Scholars@Duke
Juliessa Pavon

Juliessa Pavon

Associate Professor of Medicine
Medicine, Geriatrics and Palliative Care
Box 3003, Durham, NC 27710
Box 3003, Durham, NC 27710

Selected Publications

Defining key deprescribing measures from electronic health data: A multisite data harmonization project.

Conference J Am Geriatr Soc · November 28, 2024 BACKGROUND: Stopping or reducing risky or unneeded medications ("deprescribing") could improve older adults' health. Electronic health data can support observational and intervention studies of deprescribing, but there are no standardized measures for key ... Full text Link to item Cite

Fall Outcomes in Older Adults Following Benzodiazepine/Z-Drug Discontinuation: A Retrospective Cohort Study in an Academic Health System.

Journal Article Drugs Aging · October 2024 BACKGROUND: Benzodiazepines and z-drugs increase the fall risk in older adults. There is a lack of real-world data examining the association between falls and deprescribing medications. OBJECTIVE: In a retrospective cohort study of older adults with chroni ... Full text Link to item Cite

Factors influencing central nervous system medication deprescribing and behavior change in hospitalized older adults.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: Central nervous system (CNS) medications are linked to higher morbidity and mortality in older adults. Hospitalization allows for deprescribing opportunities. This qualitative study investigates clinician and patient perspectives on CNS medicat ... Full text Link to item Cite

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program ... Full text Link to item Cite

Central nervous system medication use around hospitalization.

Journal Article J Am Geriatr Soc · June 2024 BACKGROUND: Central nervous system (CNS) medication use is common among older adults, yet the impact of hospitalizations on use remains unclear. This study details CNS medication use, discontinuations, and user profiles during hospitalization periods. METH ... Full text Link to item Cite

Deprescribing in older adults with polypharmacy.

Journal Article BMJ · May 7, 2024 Polypharmacy is common in older adults and is associated with adverse drug events, cognitive and functional impairment, increased healthcare costs, and increased risk of frailty, falls, hospitalizations, and mortality. Many barriers exist to deprescribing, ... Full text Link to item Cite

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure.

Journal Article JAMA Health Forum · May 3, 2024 IMPORTANCE: Comprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourag ... Full text Link to item Cite

Deprescribing medications among patients with multiple prescribers: A socioecological model.

Journal Article J Am Geriatr Soc · March 2024 Deprescribing is the intentional dose reduction or discontinuation of a medication. The development of deprescribing interventions should take into consideration important organizational, interprofessional, and patient-specific barriers that can be further ... Full text Link to item Cite

Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls.

Journal Article J Am Geriatr Soc · February 2024 BACKGROUND: Falls are the most common medication-related safety event in older adults. Deprescribing fall risk-increasing drugs (FRIDs) may mitigate fall risk. This study assesses the effects of an innovative deprescribing program in reducing FRID burden a ... Full text Link to item Cite

Machine learning functional impairment classification with electronic health record data.

Journal Article J Am Geriatr Soc · September 2023 BACKGROUND: Poor functional status is a key marker of morbidity, yet is not routinely captured in clinical encounters. We developed and evaluated the accuracy of a machine learning algorithm that leveraged electronic health record (EHR) data to provide a s ... Full text Open Access Link to item Cite

Potential Clinical and Economic Outcomes of Over-the-Counter Hearing Aids in the US.

Journal Article JAMA Otolaryngol Head Neck Surg · July 1, 2023 IMPORTANCE: Over-the-counter (OTC) hearing aids are now available in the US; however, their clinical and economic outcomes are unknown. OBJECTIVE: To project the clinical and economic outcomes of traditional hearing aid provision compared with OTC hearing ... Full text Link to item Cite

State of research in adult Hospital Medicine: Updated results of a national survey and longitudinal analysis of national data.

