Gregory Michael Ouellet
· Assistant ProfessorVerifiedYale University · Geriatrics and Palliative Medicine
Active 2008–2025
About
Dr. Gregory Michael Ouellet is an Assistant Professor in Geriatrics at Yale School of Medicine. He graduated from Brown University with a Bachelor of Science in biology and completed medical school at the University of Rochester. His clinical training in Internal Medicine and Geriatrics was completed at Yale, where he also undertook a postdoctoral fellowship in Geriatric Epidemiology and Aging-Related Research, earning a Master in Health Science degree in 2018. Dr. Ouellet subsequently joined the full-time faculty in the Section of Geriatrics. His research focuses on improving the care of chronic conditions for vulnerable older adults, particularly those with dementia. He has worked on understanding whether the benefits of multiple antihypertensives extend to complex older adults and has collaborated on national efforts to transform decision-making for persons with multiple chronic conditions through the Patient Priorities Care initiative. His current work extends the science of complex decision-making to older adults with dementia, investigating treatment decisions such as anticoagulant use in patients with atrial fibrillation. Dr. Ouellet's ultimate goal is to impact the lives of older adults by optimizing complex decision-making to maximize benefits, minimize harms, and reduce treatment burden.
Research topics
- Psychiatry
- Medicine
- Internal medicine
- Cardiology
- Intensive care medicine
- Emergency medicine
- Gerontology
- Medical emergency
- Surgery
- Psychology
- Nursing
Selected publications
What Matters Most: An Example of Implementing Patient Priorities Care
The Senior Care Pharmacist · 2025-07-01 · 1 citations
articleThis is the first in a series of Age-Friendly case studies developed as a function of the John A. Hartford Foundation grant to the American Society of Consultant Pharmacists and the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy to Leverage Pharmacists as Age-Friendly 4Ms Champions. This series presents a case for each of the 4Ms: What Matters, Medication, Mentation, and Mobility, and examines how these elements interrelate to optimize care for older patients. This report involves adopting the 4Ms Framework of an Age-Friendly Heath System (What Matters, Medication, Mentation, and Mobility) in combination with the Patient Priorities Care (PPC) approach for a female patient with multiple chronic conditions. PPC supports patients and care teams in aligning health care decisions with what matters most to the patient. While applicable to all patients, it is particularly valuable for older patients with multiple chronic conditions, such as the patient in this case.The authors sought to identify what matters most to the patient, specifically her desires to spend more time with her grandchildren, volunteer in her community, and maintain independence in mobility. They then worked with the care team to determine how best to support those goals.Fatigue was identified as the greatest barrier. The team evaluated potential interventions to reduce the patient’s fatigue, considering their risks, benefits, relative likelihood of effect, and feasibility. After engaging in collaborative decision-making with the patient, the team selected an intervention and followed up to assess its impact on the patient’s ability to achieve her goals.This case illustrates how the PPC approach can help operationalize patient-centered care by aligning clinical decisions with what matters most to older adults with multiple chronic conditions.
Age Friendly Health System 4M Competency-Based Curriculum for Internal Medicine Residents
Innovation in Aging · 2025-12-01
articleOpen accessAbstract The Age Friendly Health System 4Ms is an evidence-based framework to provide high value care to older adults, with which educational content in Geriatrics is increasingly aligned. Focusing on Internal Medicine residents, who provide care to older adults in a variety of settings, we aimed to assess perceived proficiency in core competencies, as identified by AGS/ADGAP and organized using the 4Ms framework. We surveyed Internal Medicine residents in three programs at one academic medical center. The survey asked residents about their self-reported proficiency in AGS/ADGAP competencies on a scale of 1-5 (1 “completely unable to perform this skill”, 5 “I am expert and can teach this skill to others”). A total of 35 residents responded to the pre-curriculum survey, including 13 PGY1, 17 PGY2 and 5 PGY3 residents. Most (71%) had no Geriatrics-focused experience in medical school, yet 27 individuals (77%) had >1 Geriatrics rotation during residency. Residents self-reported lower proficiency scores in competencies related to mobility (3.21) and multicomplexity (3.39). Of the competencies, residents scored lowest in their ability to screen for pressure injuries (2.95) and develop a multifaceted plan for fall prevention (3.00). Our findings highlight gaps in Internal Medicine residents’ self-reported proficiency in key Geriatrics competencies. These results will inform our development of a QR-generated skills tracker for residents to have skills in Geriatrics evaluated in real time by trained faculty. This will also help align curricular content in didactics and rotations to target highest priority learning needs.
