Scholars@Duke
Heidi Kay White

Heidi Kay White

Professor of Medicine
Medicine, Geriatrics and Palliative Care
white031@mc.duke.edu
Duke Box 3003, Durham, NC 27710
2515 Hosp South, Durham, NC 27710

Selected Publications

Geriatrics Models of Care: Bringing ‘Best Practice’ to an Aging America, Second Edition

Book · January 1, 2024 Following the success of the previous edition, the second edition of Geriatrics Models of Care is the definitive resource for systems-based practice improvement for the care of older adults. Several new models of care have been published in the last eight ... Full text Cite

Preface: Excellent Systems of Care for Entire Communities of Older Adults

Journal Article Geriatrics Models of Care Bringing Best Practice to an Aging America Second Edition · January 1, 2024 Cite

The interagency care team: A new model to integrate social and medical care for older adults in primary care.

Journal Article Geriatr Nurs · 2023 To integrate management of social drivers of health with complex clinical needs of older adults, we connected patients aged 60 and above from primary care practices with a nurse practitioner (NP) led Interagency Care Team (ICT) of geriatrics providers and ... 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

On the Move clinic: A fall prevention nurse practitioner-driven model of care.

Journal Article Geriatr Nurs · 2021 Falls in older adults are common and interventions to reduce associated morbidity and mortality remain difficult to implement. This quality improvement project evaluated On the Move, a new clinic designed to provide tailored recommendations to reduce falls ... Full text Link to item Cite

Safe Interorganizational Health Information Exchange During the COVID-19 Pandemic.

Journal Article J Am Med Dir Assoc · December 2020 Accurate and timely transmission of medical records between skilled nursing facilities and acute care settings has been logistically problematic. Often people are sent to the hospital with a packet of paper records, which is easily misplaced. The COVID-19 ... Full text Open Access Link to item Cite

Factors associated with falls in older women with breast cancer: the use of a brief geriatric screening tool in clinic.

Journal Article Breast Cancer Res Treat · November 2020 PURPOSE: Unintentional falls and breast cancer are common among older women, but the associations between them are understudied. We aimed to identify factors associated with falls in older women with breast cancer. METHODS: We retrospectively reviewed clin ... Full text Link to item Cite

The Role of Prevention in Healthy Aging.

Journal Article Clin Geriatr Med · November 2020 This article explores the role of prevention in healthy aging from the perspective of individualized prevention in the clinic and population-based prevention with system-level support. The traditional medical model has significant limitations to effectivel ... Full text Link to item Cite

Detecting geriatric needs in older patients with breast cancer through use of a brief geriatric screening tool.

Journal Article J Geriatr Oncol · November 2019 INTRODUCTION: Identification of geriatric syndromes is important for determining functional age and optimizing care for people with cancer. Based on administration of a geriatric screening tool, we aimed to describe needed resources for geriatric syndromes ... Full text 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

Post-acute Care: Current State and Future Directions.

Journal Article J Am Med Dir Assoc · April 2019 Full text Link to item Cite

Higher symptom burden is associated with lower function in women taking adjuvant endocrine therapy for breast cancer.

Journal Article J Geriatr Oncol · March 2019 OBJECTIVE: To explore the impact of symptoms on physical function in women on adjuvant endocrine therapy for breast cancer. METHODS: Eligible women were postmenopausal, had hormone receptor positive, stage I-IIIA breast cancer, completed surgery, chemother ... Full text Open Access Link to item Cite

Health Optimization Program for Elders: Improving the Transition From Hospital to Skilled Nursing Facility.

Conference J Nurs Care Qual · 2019 BACKGROUND: Individuals discharged from the hospital to skilled nursing facilities (SNFs) experience high rates of unplanned hospital readmission, indicating opportunity for improvement in transitional care. LOCAL PROBLEM: Local physicians providing care i ... Full text Link to item Cite

Healthy Aging: American Geriatrics Society White Paper Executive Summary.

