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Malaz Boustani, MD

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General Internal Medicine

Richard M. Fairbanks Professor of Aging Research; Professor of Medicine; Adjunct Professor, School of Public Health; Adjunct Professor, School of Informatics and Computing
Center Scientist, Indiana University Center for Aging Research
Investigator, Regenstrief Institute, Inc.
Chief Research Officer, Indianapolis Discovery Network for Dementia
Research Director, Healthy Aging Brain Center

Academic Office

Health Information and Translational Sciences, Suite 2000
410 W. 10th St.
Indianapolis IN 46202-3012 Map

Contact Information

Phone: (317) 274-9235
Email:

Research Interests

Dr. Boustani's main research focuses on rapid translation of aging brain research discovery into health care delivery by using the lens of complexity science, the tools of medical informatics, and the methods of public health epidemiology.

Clinical Interests

Geriatric Medicine

Education and Training

Public Health, General North Carolina University Of
Medical Informatics Fellowship Regenstrief Institute Indianapolis, Indiana
Internal Medicine Residency Mt. Sinai Medical Center, Case Western Reserve University Cleveland, Ohio
Masters - Public Health Care & Prevention UNC-CH, School of Public Health Chapel Hill, North Carolina
Medicine (M.D.) Damascus University, Syria
Masters - Public Health Care & Prevention UNC-CH, School of Public Health Chapel Hill, North Carolina

Publications (28)¹

The confusion assessment method for the intensive care unit in patients with cirrhosis.
Journal: Metabolic brain disease
Authors: Orman ES; Perkins A; Ghabril M; Khan BA; Chalasani N; Boustani MA;
Publication Date: 2015 May 7

Abstract

In the intensive care unit (ICU), delirium is routinely measured with the widely-used, validated Confusion Assessment Method for the ICU (CAM-ICU), but CAM-ICU has not been studied in patients with cirrhosis. We studied a group of patients with cirrhosis to determine the relationship between delirium measured by CAM-ICU and clinical outcomes. Consecutive patients with cirrhosis admitted to the ICU from 2009 to 2012 were included in a retrospective cohort study. Patients were screened twice daily for coma and delirium during their ICU stay using the Richmond Agitation Sedation Scale (RASS) and CAM-ICU. The association between delirium/coma and mortality was determined using multiple logistic regression. RASS and CAM-ICU were also compared to a retrospective assessment of hepatic encephalopathy (HE). Of 91 patients with cirrhosis, 26 (28.6 %) developed delirium/coma. RASS/CAM-ICU had fair agreement with the HE assessment (? 0.38). Patients with delirium/coma had numerically greater mortality in-hospital (23.1 vs. 7.7 %, p?=?0.07) and at 90 days (30.8 vs. 18.5 %, p?=?0.26), and they also had longer hospital length of stay (median 19.5 vs. 6 days, p?
View details for PubMedID 25947193
Older primary care patients' attitudes and willingness to screen for dementia.
Journal: Journal of aging research
Authors: Fowler NR; Perkins AJ; Turchan HA; Frame A; Monahan P; Gao S; Boustani MA;
Publication Date: 2015 Apr 20

Abstract

Objective. To understand older primary care patients' perceptions of the risks and benefits of dementia screening and to measure the association between attitudes and screening behaviors. Methods. Eligible patients completed the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire and then were asked to undergo dementia screening by a telephone screening instrument. Results. Higher scores on the PRISM-PC questionnaire items that measure attitudes about benefits of screening were associated with decreased odds of refusing screening. Participants who refused screening had significantly lower PRISM-PC questionnaire scores on the items that measure perceived benefits compared to those who agreed to screening. Participants who refused screening were less likely to agree on screening for other conditions, such as depression and cancer. Participants who know someone with Alzheimer's disease (AD) were less likely to refuse screening. Discussion. Patients' attitudes about the benefits of dementia screening are associated with their acceptance of dementia screening.
View details for PubMedID 25973274
Adverse cognitive effects of medications: turning attention to reversibility.
Journal: JAMA internal medicine
Authors: Campbell NL; Boustani MA;
Publication Date: 2015 Mar 1
Characterization of hepatic enzyme activity in older adults with dementia: potential impact on personalizing pharmacotherapy.
Journal: Clinical interventions in aging
Authors: Campbell NL; Skaar TC; Perkins AJ; Gao S; Li L; Khan BA; Boustani MA;
Publication Date: 2015 Jan 14

