About

Shelly Gray is a professor and the Elmer and Joy Plein Endowed Director of the Plein Center for Aging at the University of Washington School of Pharmacy. She has been a faculty member in the UW Department of Pharmacy since 1992 and is involved in numerous federally funded research grants. Her research interests include medication safety in older adults, deprescribing, medication use and risk for falls, fractures, and dementia, as well as pharmacoepidemiology related to Alzheimer’s disease and related dementias. Dr. Gray has authored more than sixty peer-reviewed publications and has received awards such as the American Association of Colleges of Pharmacy New Investigator Award and a Career Development Award from the National Institute on Aging. She serves on the editorial boards of several journals and has served as a consultant pharmacist for Providence Elderplace. Her educational background includes a PharmD from the University of Michigan and an MS in Epidemiology from the University of Washington. She has completed a geriatrics fellowship at the University of North Carolina at Chapel Hill and a clinical pharmacy residency at Thomas Jefferson University Hospital. Dr. Gray teaches courses such as Pharmacotherapeutics V and Seminar in Geriatrics, and her research focuses on medication safety, deprescribing, and the impact of medication use on cognitive decline and dementia.

Research topics

• Medicine
• Gerontology
• Internal medicine
• Psychiatry
• Psychology
• Intensive care medicine
• Emergency medicine
• Endocrinology

Selected publications

• Angiotensin II–Stimulating Antihypertensive Medications and Dementia-Related Neuropathology

  JAMA Network Open · 2026-02-11 · 2 citations

  articleOpen access1st authorCorresponding

  Importance: Antihypertensive medications that stimulate angiotensin II type 2 or 4 receptors (angiotensin II-stimulating medications) may be associated with lower risk of dementia. Objective: To examine associations between cumulative exposure to angiotensin II-stimulating vs angiotensin II-inhibiting antihypertensive medications and neuropathology, accounting for blood pressure. Design, Setting, and Participants: This community-based autopsy cohort study from the Adult Changes in Thought cohort was conducted at Kaiser Permanente Washington between February 24, 1994, and November 25, 2022, among 756 participants who had blood pressure measurements and at least 1 person-year (PY) of angiotensin II-stimulating or -inhibiting antihypertensive medication exposure prior to death. Statistical analysis was performed between September 2024 and August 2025. Exposure: Angiotensin II-stimulating antihypertensive medications (angiotensin II receptor blockers, dihydropyridine calcium channel blockers, thiazides) and angiotensin II-inhibiting antihypertensive medications (angiotensin-converting enzyme inhibitors, β-blockers, nondihydropyridine calcium channel blockers) were ascertained from paper-based medical records (before 1977) and electronic prescription fill data (after 1977). The primary exposure was cumulative angiotensin II PYs, and the secondary exposure was long-term use (≥15 years). Main Outcomes and Measures: Neuropathology outcomes were classified as Alzheimer disease related, vascular brain injury, or other. Exploratory outcomes included quantitative measures of Aβ42 and phosphorylated tau. Data were analyzed using multivariable modified Poisson, proportional odds, and linear regression models and accounted for potential selection bias. Results: The sample included 756 participants (mean [SD] age at death, 89.2 [6.4] years; 440 women [58.2%]; mean [SD] follow-up, 22.2 [13.5] years). Compared with exposure to 5 additional PYs of angiotensin II-inhibiting antihypertensive medications, exposure to 5 additional PYs of angiotensin II-stimulating antihypertensive medications was associated with a 6% lower risk for arteriolosclerosis (relative risk [RR], 0.94; 95% CI, 0.89-0.99), with long-term use associated with a 24% lower risk (RR, 0.76; 95% CI, 0.63-0.91). For exploratory outcomes, PYs of angiotensin II-stimulating antihypertensive medications were associated with less quantitative phosphorylated tau burden in several brain regions (temporal lobe [adjusted ratio of geometric means, 0.79; 95% CI, 0.62-1.00], hippocampus [adjusted ratio of geometric means, 0.83; 95% CI, 0.71-0.97], cornu ammonis subfield 1 [adjusted ratio of geometric means, 0.86; 95% CI, 0.74-0.99], and transentorhinal cortex [adjusted ratio of geometric means, 0.83; 95% CI, 0.70-0.98]) but not with Aβ42 quantitative measures. Conclusions and Relevance: In this community-based autopsy cohort study, angiotensin II-stimulating antihypertensive medications were associated with lower risk of neuropathological burden, supporting findings from epidemiologic dementia studies. Additional mechanistic research examining the effects of individual antihypertensive classes on Alzheimer disease-related biomarkers is warranted.

