Geriatrics & Palliative Medicine

WBEN interviewed Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, about a poll that found that 76 percent of Western New Yorkers are willing to get the COVID-19 vaccine, which Troen called “great news.” “The data show that as the vaccine rollout has proceeded, despite some fits and starts, the willingness for people to get vaccinated has increased,” he said.

In Good Health published an interview with Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, that focused on how the elderly are impacted by COVID-19. Troen, who studies Vitamin D and aging, mentioned that early data appear to suggest that Vitamin D may seem to provide some benefit even if someone becomes infected with COVID-19. “What seems to be increasingly clear is that if you have better Vitamin D status and you do get COVID, you have less of a risk of severe infection, less of a risk of transfer to the intensive care unit, and less of a chance of death. We’re conducting a study ourselves and have preliminary data, which is pointing in that direction.”

Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, provides insight during a conversation about how New York’s attorney general’s report found that nursing home deaths from COVID-19 were underreported. “There actually is not much new in this nursing home report that we did not already know beforehand,” Troen notes. “We know that nursing homes — because of staffing and financial circumstances — were very, very risky places for patents who were already very frail and at-risk, and we also have confirmation that this is really about community spread, it’s about staffing levels, and staff.” Troen says the report provides helpful recommendations for reducing residents’ risk of COVID-19 infection. However, he notes that the report does not address the fact that staff members in some nursing homes are reticent to undergo COVID-19 vaccination.

WBFO interviewed Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, about the challenges of vaccinating staff and residents inside nursing homes. Troen said in the early day of community transmission, families and citizens were a problem, but now it’s staff. “It likely has continued or, in some cases, gotten worse because there is transmission of the disease through staff, through folks who work at the nursing homes,” he said. “So it’s not just about actually vaccinating the residents of the nursing homes, but hand in hand, that means staff.”

An article on how certain nursing homes kept residents safe from COVID-19 cites Bruce R. Troen, MD, director of the UB Center for Successful Aging, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine. “Despite the difference in ratings between the two facilities, studies show that five-star nursing homes are roughly as likely as facilities with two to four stars to do a good or poor job withstanding coronavirus spread,” the article reported and attributed to Troen.

The Pfizer COVID-19 vaccine, for which the U.S. Food and Drug Administration has said it will give emergency use authorization, has been proved to be effective in reducing or eliminating illness associated with COVID-19. Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, is among the doctors who have advocated for nursing home residents to be among the first to receive the vaccine. However, he believes there still needs to be caution in nursing home settings even after the vaccine has been distributed throughout those facilities. “I think we still have to be very cautious,” Troen says. “My hope is that in two or three months, we’ll have information that will say the spread is reduced (by the vaccine). Until that time, we still have to be very cautious.”

In an editorial, Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, commended a research team for their “well-executed effort” to determine whether high-dose vitamin D supplementation prevents falls in older adults. However, he questioned the study’s methodology. “The investigators’ commitment to ‘first do no harm’ by providing the control group with 200 IU (per day) of vitamin D is commendable, but does this strategy prevent the modeling of real-world scenarios — such as frank vitamin D deficiency — in which community-dwelling older adults might realize benefits?” Troen asked. “The answer is important because older adults with greater insufficiency or frank deficiency, particularly those with 25-(OH)D levels of 25 nmol/L or less, may be those most likely to benefit from vitamin D supplementation,” he said.

A story reported on a study in mice suggests that a dosage of vitamin D five times the current recommended amount for older adults could slow the development of frailty, however, the researchers now need to confirm this finding in humans. “We found that in aged mice, low levels of vitamin D [resulted] in physical declines, such as reduced grip strength and grip endurance — the ability to sustain a grip — and that they started developing as soon as one month after reduction of vitamin D intake,” says Kenneth L. Seldeen, PhD, research assistant professor of medicine in the Division of Geriatrics and Palliative Medicine, and the study’s first author.

A study of mice ages 24-28 months old, the equivalent of 65-to-80-year-old adults, has found that frailty can be slowed with what might be considered “over” supplementation with vitamin D, referred to as “hypersufficiency.” The research builds on previous work that Kenneth L. Seldeen, PhD, research assistant professor of medicine, has been conducting for more than a decade with colleague Bruce R. Troen, MD, professor of medicine, chief of the Division of Geriatrics and Palliative Medicine and director of UB’s Center for Successful Aging. 

An article on vitamin D reducing risk of COVID-19 includes quotes from Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine. “Many people don’t realize that vitamin D impacts many different tissues and organs in the body,” Troen said. “If you want to take a vitamin D supplement, it likely won’t hurt,” Troen says, noting that he does. “We have tantalizing information that suggests there is a link between vitamin D status and COVID,” he says. “There’s little harm and potential benefit in taking vitamin D.”

Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, is quoted in a story on how nursing homes can safely plan for family visits. He noted that outdoor visits are best. “I do like the idea that they conduct this outside. Even if there’s inadvertent lack of distancing, if you’re outside with good circulation, that reduces the chance. Infection risk isn’t just matter of distance, it’s also a matter of circulation, ventilation, and time.”

New York’s coronavirus death toll in nursing homes, already among the highest in the nation, could actually be a significant undercount. Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, says the coronavirus has exposed a weakness in nursing homes. “The fundamental issue is they are cauldrons waiting for infections to happen. So what the pandemic has done has pulled back this Band-Aid over what has been in many cases substandard conditions,” says Troen. “The official death toll refers to people who died while at the nursing home, and we know there are others who were taken to the hospital and died at the hospital. I think the best path is here is plan for the future so when there's another pandemic how are nursing homes will be better protected.”

WBEN featured Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, in an extensive interview about the New York State report on COVID-19 infections in nursing homes. “If we want to protect nursing homes in the future, we have to do as great a job as possible in reducing community-based infection. Yes, almost certainly it was nursing home staff and family members who inadvertently brought the virus to nursing homes but this was well before we knew the nature of the illness,” Troen said.

A story in the Billings Gazette reporting on nursing home deaths in Montana quotes Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine. “It’s almost as if you could not create an environment that would be more predisposed to, unfortunately, causing infection,” he said.

Bruce R. Troen, MD, professor of medicine and chief of the Division of Geriatrics and Palliative Medicine, provides insight in an article about the impact of COVID-19 nursing home residents and their families. “Family members are often essential members of the clinical care team for older adults who are so frail, and especially those with dementia,” says Troen. He thinks a designated family member who is “able and willing to follow all the procedures” that apply to staff could safely go into nursing homes on a regular basis. Troen also says COVID-19 can be kept out of nursing homes, with “intensive, appropriate, and persistent procedures” that include frequent testing of staff.