Age Friendly Health System 4M Competency-Based Curriculum for Internal Medicine Residents
Innovation in Aging · 2025-12-01
articleOpen accessAbstract The Age Friendly Health System 4Ms is an evidence-based framework to provide high value care to older adults, with which educational content in Geriatrics is increasingly aligned. Focusing on Internal Medicine residents, who provide care to older adults in a variety of settings, we aimed to assess perceived proficiency in core competencies, as identified by AGS/ADGAP and organized using the 4Ms framework. We surveyed Internal Medicine residents in three programs at one academic medical center. The survey asked residents about their self-reported proficiency in AGS/ADGAP competencies on a scale of 1-5 (1 “completely unable to perform this skill”, 5 “I am expert and can teach this skill to others”). A total of 35 residents responded to the pre-curriculum survey, including 13 PGY1, 17 PGY2 and 5 PGY3 residents. Most (71%) had no Geriatrics-focused experience in medical school, yet 27 individuals (77%) had >1 Geriatrics rotation during residency. Residents self-reported lower proficiency scores in competencies related to mobility (3.21) and multicomplexity (3.39). Of the competencies, residents scored lowest in their ability to screen for pressure injuries (2.95) and develop a multifaceted plan for fall prevention (3.00). Our findings highlight gaps in Internal Medicine residents’ self-reported proficiency in key Geriatrics competencies. These results will inform our development of a QR-generated skills tracker for residents to have skills in Geriatrics evaluated in real time by trained faculty. This will also help align curricular content in didactics and rotations to target highest priority learning needs.
JAMA Network Open · 2024-10-17 · 15 citations
articleOpen access1st authorCorrespondingJournal of the American Geriatrics Society · 2022-10-30 · 21 citations
articleOpen access1st authorCorrespondingBACKGROUND: Approximately 20% of older persons with dementia have atrial fibrillation (AF). Nearly all have stroke risks that exceed the guideline-recommended threshold for anticoagulation. Although individuals with dementia develop profound impairments and die from the disease, little evidence exists to guide anticoagulant discontinuation, and almost one-third of nursing home residents with advanced dementia and AF remain anticoagulated in the last 6 months of life. We aimed to quantify the benefits and harms of anticoagulation in this population. METHODS: Using Minimum Data Set and Medicare claims, we conducted a retrospective cohort study with 14,877 long-stay nursing home residents aged ≥66 between 2013 and 2018 who had advanced dementia and AF. We excluded individuals with venous thromboembolism and valvular heart disease. We measured anticoagulant exposure quarterly, using Medicare Part D claims. The primary outcome was all-cause mortality; secondary outcomes were ischemic stroke and serious bleeding. We performed survival analyses with multivariable adjustment and inverse probability of treatment (IPT) weighting. RESULTS: VASC score was 6.19 ± 1.58. In multivariable survival analysis, anticoagulation was associated with decreased risk of death (HR 0.71, 95% CI 0.67-0.75) and increased bleeding risk (HR 1.15, 95% CI 1.02-1.29); the association with stroke risk was not significant (HR 1.08, 95% CI 0.80-1.46). Results were similar in models with IPT weighting. While >50% of patients in both groups died within a year, median weighted survival was 76 days longer for anticoagulated individuals. CONCLUSION: Persons with advanced dementia and AF derive clinically modest life prolongation from anticoagulation, at the cost of elevated risk of bleeding. The relevance of this benefit is unclear in a group with high dementia-related mortality and for whom the primary goal is often comfort.
