Abraham A Brody

Faculty

Ab Brody headshot

Abraham A. Brody

FAAN PhD RN

Mathy Mezey Professor of Geriatric Nursing
Associate Director, Hartford Institute for Geriatric Nursing

1 212 992 7341

433 First Ave
Room
New York, NY 10010
United States

Accepting PhD students

Abraham Brody, PhD, RN, FAAN is associate director of the Hartford Institute for Geriatric Nursing and Professor of Nursing and Medicine at NYU Meyers College of Nursing. He is also the founder of Aliviado Health and the Pilot Core Lead of the NIA IMPACT Collaboratory. His work focuses on the intersection of geriatrics, palliative care, quality, and equity. The primary goal of his research, clinical, and policy pursuits is to improve the quality of care for older adults with serious illnesses wherever they reside. His primary mode for doing so is through the development, testing, and dissemination of real-world, technology, and informatics-supported quality improvement interventions. He is currently the principal investigator of two NIH-funded large-scale pragmatic clinical trials to improve the quality of care and quality of life for persons living with dementia and their caregivers in the community and a co-investigator on several other pragmatic trials and health services research projects in geriatrics and palliative care.

From a leadership perspective, Brody works across disciplines to help advance geriatrics and palliative care nationally. As pilot core lead of the $53.4 million nationwide Collaboratory, he is responsible for heading the pilot program, which, in collaboration with the National Institute on Aging, reviews and awards funds to help investigators prepare for large-scale pragmatic clinical trials for persons living with dementia and their caregivers. He also serves on the Steering Committee of the NINR Funded Palliative Care Research Cooperative, the policy-setting body for the organization. 

In addition to his research and national leadership responsibilities, Brody is passionate about mentoring and developing a diverse nursing and scientific workforce. To this end, he developed the Hospice and Palliative Nurses Association Leadership Development Program and is the technology core director of NYU Meyer’s P20 Exploratory Center for Precision Health in Diverse Populations, and serves on the Executive Committee of the Training, Research, and Education Core of the NYU-HHC Clinical Translational Sciences Institute. He mentors faculty, post-doctoral scholars, and PhD students across multiple disciplines and institutions. Brody also maintains an active practice in the Geriatric and Palliative Consult Services at NYU Langone Health.
 
Home Health Study
HAS-QOL Study

PhD - University of California, San Francisco (2008)
MSN - University of California, San Francisco (2006)
BA - New York University, College of Arts and Sciences (2002)

Home care
Palliative care
Non-communicable disease
Health Policy
Gerontology
Interprofessionalism
Chronic disease
Community/population health
Neurology
Research methods
Underserved populations

American Geriatrics Society
Eastern Nursing Research Society
Gerontological Society of America
Hospice and Palliative Nurses Association
International Home Care Nurses Organization
Palliative Care Research Cooperative
Sigma Theta Tau, Upsilon Chapter

Fellow, American Academy of Nursing (2017)
Fellow, Palliative Care Nursing, Hospice and Palliative Nurses Association (2017)
Fellow, New York Academy of Medicine (2016)
Fellow, Gerontological Society of America (2016)
Nurse Faculty Scholar, Robert Wood Johnson Foundation (2014)
Sojourns Scholar, Cambia Health Foundation (2014)
Medical Reserve Corps, NYC, Hurricane Sandy Award (2013)
Goddard Fellowship, NYU (2013)
Research Scholar, Hospice and Palliative Nurses Association (2010)
Finalist, SRPP Section Young Investigator, Gerontological Society of America (2008)
Edith M. Pritchard Award, Nurses' Education Funds (2006)
Scholar, Building Academic Geriatric Nursing Capacity, John A Hartford (2006)
Finalist, Student Regent, University of California, San Francisco (2005)
Inducted into Sigma Theta Tau, Nursing Honor Society (2004)

Complex Care Needs at the End of Life for Seriously Ill Adults With Multiple Chronic Conditions

Murali, K. P., Merriman, J. D., Yu, G., Vorderstrasse, A., Kelley, A. S., & Brody, A. A. (2023). Journal of Hospice and Palliative Nursing, 25(3), 146-155. 10.1097/NJH.0000000000000946
Abstract
Abstract
Understanding the complex care needs of seriously ill adults with multiple chronic conditions with and without cancer is critical for the delivery of high-quality serious illness and palliative care at the end of life. The objective of this secondary data analysis of a multisite randomized clinical trial in palliative care was to elucidate the clinical profile and complex care needs of seriously ill adults with multiple chronic conditions and to highlight key differences among those with and without cancer at the end of life. Of the 213 (74.2%) older adults who met criteria for multiple chronic conditions (eg, 2 or more chronic conditions requiring regular care with limitations of daily living), 49% had a diagnosis of cancer. Hospice enrollment was operationalized as an indicator for severity of illness and allowed for the capture of complex care needs of those deemed to be nearing the end of life. Individuals with cancer had complex symptomatology with a higher prevalence of nausea, drowsiness, and poor appetite and end of life and lower hospice enrollment. Individuals with multiple chronic conditions without cancer had lower functional status, greater number of medications, and higher hospice enrollment. The care of seriously ill older adults with multiple chronic conditions requires tailored approaches to improve outcomes and quality of care across health care settings, particularly at the end of life.

