January 23, 2012

Enhancing the golden years

Interprofessional center to focus on innovative care in aging

The aging of America is undeniable. Nearly 10,000 people turn 65 every day, with the total number of senior citizens to soon pass the 40 million mark.

The number will climb only higher, as people reaching age 65 have an average life expectancy of an additional 18.6 years, according to the Administration on Aging, and those ages 55 to 64 are projected to be the fastest-growing segment of the adult population during the next decade.

The impact on the health care system will be profound.

“We’re facing an unprecedented demographic shift,” said Sarah L. Szanton, an assistant professor at the School of Nursing and an expert on geriatric nursing. “We’re on a collision course with this demographic trend.”

To better address the needs for the growing senior population, the School of Nursing recently founded the Center for Innovative Care in Aging. The interprofessional initiative will seek to develop and advance behavioral interventions that support the well-being of older adults and their families.

Specifically, the center seeks to shorten the time from intervention to implementation of clinical trial evidence, and enhance the yield of programs, policies, practices and tools to help older adults and family members remain healthy, independent and living in their own homes and communities.

Center director Laura N. Gitlin, a professor in the Department of Health Systems and Outcomes at the School of Nursing with a joint appointment in Psychiatry at the School of Medicine, said that the center’s focus will be on generating novel interventions that enhance quality of life and enable older adults to age in place.

“As the nation’s population is aging, people would rather live in their own homes than move to an assisted living or nursing facility,” Gitlin said. “The center will generate interventions that equip older adults with the behavioral, self-management, physical and environmental tools to live longer, healthier and more-productive lives in their advancing years.”

Gitlin said that the center seeks a national and international impact by serving as a think tank to advance intervention and implementation science. The center’s faculty will engage in research to develop and test innovative interventions; apply evidence-based programs in community and practice settings; provide research training, education and mentorship to emerging scholars and practitioners; create scholarly forums for meaningful exchanges; and develop useful templates and tools to advance the science of intervention research.

The center’s inaugural faculty includes Gitlin, Szanton, Cheryl Dennison-Himmelfarb, Nancy Hodgson, Sharon Kozachik, Marie Nolan, Miyong Kim and Elizabeth “Ibby” Tanner. Areas of expertise currently represented among this group—which will expand to include faculty from other divisions—include advancing interventions in chronic disease management, health disparities, depression, dementia care, caregiving, end of life, aging in place, fall prevention and care transitions.

Gitlin, for example, is working on a nonpharmacological intervention to reduce agitation in people with dementia. The study seeks to identify and exploit the “preserved” capabilities of the person by simplifying activities and training family members to assist.

“Our approach seeks to give meaning to people with dementia and re-engage them in their environment,” she said. “Dementia has reached epidemic proportions but has been severely underaddressed.”

Szanton will continue her study of older low-income citizens living on their own in Baltimore City through a $325,000 grant from the Robert Wood Johnson Foundation. She will interact with 60 households in her CAPABLE study, a community outreach project that addresses both the environmental and health needs of older adults.

The study, which launched in August 2010, has already helped dozens of seniors age safely at home. Through a collaboration with Baltimore City, improvements have been made to bathrooms, stairways, kitchens and other living spaces to ensure that seniors are able to perform basic tasks without risk of an injury.

Szanton said that nursing can and should provide a holistic approach to dealing with issues related to aging.

“We will look at the person in his or her environment, not just the diseases or conditions,” Szanton said.

Tanner, an associate professor of geriatric medicine with joint appointments in the schools of Nursing and Medicine, is currently studying the impact of high-intensity volunteering on older adults’ health and whether it prevents disability-related decline. She said that the center will be critical to enhancing and supporting interdisciplinary intervention research in aging at the School of Nursing, especially at this time when limited federal funding is available.

“The center is also crucial in enabling our faculty to organize our efforts, under the direction of Dr. Gitlin, and provide expertise and leadership for others in the field of aging, both nationally and internally—and communicate what we are doing so that we can impact others,” she said. “As an organized center, we are very, very strong and will make great contributions to the field of aging research.”

The center’s first year will be a busy one, Gitlin says.

In early March, the center will launch a monthly series called The Issue Is … , a forum for faculty and students to explore pressing issues related to behavioral intervention and implementation science.

This spring, the center will start a lecture series, beginning with a visit by Martin Prince, a world-renowned scientist in dementia care and president of Alzheimer’s International.

From June 14 to 16, the center will host a Summer Research Institute on Behavioral Intervention in Aging for nationwide investigators in all disciplines.

Additionally, the center will convene brainstorming sessions with core faculty to learn about scholarly needs and identify future directions for center activities. Other planned activities include the establishment of a network of practice and community sites to implement evidence-based programs generated by the center’s faculty.

Gitlin, who has a background in sociology and social psychology, joined Johns Hopkins in January 2010. Prior to her arrival in Baltimore, she was the founding director of the Jefferson Center for Applied Research in Aging and Health at Thomas Jefferson University in Philadelphia. She previously served as co-director of the Jefferson Health System’s Senior Health Institute.

Gitlin said that the Center for Innovative Care in Aging will actively seek collaborations with other university divisions. She has already identified more than 20 faculty members from the schools of Public Health and Medicine who are in various stages of developing behavioral types of interventions related to aging.

“We would like to invite faculty with a wide range of expertise and interests to work with us in the design and implementation of novel models of care and interventions for older adults,” she said. “It’s important that we have people from diverse backgrounds representing many areas of expertise as core faculty of the center to advance our mission.”

The center plans to bring together experts in trial methodology, basic science, bioethics, health policy, health disparities, community-participatory research, biobehavioral measurement, implementation science, epidemiology, health economics, health systems design and geriatrics from throughout Johns Hopkins and elsewhere.

For more information on the center, go to nursing.jhu.edu/areas_of_excellence/aging/center.