  PublisherOA PDFDOI

• Educational Interventions to Improve Student Pharmacists’ Empathy and Attitudes Toward Older Adults or Aging: A Scoping Review

  American Journal of Pharmaceutical Education · 2026-03-02

  articleOpen access1st authorCorresponding

  OBJECTIVES: Ageism remains a pervasive barrier to delivering high-quality health care to older adults. The objective of this scoping review is to describe studies on educational interventions aimed at improving the empathy and attitudes of student pharmacists toward aging and older adults. FINDINGS: Of the 723 studies retrieved, 9 studies were eligible for inclusion. Studies were conducted in the United States (5), Malaysia (1), Brazil (1), Australia (1), and Singapore (1). Most studies (n = 8) used a single-group pre/post-test design, whereas 1 study employed a randomized, parallel-group, open-label design. Six studies employed direct interventions (ie, simulation-based, direct interaction with older adults, or technology-based), and 3 studies employed curriculum-based interventions (ie, geriatrics elective or Advanced Pharmacy Practice Experience). Seven studies utilized validated tools to measure empathy and attitudes, including the Geriatric Attitude Scale (n = 3), the Jefferson Scale of Empathy-Health Professions Students (n = 3), and the Kiersma-Chen Empathy Scale (n = 3). The 8 studies that used a pre/post-test design reported improvements in empathy or attitudes on at least 1 tool. The randomized study assessing an aging simulation suit found no significant differences between the intervention and control groups immediately following the intervention or at 12 weeks. SUMMARY: Although studies using quasi-experimental designs reported that interventions improved student pharmacists' empathy or attitudes toward aging or older adults, the randomized study did not support these findings. This review highlights the need for more rigorous research to evaluate interventions to improve empathy and attitudes in student pharmacists.

  PublisherDOI

• Impact of Anticholinergic Burden and Clinical-Demographic Characteristics on Incident Dementia in Parkinson Disease

  Journal of Geriatric Psychiatry and Neurology · 2025-01-07 · 2 citations

  articleOpen access

  PurposeAnticholinergic medication use measured via the Anticholinergic Cognitive Burden (ACB) scale has been associated with an increased dementia incidence in older adults but has not been explored specifically for Parkinson disease dementia (PDD). We used adjusted Cox models to estimate the risk of incident PDD associated with demographic factors, clinical characteristics, and time-varying total ACB in a longitudinal, deeply-phenotyped prospective PD cohort.Major findings56.5% of study participants were taking ACB-scale drugs at enrollment. Increasing age, motor symptom burden and psychosis were associated with PDD risk. Female sex and educational achievement were protective against PDD. ACB categories were not associated with PDD overall, but depression and impulse control disorder were strongly associated with PDD in a subsample with high baseline ACB.ConclusionsPatient and clinical factors modify PDD risk. PD drug safety and drug-disease interaction studies may require considering multiple mechanisms and including dose-based, prospectively acquired medication exposure measures.

  PublisherOA PDFDOI

• Deprescribing Central Nervous System-Active Medications Among Community-Dwelling Older Adults with Dementia in Primary Care: A Feasibility Study

  International Journal of Environmental Research and Public Health · 2025-10-22

  articleOpen accessSenior author

  Central nervous system (CNS)-active medications pose serious health risks for older adults with dementia but are nonetheless commonly used. Few deprescribing interventions have focused on people with dementia. We conducted a one-arm pilot study in six primary care practices of an integrated healthcare system between February and August 2023. The deprescribing intervention consisted of patient/care partner education and self-management materials and provider decision support. Participants were aged 60+ with diagnosed dementia and prescribed at least one CNS-active medication for three or more months of the six-month period prior to study start. We assessed feasibility and acceptability of the intervention and feasibility of ascertaining medication discontinuation and medically treated falls. The intervention was delivered to all (N = 114) eligible participants; their mean age was 80 ± 9 years; 72% were female and 13% non-White. Intervention acceptability, assessed by Weiner’s Acceptability of Intervention measure, was rated 3.5/5 (range 1–5; higher scores indicate higher acceptability). Among baseline antipsychotic users (N = 89), 39 (43.8%) had discontinued at follow-up. Among baseline tricyclic antidepressant users (N = 11), 6 (54.5%) had discontinued at follow-up. Among baseline skeletal muscle relaxant users (N = 3), 2 (66.7%) had discontinued at follow-up. Among baseline benzodiazepine users (N = 3), 1 (33.3%) had discontinued at follow-up. Among baseline opioid users (N = 13), 1 (7.7%) had discontinued at follow-up. Medically treated falls occurred among 22% at baseline vs. 21% at follow-up. The intervention is feasible and acceptable and may achieve meaningful reduction in CNS-active medication prescriptions. Findings support a controlled trial with sufficient power to assess effects on relevant clinical outcomes.

