Stefan Gravenstein Professor of Medicine, Professor of Health Services, Policy and Practice, Adjunct Professor of Health Services, Policy and Practice

Geriatrician, formerly John Franklin Chair of Geriatrics and Director of the Glennan Center for Geriatrics and Gerontology at Eastern Virginia Medical School (1996-2007), now Associate Division Chief for Geriatrics at University Medicine. Dr. Gravenstein has a long-standing interest in immunity, inflammation and aging especially in the context of influenza and nursing home care, and the topic of the majority of his publications. He also has a specific interest in quality improvement in health care, the culture of care, and how to improve care across care transitions. He is Clinical Director at Quality Partners of Rhode Island, Medicare's Quality Improvement Organization for Rhode Island, where he works with a team to improve patient safety and care transitions. At Brown he works with the Department of Community Health (Mor, PI; Gozalo) and Pop-Vicas on evaluating the impact of influenza vaccine on outcomes in long-term care.

Brown Affiliations

Research Areas

scholarly work

67. Schilling M, Gravenstein S, Drinka P, Cox N, Krause P, Povinelli L, Shult P. Emergence and transmission of Amantadine-resistant Influenza A in a nursing home, J Am Geriatr Soc; 52(12):2069-73, 2004

91. High, K. P., S. F. Bradley, Gravenstein S, et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc 57(3): 375-94, 2009. PMID: 19278394

89. Pop-Vicas A, Tacconelli AE, Gravenstein S, et al. Influx of multidrug-resistant, gram-negative bacteria in the hospital setting and the role of elderly patients with bacterial bloodstream infection. Infect Control Hosp Epidemiol 30(4): 325-31, 2009. PMID: 19220162

88. High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, Yoshikawa TT. Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities. Update by the Infectious Diseases Society of America. Clin Infect Dis 48(2): 149-71, 2009. PMID: 19072244

90. Harper SA, Bradley, JS, Englund JA, File TM, Gravenstein S, et al. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 48(8): 1003-32, 2009. PMID: 19281331

92. Han LF, Davidson HE, Gravenstein S. Steps to managing difficult behavior in people with dementia. Med Health R I. May;92(5):182-4, 2009.

87. Falsey AR, Walsh EE, Capellan J, Gravenstein S, Zambon M, Yau E, Gorse GJ, Edelman R, Hayden FG, McElhaney JE, Neuzil KM, Nichol KL, Simões EA, Wright PF, Sales VM. Comparison of the Safety and Immunogenicity of 2 Respiratory Syncytial Virus (RSV) Vaccines- Nonadjuvanted Vaccine or Vaccine Adjuvanted with Alum-Given Concomitantly with Influenza Vaccine to High-Risk Elderly Individuals. J Infect Dis. 198(9):1317-1326, 2008. PMID: 18855558

85. Gravenstein S, Besdine R. Editorial: From Occam's Razor to Multimorbidity: Geriatrics Comes of Age. Aging Clin Exp Res. 2008 Jun;20(3):179-80. PMID: 18594182

83. Gravenstein S. Editorial: Initiating influenza chemoprophylaxis with the first influenza case—a new Institutional Standard? Clin Infect Dis. 2008 Jul 1;47(1):53-5. PMID: 18484877

84. Baier RR, Butterfield K, Harris Y, Gravenstein S. Aiming for star performance: the relationship between setting targets and improved nursing home quality of care. J Am Med Dir Assoc. 2008 Oct;9(8):594-8. Epub 2008 Sep 7.

86. Kacergius T, Ambrozaitis A, Deng Y, Kuhn NS, Gravenstein S. Interferon-gamma augments cytotoxicity in influenza virus-infected RAW 264.7 and AMJ2-C11 macrophages by upregulating the expression of inducible nitric oxide synthase. ACTA Med Lituanica. 15(2):76-80, 2008.

