About

Dr. Terri Fried is the Humana Foundation Professor of Medicine (Geriatrics) and serves as the Section Chief of Geriatric Medicine at Yale School of Medicine. She completed her medical education at Harvard University and underwent internship and residency in Primary Care Internal Medicine at Rhode Island Hospital. Her fellowship training in geriatrics, ethics, and clinical effectiveness was also conducted at Harvard Medical School. Dr. Fried joined Yale's geriatrics section in 1996 as a clinician investigator after several years as a clinician-educator at Brown Medical School. Her research interests focus on decision-making for older persons with advanced illness and multiple conditions, with a particular emphasis on elucidating patient preferences. She has contributed significantly to understanding advance care planning, healthcare utilization among dementia caregivers, treatment burden in older adults with multiple chronic conditions, and care transitions for persons with dementia. Dr. Fried's work involves developing decision support tools, exploring patient and caregiver needs, and improving healthcare delivery for the elderly population. She is actively involved in multiple research collaborations and has a substantial publication record in her field.

Research topics

• Medicine
• Intensive care medicine
• Psychiatry
• Data Mining
• Nursing
• Computer Science
• Internal medicine
• Data science
• Psychology
• Gerontology
• Medical emergency
• Cardiology

Selected publications

• Understanding the Role of Communication in Deprescribing Behavior Change

  Journal of the American Geriatrics Society · 2026-04-05

  articleOpen access1st authorCorresponding

  BACKGROUND: The use of behavior change models to conceptualize deprescribing provides an opportunity to explore the components of communication needed to overcome the many barriers to deprescribing. METHODS: Consensus development working group composed of care partner stakeholders and international experts in geriatrics, nursing, pharmacology, communication, and community outreach. The goal of the working group was to create a framework for the communication required among patients, care partners, and clinicians in the ambulatory setting to achieve the behavior of shared decision making about medication appropriateness and deprescribing. The COM-B (Capability, Opportunity, Motivation-Behavior) model provided an apt framework for characterizing deprescribing communication. RESULTS: Each component of the model requires specific communication skills, modes, and/or content. Capability requires clinician skills including elicitation of patient/care partner concerns and patient/care partner skills including self-efficacy for raising medication questions and concerns. This facilitates a shared understanding of constructs that inform communication content, including medication benefits and harms and the "how-to" of deprescribing. Opportunity requires the allocation of time during usual care or the creation of designated visits for communication. Motivation requires communication, such as audit and feedback directed at clinicians, and testimonials directed at patients and care partners, that encourages evaluation of medication appropriateness, increases awareness of potential problems, and overcomes clinical inertia. CONCLUSIONS: The application of a behavioral health model to deprescribing communication highlights the importance of addressing capability, opportunity, and motivation in behavior change. Developing communication strategies that address these three components may enhance the effectiveness of deprescribing interventions.

  PublisherDOI

• A Retrospective National Cohort Study of Trends in Mechanical Ventilation Among Veterans Living With Dementia, 2010–2019

  Journal of the American Geriatrics Society · 2026-01-28

  articleOpen access

  BACKGROUND: Despite longstanding concern about an increase in use of invasive mechanical ventilation among persons living with dementia (PLWD), no studies have examined trends in mechanical ventilation use among PLWD in Veterans Affairs (VA) facilities. In this study, we aimed to (1) identify recent trends in use of mechanical ventilation among Veteran PLWD and (2) assess mortality trends of those who received mechanical ventilation. METHODS: In this retrospective national cohort study of all VA medical hospitalizations of Veteran PLWD ≥ 65 years from 2010 to 2019, we used data from the VA Corporate Data Warehouse and defined dementia using a VA-sanctioned list of dementia diagnosis codes. We calculated the percentage of hospitalizations with mechanical ventilation use during the study period and used linear regression to determine a temporal trend. We calculated in-hospital and one-year mortality for hospitalizations of Veteran PLWD involving mechanical ventilation and used linear regression (predictor: time; outcome: mortality) to describe mortality trends. RESULTS: Our cohort included 702,989 hospitalizations at 126 VA medical centers involving 251,545 unique Veteran PLWD. Hospitalized Veteran PLWD were 97.9% male, 89.7% non-Hispanic/Latino, and 72.7% White. Mechanical ventilation use decreased from 1.7% of hospitalizations in 2010 to 1.1% in 2019. Annual in-hospital mortality among those PLWD who received mechanical ventilation decreased from 45.9% in 2010 to 38.0% in 2019 and one-year mortality decreased from 73.4% in 2010 to 70.2% in 2018. CONCLUSIONS: The use of mechanical ventilation in hospitalizations of Veteran PLWD was lower than seen in non-VA facilities and decreased from 2010 to 2019. Among hospitalized Veteran PLWD who received mechanical ventilation, in-hospital and one-year mortality remained high throughout the study period but decreased over time. These descriptive mortality decreases may be attributable to patient selection or improved mechanical ventilation practices. Further research should examine patient- and system-level factors to explain observed trends.

