About

Timothy W. Farrell, MD, AGSF, is the Presidential Endowed Chair in the Division of Geriatrics and a Professor of Medicine and Geriatrics Division at the Spencer Fox Eccles School of Medicine at the University of Utah. He also serves as Associate Chief for Age-Friendly Care at the same institution and is a Physician Investigator at the VA Salt Lake City Geriatric Research, Education, and Clinical Center. Dr. Farrell received his A.B. from Dartmouth College and his M.D. from the University of Massachusetts Medical School, followed by family medicine residency and geriatric medicine training at Brown University. His academic interests include age-friendly health systems, medical ethics, unrepresented older adults, transitions of care, and interprofessional education and practice. He has received recognition such as the HRSA Geriatric Academic Career Award (GACA) and has held leadership roles including Chair of the American Geriatrics Society (AGS) Ethics Committee and Co-Chair of the AGS Tideswell Leaders in Aging Special Interest Group. Dr. Farrell has contributed to medical ethics through leading position statements on socially isolated older adults and ethical allocation of healthcare resources during the COVID-19 pandemic. He is actively involved in efforts to oppose ageism and has led initiatives to advance age-friendly care, including the successful application for Age-Friendly Care Excellence Status at University of Utah Health.

Research topics

• Medicine
• Gerontology
• Economic growth
• Political Science
• Business
• Economics
• Medical education
• Management
• Law
• Nursing
• Psychiatry
• Family medicine
• Marketing
• Actuarial science
• Psychology

Selected publications

• Navigating a Geriatrics Academic Career in Uncertain Times: Collective Resilience, Persistence, and the Value of Community

  Journal of the American Geriatrics Society · 2026-04-08

  articleOpen accessSenior author
  PublisherDOI

• Exploring the intersection of structural racism and ageism in healthcare

  UNC Libraries · 2025-04-17

  articleOpen access

  The American Geriatrics Society (AGS) has consistently advocated for a healthcare system that meets the needs of older adults, including addressing impacts of ageism in healthcare. The intersection of structural racism and ageism compounds the disadvantage experienced by historically marginalized communities. Structural racism and ageism have long been ingrained in all aspects of US society, including healthcare. This intersection exacerbates disparities in social determinants of health, including poor access to healthcare and poor outcomes. These deeply rooted societal injustices have been brought to the forefront of the collective public consciousness at different points throughout history. The COVID-19 pandemic laid bare and exacerbated existing inequities inflicted on historically marginalized communities. Ageist rhetoric and policies during the COVID-19 pandemic further marginalized older adults. Although the detrimental impact of structural racism on health has been well-documented in the literature, generative research on the intersection of structural racism and ageism is limited. The AGS is working to identify and dismantle the healthcare structures that create and perpetuate these combined injustices and, in so doing, create a more just US healthcare system. This paper is intended to provide an overview of important frameworks and guide future efforts to both identify and eliminate bias within healthcare delivery systems and health professions training with a particular focus on the intersection of structural racism and ageism.

  PublisherDOI

• Implementation of Care Management: An Analysis of Recent AHRQ Research

  UNC Libraries · 2025-07-24

  articleOpen access

  Care management (CM) is a promising team-based, patient-centered approach "designed to assist patients and their support systems in managing medical conditions more effectively." As little is known about its implementation, this article describes CM implementation and associated lessons from 12 Agency for Healthcare Research and Quality-sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s). Successful implementation was characterized by resource availability (both monetary and nonmonetary), identifying as well as training employees with the right technical expertise and interpersonal skills, and embedding CM within practices. Our findings facilitate future context-specific implementation of CM within medical homes. They also inform the development of medical home recognition programs that anticipate and allow for contextual variation.

