About

James L Rudolph is a Professor of Medicine and a Professor of Health Services, Policy and Practice. He is a Geriatrician and Palliative Care physician with a long-term goal of improving care for older patients. His research, education, and clinical work are focused on enhancing care delivery to older patients, with particular emphasis on areas such as cognitive aging, delirium, frailty, implementation science, long-term care, and quality improvement in healthcare. Rudolph seeks to share his enthusiasm for improving care with students, residents, fellows, and junior faculty, aiming to inspire the next generation of health improvement professionals.

Research topics

• Medicine
• Internal medicine
• Emergency medicine
• Endocrinology
• Immunology
• Demography
• Environmental health
• Pediatrics
• Database
• Gerontology
• Family medicine

Selected publications

• Dysphagia Management in Geriatric Medicine: Clinical Perspectives and Practice Patterns

  American Journal of Speech-Language Pathology · 2026-05-07

  article

  BACKGROUND: Swallowing care in older adults involves multiple providers, but how non-speech-language pathologist (SLP) providers approach dysphagia management is unclear. This study explored perspectives on dysphagia management among geriatrics-focused health care providers. METHOD: A 21-item mixed-methods online survey study was disseminated to geriatrics-focused, licensed health care providers (excluding SLPs) using Qualtrics software (Qualtrics). The survey was opt-in, and all responses were collected anonymously. Health care providers were identified through various methods, including online forum postings, local and national presentations, and the snowball method. Data were analyzed descriptively, and free-text responses were examined using inductive thematic analysis with a jointly developed codebook. Two coders completed manual coding in Excel, and a third reviewer resolved discrepancies. RESULTS: Eighty-two providers responded. Most felt confident (69.5%) and knowledgeable (81.7%) about dysphagia but wanted more training (74.4%), especially on interventions (75.6%). The primary screening barrier was poor integration into clinical workflows (52.4%), while perceived relevance to care (58.5%) was the primary screening facilitator. Though 92.7% of health care providers referred to SLPs when dysphagia was suspected, most did so for 1%-25% of patients (68.3%). Most respondents asked about swallowing in ≥ 50% of patients with dementia (69.6%). Thematic analysis revealed concerns that SLPs lack person-centered approaches, particularly regarding diet modifications. These concerns appeared related to other systems-level themes identified in the analysis, including limited interdisciplinary collaboration and constrained clinical resources. CONCLUSIONS: Our study suggests a need for better collaboration among health care professionals to improve swallowing-related care for older adults. It is likely that structural changes within the broader education and workplace systems will be necessary to improve collaboration and optimize current approaches to swallowing care.

  PublisherDOI

• Systemic inflammation, myocardial fibrosis, and subclinical cardiovascular disease in people living with HIV

  American Heart Journal · 2026-03-05

  articleOpen access

  BACKGROUND: People living with HIV experience accelerated aging, increasing their risk of age-related diseases. Chronic inflammation may play an important role in premature vascular aging and myocardial fibrosis, leading to cardiac dysfunction. METHODS: We conducted a cross-sectional pilot study of matched veterans with and without HIV receiving care at the Providence VA Medical Center to explore the relationship between systemic inflammation, myocardial fibrosis, and subclinical cardiac disease in HIV. Participants were extensively phenotyped with questionnaires, physical exam, stress test, echocardiogram, cardiac MRI, coronary calcium score, and blood measurement of markers of inflammation and fibrosis. Multivariable linear regressions were used to investigate the associations. RESULTS: 21 veterans with HIV (mean age 54 years; 71% White, 29% Black) and 20 controls (mean age 56 years; 70% White, 30% Black) were included. We found higher growth differentiation factor (GDF)-15 blood levels, increased extracellular volume, and lower right heart function on MRI among patients with HIV, suggesting the presence of increased myocardial fibrosis and subclinical myocardial dysfunction in this population. CONCLUSION: Limited data from this pilot study suggest that HIV may be associated with increased cardiac fibrosis and decreased right ventricular function. This study highlights the need for larger longitudinal studies to better understand the trajectory of HIV-associated cardiac changes and help improve cardiac disease prevention in this population.

  PublisherDOI

• Durability of Clinical Protection in Nursing Home Residents Following Monovalent KP.2 SARS-CoV-2 Vaccination.

