Scholars@Duke
Shelley R McDonald

Shelley R McDonald

Associate Professor of Medicine
Medicine, Geriatrics and Palliative Care
shelley.mcdonald@duke.edu
Box 3003, DUMC, Durham, NC 27710
Box 3003, DUMC, Durham, NC 27710

Selected Publications

Facilitators and barriers to eliciting physical function goals before and after surgery: A qualitative study with clinicians.

Journal Article Patient Educ Couns · February 2024 OBJECTIVE: Describe clinicians' perspectives of facilitators and barriers to eliciting physical function goals from patients with multiple chronic conditions pre- and post-surgery. METHODS: Semi-structured qualitative interviews were conducted with clinici ... Full text Link to item Cite

Geriatric Models of Care: Perioperative Optimization of Senior Health (POSH)

Chapter · January 1, 2024 The Perioperative Optimization of Senior Health (POSH) model is an innovative collaborative care model, which operationalizes best practices in perioperative care of older adults. The model has been shown to improve postoperative outcomes for high-risk old ... Full text Cite

Delirium education for geriatric patients and their families: A quality improvement initiative✰

Journal Article Aging and Health Research · March 1, 2023 Delirium affects up to 50% of hospitalized older adults, contributing to poor outcomes. Family members can be engaged in delirium identification, prevention, and management. Rapid cycle improvement methodology was utilized to create a new educational hando ... Full text Cite

Perioperative medical assessment of older adults

Chapter · March 28, 2022 In this latest edition, the authors take a refreshed approach to the material by rigorously applying the latest scientific research to clinical practice and increasing the use of visual examples, algorithms, and clinical practice points. ... Cite

A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study.

Journal Article Anesth Analg · January 1, 2022 BACKGROUND: Some older adults show exaggerated responses to drugs that act on the brain. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG-based measure ... Full text Link to item Cite

Geriatric Preoperative Optimization: A Review.

Journal Article Am J Med · January 2022 This review summarizes best practices for the perioperative care of older adults as recommended by the American Geriatrics Society, American Society of Anesthesiologists, and American College of Surgeons, with practical implementation strategies that can b ... Full text Link to item Cite

Perioperative Optimization of Senior Health in Spine Surgery: Impact on Postoperative Delirium.

Journal Article J Am Geriatr Soc · May 2021 BACKGROUND: Delirium is a common postoperative complication in geriatric patients, especially in those with underlying risk factors. Multicomponent nonpharmacologic interventions are effective in preventing delirium, however, implementation of these measur ... Full text Link to item Cite

Perioperative Optimization of Senior Health (POSH): A Descriptive Analysis of Cancelled Surgery.

Conference World J Surg · January 2021 BACKGROUND: Geriatric collaborative care models improve postoperative outcomes for older adults. However, there are limited data exploring how preoperative geriatric assessment may affect surgical cancellations. METHODS: This is a single-center retrospecti ... Full text Link to item Cite

Rationale and Design for a Higher (Dairy) Protein Weight Loss Intervention That Promotes Muscle Quality and Bone Health in Older Adults with Obesity: A Randomized, Controlled Pilot Study.

Journal Article J Nutr Gerontol Geriatr · 2021 In contrast to recommendations for young and middle-aged adults, intentional weight loss among older adults remains controversial and is inconsistently advised. Recent research suggests that a higher protein diet can mitigate loss of lean mass during perio ... Full text Link to item Cite

Assessments of frailty in bladder cancer.

Journal Article Urol Oncol · September 2020 BACKGROUND AND AIMS: The incidence of frailty is increasing as the population ages, which has important clinical implications given the associations between frailty and poor outcomes in the bladder cancer population. Due to a multi-organ system decline and ... Full text Open Access Link to item Cite

Delaying Elective Surgery in Geriatric Patients: An Opportunity for Preoperative Optimization.

