About

Randall W. Rupper, MD, MPH, is a Professor in the Department of Internal Medicine, Division of Geriatrics, at the University of Utah. He joined the University of Utah’s Division of Geriatrics and the Salt Lake City VA Medical Center in 2003. Dr. Rupper is a geriatrician and health services researcher whose work focuses on improving care delivery for older adults, particularly rural patients and individuals living with dementia, as well as their caregivers. He serves as Director of the Salt Lake City Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), where he leads interdisciplinary efforts in geriatric research, education, and clinical innovation. He provides geriatric medicine services through the Salt Lake City VA Medical Center and University of Utah Health. In addition, he is an investigator at the Huntsman Cancer Institute and a member of the Cancer Control and Population Sciences program. Dr. Rupper’s primary research involves developing and evaluating clinical systems that provide for surveillance of the medical decision-making needs of elderly patients and their caregivers and deliver appropriately personalized decision support. His work involves the demonstration of new models of access, especially within Federal programs, including Medicare and the Veterans Health Administration. Examples of outreach models include the use of community navigators to improve cancer care among Native Americans and the use of internet-based support for caregivers of dementia patients.

Research topics

• Medicine
• Gerontology
• Psychology
• Family medicine
• Nursing

Selected publications

• Cognitive and neurobehavioral phenotypes of post 9/11 veterans with epilepsy and mild traumatic brain injury

  Frontiers in Neurology · 2026-01-26

  articleOpen access

  Introduction: Traumatic brain injury (TBI) and epilepsy are significant health concerns among the veteran population, but the links between mild TBI and cognitive and behavioral changes in epilepsy have been little explored. This study leveraged natural language processing of medical records and chart review to assess the prevalence and patterns of cognitive and behavioral symptoms in post-9/11 veterans with epilepsy, with and without history of mild TBI. The study objective was to identify distinct neurobehavioral phenotypes, and then explore their socio-demographic factors, comorbidities, and phenotypes. Methods: We conducted a detailed chart review using NLP to extract cognitive dysfunction indicators that were categorized into seven Research Domain Criteria domains. Employing Uniform Manifold Approximation and Projection for clustering and dimensionality reduction. Results: By clustering individuals on behavioral and cognitive concepts in medical notes, this study extends beyond traditional diagnostic classifications, revealing a cognitive and behavioral phenotype of veterans. Veterans with post traumatic epilepsy often demonstrate significant cognitive risk profiles associated with RDoC domains, particularly in domains related to cognitive function and arousal/regulatory systems. Both veterans with TBI before Epilepsy post traumatic epilepsy and those with epilepsy preceding TBI displayed greater cognitive and behavioral burden compared to veteran with TBI only. Notably, epilepsy preceding TBI were found more often clustering in high behavioral risk profiles. This group with epilepsy preceding TBI was associated with, including dysfunction in the RDoC domains related to negative valence systems (44.4%), arousal/regulatory systems (37.0%), and interpersonal trauma. Discussion: These findings highlight the complex interplay between TBI and Epilepsy in shaping long term cognitive/behavioral challenges and point to the need for targeted clinical management, personalized treatment approaches, and refined therapeutic strategies to maximize the quality of life for affected veterans.

  PublisherOA PDFDOI

• Subjective cognitive decline prevalence, impacts, and discussions with healthcare professionals among middle-aged and older women veterans and non-veterans, 2021–2022

  Aging & Mental Health · 2026-03-23

  articleOpen access

  OBJECTIVES: Veterans may be at higher risk of cognitive decline due to military-related risk factors (e.g. traumatic brain injury). We compared the prevalence and impacts of subjective cognitive decline (SCD) among veteran and non-veteran women. METHOD: = 7,609 with SCD) and estimated prevalence ratios (PR). We stratified analyses by age group: 45-64 years and ≥65 years. RESULTS: = 0.24). Among women 45-64 years with SCD, veterans were more likely to have discussed their SCD with a healthcare professional, even after accounting for depression history and the social and household impacts of SCD (PR = 1.17, 95% CI: 1.06-1.29). CONCLUSION: Additional research is needed to address why women veterans may be more likely than women non-veterans to discuss their concerns about memory or thinking issues. This knowledge may be valuable in promoting early detection of dementia.

  PublisherOA PDFDOI

• Combining Machine Learning and Comparative Effectiveness Methodology to Study Primary Care Pharmacotherapy Pathways for Veterans With Depression