  PubMed · 2026-04-25

  article

  OBJECTIVES: Nursing home residents received updated monovalent SARS-CoV-2 vaccines to protect them from the most recently emerging SARS-CoV-2 variants. We evaluated the extent and durability of clinical protection following receipt of the first monovalent KP.2 vaccination in nursing home residents. DESIGN: Retrospective cohort study using a target trial emulation design. We conducted a sequential, daily comparison of KP.2 vaccination vs no SARS-CoV-2 vaccination during the study period. Residents who received KP.2 were matched to unvaccinated residents based on index date and propensity scores incorporating demographics, vaccination status, and basic clinical characteristics. SETTING AND PARTICIPANTS: Veterans Affairs nursing home residents in long-term care between September 18, 2024, and October 30, 2024. METHODS: The primary exposure was KP.2 vaccination vs no SARS-CoV-2 vaccine during the study period. The primary outcome was a test-confirmed SARS-CoV-2 infection (with or without symptoms). Secondary outcome was composite outcome of COVID-19 infection-associated hospitalizations within 21 days of infection or death within 30 days of infection. RESULTS: Among eligible residents, a matched cohort of 1711 paired person trials were created (average age 76, 95% male, 28% African American). Vaccine effectiveness against COVID-19 infection was 38% at week 12 (95% CI, 13%-56%) and 4% at week 18 (95% CI, -30 to 29%). Vaccine effectiveness against hospitalization or death was 77% at week 12 (95% CI, 60%-90%) and 53% at week 18 (95% CI, 21%-71%). CONCLUSION AND IMPLICATIONS: Vaccination with the KP.2 updated SARS-CoV-2 vaccine provided significant clinical protection against hospitalization or death among nursing home residents. This protection started to wane within a few months of vaccination, mirroring antibody decline reported in other studies. Our findings support consideration of twice-annual vaccination strategy to optimize protection in this vulnerable population.

  PublisherDOI

• Burden of Invasive Escherichia coli Disease Among Veterans Residing in Community Living Centers

  Journal of the American Medical Directors Association · 2026-01-21

  article
  PublisherDOI

• P-342. Outcomes of Human Metapneumovirus in Nursing Home Residents: A Matched Analysis

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen accessSenior author

  Abstract Background Identified in 2001, human Metapneumovirus (hMPV) is a Paramyxoviridae with bimodal age distribution - affecting children and older people. In older people, clinically severe hMPV may be associated with respiratory symptoms resulting in hospitalization and/or death. The purpose of this study was to compare hospitalization and death in older nursing home residents with hMPV or influenza. Methods Using the electronic medical records of VA Community Living Centers (CLC) during the epidemiology years of Sept 1, 2017 to August 31, 2023, we identified CLC residents who tested positive for hMPV or influenza. We collected information on demographics and comorbidities, as well as clinical testing. We developed a propensity matched cohort of hMPV and influenza positive CLC residents and used proportional hazards models to determine the hazard ratio (HR) for hospitalization, death or either during the 90 days after positive test among hMPV- and influenza-positive residents. Results During the study period, we identified 135 hMPV infections and 1170 influenza. Most hMPV included influenza testing and there were no co-infections. Both populations were older (hMPV 76.1 (10.6) vs. influenza 74.2 (10.9) years, SMD=0.18) and predominantly male (hMPV 96.7% vs. influenza 96.3%, SMD=0.02). The hMPV cohort had more pulmonary disease (42.2% vs 30.9%, SMD=0.25) and dementia (55.6% vs. 42.3%, SMD=0.26) compared to influenza cohort. The propensity matching identified 130 hMPV and 601 influenza residents that were well matched. proportional hazard model on the propensity matched cohort found equivocal hazard for hospitalization (adjusted HR 0.91 (0.55, 1.50)), death (adjusted HR 1.03 (0.61, 1.75)), and the combined outcome (adjusted HR 0.92 (0.61, 1.33)). Conclusion When hMPV develops in nursing home residents, the outcomes of hospitalization and death are comparable to influenza. Increased awareness of hMPV and appropriate point of care testing are needed to accurately detect hMPV and implement infection control measures. Additional studies are needed to better understand epidemiology, prevention, and treatment of hMPV in especially high-risk nursing home residents. Funded by Icosavax, a member of the AstraZeneca Group Disclosures Yasin Abul, MD, Moderna: Grant/Research Support|Moderna, Abt, CDC: Grant/Research Support Kevin McConeghy, Pharm.D., Genentech: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Sanofi-Pasteur: Grant/Research Support|Seqirus: Grant/Research Support Stefan Gravenstein, MD, MPH, CDC: Advisor/Consultant|CDC: Grant/Research Support|Genentech: Advisor/Consultant|Genentech: Grant/Research Support|Genentech: Honoraria|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|GlaxoSmithKline: Honoraria|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Janssen: Honoraria|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Moderna: Honoraria|NIH: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Sanofi: Advisor/Consultant|Sanofi: Grant/Research Support|Sanofi: Honoraria|Seqirus: Advisor/Consultant James L. Rudolph, MD, Icosavax / AstraZeneca: Grant/Research Support

