Last week we released our evaluation of the Hartford Geriatrics Health Outcomes Research Scholars Awards Program. The report describes how that program proved to be a catalyst for the career advancement of young physician-scientists actively pursuing the knowledge that our nation needs to transform how health care is practiced, delivered, and distributed to older adults. With great pride we have profiled many of these Scholars on this blog (see examples here and here) and highlighted the significance of their efforts. We can gain much from their work. As many of our readers know, geriatric health outcomes research is crucial. Older adults tend to be underrepresented in clinical trials and there’s a lot we don’t know.

Today, I am delighted to congratulate a 2009 awardee, Dan Matlock, MD, MPH, on his $500,000 award from the new Patient Centered Outcomes Research Institute (PCORI). PCORI’s mission is to provide evidence-based guidance to patients and professionals to enable them to make better health care decisions. The award will enable Dr. Matlock to expand and amplify the work he started first as a Health Outcomes Research Scholar and subsequently as a Beeson Scholar.

Dr. Matlock is a board-certified geriatrician and an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Colorado. His work aims to transform and improve how older adults, their caregivers, and their providers make decisions around invasive technologies such as Implantable Cardioverter-Defibrillators (ICDs), those tiny battery powered devices that deliver a jolt of electricity to correct an irregular heartbeat.

As Dr. Matlock explained in our recent conversation, although ICDs might appear to be a highly specialized area, they are in fact an ideal model to explore strategies to improve decision making. Not only are nearly 500,000 Medicare beneficiaries eligible for these devices for the prevention of sudden cardiac death, the decision to use them is complicated. While ICDs prolong life in selected patients, the devices are associated with potential risks including implantation complications, a lower quality of life if shocked, more hospitalizations, and potential suffering at the end of life. Moreover, unlike specialty guidelines that acknowledge age and patient preferences, ICD guidelines are blunt in recommending that all eligible patients receive an ICD—there’s little discussion of age, co-morbidities, or patient goals. Yet, some patients may very well prefer the option of “dying in their sleep.”

Dr. Matlock’s pioneering work has shown that many patients have poor understanding of the risks and benefits of ICDs and are often left uninvolved in decision making. Surprisingly (or perhaps not so surprisingly) many providers think patient preferences matter very little! Even more alarmingly, he has also shown that there is tremendous variation in the use of ICDs. The practice patterns have basically no relation to patient factors and are strongly predicted by the provider’s geographic location. While Dr. Matlock’s research will improve ICD guidelines for older adults, it also has broad policy implications. His work raises issues that apply to many technologies used by older adults including pacemakers, ventricular assist devices, and brain stimulators for Parkinson’s disease.

The profound respect for patient wishes at the core of Dr. Matlock’s research extends to his work as a practicing specialist in palliative care. Earlier this year, he posted a blog post on Geripal (“Being Accused of Murder”) which received huge media attention, including from Colorado Public Radio and the New York Times’ “The New Old Age” blog. The episode that Dr. Matlock recounts about a conflict over following a patient’s advance directives is a powerful reminder of the need for culture change in a health care system that often ignores the wishes of older adults, and that can at times feel terribly antiquated despite all its modern gadgetry. Dr. Matlock’s strength and courage is testament to his character and his dedication to the health care of older adults.