  PublisherOA PDFDOI

• High-Risk Medication Prescriptions Among Older Adults Discharged from the Emergency Department

  JAMA Internal Medicine · 2026-02-09 · 1 citations

  articleOpen access

  This cross-sectional study identifies the prescribing rate and most commonly prescribed classes of potentially inappropriate medications for older patients at emergency department discharge.

  PublisherOA PDFDOI

• The COVID-19 Pandemic and Goals-of-Care Conversations in Veterans Health Administration Clinics

  JAMA Network Open · 2025-06-16 · 2 citations

  articleOpen access

  Importance: The onset of the COVID-19 pandemic created urgency for advance care planning, including documenting goals-of-care conversations (GoCCs), while seismically disrupting usual health care delivery. Characterizing trends in GoCC rates during the pandemic can provide insight into the extent to which health care systems prioritized advance care planning in the face of competing clinical demands, shifts to telemedicine, and staffing shortages. Objective: To determine how the COVID-19 pandemic was associated with changes in outpatient first-ever GoCCs. Design, Setting, and Participants: Retrospective cohort study of patients eligible for their first-ever documented GoCC in outpatient clinics at 123 US Veterans Health Administration facilities nationwide from March 2019 to February 2023. Exposure: COVID-19 pandemic. Main Outcomes and Measures: National- and facility-level weekly GoCC rates, defined as number of first-ever documented GoCCs per 100 000 outpatient appointments. Secondary analyses examined associations between facility-level characteristics and facility GoCC rates. Results: Of 5 027 956 patients nationally, 124 216 (2.5%) had a first-ever outpatient GoCC during the study period (facility-level range: 0.01%-26.3%). The mean (SD) weekly national first-ever outpatient GoCC rate was 99.6 (12.1) in the year preceding the pandemic. At pandemic onset, mean weekly outpatient GoCC rates dropped to a nadir of 74.1 (week of March 21, 2020), then sharply increased, peaking at 177.4 (week of April 18, 2020), before steadily declining to pre-COVID-19 rates and ending with a COVID year 3 mean (SD) of 96.6 (11.5). At the facility level, 29 of 123 facilities (23.6%) significantly increased outpatient GoCC rates in the early pandemic and maintained or further improved through COVID year 3, with significant rate increases pre-COVID to COVID year 3. Conclusions and Relevance: In this retrospective cohort study of outpatient GoCC rates, the early COVID-19 pandemic was associated with initial disruption and then with increased first-ever outpatient GoCC rates nationally. Despite unprecedented challenges to health care delivery, several facilities increased GoCC rates during the first COVID-19 surge and maintained increased rates through 2023. These facilities could serve as models for best practices to improve advance care planning.

  PublisherOA PDFDOI

• Moderate stability of risk and ambiguity attitudes across quantitative and qualitative decisions

  Scientific Reports · 2025-01-24 · 1 citations

  articleOpen access

  Uncertainty lies at the heart of everyday choices, affecting both decisions about precise quantities and those with less tangible, more qualitative, outcomes. Previous literature on decisions under uncertainty focused on alternatives with quantifiable outcomes, for example monetary lotteries. In such scenarios, decision-makers make decisions based on success chance, outcome magnitude, and individual preferences for uncertainty. It is not clear, however, how individuals construct subjective values when outcomes are not directly quantifiable. To explore how decision-makers choose between non-quantifiable uncertain outcomes, we focus here on medical decisions with qualitative outcomes. Specifically, we ask whether decision-makers exhibit similar attitudes towards uncertainty, focusing on ambiguity, across domains with quantitative and qualitative outcomes. We designed an online decision-making task where participants made binary choices between alternatives offering either guaranteed low outcomes or potentially better outcomes that were associated with some uncertainty. Outcomes were either hypothetical monetary gains of varying magnitudes or levels of improvement in a hypothetical medical condition. We recruited 429 online participants and repeated the survey in two waves, which allowed us to compare the between-domain attitude consistency with within-domain consistency over time. We found that uncertainty attitudes were moderately correlated across domains and time. We discuss the implications and applicability of our paradigm to broader contexts with non-quantifiable outcomes.