  PublisherDOI

• Depressive Symptoms Before and During the COVID‐19 Pandemic in Veteran Nursing Home Residents

  International Journal of Geriatric Psychiatry · 2025-06-01 · 1 citations

  article

  OBJECTIVES: Infection control measures in the Department of Veterans Affairs Community Living Centers (CLCs), analogous to nursing homes, during the COVID-19 pandemic may have impacted residents' mental health. The purpose of this study was to examine changes in depressive symptoms before and during the COVID-19 pandemic in CLC residents. METHODS: This cross-sectional national cohort study evaluated depressive symptoms in Veteran CLC residents from geographically diverse CLCs across four 9-month periods of the COVID-19 pandemic: pre (before COVID-19), early (before vaccine), mid (before booster), and late (after booster). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9), a standardized depression assessment, which is a required measure in the Minimum Data Set (MDS). We computed change in PHQ-9 scores from the initial to the last PHQ-9 assessment for each pandemic period. We also performed a focused analysis of residents with a past year depression diagnosis. RESULTS: The overall sample comprised 47,755 Veteran CLC residents, 43% percent (n = 20,554) of whom had a depression diagnosis. The overall cohort mean PHQ-9 scores were similar across pandemic periods (pre = 2.64, early = 2.48, mid = 2.61, late = 2.45). There was intra-resident decline in PHQ-9 during each period which was statistically, but not clinically significant (pre = -0.54, early = -0.47, mid = -0.55, late = -0.49). Residents with a depression diagnosis followed a similar pattern for scores and decline in the periods compared with the full sample. PHQ-9 average scores indicated minimal depression even among those with a depression diagnosis, limiting ability to detect changes over time. CONCLUSIONS: For CLC residents during the COVID-19 pandemic, PHQ-9 scores were not meaningfully different between time periods. Characteristics of the study (e.g., sample/setting) or of older adults generally (e.g., resilience) may explain the low rates of depression.

  PublisherDOI

• Choose Home: Effectiveness and Acceptability of a Novel Geriatric Home-based Program

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Older Veterans prefer to ‘age in place’ in their homes/communities. However, complex, chronic medical conditions and limited resources put Veterans at risk for avoidable acute care use and long-term institutionalization. VA Boston Healthcare System developed Choose Home, an interdisciplinary, home-based program that provides intensive, short-term support via telephone and in-home medical and psychosocial case management. The program is designed to stabilize high-risk Veterans in their homes, promoting independence and connecting them to needed services. To evaluate the program’s impact from Veterans’ and their caregivers’ perspectives, we collected anonymous surveys at program discharge (n = 68) and conducted in-depth, semi-structured interviews with 12 Veterans (including 8 caregivers). 84% (n = 57) of Veterans/caregivers felt they were doing better at home after program participation, 90% (n = 61) felt better able to manage their care independently, and 88% (n = 60) felt satisfied with the program. We used thematic analysis to identify key programmatic outcomes from Veterans’ viewpoints, including: 1) independence/aging in place, via providing supports that allow Veterans to maintain autonomy and dignity; (2) holistic care during health crises, by offering coordinated support to help Veterans and families navigate overwhelming medical events; (3) caregiver empowerment, through education, respite, and practical assistance to mitigate burnout. Veterans’ perceptions of how Choose Home impacted their trajectory provide important insights into the program’s mechanisms of success which are essential for sustainment and scalability. Findings reflect the perceived effectiveness and acceptability of the program and highlight the value of integrated, community-based care models in enhancing the well-being and autonomy of Veterans and their caregivers.

  PublisherOA PDFDOI

• Social Connectedness and Successful Nursing Home Discharge After Heart Failure Hospitalization

