Dr. Meera Sheffrin is a clinician educator in geriatrics, and is the Medical Director of the Stanford Senior Care clinic and Home-Based Senior Care clinic. She cares for patients as a primary care physician for older adults. Her academic interests include treatment of dementia, geriatric education, and home care medicine.
- Geriatric Medicine
Clinical Assistant Professor, Medicine - Primary Care and Population Health
Medical Director, Stanford Senior Care clinic, Stanford Healthcare (2020 - Present)
Medical Director, Stanford Home-Based Senior Care program, Stanford Healthcare (2019 - Present)
Honors & Awards
Stanford Primary Care and Population Health Division Faculty of the Year Award, Stanford University School of Medicine (2020)
SGIM Annual Meeting Best Geriatrics Poster Award, Society of General Internal Medicine (2014)
Charles Dorsey Armstrong Award for Clinical Excellence in Caring for Patients by a Senior Resident, Stanford University School of Medicine (2013)
Julian Wolfshon Award for Outstanding Performance in Internal Medicine and Neurology, Stanford University School of Medicine (2012)
UCSF Geriatrics Scholarship Award, University of California, San Francisco (2011)
Alpha Omega Alpha, University of Pittsburgh School of Medicine (2009)
Gold Humanism Honor Society, Charles G. Watson Chapter (2009)
Morris H. and Gertrude M. Harris Foundation Merit Scholarship, University of Pittsburgh School of Medicine (2007- 2009)
Boards, Advisory Committees, Professional Organizations
Ethics Committee, Stanford Health Care (2020 - Present)
Ethnogeriatrics Committee, American Geriatrics Society (2022 - Present)
Geriatrics Commission, Society of General Internal Medicine (2019 - Present)
Residency: Stanford University Internal Medicine Residency (2013) CA
Board Certification: American Board of Internal Medicine, Geriatric Medicine (2016)
Board Certification, American Board of Internal Medicine, Geriatric Medicine (2016)
Fellowship, University of California, San Francisco, Geriatric Medicine (2016)
Masters, University of California, San Francisco, Masters of Advanced Studies in Clinical Research (2015)
Board Certification, American Board of Internal Medicine, Internal Medicine (2013)
Residency, Stanford Medicine Internal Medicine Residency, Internal Medicine (2013)
Medical Education, University of Pittsburgh School of Medicine (2010)
Current Research and Scholarly Interests
Implementation and evaluation of home-based care
Improving care for older adults with dementia
Graduate and Fellowship Programs
Geriatric Medicine (Fellowship Program)
"It Isn't the Same": Experiences of Informal Caregivers of Older Adults Enrolled in a Home-Based Senior Care Program During COVID-19.
Journal of gerontological nursing
2023; 49 (3): 19-26
The coronavirus disease 2019 (COVID-19) pandemic placed new strains on informal caregivers, who are already vulnerable to negative psychosocial effects due to demands of the caregiving role. The current study aimed to explore the early impact of COVID-19 on caregivers living with and apart from care recipients. Semi-structured qualitative interviews with seven cohabitating and 10 distanced caregivers of patients in a home-based primary care program were conducted from April to November 2020. A framework matrix was used to identify patterns in caregiver experiences. Cohabitating and distanced caregivers reported shared concerns about COVID-19 and unique concerns dependent on cohabitation status. Cohabitating caregivers reported financial worries, care recipients with dementia being unable to understand restrictions, and concerns about community business changes. Distanced caregivers reported communication challenges with cognitively impaired care recipients and challenges with visitation policies. During pandemics, caregivers' clinical and policy support needs may differ depending on their place of residence relative to care recipients. [Journal of Gerontological Nursing, 49(3), 19-26.].
View details for DOI 10.3928/00989134-20230209-04
View details for PubMedID 36852991
Home-Based Primary Care for Older Adults: Matched Case-Control Evaluation of Program's Impact on Healthcare Utilization
HOME HEALTH CARE MANAGEMENT AND PRACTICE
View details for DOI 10.1177/10848223231151975
View details for Web of Science ID 000930814900001
Geriatric update 2022: Preventing Alzheimer disease and more.
Cleveland Clinic journal of medicine
2022; 89 (11): 617-624
Articles published in 2020 and 2021 contain important research related to preventing Alzheimer dementia; the relationships between frailty, social isolation, and mortality; COVID-19 risks in patients with dementia; hospital-at-home programs; deprescribing antihypertensive drugs; bisphosphonate-related atypical femoral fractures; and cannabis use in older adults.
View details for DOI 10.3949/ccjm.89a.21094
View details for PubMedID 36319045
Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment.
