Geriatrics and Gerontology / Stroud Center Barry J. Gurland, M.D., Chief of Psychiatric
Research and Sidney Katz Professor of Psychiatry OVERVIEW CURRENT RESEARCH Sharing of information and skills between long term care sites and disciplines: A limit on improving intervention strategies in long term care can be traced to a persistent communication gap between researchers and service providers, and especially between academic centers and community agencies. In order to bridge this divide, the Alliance Project has been established in collaboration with Drs. Linda Nolke, David Bass, and Richard Browdie of the Benjamin Rose Institute. This project is defining a common language that can facilitate interdisciplinary development of administrative, intervention and policy standards for improving the quality of life in long term care. Interaction of genes and the environment: It is not clear to what degree specific human qualities of life are limited by genetics. Addressing this issue, a collaboration with Dr. William Page of the Medical Follow-up Program of the Institute of Medicine and Dr. Brenda Plassman of Duke University led to a study and a report on male military veteran twins in their eighth decade. The twins were identical in 1,384 pairs while 1,337 were not identical. The great majority of impaired function among these elders is attributable to non-inherited illness, accident, life style and aging effects. These findings suggest that there is an important role for public health, personal initiatives, and service interventions in lengthening the period of active life. A follow-up of these twins has now been completed and the data are being prepared for comparable analyses of the heritability of active life expectancy and of successful aging . Culture Fair Assessment: Building on almost three decades of cross-cultural research, the Columbia University Stroud Center has been at the forefront of developing and evaluating culture-fair assessment methodologies. Based on this work, and on collaborative relationships with the Resource Center for Minority Aging Research (RCMAR) and the Hebrew Home for the Aged, Research Unit, members of the Stroud Center have engaged in several related activities. A special issue of Medical Care is being prepared, based on a measurement conference held in May, 2001 that was sponsored by the Agency for Healthcare Research and Quality (AHRQ), the National Cancer Institute (NCI) and the National Institute on Aging (NIA). This conference was devoted to measurement issues related to reducing health disparities among ethnically diverse populations. Planning has also gone forward for a conference (to be held in June, 2004 in Bethesda) sponsored by several federal government agencies, including the National Cancer Institute, with a Stroud Center principal as a featured speaker on differential item functioning (DIF). The purpose of the conference is to discuss applications of modern measurement methods to health assessment; the proceedings will be published in a major medical journal. The Stroud Center principal is a Co-PI of the Resource Center for Minority Aging Research (RCMAR) and heads the Methods and Data Seminars that provide the main structure for mentoring RCMAR minority investigators. Members of the Stroud Center provide expertise in measurement among ethnically diverse populations to numerous groups at Columbia/Psychiatric Institute, including a collaboration with the IDEATel project, a large multi-site study of delivery of a telemedicine to individuals with diabetes residing in medically underserved areas. Finding connections between early and late life: The ‘whole life’ is composed of interconnected time phases. A particular connection concerns the influence of childhood experiences on functioning and other qualities in later life. This connection might have implications for a public policy that unites the interests of widely separated generations. Geo-mapping of the distribution of the experience of formal education in Puerto Rico during the period 1920-1930 revealed striking regional contrasts providing an opportunity to examine the possibility of late effects evident in persons currently in their eighth and ninth decade. Secondary analysis of census data confirmed an association between early residence in the mapped geo-regions and risk of poor quality of later life. However, plotting the elements in this association between regions and effects has required complex analyses, some of which have exceeded the information available from secondary analyses. A report is being prepared on the design requirements for avoiding such confounds in a field study (in collaboration with Dr. David Wilder).
