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From Research to Practice

(Charlene Quinn, RN, PhD) -- Welcome to the Horizon Foundation web column, Health and Aging: Research to Community and Practice.  This series will present research findings which will assist those in the community—nurses, physicians, social workers, families, older adults themselves –to redefine our perceptions of aging and health.

Headlines remind us that we are seeing a demographic shift in our society, with profound implications for health and benefit programs.  Each day more than 7900 Americans turn age 60.  By 2030, one-fifth of Americans will be over the age of 65.  

Fortunately, over the past century, both the life expectancy and the health of Americans of all ages have improved dramatically.  The increase in life expectancy, however, has increased the prevalence of chronic health conditions, including high blood pressure, diabetes, Alzheimer’s disease and other cognitive impairments. Chronic conditions limit the daily activities of 34 percent of older adults (CDC).  

Delaying disease progression and treating or managing these chronic conditions is critical.  Fortunately, we are seeing a transformational change in how health and medical research findings are adapted in communities. Translation Research includes application of discoveries in the laboratory to studies in humans (for example genetics or drug studies) and research aimed at enhancing the adoption of best practices in the community. Cost-effectiveness of prevention and treatment strategies is also an important part of translational science.

The Horizon Foundation and the Howard County Office on Aging recently sponsored the Maryland Health and Aging Summit. The Summit provided a forum for translational science for several Maryland academic institutions and nationally recognized researchers in the study of aging. Click here for more information on the Summit and links to the presentations.

Dr. Linda Fried, Director of Geriatric Medicine and the Center on Aging and Health at the Johns Hopkins Medical Institutions spoke about both the heterogeneity and the complexity of health care for older adults. Based on what we know about aging and health, Dr. Fried recommends a health care system that provides coordinated care for persons across transitions (i.e. discharge from hospital to home), regional electronic medical records, geriatric health care physicians and health teams targeting frail elderly, geriatric competency training for all primary care physicians, and integration of community based services with health care.

Dr. Rich Macko, Professor at the University of Maryland School of Medicine & Baltimore Veterans Administration Medical Center and Director, Maryland Exercise & Robotics Center of Excellence (MERCE), described his studies of task-oriented exercise (e.g. treadmill walking with cane) following stroke.  Approximately 750,000 strokes occur each year. This number is expected to double by 2040 with a cumulative cost of $2.2 trillion by 2050 (Annals of Neurology, 2006). Current treatment guidelines focus on rehabilitation in the first few months following the stroke, but do not include recommendations to promote exercise when the patient returns to community settings, despite the fact that about 75% of older stroke patients experience persistent deficits.  

Studies conducted in Dr. Macko’s exercise and robotics lab and collaborative work in Italy have shown considerable promise. Task oriented and aerobic exercise improved socialization, fitness, insulin and glucose metabolism, gait balance and walking, even years post-stroke.  Dr Macko’s team will conduct new research in Howard County senior centers, Maryland Health Enterprises facilities and several sites in Baltimore County hoping to replicate the previous results.

Dr. Kostas Lyketsos, Professor and Chair, Department of Psychiatry, Johns Hopkins Bayview presented results of studies of dementia.  Based on the Maryland Assisted Living Facilities (ALFs) studies, Johns Hopkins researchers determined about one third of person 85 years and older have dementia, and 30 percent of dementia cases among AFL residents weren’t detected.  The MD-ALF study also showed that the presence of dementia accelerates discharge from assisted living to higher levels of care.

The researchers found that treatment of dementia may attenuate this effect. There is also a suggestion that activity participation and improved mobility might delay discharge of residents with dementia. These findings suggest that detection and treatment of dementia may make a real difference for AL residents (JAGS, 2007).

These findings led to development of the MIND@HOME Demonstration Project, scheduled to launch in early 2008.  The study will focus on improving the care and outcomes for Baltimore City elders with memory loss who are living in their own home. Using existing community resources, MIND@HOME will test the effectiveness of a broadly-based dementia detection method and a proactive, care coordination model, guided by the principles of dementia care.  Dr. Lyketsos referred to the “5-50 hypothesis”—through early detection and treatment he hypothesized we can obtain a 5 year delay in dementia that leads to dysfunction and a 50% reduction in dementia cases.
 
Another panel of presenters at the Summit explored the role of technology in promoting the health and independence of older adults. Older adults and their families are finding new uses for technology, including “smart homes”, health monitors which can relay vital information (blood pressure, weight, daily blood glucoses) directly to health care providers, and robotic assistance for frail older adults.

Clearly, many of the research discussions at the Summit on Health and Aging are models for translating research to practical use in the community.