Circulation · 2022-11-08
articleIntroduction: Contemporary HFrEF patients are older and have a higher prevalence of cognitive impairment compared to those studied in the original beta-blocker (BB) trials. While BB decrease mortality and morbidity in HFrEF, their use has been linked to higher fall risk and possibly acceleration of cognitive decline among older adults with Alzheimer’s Disease and Related Dementias (ADRD). The risk/benefit trade-off of beta blocker (BB) use in patients with HFrEF and dementia has not been examined. Methods: Using a 100% sample of patients enrolled in Medicare A, B and a 40% sample of D with ≥1 hospitalization for HFrEF between 2008 and 2018, we created a cohort of beneficiaries with HFrEF but no prior diagnosis of ADRD. We then subset to the population to those that developed ADRD in the year after their HFrEF hospitalization and compared BB use pre/post ADRD diagnosis and is association with outcomes using a time varying exposure. Results: The highest 1-year survival after ADRD diagnosis was observed among those continued on BB after ADRD diagnosis, regardless of whether they were on BB before (HR 0.427, 95% CI 0.406, 0.465, p<0.001) the ADRD diagnosis or not (HR=0.629, 95% CI 00.545, 0.670, p<0.001; Figure 1 ). The poorest survival was observed among those who had their BB stopped after their ADRD diagnosis (HR=2.34, 95% CI 2.15, 2.46). Conclusion: Among patients with HFrEF, stopping BB therapy after a diagnosis of ADRD is associated with the poorest survival. The best survival was observed among those continued on BB after ADRD diagnosis. Therefore, unless there is a clear clinical indication, BB therapy should not be stopped after a diagnosis of ADRD.
Journal of the American Geriatrics Society · 2022-10-14 · 7 citations
articleBACKGROUND: Contemporary patients with heart failure with reduced ejection fraction (HFrEF) are older and have a higher prevalence of cognitive impairment than those studied in trials. The risk/benefit trade-off of routine beta-blocker (BB) use in patients with HFrEF and Alzheimer's disease and related dementias (ADRD) has not been explored. This study aimed to determine the association between BB use and outcomes among patients with HFrEF and ADRD. METHODS: Using a random 40% sample of Medicare Parts A, B, and D data we identified patients with ≥1 hospitalization for HFrEF between 2008 and 2018. Each patient was classified based on BB use prior to admission and after discharge. Outcomes include 90-day and 1-year mortality and readmission. RESULTS: Between 2008 and 2018, we identified 357,030 patients hospitalized with HFrEF; 12.7% had ADRD. Patients with HFrEF and ADRD had higher 90-day and 1-year mortality compared to patients with HFrEF-only. Among patients admitted on a BB, 60.5% of patients with HFrEF-only were continued on therapy after discharge, compared to 56.8% of patients with HFrEF and ADRD. Discontinuing BB was associated with a 2.2-fold higher risk of 90-day mortality (p < 0.001) among patients with HF-only and a 2.- fold higher risk of 90-day mortality (p < 0.001) among patients with HFrEF + ADRD. Not starting a BB was associated with a 1.8-fold higher risk of 90-day mortality (p < 0.001) among patients with HFrEF-only and a 1.7-fold higher risk of 90-day mortality (p < 0.001) among patients with HFrEF + ADRD. Similar risks were seen at 1 year. CONCLUSIONS: BB therapy is associated with significantly lower short and long-term mortality rates among all patients with HFrEF; the magnitude of these associated benefits appear at least as large in patients with HFrEF and ADRD compared to patients with HFrEF-only.
Anticoagulant Use for Atrial Fibrillation Among Persons With Advanced Dementia at the End of Life
JAMA Internal Medicine · 2021 · 28 citations
1st authorCorresponding- Medicine
- Intensive care medicine
- Medical emergency
This cross-sectional study evaluates the degree of anticoagulant use among nursing home residents with advanced dementia and atrial fibrillation at the end of life.