Choices, choosing and the nature of quality of life: A new theory and model of quality of life, constructed and detailed by members of the Center, has isolated the transactions surrounding choices and choosing as necessary and sufficient for understanding, evaluating and improving health related quality of life. Consequently, a study has been envisaged for examining the extent to which residents can make personal choices in long term care settings. An extensive program of informal visits to nursing homes, assisted living and special care units was undertaken in a wide region around New York and London, with special emphasis on services of acknowledged excellence. Open-ended, anonymous and narrative (not data based) discussions with administrators and staff, and review of staff and activity organization and of building design enabled an impression to be obtained of innovations intended to provide opportunities for residents to express and achieve their preferred ways of living. From this and a thorough literature search, a set of methods has been established as a step towards domestic and international research in this area. This effort is expected to lead to new ways of assisting elders to interact with the environment in seeking to fulfill their quality of life needs. In collaboration with Drs. Ethel Mitty (now also of the Stroud Center), Terry Fulmer, and Mathy Mezey of the School of Nursing at New York University; and with Drs. Alastair Macdonald and Kate Briggs, Kings College Hospital, London University. Overcoming Impediments to Communication: Inadequate
ability to communicate one’s needs narrows the opportunities for
help in overcoming challenges to quality of life. Recent work in this
area has involved an analysis of data from the NIA Collaborative Studies
of Special Care Units for Alzheimer’s Disease. Specifically, dementia
patients’ levels of communication at different intervals of cognitive
impairment and at different stages of dementia have been examined. In
a related longitudinal study, linguistic patterns in a 94 year-old, blind,
hearing-impaired Holocaust survivor have been examined over 7 years. EDUCATION AND TRAINING Post-Professional Education of Health Care Professionals: This program provides interdisciplinary education focused on issues, treatments, and service delivery models in geriatrics for a broad range of health care professionals. The major components are: The Statewide Geriatric Psychiatry Residency and Research Fellowship: This one or two year full-time training program is accredited by the ACGME. It is based at Binghamton and Middletown Psychiatric Centers in upstate New York with monthly rotations at Psychiatric Institute and Rockland Psychiatric Center, and includes rotation sites at upstate affiliated hospitals and health care facilities and in New York City. The first year is focused on the practice of geriatric psychiatry as related to the transition of the public mental health system from a concentration on inpatients in state hospitals to integrated hospital and community mental health sites of service. Fellows are appointed for a second year to conduct research on topics related to chronically mentally ill elders in under-served populations. (In collaboration with Binghamton and Middletown Psychiatric Centers in upstate New York). Statewide Geriatric Grand Rounds Series: A 14 session series of Grand Rounds and Clinical Case Conferences by the Columbia Geriatric Psychiatry Program faculty is presented annually. Those attending represent a broad range of disciplines serving in public mental health centers. (In collaboration with Binghamton, Middletown and Rockland Psychiatric Centers). The Geriatric Scholar Certificate Program: The Columbia-New York Geriatric Education Center, a collaboration with New York University and the Center for Healthy Aging in Upstate New York, provides certificates in post-professional training in interdisciplinary Geriatrics and Gerontology. A repeated 40-hour program is offered over five days in a variety of sites across the metropolitan region and in upstate New York. There is a faculty exchange between academic centers in New York City and upstate academic and service-oriented centers. (In collaboration with Dr. Terry Fulmer of New York University). Resource Center on Evidence-based Practices in Nursing Homes and Adult Care Facilities: In collaboration with the New York State Department of Health (NYSDOH) and the New York State Office of Mental Health (NYSOMH), a resource center has been established for developing and disseminating evidence-based best practices guidelines in nursing homes and adult care facilities representing a target population of several million individuals with chronic health and mental disorders. (In collaboration with Drs. Suzanne Broderick, NYDOH and Molly Ferguson, NYSOMH). The Quentin N. Burdick Program for Rural Interdisciplinary Training: This three-year program, which is supported by funding from the Health Resources and Services Administration, is developing a national model for implementing, evaluating, and sustaining interdisciplinary rural training for health care learners with the goal of improving access to mental health services for the geriatric population in medically underserved Central New York. The program is being conducted in collaboration with two co-applicants, New York University Division of Nursing and Utica College of Syracuse University. The Geriatric Mental Health Program on Disaster Preparedness and Bioterrorism: This program, which began after 9/11 and received funding in 2004 from the Department of Health and Human Services, Health Resources and Services Administration, is developing and disseminating a national curriculum that focuses on the mental health consequences of disasters, emergencies and associated public health crises on the aged. The target audience of the curriculum is health care professionals and allied health care providers. (in collaboration with NYU and Mt. Sinai Medical Center)
Lyons B, Teresi J, Ramirez M, Eimicke J, Holmes D. Differences between older black residents of special care units (SCUs) and of traditional units. Journal of Social Work in Long-Term care 3:29-41, 2003. Teresi J, Morse AR, Holmes D, Yatzkan E, Ramirez M, Rosenthal B, Kong J. The impact of a low vision intervention on affective states among nursing home residents. Journal of Mental Health and Aging 9:73-84, 2003.
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