  Journal of the American Medical Directors Association · 2025-09-02 · 1 citations

  articleOpen access

  OBJECTIVES: Social connectedness is associated with positive health outcomes. Patients discharged to skilled nursing facilities (SNFs) after heart failure (HF) hospitalization face a high risk of hospital readmission, but the association between social connectedness and successful discharge from postacute SNF care is unknown. This study aimed to quantify the association between social connectedness and successful discharge from postacute SNF care among veterans with HF. DESIGN: This retrospective cohort study's primary outcome was successful discharge, defined as discharge to the community within 90 days of admission to the SNF, and survival 30 days after discharge without hospitalization or institutionalization. Social connectedness was measured by the Social Connectedness Index [SCI, range 0-5: binarized into low (SCI = 0-4) or high social connectedness (SCI = 5)]. SETTING AND PARTICIPANTS: Veterans admitted to a Department of Veterans Affairs Medical Center for HF and subsequently discharged to a SNFs between January 2011 and June 2019. METHODS: We estimated the association of high SCI with successful discharge using a modified Poisson regression with robust error variance. RESULTS: A total of 29,725 veterans were included. Veterans with high social connectedness (SCI = 5) in SNF settings were more likely to have successful discharge than those with lower social connectedness [adjusted relative risk (95% CI): 1.21 (1.13-1.31)]. This association was seen in patients with Alzheimer disease or Alzheimer disease and related dementias (AD/ADRD) [1.32 (1.16-1.49)] and without ADRD [1.14 (1.04-1.25)] cohorts. CONCLUSIONS AND IMPLICATIONS: Veterans with HF who were more socially connected in the SNF setting had higher rates of successful discharge than those with lower social connectedness. Low social connectedness may be an indicator of care needs that make discharge from SNF to home more challenging. Clinical social isolation measurement may be a useful tool in identifying successful discharge candidates.

  PublisherOA PDFDOI

• Post‐Hospitalization Outcomes for Veterans Receiving Age‐Friendly Health Systems <scp>4M</scp> Care

  Journal of the American Geriatrics Society · 2025-10-16

  articleOpen access

  BACKGROUND: The Age-Friendly Health System movement has been building teams and systems to implement the assessment of the "4Ms" (What Matters, Medications, Mobility, and Mentation). Although each of the 4Ms is an evidence-based practice, the reporting of outcomes for people who receive the assessment of all 4Ms has been limited. METHODS: This retrospective matched cohort study included Veterans admitted to six VA medical centers implementing inpatient assessment of the 4Ms from January 2022 to December 2024. Using electronic health records, we identified a cohort of Veterans admitted to inpatient wards and with documented assessment of the 4Ms. Propensity score matching was used to select a matched cohort without complete 4M assessments. The matching algorithm required matching on facility, admission quarter, and year in addition to a propensity score based on covariates including demographics and comorbidities. We selected the AFHS outcomes of 30-day readmission, emergency department use, and mortality. We used Kaplan-Meier methods to estimate cumulative incidence of outcomes and Cox proportional hazard models to estimate hazard ratios. RESULTS: The propensity matching analysis resulted in 2420 Veterans with 4Ms care and 4688 matched Veterans without (mean age 79 years, 97% male). The matched groups were well balanced. AFHS care with the 4Ms was associated with reduced hazard for readmission (HR 0.67, 95% CI 0.62-0.73) and statistically similar hazard for ED visits in 30 days (HR 0.95, 95% CI 0.82-1.13) and mortality (HR 1.02, 95% CI 0.86-1.21). Results were similar when restricting to those with dementia and excluding those with any of the 4Ms assessments in the control group. CONCLUSIONS: In this retrospective cohort study, AFHS care including assessment of the 4Ms was associated with reduced readmission without changes in emergency department visits or mortality. The results support the effort of implementing AFHS evidence-based practices into inpatient care sites.

  PublisherOA PDFDOI

• Cardiovascular outcomes of patients transitioned from ibrutinib to an alternate bruton tyrosine kinase inhibitor for hypertension and/or cardiovascular adverse events