81. Ershler W, Gravenstein S, Geloo Z. "Thymosin Alpha 1 as an Adjunct to Influenza Vaccination in the Elderly: Rationale and Trial Summaries." Ann N Y Acad Sci., 1112:375-84, 2007. PMID: 17600281

79. Jing Y, Gravenstein S, Rao Chaganty N, Chen N, Lyerly, KH, Joyce S, Deng Y. Aging is associated with a rapid decline in frequency, alterations in subset composition, and enhanced Th2 response in CD1d-restricted NKT cells from human peripheral blood. Exp Gerontol 42(8): 719-32, 2007. PMID: 17368996

80. Bluestein D, Brantley C, Barnes-Eley M, Gravenstein S, Basta S. "Measuring international normalized ratios in long-term care: a comparison of commercial laboratory and point-of-care device results." J Am Med Dir Assoc 8(6): 404-8, 2007. PMID: 17619039

82. Gravenstein S. Nursing homes: introduction. Med Health RI. 90(7):204, 2007. PMID: 17711076

78. Kačergius T, Ambrozaitis A, Deng Y, Gravenstein S. Neuraminidase inhibitors reduce nitric oxide production in influenza virus-infected and gamma interferon-activated RAW 264.7 macrophages. Pharmacol Rep 58(6):924-39, 2006. PMID: 17220551

77. Drake RR, Deng Y, Schwegler EE, Gravenstein S. Proteomics for biodefense applications: progress and opportunities, Expert Rev Proteomics, 2(2):203-13 2005. PMID: 15892565

75. Ambrozaitis A, Gravenstein S, van Essen GA, Rubinstein E, Balciuniene L, Stikleryte A, Crawford C, Elliott M, Shult P. Inhaled zanamivir versus placebo for the prevention of influenza outbreaks in an unvaccinated long-term care population. J Am Med Dir Assoc. 6(6):367-74, 2005.

74. Gravenstein S, Drinka P, Osterweil D, Schilling M, Krause P, Elliott M, Shult P, Ambrozaitis A, Kandel R, Binder E, Hammond J, McElhaney J, Flack N, Daly J, Keene O. Inhaled zanamivir versus rimantadine for the control of influenza in a highly-vaccinated long-term care population. J Am Med Dir Assoc, 6(6):359-66, 2005.

72. Drinka P, Krause P, Nest L, Goodman B, Gravenstein S. Risk of acquiring influenza B in a nursing home from a culture-positive roommate. J Am Geriatr Soc., 53(8):1437, 2005.

70. Drake RR, Deng Y, Schwegler EE, and Gravenstein S. Proteomics for biodefense applications: progress and opportunities Expert Rev Proteomics. 2(2):203-13, 2005.

69. Freund, B., Gravenstein, S., Ferris, R., Burke, B., Shaheen, E. Drawing Clocks and Driving Cars: Use of Brief Tests of Cognition to Screen Driving Competency in Older Adults. Journal of General Internal Medicine, 20(3):240-4, 2005.

71. Gravenstein, S. Impact of influenza vaccination on seasonal mortality in the U.S. population. Consult Pharm, 20(6):530-1, 2005.

76. Drake RR, Deng Y, Schwegler EE, Gravenstein S. Proteomics for biodefense applications: progress and opportunities, Future Drugs Ltd, p 1-11, 2005.

68. Artz AS, Fergusson D, Drinka PJ, Gerald M, Gravenstein S, Lechich A, Silverstone F, Finnigan S, Janowski MC, McCamish MA, Ershler WB. Prevalence of anemia in skilled-nursing home residents. Arch Gerontol Geriatr, 39(3):201-6, 2004.

65. Freund, B., and Gravenstein, S. Recognizing and Evaluating Potential Dementia in the Office Setting. Clin Geriatr Med, 20 (1), 1-14, 2004.

63. Deng, Y, Jing Y, Campbell AE, Gravenstein S. Age-related impaired type 1 T cell responses to influenza: reduced activation ex vivo, decreased expansion in CTL culture in vitro, and blunted response to influenza vaccination in vivo in the elderly. J Immunol 172(6): 3437-46, 2004. PMID: 15004143

62. McElhaney JE, Gravenstein S, Cole SK, Davidson E, O'Neill D, Petitjean S, Rumble B, Shan J. A placebo-controlled trial of a proprietary extract of North American Ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults. J Am Geriatr Soc., 52(1): 13-9, 2004.