Defining a taxonomy of Medicare-funded home-based clinical care using claims data

Ankuda, C. K., Ornstein, K. A., Leff, B., Rajagopalan, S., Kinosian, B., Brody, A. A., & Ritchie, C. S. (2023). BMC Health Services Research, 23(1). 10.1186/s12913-023-09081-8
Abstract
Abstract
Background: As more Americans age in place, it is critical to understand care delivery in the home. However, data on the range of home-based services provided by Medicare is limited. We define a taxonomy of clinical care in the home funded through fee-for-service Medicare and methods to identify receipt of those services. Methods: We analyzed Fee-for-service (FFS) Medicare claims data from a nationally-representative cohort of older adults, the National Health and Aging Trends Study (NHATS), to identify home-based clinical care. We included 6,664 NHATS enrollees age ≥ 70 and living in the community, observed an average of 3 times each on claims-linked NHATS surveys. We examined provider and service type of home-based clinical care to identify a taxonomy of 5 types: home-based medical care (physician, physician assistant, or nurse practitioner visits), home-based podiatry, skilled home health care (SHHC), hospice, and other fee-for-service (FFS) home-based care. We further characterized home-based clinical care by detailed care setting and visit types. Results: From 2011–2016, 17.8%-20.8% of FFS Medicare beneficiaries age ≥ 70 received Medicare-funded home-based clinical care. SHHC was the most common service (12.8%-16.1%), followed by other FFS home-based care (5.5%-6.5%), home-based medical care (3.2%-3.9%), and hospice (2.6%-3.0%). Examination of the other-FFS home-based care revealed imaging/diagnostics and laboratory testing to be the most common service. Conclusions: We define a taxonomy of clinical care provided in the home, serving 1 in 5 FFS Medicare beneficiaries. This approach can be used to identify and address research and clinical care gaps in home-based clinical care delivery.

Engagement, Advance Care Planning, and Hospice Use in a Telephonic Nurse-Led Palliative Care Program for Persons Living with Advanced Cancer

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Abstract
Abstract
Persons living with advanced cancer have intensive symptoms and psychosocial needs that often result in visits to the Emergency Department (ED). We report on program engagement, advance care planning (ACP), and hospice use for a 6-month longitudinal nurse-led, telephonic palliative care intervention for patients with advanced cancer as part of a larger randomized trial. Patients 50 years and older with metastatic solid tumors were recruited from 18 EDs and randomized to receive nursing calls focused on ACP, symptom management, and care coordination or specialty outpatient palliative care (ClinicialTrials.gov: NCT03325985). One hundred and five (50%) graduated from the 6-month program, 54 (26%) died or enrolled in hospice, 40 (19%) were lost to follow-up, and 19 (9%) withdrew prior to program completion. In a Cox proportional hazard regression, withdrawn subjects were more likely to be white and have a low symptom burden compared to those who did not withdraw. Two hundred eighteen persons living with advanced cancer were enrolled in the nursing arm, and 182 of those (83%) completed some ACP. Of the subjects who died, 43/54 (80%) enrolled in hospice. Our program demonstrated high rates of engagement, ACP, and hospice enrollment. Enrolling subjects with a high symptom burden may result in even greater program engagement.

Improving sleep using mentored behavioral and environmental restructuring (SLUMBER): A randomized stepped-wedge design trial to evaluate a comprehensive sleep intervention in skilled nursing facilities

