UND-led Dakota Geriatrics group awarded $5 million federal grant

 Grant will help group expand geriatrics programs, educate geriatric healthcare workforce

“Look – North and South Dakota are ranked numbers four and five on the list of states for the percentage of Alzheimer’s incidence,” stressed Dr. Don Jurivich, chair of the UND School of Medicine & Health Sciences Department of Geriatrics. “We’re still not doing enough early detection and need to move the needle on that. And we’ve not been able to put a dent in the reduction of injury from falls. All of this remains a problem for older adults’ morbidity and mortality.”

In other words, tackling the chronic health challenges facing older adults in the Dakotas hasn’t been easy for Jurivich and his Dakota Geriatrics crew.

Fortunately, addressing such thorny challenges effectively just got much easier.

Jurivich received word recently that the UND-led Dakota Geriatrics group was the recipient of a second $5 million Geriatrics Workforce Enhancement Program (GWEP) grant from the federal Health Resources and Services Administration (HRSA). The new grant will be used to expand existing geriatrics programs in the Dakotas and educate better the geriatric healthcare workforce, particularly within the states’ Tribal, Tribal Organization, Underserved, and Rural – or TTOUR – constituencies.

What that means, said Dr. Gunjan Manocha, UND assistant professor of geriatrics and associate program director for Dakota Geriatrics, is that Dakota Geriatrics retains the capacity to redouble its development of more and better “age-friendly and dementia-friendly care for older adults in integrated geriatrics and primary care health systems.”

GWEP redux

Looking to reduce avoidable hospital admissions, among other goals, Jurivich said the grant will help providers across the region better prevent conditions that remain preventable.

“Falls and frailty are often preventable,” he said. “Cognitive decline may be slowed or prevented, but you have to start early. Once the cat is out of the bag with cognitive decline, it becomes a battle to suppress or slow the degeneration process.”

Referencing the programs Dakota Geriatrics has already developed, Manocha noted that HRSA awarded UND its initial GWEP grant in 2019. That original $3.75 million award was used to advance geriatrics education and healthcare system transformation in the Dakotas, which, although boasting a population with a relatively low median age also claim half of the top 10 U.S. counties with populations age 85 and over, according to one 2023 U.S. Census Bureau report.

“We’ve added ‘multi-complexity’ to our geriatric 4Ms,” she said, explaining the expansion of her group’s initial focus on medication, mentation, mobility, and “what matters” in older adults. “With multi-complexity as part of the mix now, we can bring technology to rural and Tribal areas. That will strengthen chronic disease management.”

Partnering with the SMHS on the original GWEP were the North Dakota State Division on Aging Services and Health Promotion, UND Center for Rural Health, Good Samaritan Society, Alzheimer’s Association, Memory Café, North Dakota State University, and South Dakota State University. Joining this list of partners in 2024 are the University of South Dakota, Indian Health Service (IHS), and Spirit Lake Nation, among other organizations.

“Spirit Lake has partnered with their elders and we’ll be helping them create health promotion programs as part of those activities,” said Jurivich. “These will be almost monthly events that provide socialization, support cultural identity, and just augment general living skills for Indigenous Elders. A few months ago, we hosted model drag car racing to encourage socialization, mobility, and team building amongst the elders, and I was impressed that the women smoked the men in the race. ”

‘Tremendous pressure’

“The new GWEP is a lot more ambitious,” continued Manocha. “We’re trying to cover all entities, but will focus primarily on clinical programming and long-term care.”

And as Jurivich put it, such expanded programming for rural and underserved areas couldn’t have come at a better time. Rural long-term care facilities — many of which have closed since COVID-19 hit rural and tribal areas hard — are under “tremendous pressure” to remain solvent as their resources dwindle, he said.

“North and South Dakota are 60% rural, so the vast majority of the population here is not receiving the same support as more urban areas,” he explained. “There has been a lot of turnover, and we have staff shortages across the board. So, we’re hoping to be a catalyst that brings new trainees into areas that have not traditionally been seen as venues for provider training. We want to infuse educational resources into these areas, with the dual effort of bringing faculty expertise that can help sustain the interest of the physicians or nurses or therapists in these regions.”

“We’ll really be emphasizing interprofessional training,” added Manocha, noting that the Dakota Geriatrics GWEP grant runs through 2029.

To that end, said Jurivich, the grant proposal identified a series of “milestones” it hopes to meet, including achieving a higher percentage of dementia detection for older adults and a higher percentage of seniors assessed for fall risk, relative to current figures. The program has also identified reducing the percentage of older adults on unnecessary medications as a goal.

“And then, just a lot of promoting preventive medicine,” Jurivich concluded. “Having a mobility plan for older adults, knowing what matters most to them, and making sure that the healthcare plan from providers is aligned to the patient’s wishes and not somebody else’s agenda, whether it be a family member or provider who says ‘you must do this.’ We always have to align what’s important for the patient and not impose medical authority when that may not be in patients’ best interest.”


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