The Division consists of 48 faculty members including thirty physicians, eleven PhD basic scientists, and seven PhD social and behavioral scientists in four different sections (Table 1). Alan Siegal, MD, served as the Division Director from 1987-1990 when the division had a total of 8 faculty members, seven of whom were PhD basic scientists. Dr. Siegal obtained accreditation for a Geriatric Medicine fellowship in 1989. After being a faculty member at UAB for four years, Richard Allman, MD was appointed as Division Director in 1990. In 2006, the division’s name was changed to include palliative care in recognition of the expanding activities of this new medical specialty within the division. The fellowship program in Palliative Care was established in 2001 and achieved ACGME accreditation in 2009, the first year such recognition was possible. Over the last two decades, the division has become recognized as one of the best programs in the nation.
The 2010 US News and World Report ranked UAB Geriatric graduate education and clinical care 15th and 16th, respectively. UAB is one of only six Resource Centers in Minority Aging Research (RCMAR) funded by the National Institute on Aging (NIA), one of only eight Palliative Care programs recognized by the Center to Advance Palliative Care as a Palliative Care Leadership Center, one of eight programs nationally recognized by the American Academy and Palliative Medicine (AAHPM) as a clinical scholar training site, and one of 25 Hartford Centers of Excellence, and is affiliated with one of the nation’s twenty VA-based Geriatric Research, Education, and Clinical Centers (GRECCs). Division faculty members provide leadership for a number of centers and programs at UAB, the VA and in the community.
Clinical Programs. The William Clifford and Margaret Spain McDonald Clinic houses several of the Division’s outpatient programs including the Geriatric Clinic, Palliative and Supportive Care Clinic, Geriatric Heart Failure Clinic, and the Camellia Medical Group. The McDonald Clinic opened in 2004 and was made possible by a generous gift from Scott and Cameron Vowell and Billy and Nancy McDonald. Physician leadership for primary care activities for older adults has been supported by the Eleanor Kidd Endowed Chair held by Doug Tilt, MD. The Continence Clinic at the Kirklin Clinic offers comprehensive evaluation and treatment of urinary and fecal incontinence. An Acute Care for the Elderly (ACE) Program that includes hospital Geriatric consults is offered at UAB Highlands and University Hospital. Palliative care inpatient units and consult services are available at both the University Hospital and the Birmingham Veterans Affairs Medical Center (BVAMC),, both of which have also greatly benefitted from the generous support of our community donors . Other VA-based programs include GRECC Fall Prevention and Continence Clinics, an outpatient Geriatric Assessment Clinic, hospital consultations, Home-Based Primary Care, and a Palliative Care Program, including outpatient and home-based care, and the inpatient Safe Harbor Unit. We were awarded $633,704 in VA funding in 2010 to establish a clinical demonstration program to provide caregiver support and education in order to reduce risk for nursing home placement for dementia patients.
The Health System has provided support for the development and implementation of UAB’s Chronic and Supportive Care Program, permitting us to achieve goals such as reducing lengths of stay, avoiding hospital complications, and preventing readmissions. These efforts led to the UAB Acute Care for the Elderly (ACE) Unit at Highlands which received the top award for Innovation by the Health System this year. Division faculty members also provide medical directorships for community-based continuing care communities, a Geriatric Health Center, assisted-living facilities, geriatric care management, home care programs, and several hospice providers.
Education. The Division provides training in geriatric medicine and palliative care for medical students and medical residents. These efforts were greatly enhanced in 2008 by the award of a 4-year $2 million grant from the Reynolds Foundation and $1 million in matching funds from the School of Medicine to develop and implement the Care of the Complex Older Adult (COCOA) curriculum. When fully implemented, the COCOA curriculum will be integrated into all four years of medical school training and also into the educational programs for residents in internal medicine, emergency medicine, family medicine, and pediatrics. UAB faculty will provide leadership for the development of web-based educational modules using patient cases that will be peer-reviewed and pilot tested at five other medical schools. It is expected that the UAB COCOA curriculum will be disseminated nationally to other medical schools, residency programs, and through continuing education programs for practicing physicians.
The Division is also committed to providing interdisciplinary geriatric and palliative care educational programs. These efforts are supported by the federally funded Geriatric Education Center (GEC), the GRECC, the Center for Aging, the Center for Palliative Care, and the Gerontology Education Program. The Gwen McWhorter Endowed Chair, currently held by Dr. Patricia Goode, provides support for many of these educational activities. Mr. Harry Vickers and Mr. John Beard have also provided support for our Geriatric Scholar Program, making it possible for us to provide geriatric education and training to UAB nurses. Division faculty members also provide medical education on the general medicine inpatient services of the BVAMC, UAB Hospital, and in the VA out‑patient clinic.
The Division offers one-year, clinical fellowships in both Geriatric Medicine and Palliative Care. The Palliative Care fellowship offers a pediatric track at Children’s Hospital. Both clinical fellowships are designed to prepare internists and family medicine physicians to meet eligibility for their respective specialty boards. The Palliative Care fellowship is open to all medical specialties that oversee accreditation of palliative care fellowships. The Division encourages physicians to consider completing both clinical fellowships or to obtain two to three years of advanced post-doctoral training in research, education, or administration after completing their clinical training. Advanced training opportunities are available through the Hartford Southeast Center of Excellence in Geriatric Medicine (SCEGM), a VA Special Fellowship in Advanced Geriatrics, the NIA Resource Center for Minority Aging Research, the NIA Advanced Illness and Multi-Morbidity Research Program, or in collaboration with other research and career development training programs at UAB or the VA.
Research. Many Division faculty members are active in research activities that focus on mobility, urinary and fecal incontinence, Alzheimer’s disease and related memory problems, nutrition, geriatric heart failure, end-of-life care, advanced illness management, functional outcomes of geriatric health care, and quality improvement. Basic biomedical research initiatives include studies of cellular and molecular mechanisms involved in atherosclerosis and Alzheimer’s disease including the role of monocytes and macrophages, endothelial cells, apolipoproteins, dietary factors, and the anti-atherosclerotic and anti-inflammatory activity of peptide mimics of apolipoproteins. These research activities are supported by extramural grants and contracts totaling $8.1 million in the current year. These include longstanding awards such as an atherosclerosis program project grant directed by Dr. Jere Segrest in its fifth five-year cycle of funding from NHLBI, the NIA-funded UAB Study of Aging (Mobility Among Older African Americans and Whites) in its third five-year cycle of funding, the Southeast Center of Excellence in Geriatric Medicine (in its 12th year of funding from the Hartford Foundation), and the Birmingham/Atlanta VA GRECC, celebrating its 10th anniversary in November 2010. Career development awards are currently held by Cynthia Brown and Alayne Markland (funded by VA); Caroline Harada and Marisol Lance (funded by HRSA); and C. Barrett Bowling and Kendra Sheppard (funded by the Hartford Foundation). Community donors have been critically important in supporting the division’s research programs through the Parrish Endowed Professorship held by Dr. Allman, the Atherosclerosis Research Fund, and gifts given in support of Dementia and Alzheimer’s Disease, Geriatric Heart Failure, and the Women Veterans Continence Research.