  Medical Care · 2025-04-22

  article

  OBJECTIVES: To demonstrate an innovative method combining machine learning with comparative effectiveness research techniques and to investigate a hitherto unstudied question about the effectiveness of common prescribing patterns. DATA SOURCES: United States Veterans Health Administration Corporate Data Warehouse. STUDY DESIGN: For Operation Enduring Freedom/Operation Iraqi Freedom veterans with major depressive disorder, we generate pharmacotherapy pathways (of antidepressants) using process mining and machine learning. We select the medication episodes that were started at subtherapeutic doses by the first assigned primary care physician and observe the paths that those medication episodes follow. Using 2-stage least squares, we test the effectiveness of starting at a low dose and staying low for longer versus ramping up fast while balancing observable and unobservable characteristics of patients and providers through instrumental variables. We leverage predetermined provider practice patterns as instruments. DATA COLLECTION: We collected outpatient pharmacy data for selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, patient and provider characteristics (as control variables), and the instruments for our cohort. All data were extracted for the period between 2006 and 2020. PRINCIPAL FINDINGS: There is a statistically significant positive effect (0.68, 95% CI 0.11-1.25) of "ramping up fast" on engagement in care. When we examine the effect of "ramping up slow", we see an insignificant negative impact on engagement in care (-0.82, 95% CI -1.89 to 0.25). As expected, the probability of drop-out also seems to have a negative effect on engagement in care (-0.39, 95% CI -0.94 to 0.17). We further validate these results by testing with medication possession ratios calculated periodically as an alternative engagement in care metric. CONCLUSIONS: Our findings contradict the "Start low, go slow" adage, indicating that ramping up the dose of an antidepressant faster has a significantly positive effect on engagement in care for our population.

  PublisherDOI

• Sex differences in unmet needs between male and female older Veterans

  Journal of Women & Aging · 2024-07-08 · 4 citations

  article

  = 490,148), 93.9% males and 6.1% females. We evaluated needs and unmet needs across the following domains: activities of daily living (ADLs), instrumental ADLs (IADLs), health management, and social. We calculated weighted estimates and compared sex differences using age-adjusted prevalence ratios. On average, female Veterans were younger, more were Non-Hispanic Black and unmarried. Females and males reported a similar prevalence of problems across all domains. However, compared to males, female Veterans had a lesser prevalence of missed appointments due to transportation (aPR 0.49; 95% CI: 0.26-0.92), housework unmet needs (aPR: 0.44; 95% CI: 0.20-0.97), and medication management unmet needs (aPR: 0.33; 95% CI: 0.11-0.95) but a higher prevalence of healthcare communication unmet needs (aPR: 2.40; 95% CI: 1.13-5.05) and monitoring health conditions unmet needs (aPR: 2.13, 95% CI: 1.08-4.20). Female Veterans' common experience of unmet needs in communicating with their healthcare teams could result in care that is less aligned with their preferences or needs. As the number of older female Veterans grows, these data and additional work to understand sex-specific unmet needs and ways to address them are essential to providing high-quality care for female Veterans.

  PublisherDOI

• INTERAGENCY COLLABORATION TO SUPPORT CAREGIVERS IN RURAL COMMUNITIES

  Innovation in Aging · 2024-12-01

  articleOpen access

  Abstract The Utah Geriatric Education Consortium (UGEC) is a Health Resources and Services Administration (HRSA) Geriatrics Workforce Enhancement Program committed to providing age- and dementia-friendly education to primary care and geriatrics workforces and supporting caregivers of people with dementia. We partnered with three rural, multi-county Area Agencies on Aging (AAA) to design and implement hybrid dementia caregiver conferences. Other partners included the Utah Chapter of the Alzheimer’s Association, Utah Department of Health and Human Services, VA Salt Lake City Healthcare System Geriatric Research Education and Clinical Center, and Utah Department of Veterans and Military Affairs. Conference topics included: UGEC educational programs and resources; local AAA community-based programs and resources; dementia, depression, and delirium screening; understanding/responding to dementia-related behaviors; caregiver grief; VA healthcare enrollment and caregiver support programs. The conferences averaged 70.33 (range 54-92) in-person attendees and 12 (range 3-21) virtual attendees. Attendees reported positive levels of satisfaction on a 5-point scale, including that the conferences were engaging (X = 4.55) and effective (X = 4.62), provided examples useful to their education (X = 4.59), met stated goals (X = 4.53), and were better/a lot better compared to similar programs (X = 4.40). In-person attendees reported a sense of community amongst caregivers, and appreciation for the topics related to grief and caregiver support. Attendees suggested adding a caregiver panel, and more local long-term care services and support vendors. In conclusion, rural caregiver conferences which include in-person and virtual modalities meet the educational and flexibility needs of rural caregivers in Utah.

  PublisherDOI

• Impact of Veterans Affairs Geriatric Research, Education, and Clinical Centers: Incubators of innovation in geriatrics

  Journal of the American Geriatrics Society · 2024-07-31 · 4 citations

  articleOpen access

  Since their inception in 1975, the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers (GRECCs) have served as incubators of innovation in geriatrics. Their contributions to the VA mission were last reviewed in 2012. Herein, we describe the continuing impact of GRECCs in research, clinical, and educational areas, focusing on the period between 2018 and 2022. GRECC research spans the continuum from bench to bedside, with a growing research portfolio notable for highly influential publications. GRECC education connects healthcare professions trainees and practicing clinicians, as well as Veterans and their caregivers, to engaging learning experiences. Clinical advancements, including age-friendly care, span the continuum of care and leverage technology to link disparate geographical sites. GRECCs are uniquely positioned to serve older adults given their alignment with the largest integrated health system in the United States and their integration with academic health centers. As such, the GRECCs honor Veterans as they age by building VA capacity to care for the increasing number of aging Veterans seeking care from VA. GRECC advancements also benefit non-VA healthcare systems, their academic affiliates, and non-Veteran older adults. GRECCs make invaluable contributions to advancing geriatric and gerontological science, training healthcare professionals, and developing innovative models of geriatric care.