  Blood · 2025-11-03

  article

  Abstract Introduction: Bruton tyrosine kinase inhibitors (BTKi) are highly efficacious oral agents FDA-approved for treatment of specific B-cell malignancies. BTKi are generally administered until disease progression, intolerable toxicity, or death. The emergence of cardiovascular adverse events (CVAE) including hypertension (HTN), arrhythmias, heart failure, and sudden death have limited the use of ibrutinib (Ibr), the first-in-class BTKi FDA-approved in 2013. Hypertension (HTN) is a frequent and cumulative toxicity of Ibr that is associated with increased risk of major adverse cardiac events. Alternate covalent BTKi (acalabrutinib, zanubrutinib) and non-covalent BTKi (pirtobrutinib) have lower rates of CVAE in clinical trials compared with Ibr. The objective of this study was to analyze the real-world incidence of HTN and CVAE in patients (pts) on Ibr and the outcome of pts with new or worsening HTN on Ibr who were then transitioned to an alternate BTKi. Methods: We conducted a retrospective electronic medical record review of pts with hematologic malignancies treated with Ibr from January 2013 to July 2024 at the University of Pennsylvania. Blood pressure (BP), cardiovascular medications, comorbidities, and CVAE were analyzed prior to Ibr (baseline), while on Ibr, and while on subsequent BTKi (acalabrutinib, zanubrutinib, or pirtobrutinib). Eligible pts had at least 3 BP measurements available during each of the following periods: 1) within 12 months of Ibr initiation; 2) while on Ibr; and 3) while on subsequent BTKi. All available BP values were used to calculate medians and means for each therapy period. HTN was defined as elevated systolic BP (SBP) ≥130 and/or diastolic BP (DBP) ≥80 on more than one occasion with physician confirmation of the diagnosis. Worsening HTN was defined as pts with antecedent HTN with an increase in the number or doses of prescribed antihypertensives. Graphpad/R 4.4.0 were used for statistical analysis. Results: A total of 114 pts received Ibr for 408.7 patient-years and 77 (68%) of pts had CLL. The median age was 67 (range 27-86) and 81 (71%) pts were men. On Ibr, 109 (96%) pts had systolic HTN and 100 (88%) had diastolic HTN. Across all BTKi, 74 (65%) pts had a CVAE. CVAE led to Ibr discontinuation in 58 (51.5%) pts, including HTN (n = 20, 18%), atrial fibrillation (n = 25, 22%), other arrhythmia (n = 1, 0.9%), palpitations (n = 2, 1.8%) and hemorrhage (n = 10, 8.8%). Among all pts on Ibr, 67 (59%) had either new onset HTN (n = 49, 43%) or developed worsening HTN with an increase in anti-HTN medications (n = 18, 16%). The median time on Ibr to first elevated SBP and maximum SBP were 32 (95% CI: 24 – 49) and 342 (95% CI: 229 – 604) days, respectively. The median time on Ibr to first elevated DBP and maximum DBP were 114 (95% CI: 83 –199) and 335 (95% CI: 250 – 465) days, respectively. Among the 109 pts with HTN on Ibr, transition to acalabrutinib (n = 67, 61%) or zanubrutinib (n = 33, 20%) resulted in a mean reduction in SBP of -9 mm/Hg (95%CI: -13 to -5.1) and -6 mm/Hg (95%CI: -11 to -0.8), respectively, without a change in number of antihypertensive medications. There were no observed differences in SBP, DBP, or the number of anti-HTN medications among pts with HTN on Ibr who transitioned to pirtobrutinib (n = 9, 8%). Among pts with HTN on Ibr, 45 (41.3%) had resolution of HTN with a median time to resolution (mTTR) of 2,277 days (95% CI: 1,996 – 2,463), although this time estimate is biased by infrequent follow-up. Among 55 pts with documented HTN on Ibr who transitioned to acalabrutinib, 20 (36.4%) had resolution of HTN with mTTR of 1,463 days (95% CI: 976 – NE). Among pts with documented HTN on Ibr who transitioned to zanubrutinib (n = 26) and pirtobrutinib (n = 8), HTN resolved in 8 (30.8%) and 2 (25%) with mTTRs of 683 (95%CI: 606 – NE) and NR (95%CI: 158 – NE) days, respectively. Conclusion: BTKi are associated with increased risk of CVAE; 43% of pts on Ibr developed new onset HTN and 52% of pts discontinued Ibr due to a CVAE. Among pts with HTN on Ibr, transition to alternate covalent BTKi was associated with a reduction in mean SBP as well as resolution of HTN, in some patients, without an increase in number or dose of antihypertensive medications. Despite the development of HTN on Ibr, BP can improve after replacing Ibr with an alternate BTKi.

  PublisherDOI

Recent grants

• Greater Boston Medical Student Training in Aging Research

  NIH · $991k · 2010–2025

• Evaluation of Veteran-Directed Home and Community Based Services

  NIH · 2017–2020

• NIH Grant R03AG029861

  NIH · $112k · 2010

Frequent coauthors

• Edward R. Marcantonio

  Harvard University

  299 shared

• Wen‐Chih Wu

  Brown University

  244 shared

• Sebhat Erqou

  Providence VA Medical Center

  215 shared

• Sharon K. Inouye

  Beth Israel Deaconess Medical Center

  213 shared

• Richard N. Jones

  Butler Hospital

  209 shared

• Stefan Gravenstein

  Brown University

  128 shared

• Andrew R. Zullo

  Brown University

  123 shared

• Frances M. Yang

  University of Kansas Medical Center

  115 shared