2022; 5 (2): e34326
Despite the increasing availability of telemedicine video visits during the COVID-19 pandemic, older adults have greater challenges in getting care through telemedicine.We aim to better understand the barriers to telemedicine in community-dwelling older adults to improve the access to and experience of virtual visits.We conducted a mixed methods needs assessment of older adults at two independent living facilities (sites A and B) in Northern California between September 2020 and March 2021. Voluntary surveys were distributed. Semistructured interviews were then conducted with participants who provided contact information. Surveys ascertained participants' preferred devices as well as comfort level, support, and top barriers regarding telephonic and video visits. Qualitative analysis of transcribed interviews identified key themes.Survey respondents' (N=249) average age was 84.6 (SD 6.6) years, and 76.7% (n=191) of the participants were female. At site A, 88.9% (111/125) had a bachelor's degree or beyond, and 99.2% (124/125) listed English as their preferred language. At site B, 42.9% (51/119) had a bachelor's degree or beyond, and 13.4% (16/119) preferred English, while 73.1% (87/119) preferred Mandarin. Regarding video visits, 36.5% (91/249) of all participants felt comfortable connecting with their health care team through video visits. Regarding top barriers, participants at site A reported not knowing how to connect to the platform (30/125, 24%), not being familiar with the technology (28/125, 22.4%), and having difficulty hearing (19/125, 15.2%), whereas for site B, the top barriers were not being able to speak English well (65/119, 54.6%), lack of familiarity with technology and the internet (44/119, 36.9%), and lack of interest in seeing providers outside of the clinic (42/119, 35.3%). Three key themes emerged from the follow-up interviews (n=15): (1) the perceived limitations of video visits, (2) the overwhelming process of learning the technology for telemedicine, and (3) the desire for in-person or on-demand help with telemedicine.Substantial barriers exist for older adults in connecting with their health care team through telemedicine, particularly through video visits. The largest barriers include difficulty with technology or using the video visit platform, hearing difficulty, language barriers, and lack of desire to see providers virtually. Efforts to improve telemedicine access for older adults should take into account patient perspectives.
View details for DOI 10.2196/34326
View details for PubMedID 35438648
Identifying and categorizing spurious weight data in electronic medical records.
The American journal of clinical nutrition
2018; 107 (3): 420–26
Spurious weights compromise the validity of summary measures, such as averages and trends. Even rare errors in weight records can undermine the utility of electronic medical record (EMR) data.We sought to estimate the prevalence of spurious weight values in a large EMR, to ascertain the likely causes, and to develop and test straightforward algorithms for identifying spurious weight data.Using EMR data from 10,000 randomly selected patients aged ≥65 y in the VA system, we examined the percentage of weight change across various time intervals, from 1 to 3000 d. We examined descriptive results and developed 3 algorithms to categorize degree of weight change over time. On the basis of distributions, we identified cases that were most likely spurious. We manually reviewed these and categorized the type of error.The data followed the expected distributions. The algorithms reliably identified spurious weight. Approximately 0.8% of all weights in the record appeared to be spurious and ∼1 in 5 patient charts included ≥1 spurious weight value. The most common type of error involved the misentry of a single digit (e.g., 148 for 178).Spurious weights are common in EMRs. Straightforward algorithms can identify and remove them, and thus enhance the reliability of EMR data.
View details for PubMedID 29566188
Methods Employed to Assess Weight Loss in Older Adults by Means of Electronic Medical Records: A Systematic Review.
Journal of nutrition in gerontology and geriatrics
2017; 36 (1): 18-30
Electronic medical records (EMRs) can be used to identify and categorize weight loss in older adults, but research has not scrutinized methods for doing so. Through a modified PRISMA protocol, we systematically reviewed published methods for quantifying weight change from EMRs. Articles (all available through July 2016) were identified through PubMed and SCOPUS searches, screened, and evaluated. We abstracted relevant data and tabulated the methods to assess weight change. The 13 selected articles showed little consistency in the approach to key methodological issues: 1) time ranges assessed; 2) removal of spurious values; 3) metrics to quantify weight change; 4) number of measures needed to estimate change; 5) threshold for significant weight change; and 6) relation to ideal weight. There was essentially no consensus around how to identify and categorize weight loss. Further investigation is needed to establish scientifically validated and clinically useful algorithms, accounting for the six issues above.
