD) rest on clinical research, that will need to enroll AD patients, many of whom lack capacity to consent to research. This project will study how responsible parties or agents make decisions about entering Alzheimer disease patients into research projects. It will present protocols of varying risk and benefit levels (1) to determine influences on proxies’ research decisions and perceptions of research and (2) to examine potential influences on the decision making abilities of the proxies themselves.

Improving Medication Therapy for Older Patients with Common Co-morbidities

—Janice B. Schwartz, MD and Michael Steinman, MD

The overall goal is to improve the use of medications for older people with multiple medical disorders. Our first step will be to identify the prevalence, type, and severity of prescribing problems in older people with defined patterns of multiple co-morbidities (“morbidotypes”) from databases of representative large groups of older men and women (Veterans Administration databases for older men and Nursing Home database(s) for older and very old women and men). The next step will be to develop “potentially optimized prescribing (POP)” algorithms that would be predicted to result in fewer medications prescribed, fewer unwanted effects, and be appropriate and efficacious for the older patient. The development process will consider clinical practice guidelines for each disorder, pharmacologic properties and interactions of medications used for the disorders (pharmacokinetic and pharmacodynamic), and geriatric conditions (function, projected length of life, care for vulnerable elderly) that would modify the approach to treatment of the disorder. The proposed optimized therapeutic combinations will then be evaluated and modified by experts from medical disciplines of the practice guidelines, clinical pharmacology and pharmacy, geriatrics, and health care utilization. The potentially optimized regimens identified will be used to design a subsequent comparative effectiveness study of the optimized combinations and “usual” therapy.

Clinical Impact of Unstable Anti-Epilepsy Drug (AED) Levels in Elderly Nursing Home Epilepsy Patients

– Janice B. Schwartz, M.D. and Angela Birnbaum, Ph.D. (U. Minnesota)

The Jewish Home is one of four nursing homes enrolling residents in this project, based at the University of Minnesota. The goals are to determine appropriate levels for optimal outcomes, identify factors associated with instability of concentrations, determine if new AEDs are associated with fewer adverse events, evaluate the usefulness of measuring AEDs, and determine the total cost (drug, hospitalizations, nursing time, etc.) of AED therapy in the nursing-home setting, where they may be used for the treatment of pain disorders, in addition to seizure disorders.

Implementation and Outcomes of Antimicrobial Stewardship Targeting Urinary Tract Infections

– Kavita Trivedi, M.D. and Arjun Srinivasan, M.D. (California Department of Public Health)

The primary objective of this research study is to demonstrate that implementation of an Antimicrobial Stewardship Program (ASP) in stand-alone long-term care facilities (LTCFs), utilizing the syndromic approach targeting urinary tract infections (UTIs), is feasible. Secondary objectives are to demonstrate the efficacy of an ASP in LTCFs by comparing pre- and post-ASP susceptibility profiles, antimicrobial utilization data, and antimicrobial-related adverse effects. Lessons learned will be documented and used as a guideline for implementing ASPs in stand-alone LTCFs.

Research Application Procedures

It is our goal to facilitate research projects at the Jewish Home, while meeting the highest ethical standards and compliance with government regulations and Jewish Home policies and procedures.

Applications for research at the Jewish Home are welcomed. Researchers considering projects at the Jewish Home are encouraged to contact Dr. Schwartz before completing the application for research at the Jewish Home.

Applications undergo review by the Jewish Home Research Committee but must have a licensed Institutional Review Board approval or Committee on Human Research Approval before they can be considered.

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