Open Heart · 2021-01-01 · 13 citations
articleOpen accessOBJECTIVE: To develop a 180-day readmission risk model for older adults with acute myocardial infarction (AMI) that considered a broad range of clinical, demographic and age-related functional domains. METHODS: We used data from ComprehenSIVe Evaluation of Risk in Older Adults with AMI (SILVER-AMI), a prospective cohort study that enrolled participants aged ≥75 years with AMI from 94 US hospitals. Participants underwent an in-hospital assessment of functional impairments, including cognition, vision, hearing and mobility. Clinical variables previously shown to be associated with readmission risk were also evaluated. The outcome was 180-day readmission. From an initial list of 72 variables, we used backward selection and Bayesian model averaging to derive a risk model (N=2004) that was subsequently internally validated (N=1002). RESULTS: Of the 3006 SILVER-AMI participants discharged alive, mean age was 81.5 years, 44.4% were women and 10.5% were non-white. Within 180 days, 1222 participants (40.7%) were readmitted. The final risk model included 10 variables: history of chronic obstructive pulmonary disease, history of heart failure, initial heart rate, first diastolic blood pressure, ischaemic ECG changes, initial haemoglobin, ejection fraction, length of stay, self-reported health status and functional mobility. Model discrimination was moderate (0.68 derivation cohort, 0.65 validation cohort), with good calibration. The predicted readmission rate (derivation cohort) was 23.0% in the lowest quintile and 65.4% in the highest quintile. CONCLUSIONS: Over 40% of participants in our sample experienced hospital readmission within 180 days of AMI. Our final readmission risk model included a broad range of characteristics, including functional mobility and self-reported health status, neither of which have been previously considered in 180-day risk models.
Circulation · 2021-11-16
articleIntroduction: The average Medicare beneficiary with HFrEF is now 80 years old. Alzheimer’s Disease and Related Dementias (ADRD) is more common among older adults. Yet, to date the rate of ADRD in HFrEF has not been well studied. This is important because the treatment of HFrEF relies on a complex medication regimen and often-challenging lifestyle modifications, things that are particularly difficult in the setting of concurrent cognitive impairment. The aim of this study is to determine the prevalence and outcomes of patients with concurrent HFrEF and ADRD (HF+ADRD). Methods: We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of 397,680 fee-for-service beneficiaries with ≥1 hospitalization for HFrEF between 2012 and 2018. We required 1 year of FFS before and after discharge to capture comorbidities and measure outcomes over time. We used previously validated ICD-9/10 codes to define ADRD. Results: Thirteen percent (n=53,092) of patients with HFrEF have concurrent ADRD. The average patient with HF+ADRD is 4 years older than the average non-ADRD HF patient and rates of hypertension, diabetes, renal failure, lung disease, vascular disease and frailty are all higher among HF+ADRD patients (p<0.001; Table 1 ). Differences in 30-day and 1-year readmission rates are statistically significant, but relatively small. (30-day: 23% vs. 25%; 1-year: 64% vs. 66% ,p<0.001). However, 30-day and 1-year mortality rates are markedly higher for HF+ADRD patients (30-day: 5% vs. 10%; 1-year: 30% vs. 49%). Conclusions: Thirteen percent of HFrEF patients have concurrent ADRD. On average, this population is older, frailer and has more comorbidities than HFrEF patients without ADRD. While readmission rates are similar, HF+ADRD patients have markedly higher short and long-term mortality. Additional work is needed to understand how much of this increased mortality can be prevented with improved HFrEF care.
Frequent coauthors
- 9 shared
Jonathan Skinner
Dartmouth College
- 9 shared
Sarwat I. Chaudhry
- 9 shared
Mary E. Tinetti
- 8 shared
Ilan Goldenberg
University of Rochester Medical Center
- 8 shared
Scott McNitt
- 8 shared
Andrew Cohen
Yale University
- 6 shared
Mary Geda
Yale University
- 6 shared
Wojciech Zaręba
Education
B.S., biology
Brown University
M.D.
University
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