Duke University
Center for the Study of Aging and Human Development

                       Dr. Cohen's research program involves clinical research exploring overlapping aspects of geriatric assessment, cancer in the elderly and the mechanisms behind age-related functional decline, comorbidities and frailty.

GERIATRIC ASSESSMENT: This part of the program explores the outcomes to be derived from varying approaches to geriatric assessment. Utilizing specifically designed clinical trials we have studied geriatric consultation teams, inpatient geriatric evaluation units and outpatient geriatric clinics. We are particularly interested in functional and quality of life outcomes and also in relationship of such programs to drug prescribing appropriateness and related outcomes. Substantial data from completed studies are available for secondary analyses and prospective studies under consideration.

CANCER: BIOLOGIC BEHAVIOR AND TREATMENT IN THE ELDERLY: This program explores ways that neoplasia differs in clinical presentation, aggressiveness, management and outcome as a function of patient age; and the application of geriatric assessment approach, functional assessment and the use of quality of life measures in diagnosing, designing and evaluating treatment of the elderly cancer patient. Clinical trials of elderly cancer patients are performed with CALGB and local clinical oncology consortium, including pharmacokinetic studies of new agents. Secondary analysis of CALGB data and EPESE cancer and cancer prevention data are available.

BIOLOGIC UNDERPINNINGS OF FRAILTY: Utilizing clinical, functional biologic and demographic data from several epidemiological studies, e.g., EPESE, we are exploring the possible mechanisms by which frailty and its subsequent outcomes develop. The impact of multiple morbidities, physiologic decline and environmental influences on functional status is of particular interest. A major focus is the activation of inflammatory and coagulation pathways in this process. Additional prospective studies are in development.

Representative publications of his work:

Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy RC, Hsieh F, Phibbs C, Lavori P: A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management. New England Journal of Medicine, 346:12:905-912, 2002.

Ingram SS, Seo PH, Martell RE, Clipp EC, Doyle ME, Montana GS, and Cohen HJ: Comprehensive Assessment of the Elderly Cancer Patient: The Feasibility of Self-Report Methodology. Journal of Clinical Oncology, 20:3:770-775, 2002.

Cohen HJ, Harris T, Pieper CF. Coagulation and Activation of Inflammatory Pathways in the Development of Functional Decline and Mortality in the Elderly. American Journal of Medicine 114(3):180-187, 2003.

Garman KS, Pieper CF, Seo P, and Cohen HJ: Function in Elderly Cancer Survivors Depends on Comorbidities. Journal of Gerontology: Medical Sciences 58A(12):1119-1124, 2003.

Wilson CJ, Cohen HJ, and Pieper CF: Cross-linked Fibrin Degradation Products (D-Dimer), Plasma Cytokines, and Cognitive Decline in Community-Dwelling Elderly Persons. Journal of the American Geriatrics Society 51:1374-1381, 2003