  PublisherOA PDFDOI

• Understanding Differences in Treatment Burden Among Older Adults with Multiple Chronic Conditions

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Older adults managing multiple chronic conditions (MCCs) often need to balance various medications, treatments, and interventions, so this group of older adults is expected to experience healthcare burden. In this study, we examined the treatment burden of a group of 397 veterans who were older than 65 with three or more chronic conditions and/or ten or more medications. Of this group, 115/397 surprisingly reported no burden (NB) on the Treatment Burden Questionnaire (overall score = zero) while 282/397 reported an average score of 50 during baseline data collection. A chi-square test was run on different demographic variables to determine differences between participants reporting NB versus some burden (SB). NB and SB groups had older adults of similar race, gender, ethnicity, housing status, and educational level. However, older adults reporting NB more frequently reported perfect scores on the PROMIS questionnaire (NB: 48.7%; SB: 17.4%) and a 27/30 (90%) or better on the WBS questionnaire (NB: 52.2%; SB: 19.9%). Older adults reporting SB more frequently reported using assistive devices (NB: 20%; SB: 34.8%) and feeling as if every task was effortful (NB: 23.5%; SB: 40.8). These findings suggest that despite similar background and management of MCCs, older adults with minimal functional and mobility limitations often report NB. Furthermore, perceptions of treatment burden are related to perceptions of wellbeing and quality of life.

  PublisherOA PDFDOI

• Emergency Department Utilization Among Co‐Residing Family Caregivers of Persons Living With Dementia

  Journal of the American Geriatrics Society · 2025-05-10 · 2 citations

  articleOpen access

  The authors declare no conflicts of interest. Table S1. ICD-10 codes used to identify dementia. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

  PublisherOA PDFDOI

• Development and Feasibility of <scp>PATH</scp> : Preparation for Appropriate Transitions From Home

  Journal of the American Geriatrics Society · 2025-12-31

  article1st authorCorresponding

  BACKGROUND: Despite efforts to promote aging in place, millions of caregivers face decisions about whether a person living with dementia (PLwD) should move from home to another residential setting, such as a nursing home or assisted living facility. These decisions are frequently made during times of crisis, and caregivers report many unmet needs regarding decision making. Tools to support this decision making are lacking. METHODS: Focus groups of caregivers and an expert panel provided the content for a decision support tool. The tool was then iteratively reviewed with a new cohort of 53 caregivers, who participated in cognitive interviews and rated the tool's clarity, trustworthiness, and whether it made them more comfortable thinking about care transitions. RESULTS: In focus groups, caregivers highlighted the importance of understanding decision making in the context of the entire relationship between the caregiver and PLwD, and they repeatedly called attention to the role of guilt. The expert panel grappled with the ethical standing of the caregiver's well-being in decision making on behalf of the PLwD. The tool consists of two booklets. The first addresses the cognitive and emotional aspects of decision making and the second provides education. Over 95% of caregivers gave a rating of "Good" or "Very Good" for the booklets' clarity, ease of understanding, and trustworthiness. At least 80% agreed or strongly agreed that they were comfortable thinking about the issues and wanted to learn more. CONCLUSIONS: A decision support tool for caregivers of PLwD that provides education about transitions in care site, along with support for the emotional aspects of decision making, is highly acceptable and supports caregivers' ability to engage with what can be a challenging topic.