Journal Article Anesth Analg · January 2020 Deciding whether to pursue elective surgery is a complex process for older adults. Comprehensive geriatric assessment (CGA) can help refine estimates of benefits and risks, at times leading to a delay of surgery to optimize surgical readiness. We describe ... Full text Open Access Link to item Cite

The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.

Journal Article J Alzheimers Dis · 2020 BACKGROUND: Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the A ... Full text Open Access Link to item Cite

Bach to the Basics: Implementation and Impact of a Postoperative, Inpatient Personalized Music Program for Older Adults.

Journal Article J Perianesth Nurs · April 2019 PURPOSE: Music as an intervention to mitigate pain and anxiety has been well studied in the perioperative period. We present a quality improvement (QI) report describing implementation and evaluation of a postoperative, inpatient personalized music program ... Full text Link to item Cite

Influence of Weight Reduction and Enhanced Protein Intake on Biomarkers of Inflammation in Older Adults with Obesity.

Journal Article J Nutr Gerontol Geriatr · 2019 Both aging and obesity are associated with increased levels of pro-inflammatory metabolites, while weight reduction is associated with improvements in inflammatory status. However, few studies have explored the response of key inflammatory markers to the c ... Full text Link to item Cite

The importance of the STOP- BANG questionnaire as a preoperative assessment tool for the elderly population.

Journal Article Geriatr Nurs · 2019 Undiagnosed obstructive sleep apnea (OSA) may adversely impact surgical patients and can lead to increased morbidity and mortality during the perioperative period, especially among the geriatric patient population (Chung et al. 2008, 2012, 2014; McDonald e ... Full text Link to item Cite

Impact on cardiometabolic risk of a weight loss intervention with higher protein from lean red meat: Combined results of 2 randomized controlled trials in obese middle-aged and older adults.

Journal Article J Clin Lipidol · 2019 BACKGROUND: The recognized benefits of a higher protein diet on muscle mass and strength in older adults are tempered by concerns of the potentially negative cardiometabolic impact of dietary sources of animal protein. OBJECTIVE: The aim of this study was ... Full text Link to item Cite

Development and validation of machine learning models to identify high-risk surgical patients using automatically curated electronic health record data (Pythia): A retrospective, single-site study.

Journal Article PLoS medicine · November 2018 BackgroundPythia is an automated, clinically curated surgical data pipeline and repository housing all surgical patient electronic health record (EHR) data from a large, quaternary, multisite health institute for data science initiatives. In an ef ... Full text Cite

Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative.

Journal Article JAMA Surg · May 1, 2018 IMPORTANCE: Older adults undergoing elective surgery experience higher rates of preventable postoperative complications than younger patients. OBJECTIVE: To assess clinical outcomes for older adults undergoing elective abdominal surgery via a collaborative ... Full text Link to item Cite

Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.

Journal Article J Am Geriatr Soc · March 2018 OBJECTIVES: To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriat ... Full text Open Access Link to item Cite

Preoperative Screening.

Journal Article Clin Geriatr Med · February 2018 Older adults undergoing elective surgical procedures suffer higher rates of morbidity and mortality than younger patients. A geriatric-focused preoperative evaluation can identify risk factors for complications and opportunities for health optimization and ... Full text Link to item Cite

Markers of Renal Function in Older Adults Completing a Higher Protein Obesity Intervention and One Year Later: Findings from the MEASUR-UP Trial.

Journal Article J Nutr Gerontol Geriatr · 2018 Increases in rates of obesity in the older population are hastening the development of chronic illnesses, including chronic kidney disease (CKD). However, obesity reduction in older adults is besought with concerns about the long-term benefit/risk, especia ... Full text Link to item Cite

Quality of Life and Mental Health in Older Adults with Obesity and Frailty: Associations with a Weight Loss Intervention.

