The University of Alabama at Birmingham (UAB) Geriatric Emergency Medicine research program aims to improve healthcare efficiency and mitigate disparities in the acute care of older adults through patient-centered outcomes research, establishing geriatric emergency care protocols, and translating research evidence to clinical practice. The rapidly aging U.S. population of adults 65 or older brings unique challenges for those providing emergency care, as older adults visiting the ED often present with multiple chronic conditions, polypharmacy, and social/physical needs. To address these challenges, UAB Hospital – Highlands received Level 1 Geriatric ED accreditation, which is part of UAB’s Age-Friendly Healthcare System (AFHS) to provide high-quality care to older adults. Our group is working within the 4Ms – What Matters, Medication, Mentation, and Mobility - AFHS framework by developing novel programs to improve the care delivered to acutely ill older adults.

Primary research areas with dedicated effort and funding include developing preventive and management strategies for delirium in the ED, improving early recognition and management of potentially inappropriate medications (PIMs) leading to adverse outcomes in the ED, and designing care transition models for older adults, especially persons living with dementia (PLWD), to improve continuity of care from the ED. Other geriatric-focused quality improvement initiatives include implementing computerized clinical decision support (CDS) tools to screen older adults at high-risk of frailty fractures and falls, enhance quality of prescribing practices for older adults discharged from the ED, and improve communication of patient and caregiver preferences and goals.

Ongoing Projects

NIA R33 AG058926

PI: Hwang U
Site PI: Skains R
08/01/22-07/31/24
Geriatric Emergency Care Applied Research (GEAR) 1.0 Pilot Grant
Impact of Potentially Inappropriate Medications Prescribed at ED Discharge on Geriatric Patient-Level Outcomes

NIA R03 AG082923

PI: Skains R
09/01/23-05/31/25
Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR)
Risk Factors and Time Course of Incident Delirium Among Older Adults in the Emergency Department (ED)

NIA R21 AG08421

Co-PIs: Skains, R, Kennedy, R
11/01/23-10/31/25
Comprehensive Assessment of Delirium Risk due to Medications

SAEMF/EMF GEM2023-00000000008

PI: Skains, R
12/31/23-12/20/25
GEMSSTAR for Emergency Medicine Supplemental Funding Program

NIA U19AG078105

MPI: Chodosh, J, MPI
Site Co-I: Skains R
07/2023-06/2028
ED-LEAD: Emergency Departments LEading the Transformation of Alzheimer’s and Dementia Care - Emergency Care Redesign

Recently Completed Projects

AHRQ/NRSA T32 HS013852

Mugavero M, PI); 07/01/20-06/30/22
Health Services, Outcomes, and Effectiveness Research (HSOER)
Role: Postdoctoral Fellow

UAB ICAR Pilot Grant

PI: Skains R, PI
06/01/21-05/31/22
Risk of Delirium with Opioid Use Among Older Adults in the Emergency Department

NIDA 5UH3DA047003

PIs: Melnick ER, D’Onofrio G
Site PI: Walter L
04/01/19-06/30/20
EMBED: Pragmatic trial of user-centered clinical decision support to implement Emergency department-initiated BuprenorphinE for opioid use Disorder
Role: Fellow