  PublisherDOI

• Addressing the Needs of Chinese American Dementia Caregivers in Feeding Decisions Through Community Engagement

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Feeding difficulties are common among individuals with advanced dementia. Dementia family caregivers have to make difficult decisions about feeding options. Despite limited clinical benefit, over 50% of Chinese individuals with advanced dementia receiving tube-feeding. Little is known about Chinese American dementia caregivers’ attitudes towards tube feeding and their decision-making needs regarding feeding options. In collaboration with CaringKind, a community agency serving dementia caregivers in NYC, we conducted a multi-method study among Chinese American dementia caregivers consisting of an original survey to capture knowledge/attitudes about feeding decisions and a qualitative descriptive study to inform a culturally adapted decision aid. We calculated descriptive statistics for quantitative data and used thematic analysis for qualitative data. The survey (n = 63) showed that participants had limited knowledge about tube feeding; 35% opted for tube feeding in an end-of-life scenario, while 41% were uncertain. Qualitative interviews with 21 Chinese American dementia caregivers and 13 healthcare providers indicated that: 1) caregivers value family-based and harmony-oriented decision-making and often misunderstand that careful hand feeding equates to starvation; and 2) Chinese American persons with dementia prefer indirect communication regarding their end-of-life care wishes. Based on study results, we culturally adapted an appropriate decision aid titled “Making choices: feeding options for patients with dementia” successfully used with dementia caregivers. We are collecting feedback from caregivers and health care providers to make refinements. Next, we will pilot test the feasibility, acceptability, and preliminary efficacy of the culturally adapted decision aid intervention to better address the needs of our caregiver group.

  PublisherOA PDFDOI

• Emergency department utilization among family caregivers of persons living with dementia

  Alzheimer s & Dementia · 2025-12-01

  articleOpen access

  BACKGROUND: Caring for a person living with dementia (PLWD) can place significant psychological and physical strain on family caregivers, making caregiver burden a critical concern amid the increasing global prevalence of dementia. While many studies have focused on resources to support caregiving or care-seeking patterns of PLWD, few have examined caregivers' own healthcare utilization. We sought to characterize emergency department (ED) visit use among family caregivers of PLWD. METHODS: We performed an observational cohort study using the 2016 to March 2020 Medical Expenditure Panel Survey data. We identified PLWD based on ICD-10 codes and caregivers through specified relationships to the reference PLWD. The primary outcome was the rate of monthly ED visits among PLWD family caregivers (cases) compared to matched MEPS participants not caring for PLWD family members (controls), using a 1:1 propensity score matching approach to adjust for caregiver age, gender, race, education, and health conditions. We determined risk ratios between groups to account for differences in follow-up time and quantify differences in ED visit rates. RESULTS: The analytic sample included 510 participants, comprising 255 cases and 255 controls - 54.7% were female, 49.8% were White, and the average age was 45.5 years old. Aggregated across all study years, PLWD caregivers had 4.57 ED visits/100 person-months, while matched controls had 3.51 ED visits/100 person-months, representing a 30% higher rate of ED visits for PLWD caregivers (95% CI: 1.02, 1.66) compared to controls. CONCLUSION: Caregivers of PLWD have higher ED visit rates than matched controls not caring for family members with dementia. These findings highlight the potential healthcare challenges faced by dementia caregivers and emphasize the need for targeted interventions and policies to support their health and well-being.

  PublisherOA PDFDOI

Recent grants

• NIH Grant I01HX000906

  NIH · 2016

• NIH Grant K02AG020113

  NIH · $524k · 2007

• Yale Training Program in Geriatric Clinical Epidemiology and Aging-related Research

  NIH · $7.5M · 2001–2031

• CORE-001 - OPERATIONS CORE

  NIH · $6.1M · 2002–2028

• NIH Grant R21AG037791

  NIH · $372k · 2014

Frequent coauthors

• John R. O’Leary

  144 shared

• Linda S. Williams

  Indiana University – Purdue University Indianapolis

  91 shared

• John Concato

  United States Food and Drug Administration

  91 shared

• Dawn M. Bravata

  Quality Enhancement Research Initiative

  91 shared

• Joseph V. Agostini

  Hôpital Jean Jaurès

  90 shared

• Lawrence Brass

  Centre Hospitalier Sainte-Anne

  89 shared

• Albert Lo

  Eli Lilly (United States)

  87 shared

• Vincent McClain

  Regenstrief Institute

  86 shared

Education

• M.D.

  Harvard

• Other, Primary Care Internal Medicine

  Rhode Island Hospital