Journal Article J Nutr Health Aging · 2018 OBJECTIVE: To examine the bi-directional associations of a weight loss intervention with quality of life and mental health in obese older adults with functional limitations. DESIGN: Combined-group analyses of secondary variables from the MEASUR-UP randomiz ... Full text Link to item Cite

Influence of Protein Intake, Race, and Age on Responses to a Weight-Reduction Intervention in Obese Women.

Journal Article Curr Dev Nutr · May 1, 2017 BACKGROUND: Women have higher rates of obesity than men and develop more pronounced functional deficits as a result. Yet, little is known about how obesity reduction affects their functional status, including whether their responses differ when protein int ... Full text Link to item Cite

Improved Function With Enhanced Protein Intake per Meal: A Pilot Study of Weight Reduction in Frail, Obese Older Adults.

Journal Article J Gerontol A Biol Sci Med Sci · October 2016 BACKGROUND: Obesity is a significant cause of functional limitations in older adults; yet, concerns that weight reduction could diminish muscle along with fat mass have impeded progress toward an intervention. Meal-based enhancement of protein intake could ... Full text Open Access Link to item Cite

Incorporating shared decision making into perioperative care of older adults

Journal Article Current Surgery Reports · August 1, 2016 Purpose of review Older patients represent a growing and significant portion of the surgical population. Due to age-related changes in physiology and the presence of multiple comorbidities, older patients are more likely to experience complications, functi ... Full text Cite

Challenges in the Management of Geriatric Obesity in High Risk Populations.

Journal Article Nutrients · May 4, 2016 The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially ... Full text Open Access Link to item Cite

Nutritional Vulnerability in Older Adults: A Continuum of Concerns.

Journal Article Curr Nutr Rep · June 2015 A nutritionally vulnerable older adult has a reduced physical reserve that limits the ability to mount a vigorous recovery in the face of an acute health threat or stressor. Often this vulnerability contributes to more medical complications, longer hospita ... Full text Link to item Cite

Meal-based enhancement of protein quality and quantity during weight loss in obese older adults with mobility limitations: rationale and design for the MEASUR-UP trial.

Journal Article Contemp Clin Trials · January 2015 Obese older adults with even modest functional limitations are at a disadvantage for maintaining their independence into late life. However, there is no established intervention for obesity in older individuals. The Measuring Eating, Activity, and Strength ... Full text Link to item Cite

Obesity and physical frailty in older adults: a scoping review of lifestyle intervention trials.

Journal Article J Am Med Dir Assoc · April 2014 Many frail older adults are thin, weak, and undernourished; this component of frailty remains a critical concern in the geriatric field. However, there is also strong evidence that excessive adiposity contributes to frailty by reducing the ability of older ... Full text Link to item Cite

Concurrent administration of coenzyme Q10 and alpha-tocopherol improves learning in aged mice.

Journal Article Free Radic Biol Med · March 15, 2005 The main purpose of this study was to determine whether supplemental intake of coenzyme Q10 (CoQ) (ubiquinone-10) or alpha-tocopherol, either alone or together, could improve brain function of aged mice, as reflected in their cognitive or psychomotor perfo ... Full text Link to item Cite

Lifelong vitamin E intake retards age-associated decline of spatial learning ability in apoE-deficient mice

Journal Article Age · March 1, 2005 The potential for lifelong vitamin E supplementation to delay age-associated cognitive decline was tested in apoE-deficient and wild-type C57BL/6 mice. Beginning at eight weeks of age, the mice were maintained on a control diet or diets supplemented with d ... Full text Cite

Proteomic identification of specific oxidized proteins in ApoE-knockout mice: relevance to Alzheimer's disease.

Journal Article Free Radic Biol Med · May 1, 2004 We have examined oxidized proteins in the brain regions of wild-type (WT) and ApoE-knockout (KO) animals. Total protein oxidation in the hippocampus of young-KO (6 month) animals was approximately 2-fold greater than that of young-WT (6 month) animals and ... Full text Link to item Cite