  PublisherDOI

• Medication Use Quality and Safety in Older Adults: 2023 Update

  Journal of the American Geriatrics Society · 2025-01-27 · 3 citations

  reviewOpen accessSenior author

  Improving the quality of medication use and medication safety are important priorities for healthcare providers who care for older adults. The objective of this article was to identify four exemplary articles with this focus in 2023. We selected high-quality studies that advanced this field of research. The chosen articles cover domains related to deprescribing/discontinuation, optimizing medication use, medication safety/adverse drug events, and other. The first study was a randomized clinical trial evaluating the efficacy of the patient-centered Shed-MEDS deprescribing intervention among older adults transitioning from the hospital to postacute care facilities (domain: deprescribing/discontinuation). The second study, a retrospective cohort study among Medicare beneficiaries, described the phenomenon of a prescribing cascade relic and evaluated continued potassium use after discontinuation of a loop diuretic (domain: optimizing medication use). The third study was a systematic review and meta-analysis describing the prevalence of drug-drug interactions among community-dwelling older adults (domain: other). Lastly, the fourth study was a retrospective cohort study among Medicare beneficiaries that evaluated concurrent gabapentin and opioid use and risk of mortality (domain: medication safety). Collectively, this review succinctly highlights pertinent topics related to promoting safe use of medications and promotes awareness of optimizing older adults' medication regimens.

  PublisherOA PDFDOI

• Anticholinergic drugs and dementia risk: Using stem cell–based studies to complement pharmacoepidemiology

  Alzheimer s & Dementia Translational Research & Clinical Interventions · 2025-01-01 · 1 citations

  articleOpen accessCorresponding

  BACKGROUND: Anticholinergic (AC) use remains common in older adults despite evidence of safety risks, including increased risk in dementia. Pharmacoepidemiology studies from various populations report associations between specific anticholinergic classes - antidepressants and bladder antimuscarinics - and increased dementia incidence. However, it is difficult to determine whether these associations are directly caused by the neurotoxic effects of anticholinergic drugs or by the underlying health conditions which the medications are taken for, known as confounding by indication. Here, we leverage human induced pluripotent stem cells-derived-neurons (hiPSC-Ns) to complement the pharmacoepidemiology studies by directly examining the effects of various anticholinergic classes on dementia-related cellular phenotypes. METHODS: We treated human induced pluripotent stem cell (hiPSC)-derived neurons with eight drugs representing different AC medication classes, including antidepressants, bladder antimuscarinics, antihistamines, and antispasmodics. We analyzed these neurons for cytotoxicity, amyloid beta (Aβ) peptide levels in the conditioned medium, and the level of intracellular phosphorylated tau from these cultures. RESULTS: We observed that antidepressants and bladder antimuscarinics were consistently cytotoxic, whereas antihistamines and antispasmodics did not show overt cytotoxicity at the times and concentrations that we tested. Some of the cytotoxic medications altered the amounts of Aβ1-42 peptides, but there were no significant differences in the intracellular ratio of phosphorylated tau/total tau between AC drug treatments. CONCLUSIONS: These results corroborate population-based studies and suggest a molecular basis for the differences in dementia risk observed according to AC class. This warrants future work examining the effect of AC medications on hiPSC-derived cells from multiple subjects and examining other molecular outcomes including synaptic function and neuroinflammation in hiPSC-based models. Highlights: Certain classes of anticholinergic (AC) medications are linked to dementia.Human-induced pluripotent stem cell (hiPSC) models are used to directly test the cytotoxicity of AC medications.AC classes that are associated with dementia are more neurotoxic.

  PublisherOA PDFDOI

• Abstract P3079: Proton Pump Inhibitor Use and Incident Hypertension in Postmenopausal Women: Results from the Women’s Health Initiative.

  Circulation · 2025-03-11

  article

  Introduction: Proton pump inhibitors (PPI) could impact blood pressure regulation by suppressing gastric acid required for the conversion of oral nitrite into nitric oxide. Whether PPI use is associated with incident hypertension remains unknown. Methods: We included 64,720 postmenopausal women who were free from cardiovascular disease and hypertension at enrollment into the Women’s Health Initiative Observational Study (1993-1998). Baseline PPI use and duration was ascertained from medication inventories. The outcome was physician diagnosed-treated hypertension, assessed by self-report on annual questionnaires. Kaplan-Meier curves were used to visualize unadjusted annualized incident hypertension according to baseline PPI use. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox proportional hazard models for incident hypertension according to baseline PPI use (no/yes) and duration (< 1 year, 1-3 years, >3 years). Propensity score adjustment was used to account for residual confounding by indication. Results: A total of 28,951 cases of incident hypertension were accrued after a mean follow up of 8.7 years. PPI users had significantly higher annualized hypertension incidence compared to non-users over the follow-up time (Figure). PPI use was associated with 15% higher risk of hypertension compared to non-use in the fully adjusted model (HR: 1.15, 95%CI: 1.06-1.25) and the association remained significant after propensity score adjustment (HR: 1.17, 95%CI: 1.14-1.19). Longer PPI use durations were associated with higher risk of hypertension (HR: 1.11, 1.16, 1.28, respectively) and showed a significant trend (P <.001). Conclusions: PPI use was associated with higher risk of diagnosed hypertension in postmenopausal women after adjusting for relevant confounders. The association showed a significant trend according to PPI duration of use. More research is needed to confirm such results.