View details for DOI 10.1080/21551197.2017.1282390
View details for PubMedID 28207372
Desire for predictive testing for Alzheimer's disease and impact on advance care planning: a cross-sectional study
ALZHEIMERS RESEARCH & THERAPY
View details for DOI 10.1186/s13195-016-0223-9
View details for Web of Science ID 000391413500001
Weight Loss Associated with Cholinesterase Inhibitors in Individuals with Dementia in a National Healthcare System
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
2015; 63 (8): 1512-1518
To determine whether initiation of cholinesterase inhibitors is associated with significant weight loss in a real-word clinical setting.Retrospective cohort study from 2007 to 2010 comparing weight loss in individuals with dementia newly prescribed cholinesterase inhibitors and those newly prescribed other chronic medications.National Veterans Affairs data.Individuals aged 65 and older with a diagnosis of dementia who received a new prescription for a cholinesterase inhibitor or other new chronic medication.The primary outcome was time to 10-pound weight loss over 12 months. Propensity score matching was used to control for the likelihood of receiving a cholinesterase inhibitor based on baseline characteristics. Data were analyzed in a priori defined subgroups according to age, comorbid burden, and initial weight.Of 6,504 individuals that met study criteria, 1,188 started on cholinesterase inhibitors were matched to 2,189 started on other medications. The propensity-matched cohorts were well balanced on baseline covariates. Participants initiated on cholinesterase inhibitors had a higher risk of weight loss than matched controls at 12 months (hazard ratio = 1.23, 95% confidence interval (CI) = 1.07-1.41). At 12 months, 29.3% of participants taking cholinesterase inhibitors had experienced weight loss, compared with 22.8% of nonusers, corresponding to a number needed to harm of 21.2 (95% CI = 12.5-71.4) over 1 year. There were no significant differences in the risk of weight loss within subgroups.These results are consistent with the available data from randomized controlled trials. Clinicians should consider the risk of weight loss when prescribing cholinesterase inhibitors.
View details for DOI 10.1111/jgs.13511
View details for Web of Science ID 000360207000003
View details for PubMedID 26234945
Pilot Study of Augmentation With Aripiprazole for Incomplete Response in Late-Life Depression: Getting to Remission
JOURNAL OF CLINICAL PSYCHIATRY
2009; 70 (2): 208-213
To determine the feasibility and safety of aripiprazole augmentation for incomplete response to sequential selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) pharmacotherapy in late-life depression.This study was a 12-week, open-label pilot study of 24 patients (recruited from June 1, 2006, to June 1, 2007) aged 65 years and above (mean, 73.9 years) diagnosed with major depressive disorder (MDD) (according to DSM-IV) who responded partially (17-item Hamilton Rating Scale for Depression [HAM-D-17] score of 11 to 15) or not at all (HAM-D score > 15) to a 16-week trial of escitalopram (up to 20 mg/day), followed by either duloxetine (up to 120 mg/day) or venlafaxine (up to 225 mg/day) for 12 weeks. Subjects received 2.5 to 15 mg per day of adjunctive aripiprazole (mean dose, 9.0 mg/day) for 12 weeks. The criterion for remission during treatment with aripiprazole was a HAM-D score < or = 10 for 2 consecutive weeks.Of 24 subjects in the intent-to-treat study group, 19 completed 12 weeks of augmentation with aripiprazole, 12 of 24 (50%) met criteria for remission, and 2 of 24 discontinued due to side effects (sedation, akathisia). The mean (SD) HAM-D score decreased significantly by 6.4 (5.8) points (paired t test for means, p < .01, df = 16). There were no relapses among the 12 subjects who participated in continuation treatment over a median period of 27.6 weeks.In older adults with MDD with incomplete response to SSRI and SNRI pharmacotherapy, aripiprazole was well tolerated, and symptoms of depression improved significantly during treatment with aripiprazole. A randomized, double-blind, placebo-controlled trial of adjunctive aripiprazole for incomplete response in late-life depression is warranted to further evaluate benefit and risk.clinicaltrials.gov Identifier: NCT00177671.
View details for Web of Science ID 000263627300008
View details for PubMedID 19210951
Incomplete response in late-life depression: getting to remission.
Dialogues in clinical neuroscience
2008; 10 (4): 419-430
Incomplete response in the treatment of late-life depression is a large public health challenge: at least 50% of older people fail to respond adequately to first-line antidepressant pharmacotherapy, even under optimal treatment conditions. Treatment-resistant late-life depression (TRLLD) increases risk for early relapse, undermines adherence to treatment for coexisting medical disorders, amplifies disability and cognitive impairment, imposes greater burden on family caregivers, and increases the risk for early mortality, including suicide. Getting to and sustaining remission is the primary goal of treatment, yet there is a paucity of empirical data on how best to manage TRLLD. A pilot study by our group on aripiprazole augmentation in 24 incomplete responders to sequential SSRI and SRNI pharmacotherapy found that 50% remitted over 12 weeks with the addition of aripiprazole, and that remission was sustained in all participants during 6 months of continuation treatment. In addition to controlled assessment, evidence is needed to support personalized treatment by testing the moderating role of clinical (e.g., comorbid anxiety, medical burden, and executive impairment) and genetic (eg, selected polymorphisms in serotonin, norepinephrine, and dopamine genes) variables, while also controlling for variability in drug exposure. Such studies may advance us toward the goal of personalized treatment in late-life depression.
View details for PubMedID 19170399
Di-mu-bromo-bis[(methyl isocyanide-kappa C)-(triphenylphosphine-kappa P)silver(I)]
ACTA CRYSTALLOGRAPHICA SECTION E-STRUCTURE REPORTS ONLINE
2004; 60: M1142-M1143
View details for DOI 10.1107/S1600536804017179
View details for Web of Science ID 000223069000050