Recent Publications

1. Lee S, Skains RM, Magidson PD, Qadoura N, Liu SW, Southerland LT. Enhancing healthcare access for an older population: The age-friendly emergency department. J Am Coll Emerg Physicians Open. 2024 Jun;5(3):e13182. doi: 10.1002/emp2.13182. eCollection 2024 Jun. Review. PubMed PMID: 38726466; PubMed Central PMCID: PMC11079440.
2. Jackson LE, Skains RM, Mudano A, Techarukpong N, Booth JS, Saag KG, Fraenkel L, Danila MI. An Emergency Department-based system intervention to improve osteoporosis screening for older adults at high-risk of fracture. JBMR Plus. 2024 May;8(5):ziae038. doi: 10.1093/jbmrpl/ziae038. eCollection 2024 May. PubMed PMID: 38681999; PubMed Central PMCID: PMC11055962.
3. Skains RM, Koehl JL, Aldeen A, Carpenter CR, Gettel CJ, Goldberg EM, Hwang U, Kocher KE, Southerland LT, Goyal P, Berdahl CT, Venkatesh AK, Lin MP. Geriatric Emergency Medication Safety Recommendations (GEMS-Rx): Modified Delphi Development of a High-Risk Prescription List for Older Emergency Department Patients. Ann Emerg Med. 2024 Mar 12;. doi: 10.1016/j.annemergmed.2024.01.033. [Epub ahead of print] PubMed PMID: 38483427.
4. Skains RM, Zhang Y, Osborne JD, O'Leary T, Fowler ME, Markland A, Buford TW, Brown CJ, Kennedy RE. Hospital-associated disability due to avoidable hospitalizations among older adults. J Am Geriatr Soc. 2023 May;71(5):1395-1405. doi: 10.1111/jgs.18238. Epub 2023 Jan 20. PubMed PMID: 36661192; PubMed Central PMCID: PMC10976455.
5. Chary A, Brickhouse E, Torres B, Cameron-Comasco L, Lee S, Punches B, Skains RM, Naik AD, Quatman-Yates CC, Kennedy M, Southerland LT, Liu S. Physical therapy consultation in the emergency department for older adults with falls: A qualitative study. J Am Coll Emerg Physicians Open. 2023 Apr;4(2):e12941. doi: 10.1002/emp2.12941. eCollection 2023 Apr. PubMed PMID: 37090953; PubMed Central PMCID: PMC10114865.
6. Freeman H, Martin RC, Whittington C, Zhang Y, Osborne JD, O'Leary T, Vickers JK, Flood KL, Skains RM, Markland AD, Buford TW, Brown CJ, Kennedy RE. Delirium Mediates Incidence of Hospital-Associated Disability Among Older Adults. J Am Med Dir Assoc. 2023 Apr;24(4):533-540.e9. doi: 10.1016/j.jamda.2023.02.006. Epub 2023 Mar 15. PubMed PMID: 36931323; PubMed Central PMCID: PMC10370492.
   
7. Hwang U, Carpenter C, Dresden S, Dussetschleger J, Gifford A, Hoang L, Leggett J, Nowroozpoor A, Taylor Z, Shah M. The Geriatric Emergency Care Applied Research (GEAR) network approach: a protocol to advance stakeholder consensus and research priorities in geriatrics and dementia care in the emergency department. BMJ Open. 2022 Apr 22;12(4):e060974. doi: 10.1136/bmjopen-2022-060974. PubMed PMID: 35459682; PubMed Central PMCID: PMC9036447.
   
8. Skains RM, Cohen SA, Yang Z, Shaw M, Wang KK, Elie M. Neurofilament Light and Tau Biomarkers Detect and Prognosticate Cognitive Dysfunction and Mortality in Community-Onset Sepsis. Acad Emerg Med.. 2022; 29(S1):S222. doi: 10.1111/acem.14511.
9. Carpenter CR, Hammouda N, Linton EA, Doering M, Ohuabunwa UK, Ko KJ, Hung WW, Shah MN, Lindquist LA, Biese K, Wei D, Hoy L, Nerbonne L, Hwang U, Dresden SM. Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement. Acad Emerg Med. 2021 Jan;28(1):19-35. doi: 10.1111/acem.14166. Epub 2020 Dec 12. Review. PubMed PMID: 33135274; PubMed Central PMCID: PMC7971946.
10. Whittington C, Skains RM, Zhang Y, Osborne JD, O"Leary T, Freeman HB, Martin RC, Vickers JK, Flood KL, Markland AD, Buford TW, Brown CJ, Kennedy RE. Delirium Due to Avoidable Hospitalizations Among Older Adults. Alzheimer’s Dement. 2021; 17(S10):e056449. doi: 10.1002/alz.056449.
11. Skains RM, Kennedy RE. Validation of the Nurse-Based Delirium Screening Tool (NuDESC) in the Emergency Department Setting. 28th Annual Agency for Healthcare Research and Quality (AHRQ) National Research Service Award (NRSA) Trainees Research Conference; 2022 May 24.
12. Skains RM, Hess EP, Levitan EB, McGwin G, Kennedy RE. Risk of Delirium with Opioid Use Among Older Adults in the Emergency Department. 27th Annual Agency for Healthcare Research and Quality (AHRQ) National Research Service Award (NRSA) Trainees Research Conference; 2021 June 7.

Additional Resources:

• GEAR 1.0 - Leadership
• Integrative Center for Aging Research - Past Awardees
• Geriatric Emergency Medicine - Fellow Spotlight: Rachel Skains, MD, MSPH
• UAB Hospital-Highlands Emergency Department designated as first Level 1 Geriatric ED in the Southeast
• Skains Bibliography 

Our Team

Skains, Rachel, M.D.

Associate Professor