  PublisherOA PDFDOI

• A Clinical Pharmacist-Led Transitions of Care Program for Veterans with Two Planned Care Transitions (Hospital to Skilled Care and Skilled Care to Home) amid the COVID-19 Pandemic

  Journal of the American Medical Directors Association · 2024-04-25 · 1 citations

  article
  PublisherDOI

• Identifying clinical phenotypes of frontotemporal dementia in post-9/11 era veterans using natural language processing

  Frontiers in Neurology · 2024-02-15 · 7 citations

  articleOpen access

  Introduction: Frontotemporal dementia (FTD) encompasses a clinically and pathologically diverse group of neurodegenerative disorders, yet little work has quantified the unique phenotypic clinical presentations of FTD among post-9/11 era veterans. To identify phenotypes of FTD using natural language processing (NLP) aided medical chart reviews of post-9/11 era U.S. military Veterans diagnosed with FTD in Veterans Health Administration care. Methods: A medical record chart review of clinician/provider notes was conducted using a Natural Language Processing (NLP) tool, which extracted features related to cognitive dysfunction. NLP features were further organized into seven Research Domain Criteria Initiative (RDoC) domains, which were clustered to identify distinct phenotypes. Results: Veterans with FTD were more likely to have notes that reflected the RDoC domains, with cognitive and positive valence domains showing the greatest difference across groups. Clustering of domains identified three symptom phenotypes agnostic to time of an individual having FTD, categorized as Low (16.4%), Moderate (69.2%), and High (14.5%) distress. Comparison across distress groups showed significant differences in physical and psychological characteristics, particularly prior history of head injury, insomnia, cardiac issues, anxiety, and alcohol misuse. The clustering result within the FTD group demonstrated a phenotype variant that exhibited a combination of language and behavioral symptoms. This phenotype presented with manifestations indicative of both language-related impairments and behavioral changes, showcasing the coexistence of features from both domains within the same individual. Discussion: This study suggests FTD also presents across a continuum of severity and symptom distress, both within and across variants. The intensity of distress evident in clinical notes tends to cluster with more co-occurring conditions. This examination of phenotypic heterogeneity in clinical notes indicates that sensitivity to FTD diagnosis may be correlated to overall symptom distress, and future work incorporating NLP and phenotyping may help promote strategies for early detection of FTD.

  PublisherOA PDFDOI

• Caregiver‐specific quality measures for home‐ and community‐based services: Environmental scan and stakeholder priorities

  Journal of the American Geriatrics Society · 2024-07-31 · 2 citations

  articleOpen access

  Although family caregivers are increasingly recognized for their essential role in helping vulnerable adults live in the community for as long as possible, their priorities and perspectives have not been well-integrated into quality assessments of home- and community-based services (HCBS). Our overall goal was to identify measurement gaps to guide monitoring and improve HCBS. Caregiver-specific measurement priorities were identified during a multi-level stakeholder engagement process that included 34 Veterans, 24 caregivers, and 39 facility leaders, clinicians, and staff across four VA healthcare systems. We mapped items from national quality measure sets for HCBS identified during an environmental scan onto the stakeholder-identified measurement priorities. Only 5 of 11 non-VA measure sets and three of four VA measure sets explicitly included caregiver-specific items that were aligned with or relevant to stakeholders' measurement priorities. Six of 14 stakeholder-identified priorities were not reflected in any measure sets, such as those that explicitly assess caregiver-reported experience with services that directly or indirectly support their role as caregivers within HCBS. Although family caregivers fulfill a critical role in helping adults with complex medical needs live independently for as long as possible, their priorities and perspectives have not been well-integrated into quality assessments of HCBS. Measures that acknowledge caregivers' roles and incorporate their priorities can help healthcare systems to better monitor and improve HCBS quality, thereby enabling Veterans to remain in the community as long as possible.

  PublisherOA PDFDOI

• Cover

  Journal of the American Geriatrics Society · 2023

  • Medicine
  • Gerontology

  GEC Continuum of Services for Aging Veterans. See the related article by Farrell et al., pages 18–25 . image

  PublisherOA PDFDOI

Frequent coauthors

• Bret Hicken

  VA Salt Lake City Healthcare System

  49 shared

• Matthew H. Samore

  University of Utah

  45 shared

• Jonathan R. Nebeker

  44 shared

• Wu Xu

  University of Louisiana at Lafayette

  37 shared

• Brian C. Sauer

  Lake City VA Medical Center

  36 shared

• Lucy A. Savitz

  UPMC Center for High Value Health Care

  36 shared

• Judith A. Shinogle

  University of Maryland, Baltimore

  34 shared

• J Huh

  Superconductor Technologies (United States)

  32 shared

Education

• M.D.

  Stanford University

• Other

  University of Washington

• Other

  University of North Carolina

• Other

  UNC-Chapel Hill

• Other

  University of Utah