64. Freund B, Gravenstein S, Ferris R, Shaheen E. Clock drawing test tracks progression of driving performance in cognitively impaired older adults: case comparisons. Cl Ger, 12 (7); 33-6, 2004.

66. Brown AS, Begg MD, Gravenstein S, Schaefer CA, Wyatt RJ, Bresnahan M, Babulas VP, Susser ES. Serologic evidence for prenatal influenza in the etiology of schizophrenia. Archives of General Psychiatry (8):774-80, 2004.

61. Drinka PJ, Krause P, Nest L, Goodman BM, Gravenstein S. Risk of acquiring influenza A in a nursing home from a culture-positive roommate. Infect Control Hosp Epidemiol 24(11): 872-4, 2003.

60. Freund B, Gravenstein S. Recognizing and Evaluating Potential Dementia in the Office Setting. Clinics in Geriatric Medicine, 20 (1), 1-14, 2003.

58. Gravenstein S. Case Studies in Influenza: "An elderly woman with a cough." Inside Influenza, Vol. 2 No. 2, p 9, 2003.

57. Gravenstein S, Beier M, Singer C. Challenges in the management of psychotic symptoms in long-term care. Review. J Am Med Dir Assoc. 4(4 Suppl):H17-20, 2003.

59. Gravenstein S. Case Studies on Use of Tools. Inside Influenza, Vol. 3, No. 1, p 12, 2003.

73. Mitchell D, Ruben F, Gravenstein S. Immunogenicity and safety of inactivated influenza virus vaccine in young children in 2003/2004. Ped Infec Dis Jr, 24:925-927, 2005

56. Ramanathan RK, Potter DM, Belani CP, Jacobs SA, Gravenstein S, Lim F, Kim H, Savona S, Evans T, Buchbarker D, Simon MB, Depee JK, Trump DL. Randomized trial of influenza vaccine with granulocyte-macrophage colony-stimulating factor or placebo in cancer patients. J Clin Oncol Vol 20, (21) p 4313-8, 2002.

54. Drinka PJ, Krause P, Nest Lori, Gravenstein S, Goodman B, Shult P. Delays in the Application of outbreak control prophylaxis for Influenza A in a nursing home. Infect Control Hosp Epidemiol. Oct;23(10):600-3, 2002.

51. Gravenstein S, Edward Davidson HE. Current Strategies for Management of Influenza in the Elderly Population. Clinical Infectious Diseases. Clin Infect Dis. 15;35(6):729-37, 2002. (invited article)

55. Drinka P, Krause P, Nest L, Dissing M, Gravenstein S. The Effect of culture-positive influenza type A on resource utilization and adverse events in nursing home residents. J Am Geriatr Soc, 50:1416-20, 2002.

53. Freund B, Gravenstein S, Dobbs A, Ferris R. Clock drawing test (CDT) may predict on-road driving performance. J Amer Ger Soc, 49 (4), S113, 2001.

49. Gravenstein S, Johnson S, Loeschel E, Webster A. Zanamivir a review of clinical safety in individuals at high risk of developing influenza-related complications. Drug Safety 24(15):1113-25. Review, 2001.

48. Peters P, Gravenstein S, Norwood P, De Bock V, Van Couter A, Gibbens M, von Planta TA, Ward P. Long term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail elderly population. J Am Geriatr Soc, 49(8):1025-31, 2001.

46. McElhaney JE, Gravenstein S, Drinka P, Upshaw CM, Hooton JW, Krause P, and Bleackley RC. Granzyme B: a marker of risk for influenza in institutionalized older adults.. Vaccine, 19:3744-51, 2001.

45. Gravenstein S, Fowler C, Regan S. Controlling Influenza. Geriatric Times, Vol. 2, (1), Jan/Feb 2001.

47. Letter C, Gravenstein S, McElhaney JE. Influenza vaccination is less effective for stimulating a Granzyme B response in older adults. Options for the Control of Influenza IV, International Congress Series: 713-721, 2001.