Journal Article J Hosp Med · June 2023 We sought to understand the current state of research in adult Hospital Medicine by repeating a 2018 survey of leaders in Hospital Medicine with changes to improve the response rate of surveyed programs. We also analyzed the public sources of federal resea ... Full text Link to item Cite

Model-Projected Cost-Effectiveness of Adult Hearing Screening in the USA.

Journal Article J Gen Intern Med · March 2023 BACKGROUND: While 60% of older adults have hearing loss (HL), the majority have never had their hearing tested. OBJECTIVE: We sought to estimate long-term clinical and economic effects of alternative adult hearing screening schedules in the USA. DESIGN: Mo ... Full text Link to item Cite

Predictors of Non-Transport for Older Adult EMS Patients Encountered for Falls.

Journal Article Prehosp Emerg Care · 2023 BACKGROUND: Emergency medical services (EMS) encounters for falls among older adults have been linked to poor outcomes when the patient is not transported by EMS to a hospital. However, little is known regarding characteristics of this patient population. ... Full text Link to item Cite

Estimated Monetary Value of Future Research Clarifying Uncertainties Around the Optimal Adult Hearing Screening Schedule.

Journal Article JAMA Health Forum · November 4, 2022 IMPORTANCE: Adult hearing screening is not routinely performed, and most individuals with hearing loss (HL) have never had their hearing tested as adults. OBJECTIVE: To project the monetary value of future research clarifying uncertainties around the optim ... Full text Link to item Cite

Implementation of a telehealth videoconference to improve hospital-to-skilled nursing care transitions: Preliminary data.

Journal Article J Am Geriatr Soc · June 2022 BACKGROUND: Transition-related patient safety errors are high among patients discharged from hospitals to skilled nursing facilities (SNFs), and interventions are needed to improve communication between hospitals and SNF providers. Our objective was to des ... Full text Link to item Cite

Potential Targets for Deprescribing in Medically Complex Older Adults with Suspected Cognitive Impairment.

Journal Article Geriatrics (Basel) · May 19, 2022 Deprescribing may be particularly beneficial in patients with medical complexity and suspected cognitive impairment (CI). We describe central nervous system (CNS) medication use and side effects in this population and explore the relationship between antic ... Full text Open Access Link to item Cite

Utilization of a National Writing Challenge to Promote Scholarly Work: A Pilot Study.

Journal Article Cureus · February 2022 Background Hospitalists value mentorship and scholarly work, yet often struggle to find time and mentors amid busy clinical workloads. Objective To help catalyze writing for hospitalists nationally, we created a Writing Challenge, where we asked hospitalis ... Full text Link to item Cite

Impact of Hearing Aid Use on Falls and Falls-Related Injury: Results From the Health and Retirement Study.

Journal Article Ear Hear · 2022 OBJECTIVES: Falls are considered a significant public health issue and falls risk increases with age. There are many age-related physiologic changes that occur that increase postural instability and the risk for falls (i.e., age-related sensory declines in ... Full text Open Access Link to item Cite

Evaluating the Association Between Hearing Loss and Falls in Adults With Vestibular Dysfunction or Nonvestibular Dizziness.

Journal Article Ear Hear · 2022 OBJECTIVES: Although emerging evidence suggests that hearing loss (HL) is an independent risk factor for falls, it is unclear how HL may impact falls risk in adults with vestibular dysfunction and nonvestibular dizziness. The purpose of this study was to c ... Full text Link to item Cite

Towards "mobility is medicine": Socioecological factors and hospital mobility in older adults.

Journal Article J Am Geriatr Soc · July 2021 BACKGROUND: Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE: This qualitative study uses a socioecological framework to explore factors th ... Full text Link to item Cite

Video-Enhanced Care Management for Medically Complex Older Adults with Cognitive Impairment.