Abstract

To determine the frequency of pharmacogenomic variants and concurrent medications that may alter the efficacy and tolerability of acetylcholinesterase inhibitors (AChEIs).
View details for PubMedID 25609939
The Healthy Aging Brain Care (HABC) Monitor: validation of the Patient Self-Report Version of the clinical tool designed to measure and monitor cognitive, functional, and psychological health.
Journal: Clinical interventions in aging
Authors: Monahan PO; Alder CA; Khan BA; Stump T; Boustani MA;
Publication Date: 2014 Dec 5

Abstract

Primary care providers need an inexpensive, simple, user-friendly, easily standardized, sensitive to change, and widely available multidomain instrument to measure the cognitive, functional, and psychological symptoms of patients suffering from multiple chronic conditions. We previously validated the Caregiver Report Version of the Healthy Aging Brain Care Monitor (HABC Monitor) for measuring and monitoring the severity of symptoms through caregiver reports. The purpose of this study was to assess the reliability and validity of the Patient Self-Report Version of the HABC Monitor (Self-Report HABC Monitor).
View details for PubMedID 25584024
Effectiveness of implementing a wake up and breathe program on sedation and delirium in the ICU.
Journal: Critical care medicine
Authors: Khan BA; Fadel WF; Tricker JL; Carlos WG; Farber MO; Hui SL; Campbell NL; Ely EW; Boustani MA;
Publication Date: 2014 Dec

Abstract

Mechanically ventilated critically ill patients receive significant amounts of sedatives and analgesics that increase their risk of developing coma and delirium. We evaluated the impact of a "Wake-up and Breathe Protocol" at our local ICU on sedation and delirium.
View details for PubMedID 25402299
Redesigning acute care for cognitively impaired older adults: Optimizing health care services.
Journal: Dementia (London, England)
Authors: LaMantia MA; Boustani MA; Jhanji S; Maina M; Nazir A; Messina FC; Frame A; Alder C; Chodosh J;
Publication Date: 2014 Aug 15

Abstract

Cognitive impairment (CI) is one of several factors known to influence hospitalization, hospital length of stay, and rehospitalization among older adults. Redesigning care delivery systems sensitive to the influence of CI may reduce acute care utilization while improving care quality. To develop a foundation of fundamental needs for health care redesign, we conducted focus groups with inpatient and outpatient providers to identify barriers, facilitators, and suggestions for improvements in care delivery for patients with CI.
View details for PubMedID 25128821
New workforce development in dementia care: screening for "caring": preliminary data.
Journal: Journal of the American Geriatrics Society
Authors: Cottingham AH; Alder C; Austrom MG; Johnson CS; Boustani MA; Litzelman DK;
Publication Date: 2014 Jun 10

Abstract

The United States has a significant shortage of trained geriatricians and of nurses, social workers, and paraprofessionals educated to care for elderly adults. As the aging population continues to grow, providing high-quality care will require new models that better address the many needs of aging individuals and their caregivers, using cost-effective strategies. Responding to this need, the Indiana University Center for Aging Research implementation scientists developed, tested, and are now scaling up a successful collaborative care coordination model for older adults with dementia, depression, or both: the Aging Brain Care program. This model now includes a newly created frontline care provider position, the Care Coordinator Assistant. The Care Coordinator Assistant works with individuals and caregivers to monitor biopsychosocial needs and deliver evidence-based and individualized care protocols, with close supervision from the registered nurse Care Coordinator. Recognizing that current hiring practices for frontline providers were insufficient to screen for critical abilities expected in this new position, including the ability to express "caring" and empathy, a new screening process was created building on the Multiple Mini Interview (MMI) format. The Care Coordinator Assistant MMI comprised six stations, each created to simulate challenging scenarios that will be frequently encountered and to assess important candidate abilities. Overall, the six-station MMI, with two to three items per station, provided factorially valid measures and good predictive ability. The process did not appear to be overly burdensome for candidates, and interviewers noted that it was helpful in discriminating between candidates.
View details for PubMedID 24916743
Race and documentation of cognitive impairment in hospitalized older adults.
Journal: Journal of the American Geriatrics Society
Authors: Campbell NL; Cantor BB; Hui SL; Perkins A; Khan BA; Farber MO; Nazir A; Garrett SL; Ely EW; Boustani MA;
Publication Date: 2014 Feb 27