  PublisherDOI

• Users’ perspectives on a demonstration to increase shared access to older adults’ patient portals

  BMC Health Services Research · 2025-04-23

  articleOpen access

  BACKGROUND: Many patient portals allow patients to authorize a care partner to use the portal on their behalf, with evidence suggesting a range of benefits to patients, care partners, and clinicians. Shared or proxy access aligns with patient- and family-centered care and supports care partners' legitimacy and identification by clinicians in patient portal interactions. As shared access uptake remains low, the Coalition for Care Partners ( https://coalitionforcarepartners.org ) and three healthcare delivery organizations co-designed an initiative promoting shared access to the patient portals of older adults. OBJECTIVE: To evaluate an initiative's demonstration through users' perspectives. DESIGN: The 12-month demonstration was launched at five clinics (geriatric oncology, primary care, and geriatric medicine) across the three organizations. Clinicians and staff were interviewed mid- and post-demonstration via focus groups and individually; clinic patients and care partners responded to an anonymous post-demonstration online portal survey. PARTICIPANTS: Demonstration users included established patients from the five clinics and their care partners, as well as clinic physicians, nurses, social workers, care managers, patient-facing staff, administrators, and information technology specialists. APPROACH: We followed the Consolidated Framework for Implementation Research to develop interview guides and inform our analysis of the survey's open-ended responses and interview transcripts. We analyzed 11 focus groups, 10 individual interviews, and 392 patients' and 79 care partners' survey responses employing rapid assessment procedures methodology. KEY RESULTS: The demonstration was appropriate, useful, routinized in the clinics, and well received by patients and care partners. The demonstration was perceived as undemanding and low-cost, utilizing existing infrastructure and organizational processes. Facilitators included alignments of shared access with clinics' practice and philosophy, organizations' policies, and needs of patients and care partners. Identified barriers included clinicians' competing priorities and patients' and care partners' low awareness and motivation for using shared access. CONCLUSIONS: The Coalition for Care Partners can spread this appropriate, useful, undemanding, and low-cost initiative. Further efforts might be supported by policies that ensure that shared access benefits are bolstered, potential harms of unidentifiable access are emphasized, and registration is conceptualized as an opt-out versus opt-in process.

  PublisherOA PDFDOI

• Overcoming challenges to integration of oral health into geriatric primary care

  Exploration of Medicine · 2025-01-23 · 2 citations

  articleOpen access

  The Age-Friendly Health System movement has been a unifying factor in caring for older adults at the University of Utah Health. Despite progress, challenges to efficient healthcare collaboration exist, particularly between geriatric primary care and oral health. This manuscript presents four of those challenges (lack of communication between medical and dental providers, the distance between medical and dental services, patient discomfort with the inclusion of oral health in primary health care, and provider discomfort in requesting oral health information in medical encounters) with the solutions derived at the University of Utah Health. Leaders at University of Utah Health developed five interventions to address these challenges (participation in the development of EPIC Wisdom©, a fully integrated oral health record in the electronic health record (EHR), co-location in new centers and oral health consultation in existing centers, implementing a geriatric health assessment that included oral health, widespread adoption of the 4 Ms framework). Applying the lessons learned from these challenges can benefit all older adults and may help prevent the conditions associated with periodontal disease.

  PublisherOA PDFDOI

• A Multisite Demonstration of Shared Access to Older Adults’ Patient Portals

  JAMA Network Open · 2025-02-25 · 6 citations

  articleOpen access

  Importance: The patient portal has a growing role in health care. Many health systems have implemented shared access functionality in which patients may register a care partner with unique identity credentials to access their portal. Uptake of shared access has been limited. Objective: To examine the outcomes of a multisite demonstration involving organizational strategies associated with registration and use of patient portal shared access. Design, Setting, and Participants: This quality improvement study was conducted in diverse sites within 3 health systems in the US: (1) geriatric oncology, (2) geriatric medicine, and (3) primary care. Patients aged 65 years or older with 1 or more visits during the 12-month demonstration period (July 1, 2022, through July 1, 2023, for sites 1 and 2; site 3 was delayed 3 months) and care partners who used the portal accounts of patients meeting these criteria were included. The 6-month postdemonstration period (August 1, 2023, through January 1, 2024) was compared with the 6-month predemonstration period (January 1 through June 1, 2022). Exposures: Organizational strategies (brochures, webpages, tip sheets, and implementation toolkits created using a human-centered design) to encourage shared access registration and use. Main Outcomes and Measures: Portal registration and use (logins, laboratory results viewed, clinical notes viewed, visits scheduled) by type of access (patient and care partner) from electronic health record data were examined. Patient- and care partner-reported awareness and use of shared access were measured using a postdemonstration survey. Results: A total of 16 005 patients from the 3 sites met the inclusion criteria (84.8% younger than 85 years and 61.5% women). Most patients had an activated portal account (91.0%) and logged in at least once (84.8%) during the 24 months spanning the demonstration and pre- and postdemonstration periods. New portal registrations were stable, but nonsignificant for shared access (110 of 14 758 [0.7%] vs 91 of 14 016 [0.6%]) and significantly decreased for patient access (677 of 3158 [21.5%] vs 225 of 1520 [13.2%]). Use of shared access before vs after the demonstration increased for number of logins (mean [SD], 5.9 [11.4] vs 6.8 [14.1]), laboratory results viewed (mean [SD], 0.7 [2.7] vs 1.1 [3.7]), clinical notes viewed (mean [SD], 0.2 [1.1] vs 0.6 [3.2]), and visits scheduled (mean [SD], 0.8 [10.8] vs 1.0 [5.4]). Of the 91 care partners reporting portal use in the postdemonstration survey, 48 (52.7%) indicated primarily using patient credentials and 31 (34.1%) indicated primarily using their own credentials. Less than one-half of patients (721 of 1664 [43.3%]) stated being aware of shared access. Conclusions and Relevance: These findings show no association of the multisite demonstration with increased new registrations for shared access and only modest increases in portal use among care partners of older adults. As portal use expands to encompass legal documentation, medical decision-making, and patient education, policies to support proper use of identity credentials are needed.