Journal Article J Am Geriatr Soc · January 2019 In July 2015, the Journal of the American Geriatrics Society published a manuscript titled, "Failing to Focus on Healthy Aging: A Frailty of Our Discipline?" In response, the American Geriatrics Society (AGS) Clinical Practice and Models of Care Committee ... Full text Link to item 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

Language as an Application of Mindfulness.

Journal Article J Am Med Dir Assoc · May 2018 Full text Link to item Cite

Implementation of personalized music listening for assisted living residents with dementia.

Journal Article Geriatr Nurs · 2018 Personalized music listening (PML) has been touted as a safe and inexpensive means of improving the quality of life, mood, and behavior of persons with dementia. A PML program was implemented in an assisted living facility and evaluated across the five dim ... Full text Link to item Cite

Advancing Geriatrics Education Through a Faculty Development Program for Geriatrics-Oriented Clinician Educators.

Journal Article J Am Geriatr Soc · December 2015 Geriatrician and nongeriatrician faculty need instruction as teachers to provide quality training for a broader community of physicians who can care for the expanding population of older adults. Educators at Duke University designed a program to equip geri ... Full text Open Access Link to item Cite

Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework.

Journal Article Gerontologist · August 2015 PURPOSE OF THE STUDY: To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. DESIGN AND METHODS: The study design was a qualitative, observational study of nursing home staff perceptions of the im ... Full text Link to item Cite

Predicting nursing home placement among home- and community-based services program participants.

Journal Article Am J Manag Care · December 1, 2014 BACKGROUND: Several states offer publicly funded-care management programs to prevent long-term care placement of high-risk Medicaid beneficiaries. Understanding participant risk factors and services that may prevent long-term care placement can facilitate ... Link to item Cite

Using the jigsaw cooperative learning method to teach medical students about long-term and postacute care.

Journal Article J Am Med Dir Assoc · June 2014 Since many of the frailest and most vulnerable Americans reside in nursing homes, medical students need focused education and training pertaining to this setting. A unique cooperative learning experience utilizing the jigsaw method was developed to engage ... Full text Link to item Cite

Long-term care in North Carolina.

Journal Article N C Med J · 2014 Much of long-term care is not considered health care, as it is custodial, social, and supportive. But excellent long-term care is also preventive, timely, and accessible, and it provides space for long-term care recipients to find joy and meaning in their ... Full text Link to item Cite

Design and evaluation of a prelicensure interprofessional course on improving care transitions.

Conference Gerontol Geriatr Educ · 2014 Effective management of care transitions for older adults require the coordinated expertise of an interprofessional team. Unfortunately, different health care professions are rarely educated together or trained in teamwork skills. To address this issue, a ... Full text Link to item Cite

An advanced course in long term care for geriatric medicine fellows.

Journal Article J Am Med Dir Assoc · July 2013 Long term care deserves focused attention within a geriatric medicine fellowship curriculum to ensure that graduates are prepared not only for clinical care but also for the leadership, administrative, educational, quality improvement, and health policy as ... Full text Link to item Cite

A collaborative care model for peri-operative care of older adults.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2013 Link to item Cite

MDS 3.0 perspective: a better tool for patient care.

Journal Article J Am Med Dir Assoc · March 2013 Full text Link to item Cite

(AI) Can't get off my chair.

Journal Article J Am Geriatr Soc · October 2012 Full text Link to item Cite

A prospective study of outcomes of nursing home residents with chronic kidney disease with and without anemia.

Journal Article J Am Geriatr Soc · May 2012 OBJECTIVES: To determine whether anemia is a risk factor for functional decline in nursing home (NH) residents with chronic kidney disease. DESIGN: Prospective 26-week observational study. SETTING: Eighty-two geographically representative NHs in the United ... Full text Link to item Cite

Prioritizing culture change in nursing homes: perspectives of residents, staff, and family members.

Journal Article J Am Geriatr Soc · March 2012 OBJECTIVES: To explore the perspectives and priorities of nursing home residents, family members, and frontline nursing staff concerning a broad range of items representing common targets of culture change initiatives. DESIGN: Qualitative study. SETTING: A ... Full text Link to item Cite

Minimal trauma fractures: lifting the specter of misconduct by identifying risk factors and planning for prevention.