Abstract

To evaluate whether race influences agreement between screening results and documentation of cognitive impairment and delirium.
View details for PubMedID 24576177
S100 calcium binding protein B as a biomarker of delirium duration in the intensive care unit - an exploratory analysis.
Journal: International journal of general medicine
Authors: Khan BA; Farber MO; Campbell N; Perkins A; Prasad NK; Hui SL; Miller DK; Calvo-Ayala E; Buckley JD; Ionescu R; Shekhar A; Ely EW; Boustani MA;
Publication Date: 2013 Dec 2

Abstract

Currently, there are no valid and reliable biomarkers to identify delirious patients predisposed to longer delirium duration. We investigated the hypothesis that elevated S100 calcium binding protein B (S100ß) levels will be associated with longer delirium duration in critically ill patients.
View details for PubMedID 24324346
Acceptance of and attitudes towards Alzheimer's disease screening in elderly German adults.
Journal: International psychogeriatrics / IPA
Authors: Braun SR; Reiner K; Tegeler C; Bucholtz N; Boustani MA; Steinhagen-Thiessen E;
Publication Date: 2013 Nov 27

Abstract

Considering the discussion on implementing routine dementia screening in Germany, the objective of the current study was to validate the German version of the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire and to determine the acceptance of Alzheimer's disease screening in elderly German adults.
View details for PubMedID 24284135
Risk factors for the progression of mild cognitive impairment to dementia.
Journal: Clinics in geriatric medicine
Authors: Campbell NL; Unverzagt F; LaMantia MA; Khan BA; Boustani MA;
Publication Date: 2013 Nov

Abstract

The increasing prevalence of cognitive impairment among the older adult population warrants attention to the identification of practices that may minimize the progression of early forms of cognitive impairment, including the transitional stage of mild cognitive impairment (MCI), to permanent stages of dementia. This article identifies both markers of disease progress and risk factors linked to the progression of MCI to dementia. Potentially modifiable risk factors may offer researchers a point of intervention to modify the effect of the risk factor and to minimize the future burden of dementia.
View details for PubMedID 24094301
Comorbidity profile and healthcare utilization in elderly patients with serious mental illnesses.
Journal: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
Authors: Hendrie HC; Lindgren D; Hay DP; Lane KA; Gao S; Purnell C; Munger S; Smith F; Dickens J; Boustani MA; Callahan CM;
Publication Date: 2013 Feb 6

Abstract

Patients with serious mental illness are living longer. Yet, there remain few studies that focus on healthcare utilization and its relationship with comorbidities in these elderly mentally ill patients.
View details for PubMedID 24206938
Connecting research discovery with care delivery in dementia: the development of the Indianapolis Discovery Network for Dementia.
Journal: Clinical interventions in aging
Authors: Boustani MA; Frame A; Munger S; Healey P; Westlund J; Farlow M; Hake A; Austrom MG; Shepard P; Bubp C; Azar J; Nazir A; Adams N; Campbell NL; Chehresa A; Dexter P;
Publication Date: 2012 Nov 16

Abstract

The US Institute of Medicine has recommended an integrated, locally sensitive collaboration among the various members of the community, health care systems, and research organizations to improve dementia care and dementia research.
View details for PubMedID 23204843
Comparison and agreement between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in evaluating patients' eligibility for delirium assessment in the ICU.
Journal: Chest
Authors: Khan BA; Guzman O; Campbell NL; Walroth T; Tricker J; Hui SL; Perkins A; Zawahiri M; Buckley JD; Farber MO; Ely W; Boustani MA;
Publication Date: 2012 Jul