Chodosh, J., Mitchell, M. N., Cadogan, M., Brody, A. A., Alessi, C. A., Hernandez, D. E., Mangold, M., & Martin, J. L. (2023). Contemporary Clinical Trials, 126. 10.1016/j.cct.2023.107107
Abstract
Abstract
Introduction: Poor sleep is ubiquitous in skilled nursing facilities (SNFs) and is associated with a myriad of negative symptoms. Non-pharmacological interventions can improve sleep, yet sustainability has not been demonstrated. The Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER) trial will test whether a staff mentoring approach to address resident sleep issues positively impacts sleep quality and whether improved sleep benefits mood, cognitive performance, and activity engagement for residents living in SNFs. Intervention: This is a four-year hybrid type I effectiveness/implementation randomized stepped-wedge trial using a comprehensive sleep improvement program conducted in three urban SNFs. Methods: We will provide SNF staff with sleep promotion strategies over a four-month intervention. Staff will have access to in-person workshops, webinars, weekly sleep pearls via text messaging, environmental data, and expert program mentors. We will consent residents for data collection (at baseline, end of intervention, and three- and six-months post-intervention) including resident observations, questionnaires, and wrist actigraphy (to objectively measure sleep). We will also use selected Minimum Data Set 3.0 (MDS) measures. Conclusion: SLUMBER uses a unique strategy to iteratively improve sleep interventions through SNF staff buy-in, expert mentoring, and technological supports within a quality improvement framework. As a stepped-wedge trial, the initial SNF units provide opportunities for program improvement in subsequent units, accounting for variation across resident populations at different sites. Protocol limitations include strategies which may require substantial customization for greater spread. A comprehensive staff training program that addresses both sleep quality and related symptoms has the opportunity for considerable dissemination.

Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative Care

Murali, K. P., Yu, G., Merriman, J. D., Vorderstrasse, A., Kelley, A. S., & Brody, A. A. (2023). Western Journal of Nursing Research, 45(1), 14-24. 10.1177/01939459211041174
Abstract
Abstract
The objective of this study was to characterize multiple chronic conditions (MCCs) among seriously ill adults receiving palliative care at the end of life. A latent class analysis was conducted to identify latent subgroups of seriously ill older adults based on a baseline Charlson comorbidity index (CCI) measurement, a measure of comorbidity burden, and mortality risk. The three latent subgroups were: (1) low to moderate CCI with MCC, (2) high CCI with MCC, and (3) high CCI and metastatic cancer. The “low to moderate CCI and MCC” subgroup included older adults with chronic obstructive pulmonary disease (COPD), cardiovascular disease, congestive heart failure, myocardial infarction, dementia, diabetes, and lymphoma. A “high CCI and MCC” subgroup included individuals with severe illness including liver or renal disease among other MCCs. A “high CCI and metastatic cancer” included all participants with metastatic cancer. This study sheds light on the MCC profile of seriously ill adults receiving palliative care.

Neuropsychiatric symptoms in people living with dementia receiving home health services

Lassell, R. K., Lin, S. Y., Convery, K., Fletcher, J., Chippendale, T., Jones, T., Durga, A., Galvin, J. E., Rupper, R. W., & Brody, A. A. (2023). Journal of the American Geriatrics Society. 10.1111/jgs.18548
Abstract
Abstract
Background: We sought to describe neuropsychiatric symptoms (NPS) among people living with dementia (PLWD) from diverse racial and ethnic groups receiving home health services while accounting for dementia severity, individual symptom prevalence, and neighborhood disadvantage. Methods: A prospective study using cross-sectional data from n = 192 PLWD receiving skilled home healthcare in New Jersey enrolled in the Dementia Symptom Management at Home Program trial. We prospectively measured symptom prevalence with the Neuropsychiatric Inventory Questionnaire and dementia severity using the Quick Dementia Rating System. A one-way ANOVA determined NPS prevalence by dementia severity (mild, moderate, severe). Fisher's exact tests were used to assess the association of individual symptom prevalence with race and ethnicity and cross tabs to descriptively stratify individual symptom prevalence by dementia severity among groups. A Pearson correlation was performed to determine if a correlation existed among neighborhood disadvantages measured by the Area Deprivation Index (ADI) state decile scores and NPS prevalence and severity. Results: Participants identified as non-Hispanic White (50%), non-Hispanic Black (30%), or Hispanic (13%). NPS were prevalent in 97% of participants who experienced 5.4 ± 2.6 symptoms with increased severity (10.8 ± 6.6) and care partner distress (13.8 ± 10.8). NPS increased with dementia severity (p = 0.004) with the greatest difference seen between individuals with mild dementia (4.3 ± 2.3) versus severe dementia (5.9 ± 2.3; p = 0.002). Few differences were found in symptom prevalence by racial and ethnic sub-groups. Nighttime behaviors were higher in non-Hispanic Black (78%), compared with non-Hispanic Whites (46%) with moderate dementia, p = 0.042. State ADI scores were not correlated with the number of NPS reported, or severity. Conclusions: NPS were prevalent and increased with dementia severity with commonalities among racial and ethnic groups with varying levels of neighborhood disadvantage. There is a need for effective methods for improving NPS identification, assessment, and management broadly for homebound PLWD.