Journal Article J Am Med Dir Assoc · February 2012 Minimal trauma fractures are an unfortunate, yet not uncommon, event for frail elderly individuals in long term care facilities. These fractures result in significant morbidity including pain and loss of function along with significantly increased mortalit ... Full text Link to item Cite

Nicotine treatment of mild cognitive impairment: a 6-month double-blind pilot clinical trial.

Journal Article Neurology · January 10, 2012 OBJECTIVE: To preliminarily assess the safety and efficacy of transdermal nicotine therapy on cognitive performance and clinical status in subjects with mild cognitive impairment (MCI). METHODS: Nonsmoking subjects with amnestic MCI were randomized to tran ... Full text Link to item Cite

Ensuring vitamin D supplementation in nursing home patients--a quality improvement project.

Journal Article J Nutr Gerontol Geriatr · 2012 Randomized controlled trials have shown that adequate vitamin D supplementation in nursing home (NH) residents reduces the rates of falls and fractures. In our NH, review of medication administration records of all patients (n = 101) revealed that only 34. ... Full text Link to item Cite

Urinary tract infections in long-term care residents.

Journal Article Clin Geriatr Med · May 2011 Urinary tract infection (UTI) is common in long-term care (LTC) residents; however, most infections are asymptomatic and do not require treatment. Differentiating asymptomatic from symptomatic UTI is challenging, because LTC residents typically have chroni ... Full text Link to item Cite

The Connected Learning Model for disseminating evidence-based care practices in clinical settings.

Journal Article Nurse Educ Pract · July 2010 Clinical practice guidelines have been developed to improve patient care and outcomes. Guideline implementation is often stymied by the complexity of patients' conditions, complex care environments, and limited advanced clinical training of nursing staff. ... Full text Link to item Cite

The clinical course of advanced dementia.

Journal Article N Engl J Med · January 28, 2010 Link to item Cite

Mentoring: a key strategy to prepare the next generation of physicians to care for an aging America.

Journal Article J Am Geriatr Soc · July 2009 Mentoring is an important instructional strategy that should be maximally used to develop the next generation of physicians who will care for a growing population of frail older adults. Mentoring can fulfill three specific purposes: (1) help learners choos ... Full text Link to item Cite

Effects of an oral growth hormone secretagogue in older adults.

Journal Article J Clin Endocrinol Metab · April 2009 CONTEXT: GH secretion declines with age, possibly contributing to reduced muscle mass, strength, and function. GH secretagogues (GHS) may increase muscle mass and physical performance. OBJECTIVES/DESIGN: We conducted a randomized, double-masked, placebo-co ... Full text Link to item Cite

A quality improvement program to enhance after-hours telephone communication between nurses and physicians in a long-term care facility.

Journal Article J Am Geriatr Soc · June 2008 OBJECTIVES: To determine whether satisfaction of on-site nurses with after-hours telephone communication with off-site physicians improved in one long-term care (LTC) facility after a nurse-oriented intervention. DESIGN: Longitudinal quality improvement st ... Full text Link to item Cite

The older cancer patient.

Journal Article Nurs Clin North Am · June 2008 Providing effective and tolerable cancer treatment for the growing number of older adult patients who have cancer requires an understanding of the role of aging, comorbidity, functional status, and frailty on treatment outcomes. The incorporation of compre ... Full text Link to item Cite

Staying Healthy in Later Life

Journal Article · April 15, 2008 Full text Cite

The nursing home in long-term care education.

Journal Article J Am Med Dir Assoc · February 2008 Nursing homes have long been used to teach geriatric medicine to medical students, primary care residents, and geriatric medicine fellows, but we may be able to more appropriately use this clinical setting by addressing principles of long-term care in addi ... Full text Link to item Cite

After-hours calls from long-term care facilities in a geriatric medicine training program.