Abstract

Delirium evaluation in patients in the ICU requires the use of an arousal/sedation assessment tool prior to assessing consciousness. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of RASS and SAS assessments in determining eligibility of patients in the ICU for delirium screening using the confusion assessment method for the ICU (CAM-ICU).
View details for PubMedID 22539644
Alzheimer's disease multiple intervention trial (ADMIT): study protocol for a randomized controlled clinical trial.
Journal: Trials
Authors: Callahan CM; Boustani MA; Schmid AA; Austrom MG; Miller DK; Gao S; Morris CS; Vogel M; Hendrie HC;
Publication Date: 2012 Jun 27

Abstract

Given the current lack of disease-modifying therapies, it is important to explore new models of longitudinal care for older adults with dementia that focus on improving quality of life and delaying functional decline. In a previous clinical trial, we demonstrated that collaborative care for Alzheimer's disease reduces patients' neuropsychiatric symptoms as well as caregiver stress. However, these improvements in quality of life were not associated with delays in subjects' functional decline.
View details for PubMedID 22737979
Practical clinical tool to monitor dementia symptoms: the HABC-Monitor.
Journal: Clinical interventions in aging
Authors: Monahan PO; Boustani MA; Alder C; Galvin JE; Perkins AJ; Healey P; Chehresa A; Shepard P; Bubp C; Frame A; Callahan C;
Publication Date: 2012 Jun 14

Abstract

Dementia care providers need a clinical assessment tool similar to the blood pressure cuff (sphygmomanometer) used by clinicians and patients for managing hypertension. A "blood pressure cuff " for dementia would be an inexpensive, simple, user-friendly, easily standardized, sensitive to change, and widely available multidomain instrument for providers and informal caregivers to measure severity of dementia symptoms. The purpose of this study was to assess the reliability and validity of the Healthy Aging Brain Care Monitor (HABC-Monitor) for measuring and monitoring the severity of dementia symptoms through caregiver reports.
View details for PubMedID 22791987
Delirium in hospitalized patients: implications of current evidence on clinical practice and future avenues for research--a systematic evidence review.
Journal: Journal of hospital medicine
Authors: Khan BA; Zawahiri M; Campbell NL; Fox GC; Weinstein EJ; Nazir A; Farber MO; Buckley JD; Maclullich A; Boustani MA;
Publication Date: 2012 Jun 8

Abstract

Despite the significant burden of delirium among hospitalized adults, critical appraisal of systematic data on delirium diagnosis, pathophysiology, treatment, prevention, and outcomes is lacking.
View details for PubMedID 22684893
Medication adherence in older adults with cognitive impairment: a systematic evidence-based review.
Journal: The American journal of geriatric pharmacotherapy
Authors: Campbell NL; Boustani MA; Skopelja EN; Gao S; Unverzagt FW; Murray MD;
Publication Date: 2012 Jun

Abstract

Cognitive impairment challenges the ability to adhere to the complex medication regimens needed to treat multiple medical problems in older adults.
View details for PubMedID 22657941
Enhancing care for hospitalized older adults with cognitive impairment: a randomized controlled trial.
Journal: Journal of general internal medicine
Authors: Boustani MA; Campbell NL; Khan BA; Abernathy G; Zawahiri M; Campbell T; Tricker J; Hui SL; Buckley JD; Perkins AJ; Farber MO; Callahan CM;
Publication Date: 2012 May

Abstract

Approximately 40% of hospitalized older adults have cognitive impairment (CI) and are more prone to hospital-acquired complications. The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system.
View details for PubMedID 22302355
Biomarkers for delirium--a review.
Journal: Journal of the American Geriatrics Society
Authors: Khan BA; Zawahiri M; Campbell NL; Boustani MA;
Publication Date: 2011 Nov