One accurate measurement is worth 1000 expert opinions—Assessing quality care in assisted living

David, D., & Brody, A. A. (2023). Journal of the American Geriatrics Society, 71(5), 1358-1361. 10.1111/jgs.18284

Outcomes of home-based primary care for homebound older adults: A randomized clinical trial

Federman, A. D., Brody, A., Ritchie, C. S., Egorova, N., Arora, A., Lubetsky, S., Goswami, R., Peralta, M., Reckrey, J. M., Boockvar, K., Shah, S., Ornstein, K. A., Leff, B., DeCherrie, L., & Siu, A. L. (2023). Journal of the American Geriatrics Society, 71(2), 443-454. 10.1111/jgs.17999
Abstract
Abstract
Background: Homebound older adults are medically complex and often have difficulty accessing outpatient medical care. Home-based primary care (HBPC) may improve care and outcomes for this population but data from randomized trials of HBPC in the United States are limited. Methods: We conducted a randomized controlled trial of HBPC versus office-based primary care for adults ages ≥65 years who reported ≥1 hospitalization in the prior 12 months and met the Medicare definition of homebound. HBPC was provided by teams consisting of a physician, nurse practitioner, nurse, and social worker. Data were collected at baseline, 6- and 12-months. Outcomes were quality of life, symptoms, satisfaction with care, hospitalizations, and emergency department (ED) visits. Recruitment was terminated early because more deaths were observed for intervention patients. Results: The study enrolled 229 patients, 65.4% of planned recruitment. The mean age was 82 (9.0) years and 72.3% had dementia. Of those assigned to HBPC, 34.2% never received it. Intervention patients had greater satisfaction with care than controls (2.26, 95% CI 1.46–3.06, p < 0.0001; effect size 0.74) and lower hospitalization rates (−17.9%, 95% CI −31.0% to −1.0%; p = 0.001; number needed to treat 6, 95% CI 3–100). There were no significant differences in quality of life (1.25, 95% CI −0.39–2.89, p = 0.13), symptom burden (−1.92, 95% CI −5.22–1.37, p = 0.25) or ED visits (1.2%, 95% CI −10.5%–12.4%; p = 0.87). There were 24 (21.1%) deaths among intervention patients and 12 (10.7%) among controls (p < 0.0001). Conclusion: HBPC was associated with greater satisfaction with care and lower hospitalization rates but also more deaths compared to office-based primary care. Additional research is needed to understand the nature of the higher death rate for HBPC patients, as well as to determine the effects of HBPC on quality of life and symptom burden given the trial's early termination.

Potential sources of moral distress during COVID-19: Perspectives of hospice interdisciplinary teams

Jones, T., Lin, S. Y., Durga, A., Luth, E. A., Lassell, R. K., & Brody, A. A. (2023). Palliative and Supportive Care, 21(4), 644-650. 10.1017/S1478951522000633
Abstract
Abstract
OBJECTIVE: This study aimed to examine the impact of COVID-19 on hospice Interdisciplinary team (IDT) members' self-reported stress and identify possible sources of moral distress. METHODS: A cross-sectional survey was conducted using Qualtrics to understand the impact of COVID-19 on quality improvement initiative implementation and hospice IDT members' general and dementia-specific care provision. Directed qualitative content analysis was used to analyze hospice IDT members' responses from five open-ended survey questions that were indicative of stress and possible moral distress. RESULTS: The final sample consisted of 101 unique respondents and 175 comments analyzed. Three categories related to sources of moral distress based on hospice IDT member survey responses were identified: (1) impact of telehealth, personal protective equipment (PPE), and visit restrictions on relationships; (2) lack of COVID-19-specific skills; and (3) organizational climate. Sources of moral distress were categorized in 40% of all responses analyzed. SIGNIFICANCE OF RESULTS: This study is one of the first to document and confirm evidence of potential stress and moral distress amongst hospice IDT members during COVID-19. It is imperative given the possible negative impact on patient care and clinician well-being, that future research and interventions incorporate mechanisms to support clinicians' emotional and ethical attunement and support organizations to actively engage in practices that address clinician moral distress resulting from restrictive environments, such as the one necessitated by COVID-19.

Using meta-research to foster diverse, equitable, and inclusive collaborative research networks

Stevens, E. R., Brody, A. A., Epps, F., Sloan, D. H., & Sherman, S. E. (2023). Journal of the American Geriatrics Society, 71(4), 1028-1033. 10.1111/jgs.18217
Abstract
Abstract
Fostering diverse, equitable, and inclusive collaborative research networks is important for advancing the field of aging research. Despite sizeable investment in research consortia and career development programs, there has been only moderate progress toward diversifying the research workforce studying aging. Without critically examining what works and what does not, continuing to place more resources into these same strategies may not result in a substantial improvement in diversity or the creation of collaborative networks. Using meta-research to rigorously evaluate potential strategies to promote diversity and collaboration may yield important insights that can be used to improve upon current efforts. For this reason, we sought to describe meta-research and highlight how its principles can be used to achieve the aging research community's collaboration and diversity goals.