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Featured Researcher: Liza Genao, MD

liza-genaoLiza Genao, MD, obtained her medical degree from the “Universidad Nacional Pedro Henriquez Ureña” in the Dominican Republic. She completed her training in Internal Medicine at the Mayo Clinic Rochester and Geriatric Medicine at Duke University.

Dr. Genao’s  long term research career goal is to improve the quality of life of older adults with end-stage lung disease (ESLD). These adults are burdened with a disabling shortness of breath that results from a combination of age-related changes and co-existent chronic diseases. They have a different clinical presentation and response to treatment compared to their younger counterparts. Current treatment options do not stop disease progression, minimally impact symptoms, and have challenges to which older adults are particularly vulnerable.

Dr. Genao’s research aims to understand the interaction of aging and co-existent diseases on the health care outcomes of older adults with ESLD. Dr. Genao’s first area of focus has been lung transplantation (LT) as the only curative option for older adults with ESLD. In 2005, the system for lung allocation changed in the United States, resulting in a dramatic increase in the number of adults age 65 and older undergoing LT each year (81 in 2004 and 480 in 2011). To determine the impact of LT on functional status, Dr. Genao conducted a secondary data analysis of the United Network for Organ Sharing clinical registry on all adults receiving a LT between May 2009 and December 2012.

Comparing the functional status trajectories of recipients  younger and older than 65 at transplantation, she found that for all recipients who survived to year-one post-LT, functional status improved compared to their level of baseline function. Thereafter, younger and older LT recipients had comparable rates of functional decline that rarely reached the point of significant disability (requiring assistance with self-care) at 4 years post-LT. She concluded that LT had a positive and durable effect in function for both older and younger recipients.

These results are encouraging, but the majority of older adults with ESLD do not meet the stringent but necessary criteria to ensure long-term safety and benefit from this invasive procedure. Dr. Genao’s next area of focus will be pulmonary rehabilitation (PR), which is a safe and effective treatment alternative for older adults with ESLD who are found not suitable for LT. The evidence is strong for the efficacy of PR in improving symptoms, function, and quality of life, and reducing healthcare utilization. This multidisciplinary intervention improves quality of life by targeting many factors that relate to the symptoms and disability seen in older adults with ESLDs.

In 2010, Medicare began to reimburse PR for all beneficiaries with Chronic Obstructive Lung Disease. In the next few years, Dr. Genao plans to study the barriers and facilitators in the use of PR by these patients and how it impacts their healthcare utilization.