50. Freund B., Gravenstein S, Ferris R., Shaheen E. Evaluating Driving Competence of Cognitively Impaired and Healthy Older Adults: A Pilot Study Comparing On-Road and Driving Simulation Performance. [Letter] J Am Geriatr Soc, 50:1309-10, 2001.

52. Freund B, Risser M, Cain C, Gravenstein S, Ferris R. Simulated driving performance associated with mild cognitive impairment in older adults. J Am Geriatr Soc, 49 (4), S152-152, 2001.

44. Monto A, Gravenstein S, Elliot M, Colopy M, Schweinle J. Clinical signs and symptoms predicting influenza infection. Arch Intern Med, 27;160(21):3243-7, 2000.

43. Drinka P, Gravenstein S, Krause P, Langer E H,Barthels L, Dissing M, Shult P. Re-introduction of influenza A to a nursing building. Infect Control Hosp Epidemiol, 21:732-735, 2000.

41. Briles DE, Hollingshead S, Brooks-Walter A, Nabors GS, Ferguson L, Schilling M, Gravenstein S, Braun P, King J, Swift A. The potential to use PspA and other pneumococcal proteins to elicit protection against pneumococcal infection. Vaccine 25;18(16):1707-11, 2000.

39. Nabors GS, Braun PA, Heise ML, Herrmann DJ, Pyle DJ, Gravenstein S, Ferguson LM, Briles DE, and Becker RS. Immunization of Healthy Adults with a single recombinant pneumococcal surface protein A (PspA) variant stimulates broadly cross-reactive antibodies to heterologous PspA modecules. Vaccine, 18:1743-1754, 2000.

40. Gravenstein S, Ambrozaitis A, Schilling M, Radzisauskiene D, Krause P, Drinka P, and Shult P. Surveillance for respiratory illness in long–term care settings: Detection of illness using a prospective research technique. J Am Med Dir Assoc, 1:122-8, 2000 (Honorable Mention for JAMDA's 2nd Annual Best Contributor Award, for best of formal & sponsored research).

42. Drinka P, Gravenstein S. Management of Influenza in the Nursing Home. Annals of Long-Term Care, 8(9):23-30, 2000.

38. Freund B, Gravenstein S, Elliott M, Miller I. Zanamivir: A review of clinical safety. Drug Safety, 21 (4), 267-281, 1999.

37. Monto A and Gravenstein S. Influenza prevention and treatment: A health imperative. Annals of Long Term Care, 7(12), Supplement, 1999.

35. Radzisauskiene D, Zagminas K, Ambrozaitis A, Stikleryte A, Guzovijiene R, Gravenstein S, Shult P, Povinelli L. Influenza A surveillance efficiency in a nursing home. Public Health Journal Nr. 1(7):21-29, 1999.

34. Drinka PJ, Gravenstein S, Krause P, Laner EH, Barthels L, Dissing M, Shult P, Schilling M. Non-influenza respiratory viruses may overlap and obscure influenza activity. J Am Geriatr Soc, 47(9):1087-1093, 1999.

32. Chiu KM, Schmidt MJ, Havighurst TC, Shug AL, Daynes RA, Keller ET, Gravenstein S. Correlation of serum L-carnitine and dehydro-epiandrosterone sulphate (DHEAS) levels with age and sex in healthy adults. Age Aging, 28(2):211-6, 1999.

33. Chiu KM, Keller ET, Crenshaw TD, and Gravenstein S. Carnitine and dehydroepiandrosterone sulfate induce protein synthesis in porcine primary osteoblast-like cells. Calcif Tissue Int, 64:527-533, 1999.

36. Drinka PJ, Gravenstein S, Langer L, Krause P, Shult P. Mortality following isolation of various respiratory viruses in nursing home residents. Inf Cntl Hosp Epidemiol, 20(12):812-815, 1999.