Journal Article J Am Geriatr Soc · January 2021 OBJECTIVE: This pilot study assessed feasibility of video-enhanced care management for complex older veterans with suspected mild cognitive impairment (CI) and their care partners, compared with telephone delivery. DESIGN: Pilot randomized controlled trial ... Full text Link to item Cite

Racial Disparities in Psychoactive Prescriptions in Veterans with Falls Risk

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2021 Cite

Hospitalization Risk Among Older Adults with Sensory Impairments: Development of a Prognostic Model.

Journal Article J Am Geriatr Soc · November 2020 OBJECTIVES: To develop a prognostic model for hospital admissions over a 1-year period among community-dwelling older adults with self-reported hearing and/or vision impairments based on readily obtainable clinical predictors. DESIGN: Retrospective cohort ... Full text Link to item Cite

Accelerometer-Based Machine Learning Categorization of Body Position in Adult Populations.

Conference Comput Help People Spec Needs · September 2020 This manuscript describes tests and results of a study to evaluate classification algorithms derived from accelerometer data collected on healthy adults and older adults to better classify posture movements. Specifically, tests were conducted to 1) compare ... Full text Link to item Cite

Physical Activity in the Hospital: Documentation and Influence on Venous Thromboembolism Prophylaxis.

Journal Article J Aging Phys Act · April 24, 2020 This study describes the availability of physical activity information in the electronic health record, explores how electronic health record documentation correlates with accelerometer-derived physical activity data, and examines whether measured physical ... Full text Link to item Cite

Acceptability of a Deprescribing E-Consult for Older Veterans at Risk for Falls

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2020 Link to item Cite

Accelerometer-Measured Hospital Physical Activity and Hospital-Acquired Disability in Older Adults.

Journal Article J Am Geriatr Soc · February 2020 BACKGROUND: Hospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital. OBJECTIVE: To examine whether wearable hospital activity trackers can be used to predict HAD. DESIGN: A prospective observational stu ... Full text Link to item Cite

Machine learning-based functional impairment classification with EHR-based clinical data

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · 2020 Cite

FAME: Falls Assessment of Medications in the Elderly Program

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2019 Link to item Cite

Automated versus Manual Data Extraction of the Padua Prediction Score for Venous Thromboembolism Risk in Hospitalized Older Adults.

Journal Article Appl Clin Inform · July 2018 OBJECTIVE: Venous thromboembolism (VTE) prophylaxis is an important consideration for hospitalized older adults, and the Padua Prediction Score (PPS) is a risk prediction tool used to prioritize patient selection. We developed an automated PPS (APPS) algor ... Full text Link to item Cite

Is objective mobility data associated with pharmacologic venous thromboembolism (VTE) prophylaxis use among hospitalized older adults?

Conference Journal of Hospital Medicine · April 10, 2018 Background: Clinical practice guidelines state that mobility is supposed to play an important role in determining use and duration of pharmacologic VTE prophylaxis. This study examines whether measured mobility levels relate to pharmacologic VTE prophylaxi ... Open Access Link to item Cite

Effects of Structured Exercise Interventions for Older Adults Hospitalized With Acute Medical Illness: A Systematic Review.

Journal Article J Aging Phys Act · April 1, 2018 This review examined effects of structured exercise (aerobic walking, with or without complementary modes of exercise) on cardiorespiratory measures, mobility, functional status, healthcare utilization, and quality of life in older adults (≥60 years) hospi ... Full text Link to item Cite

Improving Elder Care in a Community Based Hospital

Journal Article Journal of the American Medical Directors Association · March 2018 Full text Cite

Resident learning across the full range of core competencies through a transitions of care curriculum.

Journal Article Gerontol Geriatr Educ · 2018 The authors developed a Transitions of Care (TOC) curriculum to teach and measure learner competence in performing TOC tasks for older adults. Internal medicine interns at an academic residency program received the curriculum, which consisted of experienti ... Full text Link to item Cite

Internal Medicine Residents' Ambulatory Management of Core Geriatric Conditions.