  PublisherOA PDFDOI

• The Age‐Friendly Learning Healthcare System: Replicating electronic health record based documentation metrics for <scp>4Ms</scp> care

  Journal of the American Geriatrics Society · 2024-12-13 · 1 citations

  articleOpen access

  BACKGROUND: University of Utah Health (UUH) is an academic medical center that achieved "committed to care excellence" in age-friendly care in 2021 and has a long-standing culture of quality improvement central to a learning health system. University of California San Francisco (UCSF) developed electronic health record (EHR) documentation metrics for inpatient assessment of the 4Ms (What Matters, Medication, Mentation, and Mobility) based on the Institute for Healthcare Improvement's recommended care practice for an Age-Friendly Healthcare System. In partnership with UCSF, we replicated the assessment and action EHR metrics with local adaptations for each of the 4Ms at UUH. METHODS: The UCSF team shared 4Ms documentation metrics and Structured Query Language code used to assess 4Ms care at UCSF. At UUH, this code was adapted for a different relational database management system and local clinical context. We assessed 4Ms care, individual M, and composite measures of all 4Ms, for all patients aged 65 and older admitted to UU Hospital between January 1, 2019 and December 31, 2021. We conducted a clinical validation of individual patient cases to confirm accuracy of 4Ms queries. RESULTS: In the 3-year study period, 16,489 qualifying patients, mean age 74.2, were admitted to UU Hospital in a total of 25,070 admissions with mean length of stay of 6.08 days. We were able to replicate 14 of the 16 EHR metrics of individual 4Ms developed at UCSF and five composite measures. For the composite measure addressing completeness of 4Ms care, 50% of patient encounters had all 4Ms administered during their encounter. CONCLUSION: Indicators of the completeness of 4Ms care can be measured using EHR data to validate implementation of the 4Ms at multiple academic medical centers. Key lessons to support future scaled-up assessments include the importance of adapting EHR measures to local activities and involving expert data analysts.

  PublisherOA PDFDOI

• Reviewer #1 (Public Review): The antigenic landscape of human influenza N2 neuraminidases from 2009 until 2017

  2024-04-11

  peer-reviewOpen access

  Human H3N2 influenza viruses are subject to rapid antigenic evolution which translates into frequent updates of the composition of seasonal influenza vaccines. Despite these updates, the effectiveness of influenza vaccines against H3N2-associated disease is suboptimal. Seasonal influenza vaccines primarily induce hemagglutinin-specific antibody responses. However, antibodies directed against influenza neuraminidase (NA) also contribute to protection. Here, we analyzed the antigenic diversity of a panel of N2 NAs derived from human H3N2 viruses that circulated between 2009 and 2017. The antigenic breadth of these NAs was determined based on the NA inhibition (NAI) of a broad panel of ferret and mouse immune sera that were raised by infection and recombinant N2 NA immunization. This assessment allowed us to distinguish at least 4 antigenic groups in the N2 NAs derived from human H3N2 viruses that circulated between 2009 and 2017. Computational analysis further revealed that the amino acid residues in N2 NA that have a major impact on susceptibility to NAI by immune sera are in proximity of the catalytic site. Finally, a machine learning method was developed that allowed to accurately predict the impact of mutations that are present in our N2 NA panel on NAI. These findings have important implications for the renewed interest to develop improved influenza vaccines based on the inclusion of a protective NA antigen formulation.