Abstract

To improve delirium recognition and care, numerous serum biomarkers have been investigated as potential tools for risk stratification, diagnosis, monitoring, and prognostication of delirium. The literature was reviewed, and no evidence was found to support the clinical use of any delirium biomarker, although certain biomarkers such as S-100 beta and insulin-like growth factor-1 and inflammatory markers have shown some promising results that need to be evaluated in future studies with appropriate sample size, prospective designs, and in a more-generalizable population.
View details for PubMedID 22091570
Time-motion analysis of health care workers' contact with patients and workers' hand hygiene: open vs closed units.
Journal: American journal of critical care : an official publication, American Association of Critical-Care Nurses
Authors: Khan BA; Hui KY; Hui SL; Gulati R; Tricker J; Campbell NL; Farber MO; Boustani MA; Buckley JD;
Publication Date: 2011 May

Abstract

The effects of open (care provided by general medicine teams with a pulmonary intensivist consultant) vs closed (care provided by a dedicated critical care team) intensive care units on health care workers' contact with patients and their hand hygiene is uncertain.
View details for PubMedID 21532037
Caregiver and noncaregiver attitudes toward dementia screening.
Journal: Journal of the American Geriatrics Society
Authors: Boustani MA; Justiss MD; Frame A; Austrom MG; Perkins AJ; Cai X; Sachs GA; Torke AM; Monahan P; Hendrie HC;
Publication Date: 2011 Mar 25

Abstract

To compare attitudes toward dementia screening of older adults with and without an experience of dementia caregiving.
View details for PubMedID 21438862
Implementing innovative models of dementia care: The Healthy Aging Brain Center.
Journal: Aging & mental health
Authors: Boustani MA; Sachs GA; Alder CA; Munger S; Schubert CC; Guerriero Austrom M; Hake AM; Unverzagt FW; Farlow M; Matthews BR; Perkins AJ; Beck RA; Callahan CM;
Publication Date: 2011 Jan

Abstract

Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both the patients suffering from dementia and their informal caregivers.
View details for PubMedID 21271387
Implementing dementia care models in primary care settings: The Aging Brain Care Medical Home.
Journal: Aging & mental health
Authors: Callahan CM; Boustani MA; Weiner M; Beck RA; Livin LR; Kellams JJ; Willis DR; Hendrie HC;
Publication Date: 2011 Jan

Abstract

The purpose of this article is to describe our experience in implementing a primary care-based dementia and depression care program focused on providing collaborative care for dementia and late-life depression.
View details for PubMedID 20945236
Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system.
Journal: Clinical interventions in aging
Authors: Boustani MA; Munger S; Gulati R; Vogel M; Beck RA; Callahan CM;
Publication Date: 2010 May 25

Abstract

Complexity science suggests that our current health care delivery system acts as a complex adaptive system (CAS). Such systems represent a dynamic and flexible network of individuals who can coevolve with their ever changing environment. The CAS performance fluctuates and its members' interactions continuously change over time in response to the stress generated by its surrounding environment. This paper will review the challenges of intervening and introducing a planned change into a complex adaptive health care delivery system. We explore the role of the "reflective adaptive process" in developing delivery interventions and suggest different evaluation methodologies to study the impact of such interventions on the performance of the entire system. We finally describe the implementation of a new program, the Aging Brain Care Medical Home as a case study of our proposed evaluation process.
View details for PubMedID 20517483
Impact of cholinesterase inhibitors on behavioral and psychological symptoms of Alzheimer's disease: a meta-analysis.
Journal: Clinical interventions in aging
Authors: Campbell N; Ayub A; Boustani MA; Fox C; Farlow M; Maidment I; Howards R;
Publication Date: 2008

Abstract

To determine the efficacy of cholinesterase inhibitors (ChEIs) in improving the behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD).
View details for PubMedID 19281064
Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial.
Journal: JAMA
Authors: Callahan CM; Boustani MA; Unverzagt FW; Austrom MG; Damush TM; Perkins AJ; Fultz BA; Hui SL; Counsell SR; Hendrie HC;
Publication Date: 2006 May 10

Abstract

Most older adults with dementia will be cared for by primary care physicians, but the primary care practice environment presents important challenges to providing quality care.
View details for PubMedID 16684985