31. Drinka Paul J, Gravenstein S, Schilling M, Krause P, Miller BA, Shult P. Duration of antiviral prophylaxis during nursing home outbreaks of Influenza A: A comparison of 2 protocols. Archives of Internal Medicine, 158(19):2155-9, 1998.

29. McElhaney JE, Gravenstein S, Upshaw CM, Hooton JW, Krause P, Drinka P. Immune response to influenza vaccination in Institutionalized elderly: effect on different T-cell subsets. Vaccine, 16(4):403-9, 1998.

28. McElhaney JE, Gravenstein S, Krause P, Hooton JW, Upshaw CM, Drinka P: Assessment of markers of the cell-mediated immune response after influenza virus infection in frail older adults. Clin Diagn Lab Immunol, 5(6):840-4, 1998.

27. Lang J, Gravenstein S, Briggs D, Miller B, Froeschle, Dukes C, LeMener V, Lutsch C. Evaluation of the safety and immunogenicity of a new, heat-treated human rabies immune globulin using a sham, post-exposure prophylaxis of rabies. Biologicals, 26:7-15, 1998.

30. Schilling M, Povinelli L, Krause P, Gravenstein M, Ambrozaitis A, Jones HH, Drinka P, Schult P, Powers D, Gravenstein S. Efficacy of Zanamivir for chemoprophylaxis of nursing home influenza outbreaks. Vaccine 16(18) 1771-4, 1998.

26. Ershler W, Gravenstein S. Successful aging calls for more than drugs. West J Med. 1997 Oct;167(4):238-9, 1997.

25. Drinka PJ, Gravenstein S, Krause P, Schilling M, Miller BA, Shult PA,. Outbreaks of influenza A and B in a highly immunized nursing home population. J Family Prac, 45(6):509-14, 1997.

24. Chiu KM, Schmidt MJ, Shug AL Binkley N, Gravenstein S. Effect if dehydroepiandrosterone sulfate on carnitine acetyl transferase activity and L-Carnitine levels in oophorectomized rats. Biochim Biophys Acta, 1344(3): 201-9, 1997.

22. Drinka P J, Krause P, Schilling M, Miller B A, Shult P, Gravenstein S. Report of an outbreak: Nursing home architecture and influenza-A attack rates. J Am Geriatr Soc, 44(8):910-3, 1996.

21. Abdennabi A, Schmidt M, Robertson S, Havighurst T, Shug A, Gravenstein S. The effect of L-Carnitine and influenza vaccine response in young and old mice. Aging: Immunology & Infectious Disease, Vol. 6 No 3, 153-156, 1996.

23. Kiecolt-Glaser JK, Glaser R, Gravenstein S, Malarkey WB, Sheridan J. Chronic stress alters the immune response to influenza virus vaccine in older adults. Proc Natl Acad Sci U S A, 93(7):3043-7, 1996.

19. Wald TG, Shult P, Krause P, Miller BA, Drinka P, Gravenstein S. A rhinovirus outbreak among residents of a long-term care facility. Ann Intern Med, 123(8):588-93, 1995.

18. Wald TG, Miller BA, Shult P, Drinka P, Langer L, Gravenstein S. Can respiratory syncytial virus and influenza A be distinguished clinically in institutionalized older persons? J Am Geriatr Soc, 43(2):170-4, 1995.

20. Chair: Thomas Braciale; rapporteur: Parker Small; participants: Ada G, Bender B, Gerhard W, Gravenstein S, McMichael A, Yewdell J. Workshop 2: Immunologic aspects of pandemic influenza. Held at: Pandemic influenza: Confronting a re-emergent threat, Bethesda, MD, December 11-13, 1995. The Journal of Infectious Disease, 176(suppl 1):S76-7, 1997.

17. Juby AG, Davis P, McElhaney JE, Gravenstein S. Prevalence of selected autoantibodies in different elderly subpopulations. Brit J Rheumatol, 33(12):1121-4, 1994.