  PublisherOA PDFDOI

• American Geriatrics Society position statement: Making medical treatment decisions for unrepresented older adults

  Journal of the American Geriatrics Society · 2024-11-30 · 6 citations

  articleOpen accessSenior authorCorresponding

  This paper is an official position statement of the American Geriatrics Society (AGS) and updates the 2017 AGS position statement, Making Medical Treatment Decisions for Unbefriended Older Adults. In this updated position statement, the term "unbefriended" is replaced by "unrepresented" as a term that is more value-neutral, more accurately describes the circumstance in which a person without medical decision-making capacity does not have recognized surrogate representation, and better aligns with increasingly preferred terminology as reflected in recent medical literature. We define unrepresented older adults as those who (1) lack decisional capacity to provide informed consent for a particular medical treatment, (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so, and (3) lack representation from a surrogate decision-maker (i.e., family, friend, or legally authorized surrogate). Making medical decisions on behalf of unrepresented older adults is exceptionally challenging and, given demographic trends, is likely to become increasingly common in the years ahead. The process of arriving at treatment decisions for this population should follow standards of procedural fairness and include capacity assessment, search for potential surrogates, team-based efforts to determine the patient's values and preferences, and steps to guard against bias. Proactive measures are needed to identify older adults at risk for becoming unrepresented. This position statement also calls for national efforts to reduce state-to-state variability in legal approaches for unrepresented patients.

  PublisherDOI

• Author response: The antigenic landscape of human influenza N2 neuraminidases from 2009 until 2017

  2024-04-11

  peer-reviewOpen access

  Human H3N2 influenza viruses are subject to rapid antigenic evolution which translates into frequent updates of the composition of seasonal influenza vaccines. Despite these updates, the effectiveness of influenza vaccines against H3N2-associated disease is suboptimal. Seasonal influenza vaccines primarily induce hemagglutinin-specific antibody responses. However, antibodies directed against influenza neuraminidase (NA) also contribute to protection. Here, we analyzed the antigenic diversity of a panel of N2 NAs derived from human H3N2 viruses that circulated between 2009 and 2017. The antigenic breadth of these NAs was determined based on the NA inhibition (NAI) of a broad panel of ferret and mouse immune sera that were raised by infection and recombinant N2 NA immunization. This assessment allowed us to distinguish at least 4 antigenic groups in the N2 NAs derived from human H3N2 viruses that circulated between 2009 and 2017. Computational analysis further revealed that the amino acid residues in N2 NA that have a major impact on susceptibility to NAI by immune sera are in proximity of the catalytic site. Finally, a machine learning method was developed that allowed to accurately predict the impact of mutations that are present in our N2 NA panel on NAI. These findings have important implications for the renewed interest to develop improved influenza vaccines based on the inclusion of a protective NA antigen formulation.

  PublisherDOI

Frequent coauthors

• Ramona L. Rhodes

  The University of Texas Southwestern Medical Center

  43 shared

• Jorie Butler

  University of Utah

  31 shared

• P. Aiden McCormick

  30 shared

• Diarmuid O’Donoghue

  National University of Ireland, Maynooth

  28 shared

• Ursula K. Braun

  Baylor College of Medicine

  25 shared

• Tony Rosen

  NewYork–Presbyterian Hospital

  24 shared

• Caroline A. Vitale

  University of Michigan–Ann Arbor

  22 shared

• Andrada Tomoaia‐Cotisel

  Frederick S. Pardee RAND Graduate School

  21 shared

Education

• B.A.

  Dartmouth College

• M.D.

  University of Massachusetts Medical School

• Other, family medicine residency and geriatric medicine training

  Brown University

Awards & honors

• HRSA Geriatric Academic Career Award (GACA)
• 2016-17 Leadership Scholar by the Tideswell/AGS/ADGAP Emergi…
• AGS position statement on socially isolated "unbefriended" o…
• AGS position statement and companion manuscript regarding et…