Journal Article J Am Geriatr Soc · December 2007 OBJECTIVES: To describe after-hours telephone calls from nurses in long-term care (LTC) facilities to doctors in a geriatric medicine training program. DESIGN: Evaluation of 1,928 after-hours calls from LTC facilities over a 10-month period in 2005/06. SET ... Full text Link to item Cite

Solving the long-term care puzzle: A unique learning experience for medical students.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2007 Link to item Cite

Long-term care education: Facilitated through faculty development and project mentoring.

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 1, 2007 Link to item Cite

Development and implementation of the TrAC (Tracking After-hours Calls) database: a tool to collect longitudinal data on after-hours telephone calls in long-term care.

Journal Article J Am Med Dir Assoc · March 2007 INTRODUCTION: Effective telephone communication between long-term care (LTC) nurses and physicians is an integral part of high-quality care, yet little is known about this key aspect of LTC practice. The authors describe the development and implementation ... Full text Link to item Cite

Difficult behaviors in long-term care patients with dementia.

Journal Article J Am Med Dir Assoc · March 2007 Difficult behaviors are relatively common challenges that can occur throughout the natural progression of dementia, but are particularly common in the mid to late stages of disease. These behaviors can be challenging to manage in nursing and assisted care ... Full text Link to item Cite

Dementia assessment and management.

Journal Article J Am Med Dir Assoc · March 2007 Dementia is a common yet potentially underdiagnosed illness in the long-term care setting. Targeted screening for dementia should be routine practice, as a diagnosis of dementia will have benefits to the care of the patient. Assessment of dementia should p ... Full text Link to item Cite

Providing optimal nutrition in the assisted living environment

Chapter · January 1, 2007 Optimal nutritional status plays a critical role in successful aging, contributing to both health and quality of life.1 One key determinant of dietary intake and thus nutritional status in the later years of life is living situation, since living environme ... Cite

The older cancer patient.

Journal Article Med Clin North Am · September 2006 Providing effective and tolerable cancer treatment for the growing number of older adult patients who have cancer will require an understanding of the role of aging, comorbidity, functional status, and frailty on treatment outcomes. The incorporation of CG ... Full text Link to item Cite

Quality improvement initiative for chronic pain assessment and management in the nursing home: a pilot study.

Journal Article J Am Med Dir Assoc · May 2006 OBJECTIVES: To improve assessment and management of chronic pain in the nursing home through a method of continuous quality improvement. DESIGN: Quality improvement. SETTING: One nursing home in North Carolina as the primary site and 3 related facilities a ... Full text Link to item Cite

Difficult behaviors in long-term care patients with dementia.

Journal Article J Am Med Dir Assoc · March 2006 Difficult behaviors are relatively common challenges that can occur throughout the natural progression of dementia, but are particularly common in the mid to late stages of disease. These behaviors can be challenging to manage in nursing and assisted care ... Full text Link to item Cite

Dementia assessment and management.

Journal Article J Am Med Dir Assoc · February 2006 Dementia is a common yet potentially underdiagnosed illness in the long-term care setting. Targeted screening for dementia should be routine practice, as a diagnosis of dementia will have benefits to the care of the patient. Assessment of dementia should p ... Full text Link to item Cite

Promoting quality care in the nursing home

Journal Article Annals of Long Term Care · April 1, 2005 Substantial improvements in the quality of care provided in nursing facilities must be achieved to meet the needs of a growing older adult population. The nursing home industry must leave its historical roots and embrace systematic changes that will promot ... Cite

Medication review in the nursing home: Can stopping one drug make all the difference?

Journal Article Annals of Long Term Care · February 1, 2005 Frail older adults frequently receive care at different locations in the health care system. Prescribing by multiple providers can lead to polypharmacy arid an increased risk of adverse drug events. A case is presented of a frail older patient with heart f ... Cite

Weight loss in advanced Alzheimer's disease part II: Interventions

Journal Article Annals of Long Term Care · June 1, 2004 Weight loss is a common occurrence in advanced Alzheimer's disease. Part II of this two-part article discusses effective interventions to prevent or improve weight loss in patients with Alzheimer's disease. Certain factors in the progression of the disease ... Cite

Weight loss in advanced Alzheimer's disease, part I: Contributing factors and evaluation

Journal Article Annals of Long Term Care · May 1, 2004 Weight loss is a common occurrence in advanced Alzheimer's disease. Part I of this two-part article discusses the factors associated with the pathophysiology and progression of Alzheimer's disease that may promote weight loss, and the appropriate evaluatio ... Cite

Chronic transdermal nicotine patch treatment effects on cognitive performance in age-associated memory impairment.