Journal Article J Grad Med Educ · June 2017 BACKGROUND: Adults aged 65 years and older account for more than 33% of annual visits to internal medicine (IM) generalists and specialists. Geriatrics experiences are not standardized for IM residents. Data are lacking on IM residents' continuity experien ... Full text Link to item Cite

Overuse of pharmacologic venous thromboembolism prophylaxis in hospitalized older adults

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · May 1, 2016 Link to item Cite

Automated versus manual data extraction of venous thromboembolism risk among hospitalized older adults

Conference Journal of the American Geriatrics Society, Special Issue 2016: Annual Scientific Meeting Abstract Book · April 22, 2016 Full text Link to item Cite

Effectiveness of Intermittent Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis in High-Risk Surgical Patients: A Systematic Review.

Journal Article J Arthroplasty · February 2016 BACKGROUND: Thromboprophylaxis regimens include pharmacologic and mechanical options such as intermittent pneumatic compression devices (IPCDs). There are a wide variety of IPCDs available, but it is uncertain if they vary in effectiveness or ease of use. ... Full text Link to item Cite

Functional Measures Predict Discharge Destination But Not Readmissions

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2015 Link to item Cite

Optimizing Hospital to Skilled Nursing Facility Transitions

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2015 Link to item Cite

Assisted early mobility for hospitalized older veterans: preliminary data from the STRIDE program.

Journal Article J Am Geriatr Soc · November 2014 An important contributor to hospital-associated disability is immobility during hospitalization. Preliminary results from STRIDE, a clinical demonstration program of supervised walking for older adults admitted to the hospital with medical illness, are rep ... Full text Link to item Cite

Identifying risk of readmission in hospitalized elderly adults through inpatient medication exposure.

Conference J Am Geriatr Soc · June 2014 OBJECTIVE: To use electronic health record (EHR) data to examine the association between inpatient medication exposure and risk of hospital readmission. DESIGN: Retrospective, observational study. SETTING: Tertiary and quaternary care academic health syste ... Full text Link to item Cite

Sensitivity of osteoporosis screening guidelines for eventual hip fracture in older male veterans.

Journal Article Bonekey Rep · 2014 This study sought to determine whether guideline-recommended clinical criteria to select men for osteoporosis screening provide significantly better sensitivity than the osteoporotic screening tool (OST) among men who later went on to have a hip fracture, ... Full text Link to item Cite

Functional decline in older adults.

Journal Article Am Fam Physician · September 15, 2013 Functional disability is common in older adults. It is often episodic and is associated with a high risk of subsequent health decline. The severity of disability is determined by physical impairments caused by underlying medical conditions, and by external ... Link to item Cite

Performance of screening guidelines for osteoporosis in an older male veteran population.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2011 Link to item Cite

Factors related to extended hospital stays following deep brain stimulation for Parkinson's disease.

Journal Article Parkinsonism Relat Disord · June 2010 OBJECTIVE: Patients with Parkinson's disease (PD) are typically discharged from the hospital the day following deep brain stimulation (DBS) surgery; however, factors extending hospital stay are largely unknown. This study examined potential factors that mi ... Full text Link to item Cite

Parkinson's disease in women: a call for improved clinical studies and for comparative effectiveness research.

Journal Article Maturitas · April 2010 The incidence and prevalence of Parkinson's disease (PD) is expected to rise precipitously over the next several decades, as will the associated healthcare related costs. The epidemiology and disease manifestations of PD may differ when comparing women to ... Full text Link to item Cite

Physical performance and subsequent disability and survival in older adults with malignancy: results from the health, aging and body composition study.

Journal Article J Am Geriatr Soc · January 2010 OBJECTIVES: To evaluate objective physical performance measures as predictors of survival and subsequent disability in older patients with cancer. DESIGN: Longitudinal cohort study. SETTING: Health, Aging and Body Composition (Health ABC) Study. PARTICIPAN ... Full text Link to item Cite