Improving Care for Nursing Home residents with Diabetes and Cognitive Impairment

Public Health Significance: Nursing home (NH) residents with diabetes and Alzheimer’s disease and related dementias are a large, growing population at high risk for adverse outcomes. Unfortunately, little is known about current clinical care practices or the outcomes that result from those care practices in NH residents with diabetes and Alzheimer’s disease and related dementias. The proposed studies will examine those clinical practices and outcomes in NH residents with diabetes across the spectrum of severity of Alzheimer’s disease and related dementias. Research Aims: The proposed projects will compare the rates of fingerstick glucose measurement across the spectrum of severity of Alzheimer’s disease and related dementias (Aim 1), compare the rates of mild hypoglycemia (defined as American Diabetes Association or ADA level 1: glucose 70-54 mg/dL) and moderate hypoglycemia (ADA level 2: glucose <54 mg/dL) across the spectrum of severity of Alzheimer’s disease and related dementias (Aim 2) and determine the rates of likely glycemic overtreatment (defined as use of insulin with hemoglobin A1c or HbA1c <7.5%) and likely glycemic undertreatment (defined as use of no medications or metformin only with HbA1c >9.0%) across the spectrum of severity of Alzheimer’s disease and related dementias in long-stay nursing home residents (Aim 3). Candidate’s Career Development and Mentoring Plan: The candidate proposes to expand his successful mentorship program, taking on additional mentees to help complete the proposed projects. The candidate will continue to develop as a researcher by expanding his skills in NH research focusing on the large number of NH residents with Alzheimer’s disease and related dementias. The candidate will continue to develop as a mentor by building leadership skills and focusing on supporting mentees from disadvantaged backgrounds. Candidate’s Career Goals: Candidate’s long-term goals are to become a national leader in aging research focusing on NH residents with Alzheimer’s disease and related dementias, while becoming a pre-eminent mentor in aging research.