Journal Article Psychopharmacology (Berl) · February 2004 OBJECTIVES: Chronic transdermal nicotine has been found to improve attentional performance in patients with Alzheimer's disease (AD), but little is known about chronic nicotine effects in age-associated memory impairment (AAMI), a milder form of cognitive ... Full text Link to item Cite

A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects.

Journal Article J Am Med Dir Assoc · 2004 OBJECTIVE: Weight loss is a common occurrence in Alzheimer's disease (AD). This study was undertaken to investigate the relationship between weight loss and behavioral symptoms in institutionalized AD subjects. DESIGN: Observational study. SETTING: Two fac ... Full text Link to item Cite

A randomized controlled trial of the psychosocial impact of providing internet training and access to older adults.

Journal Article Aging Ment Health · August 2002 The Internet (electronic mail and the World Wide Web) may provide new opportunities for communication that can help older adults avoid social isolation. This randomized controlled trial assessed the psychosocial impact of providing Internet access to older ... Full text Link to item Cite

Four-week nicotine skin patch treatment effects on cognitive performance in Alzheimer's disease.

Journal Article Psychopharmacology (Berl) · April 1999 RATIONALE: Acute nicotine injections have been found to improve attentional performance in patients with Alzheimer's disease (AD), but little is known about chronic nicotine effects. OBJECTIVE: The present study was undertaken to evaluate the clinical and ... Full text Link to item Cite

Case report: Catatonia and neuroleptic malignant syndrome in the nursing home

Journal Article Annals of Long Term Care · February 4, 1999 Because many illnesses present with fever and confusion in the long- term care setting, neuroleptic malignant syndrome (NMS) in the elderly is a challenging, yet uncommon, diagnosis. Catatonia is implicated as a predisposing factor for the development of N ... Cite

Surfing the net in later life: A review of the literature and pilot study of computer use and quality of life

Journal Article Journal of Applied Gerontology · January 1, 1999 The Internet offers new opportunities for communication that can help older adults avoid social isolation. Although elders may need more time and assistance in learning computer systems, many are embracing this new technology. There is growing potential no ... Full text Cite

The association of weight change in Alzheimer's disease with severity of disease and mortality: a longitudinal analysis.

Journal Article J Am Geriatr Soc · October 1998 OBJECTIVE: To describe weight loss in relation to the severity of Alzheimer's disease (AD), to identify confounders that might account for weight loss, and to investigate the association of weight change with mortality. METHODS: This study included 666 sub ... Full text Link to item Cite

Weight change in Alzheimer's disease.

Journal Article J Nutr Health Aging · 1998 Link to item Cite

Weight change in Alzheimer's disease.

Journal Article J Am Geriatr Soc · March 1996 PURPOSE: To determine the natural history of weight change and the occurrence of clinically significant weight loss in subjects with Alzheimer's disease (AD). PATIENTS AND METHODS: Subjects with AD and cognitively normal older controls were recruited from ... Full text Link to item Cite

The Role of the Caregiver in the Drug Treatment of Dementia

Journal Article CNS Drugs · January 1, 1995 Summary Although dementia is common among the institutionalised elderly, the majority of patients with dementia are cared for at home by nonprofessional caregivers, usually a spouse or adult child, As dementia progresses, the role of the caregiver expands ... Full text Cite

Retrospective postmortem dementia assessment. Validation of a new clinical interview to assist neuropathologic study.

Journal Article Arch Neurol · June 1991 Neuropathologic studies of dementia and normal aging suffer from a lack of individuals examined for the presence and severity of dementia before death. To increase clinical information in such cases, a retrospective collateral interview was developed. Thir ... Full text Link to item Cite

Cognitive screening tests.

Journal Article J Gen Intern Med · 1991 Full text Link to item Cite