16. Chiu KM, Binkley N, Shug A, Gravenstein S. Stimulation of alkaline phosphatase activity in osteoblast-like cells by L-carnitine and dehydroepiandrosterone-sulfate. J Bone and Mineral Research, 9:C16, 1994.

14. Gravenstein S, Drinka P, Duthie EH, Miller BA, Brown CS, Hensley M, Circo R, Langer E, Ershler WB. Efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine in elderly nursing home subjects during an influenza outbreak. J Am Geriatr Soc, 42(3):245-51, 1994.

15. Mahoney J, Drinka TJK, Abler R, Gunter-Hunt G, Matthews C, Gravenstein S, Carnes M. Screening for depression: single question vs. GDS. J Am Geriatr Soc, 42(9):1006-8, 1994.

13. Ershler WB, Sun WH, Binkley N, Gravenstein S, Volk MJ, Kamoske G, Klopp RG, Roecker EB, Daynes RA, Weindruch R. Interleukin-6 and aging: blood levels and mononuclear cell production increase with advancing age and in vitro production is modifiable by dietary restriction. Lymphokine Cytokine Res, 12(4):225-230, 1993.

12. Gravenstein S. Strategies to limit influenza in the nursing home. Geriatric Focus Infect Dis, 2:1-11, 1992.

11. Gravenstein S, Miller BA, Drinka PD. Prevention and control of influenza A outbreaks in long-term care facilities. Infect Control Hosp Epidemiol, 13(1):49-54, 1992.

10. Mast EE, Harmon MW, Gravenstein S, Arden NH, Circo R, Tyska G, Davis JP. Emergence and possible transmission of amantadine resistant viruses during nursing home outbreaks of influenza A (H3N2). Am J Epidemiol; 134:988-997, 1991.

9. Gravenstein S, Drinka PJ, Duthie EH, Miller BA, Langer E, Bleifuss G, Holdridge N, Beck C, Jacobs L, Tomczak J, Boettcher C, Brown CS, Hensley M, Circo R, Ershler WB. Risks for influenza and respiratory illness in vaccinated elderly. Aging, Immunology and Infectious Disease; 2:185-193, 1990.

7. Gravenstein S, Duthie EH, Miller BA, Roecker E, Drinka P, Prathipati K, Ershler WB. Augmentation of influenza antibody response in elderly men by thymosin alpha one. J Am Geriatr Soc, 37(1):1-8, 1989.

6. Schultz KT, Gravenstein S, Curro T, Thomas C, Ershler WB. Exogenous immunosuppression with methylprednisolone does not reactivate a Type D retrovirus in rhesus monkeys. Microb Pathog, 7(1):55-61, 1989.

8. Gravenstein S, Ershler WB. Influenza prevention and treatment in the elderly. Drug Protocol, 4:24-29, 1989.

5. Ershler WB, Coe CL, Gravenstein S, Schultz KT, Klopp RG. Specific antibody synthesis in vitro. IV. The correlation of in vitro and in vivo antibody response to influenza vaccine in rhesus monkeys. Clin Exp Immunol, 73(3):355-9, 1988.

4. Ershler WB, Coe CL, Laughlin N, Klopp R, Gravenstein S, Schultz KT, Roecker R. Aging and immunity in non-human primates. II. Lymphocyte response in thymosin treated middle-aged monkeys. J Gerontol, 43(5):B142-6, 1988.

3. Ershler WB, Coe CL, Gravenstein S, Schultz KT, Klopp RG, Meyer M, Houser WD. Aging and Immunity in Non-Human Primates: I. Effects of age and gender on cellular immune function in rhesus monkeys (Macaca Mulatta). Am J Primatology, 15:181-188, 1988.

2. Gravenstein D, Gravenstein S, Wheeler KB. Serum iron depression following a marathon swim in Lake Erie. Ohio State Med J 81(4):281, 283, 285, 1985.

1. Gravenstein S, Peltz MA, Pories W. How ominous is an abnormal scan in bronchogenic carcinoma? JAMA, 241(23):2523-4, 1979.

research overview

Quality improvement in health care.
Influenza in elderly people.
Immune senescence.
Vaccine response.