December 2013 Research Spotlight : Richard Allman

richard allmanDr. Richard M. Allman earned his medical degree from West Virginia University (WVU), where he also completed a residency in internal medicine. After completing a fellowship in general internal medicine at Johns Hopkins University, he joined the faculty at UAB in 1986. Dr. Allman has been listed in Best Doctors in America since 1991 and has played important leadership roles in the American Geriatrics Society, the Gerontological Society of America, the Association of Directors of Geriatric Academic Programs, and the National VA GRECC Directors Association.

He was inducted as a permanent member of the Alabama Senior Citizens Hall of Fame and received the Robert G. Sherrill Quality Champion Award from the Alabama Quality Assurance Foundation (AQAF) in 2009 in recognition of his efforts to improve the health and well-being of older adults and their family members in the state. 
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Dr. Allman has been selected to receive the Gerontological Society of America (GSA) 2013 Kent Award in recognition of his outstanding professional leadership in gerontology through teaching and service. In addition, he will also be the recipient of the 2013 GSA Health Sciences Section Joseph T. Freeman Award, a lectureship in geriatrics awarded to a prominent physician for both practice and research in the field of aging.

Dr. Allman has provided leadership for the development of interdisciplinary research, education, community, and specialty care programs in Geriatrics and Palliative Care within the VA and at UAB since 1986. He has served as the founding director for the VA-funded Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) since 2000. He served as director of the UAB Division of Gerontology, Geriatrics, and Palliative Care from October 1990-July 2013, the Comprehensive Center for Healthy Aging since 1992, the UAB component of the Southeast Center of Excellence in Geriatric Medicine since 1998, and the NIA P30-funded Deep South Resource Center for Minority Aging Research (RCMAR) since 2007. Since 2010, he has provided leadership for the Pilot Grant and Nascent Panel Programs of the NIH Clinical and Translational Science Award (CTSA) funded UAB Center for Clinical and Translational Science (CCTS). The programs in aging at the Birmingham VA and UAB have achieved an outstanding national reputation under Dr. Allman’s leadership. In FY 2012, the Birmingham/Atlanta GRECC ranked second in total research funding among the nineteen current GRECCs. Since 1990, the Division has grown from nine to 51 faculty members. The Geriatric Medicine fellowship program is ranked 12th in the nation by U.S. News and World Report and UAB provides leadership for one of the nation’s eight Palliative Care Leadership Centers. The Comprehensive Center for Healthy Aging involves 218 faculty members from all UAB schools and the College of Arts and Sciences. Dr. Allman has served as the principal investigator for the NIA-funded UAB Study of Aging since 1998, a study focusing on risk factors for life-space mobility loss among community- dwelling older adults.

Dr. Allman has been appointed Chief Consultant for Geriatrics and Extended Care (GEC) Services for the Department of Veterans Affairs in Washington DC effective January 12, 2014. The Chief Consultant for GEC has overall responsibility for planning, organizing, directing, coordinating, and controlling policy and supporting operations for long-term care and support services throughout the VA health care system. The VA health care system is the largest integrated healthcare system in the nation with 152 medical centers and over 800 community based outpatient clinics. The VA provides health care services for nearly 9 million enrolled veterans with more than half of these being over the age of 65 years.

Abstract:

Background:Life-Space Assessment captures community mobility and social participation and quantifies the distance, frequency, and independence obtained as an older adult moves through his or her environment. Reduced estimated glomerular filtration rate (eGFR) is associated with decline in activities of daily living among older adults, but less is known about the association of eGFR with restrictions in mobility.

Study Design:Prospective observational cohort study.

Setting & Participants:Community-dwelling Medicare beneficiaries from the University of Alabama at Birmingham Study of Aging who had serum creatinine measured during a baseline in-home study visit and completed at least one telephone follow-up (N=390).

Predictor:eGFR≥60, 45-59, and, <45 mL/min/1.73 m2.

Outcome:Life-space mobility trajectory.

Measurements: Life-space mobility was evaluated by telephone every 6 months for up to 4.5 years using the previously validated Life-Space Assessment. Scores using this tool range from 0-120 (higher scores indicate greater mobility).

Results:Mean age of the 390 participants was 77.665.8 (SD) years, 41% were African American, 50.5% were women; 30.0% had eGFR of 45-59 mL/min/1.73 m2, and 20.2% had eGFR, 45 mL/min/1.73 m2. Age-,race-, and sex-adjusted mean baseline life-space mobility scores were 64.8 (95% CI, 62.0-67.6), 63.8 (95% CI, 60.3-67.4), and 58.3 (95% CI, 53.8-62.7) among those with eGFR categories≥60, 45-59,and, <45 mL/min/1.73 m2, respectively. Compared with those with eGFRs≥60 mL/min/1.73 m2, a more rapid decline in life-space mobility was found among those with eGFRs,<45 mL/min/1.73 m2, though this did not reach statistical significance (P = 0.06); a similar effect was not seen among those with eGFRs of 45-59 mL/min/1.73 m2 (P = 0.3).

Limitations:Urinary albumin or longitudinal measures of eGFR were not available.

Conclusions:eGFR, <45 mL/min/1.73 m2 was associated with a trend toward a more rapid decline in lifespace mobility among community-dwelling older adults. Findings should be confirmed in a larger population.