  PublisherDOI

• Updating <scp>STEADI</scp> for Primary Care: Recommendations From the American Geriatrics Society Workgroup

  Journal of the American Geriatrics Society · 2025-01-29 · 14 citations

  articleOpen access

  In 2012, the Centers for Disease Control and Prevention (CDC) released STEADI (Stopping Elderly Accidents, Deaths and Injuries) toolkit which is based on the 2011 American Geriatrics Society/British Geriatrics Society (AGS/BGS) fall prevention guideline. In 2024, the National Network of Public Health Institutes (NNPHI), via a Cooperative Award with the CDC of the Department of Health and Human Services (HHS), invited AGS to recommend updates to STEADI with a focus on falls prevention in primary care. An AGS workgroup reviewed the 2022/2024 publications and held three outreach events with stakeholders (448 participants) to get feedback on current STEADI materials and draft recommendations focused on primary care. Recommendations for improving uptake of STEADI included reframing the why (alignment with ambulation goals) and the how (engage all available interdisciplinary team members) and addressing time limitations by prioritizing STEADI elements that can be done with available time and completing assessments across multiple visits. Screening recommendations included using the Three Key Questions first, and only if positive, asking the remaining Stay Independent questions. Assessment recommendations were to limit the scope of some activities (e.g., consider specifically fall risk-increasing drugs) while expanding others (e.g., incorporating hearing and bladder health assessments). Where the choice of intervention is obvious from screening (e.g., referral to a physical therapist if screening questions points to a strength, mobility, or gait problem), an in-office assessment may reasonably be skipped. These recommendations could improve effectiveness and ease of implementation of STEADI in primary care and help primary care teams reframe fall prevention as a chronic condition deserving ongoing engagement, assessment, intervention, and follow-up.

  PublisherOA PDFDOI

• Leveraging Change Management Principles to Implement Computer-Based Assessments in a PharmD Program

  American Journal of Pharmaceutical Education · 2025-11-01

  articleOpen access
  PublisherDOI

• Proton Pump Inhibitor Use and Incident Hypertension in Menopausal Women

  Journal of the American Heart Association · 2025-06-27 · 2 citations

  articleOpen access

  Background Proton pump inhibitors (PPIs) could affect blood pressure regulation by suppressing gastric acid required for the conversion of oral nitrite into nitric oxide. Whether PPI use is associated with incident hypertension remains unknown. Methods We included 64 720 menopausal women who were free from cardiovascular disease and hypertension at enrollment in the Women's Health Initiative Observational Study (1993–1998). Baseline PPI use and duration were determined using medication inventories. The outcome was physician diagnosed/treated incident hypertension, assessed by self‐report on annual questionnaires. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazard models for incident hypertension according to baseline PPI use (no/yes) and duration (&lt;1 year, 1–3 years, &gt;3 years). The association between PPI use and 3‐year changes in measured blood pressure was examined using linear regression. Results There were 28 951 cases of incident hypertension after a mean follow‐up of 8.7 years. PPI use was associated with 17% higher risk of hypertension compared with nonuse in the fully adjusted model (HR, 1.17 [95% CI, 1.08–1.27]). Longer PPI use durations were significantly associated with incrementally higher risk of hypertension (HR, 1.13, 1.17, 1.28, respectively; trend P &lt;0.001). The 3‐year change in multivariable‐adjusted mean systolic blood pressure increased significantly for PPI new users (+3.39 mm Hg, P =0.049) compared with never users. Conclusions PPI use was associated with higher risk of diagnosed hypertension in menopausal women, and the risk showed a significant trend according to longer duration of use. Further studies are needed to confirm these findings.

  PublisherDOI

Frequent coauthors

• Paul K. Crane

  University of Washington

  143 shared

• Rod Walker

  Kaiser Permanente Washington Health Research Institute

  89 shared

• Zachary A. Marcum

  University of Washington

  80 shared

• John C.S. Breitner

  Douglas Mental Health University Institute

  67 shared

• Eric B. Larson

  Human Longevity (United States)

  66 shared

• Sascha Dublin

  Kaiser Permanente Washington Health Research Institute

  64 shared

• Eric B. Larson

  University of Washington

  63 shared

• Joseph T. Hanlon

  University College Cork

  62 shared

Labs

• Plein Center for AgingPI

Education

• Other

  University of Michigan

• M.S., Epidemiology

  University of Washington

Awards & honors

• American Association of Colleges of Pharmacy New Investigato…
• Career Development Award from the National Institute on Agin…