Roots of Gerontological Research Run Deep

Gerontology has been an area of particular focus and strength within the School of Nursing since the 1960’s, when faculty member Dr. Virginia Stone established the nation’s first gerontological master degree program for nurses interested in caring for older adults.

In 2000 funding from the National Institutes of Health helped to create the Trajectories of Aging and Care Center, directed by Dr. Ruth Anderson, Dr. Elizabeth Clipp, and Dr. Eleanor McConnell—each an expert in the field of gerontology nursing and research. These researchers took a big picture approach to investigating the care experienced by elderly patients as well as patterns and trends in aging and related health care.

The work of the Center was a major step in creating the Ph.D. program in 2006, and served as a catalyst in attracting the next generation of research faculty and helped to build our School’s scientific research base.

Today, under the guidance of Dr. Diane Holditch-Davis, Associate Dean of Research Affairs, our research in gerontology and elderly care carries on the tradition begun more than 50 years ago. This month, we celebrate the work of our gerontological research faculty. From examining entire health care systems to devising new ways to help stroke survivors get back on their feet or developing training for family caregivers, the research conducted by School of Nursing faculty will impact healthcare today and tomorrow.

Dr. Ruth Anderson Dr. Ruth Anderson has been one of the most important researchers at the School of Nursing with scholarship dedicated to improving management of nursing homes, an area of rapidly growing need in light of the aging baby boomer population. Her work has revolutionized understanding of the nursing home environment and her contributions have illuminated how to implement real and measurable changes in the delivery of care to improve quality of life for older adults in long-term care facilities.

Her work has always focused on interdisciplinary collaboration including working with scholars at Duke and across the country in schools of nursing, business, economics, engineering and medicine. Her research has shown the relationships between patient outcomes and organizational structure, interpersonal relationships of staff and families, patterns of staff communication, and employee turnover have given researchers new tools for implementing evidence-based changes in the care delivery practices in long term care facilities.

Dr. Anderson is Virginia Stone Professor of Nursing and a Senior Fellow in the Duke University Center for Aging and Human Development. She is also a Research Development Coordinator in the Office of Research Affairs in the School of Nursing and co-director of the ADAPT Center for Cognitive/Affective Symptom Science.

Dr. Melissa Aselage For many elderly adults with dementia, meal times can be very challenging, especially when they turn away from the food or push away a hand trying to help. When caregivers do not respond appropriately, such as interpreting this behavior as resisting the food, this puts elders with dementia at risk for malnutrition and dehydration. The ability to feed oneself is the last ability lost as Alzheimer’s disease progresses. Caregiver support becomes critical for maintaining dignity and to provide appropriate amounts of help during meals. Dr. Aselage is interested in defining the option of careful hand feeding techniques for helping elderly patients with dementia maintain their dignity, help these elders eat more during meals, and train nursing home staff to recognize challenges and respond appropriately during meals.

She’s currently the principal investigator for the first pilot study comparing three careful hand-feeding techniques that can be used within nursing homes. This research is critically important since dementia is a leading cause of death globally and the fifth leading cause of death in the US for adults over 65 years of age. Maintaining good nutrition for elderly adults is important for this vulnerable population.

Dr. Aselage joined the School of Nursing faculty in 2011 and is board certified as both a Family Nurse Practitioner and a Gerontological Registered Nurse.

Dr. Chip Bailey Dr. Bailey’s research has focused on self-management in patients with serious life-limiting illnesses such as prostate cancer, chronic hepatitis C, or end-stage liver disease. Patients with life-limiting illnesses confront complex challenges to their physical health as well as with their emotional and spiritual well-being. But while they grapple with these multidimensional challenges, many are left to navigate this course on their own.

His research has focused on creating models of self-management care where a nurse or other health care provider teaches patients and their caregivers coping skills, stress management, and symptom support. Ultimately these strategies help patients and caregivers reframe their thinking about their disease and improve their quality of life. Currently, Dr. Bailey is testing the effectiveness of a psychosocial intervention delivered via telephone to patients and caregivers as they wait for a liver transplant. His recently-funded two-year study will examine self-management for patients with chronic hepatitis C that undergo treatment with two newly approved protease inhibitors.

Dr. Bailey also served as a faculty representative to the National Task Force on the revision of The Essentials of Baccalaureate Education for Professional Nursing Practice— AACN (2008) and on the expert panel to revise the document, Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care—AACN/John A. Hartford Foundation (2010).

Dr. Janet Prvu Bettger More than half of the 800,000 stroke survivors do not receive any rehabilitative services, even though almost three-quarters of these patients cannot walk following their stroke. Consequently, these patients are at risk of injuring themselves due to falls or even developing further complications such as diabetes due to lack of exercise.

Dr. Bettger is currently lead investigator for a research study at the Duke Clinical Research Institute focusing on the benefits and risks of different stroke rehabilitation service options. Her research explores a new clinical approach that stroke survivors should begin physical therapy and exercise as soon as possible following a stroke in order regain their ability to walk and to build strength.

Dr. Bettger’s research is dedicated to improving health care quality and care coordination for older adults with chronic conditions, particularly stroke and those at risk for functional decline or rehospitalization. She is an assistant professor and health services researcher at the Duke University School of Nursing and Duke Clinical Research Institute, and a Senior Fellow of the Duke Center for the Study of Aging and Human Development. She serves as a Senior Scientist for the Duke Translational Nursing Institute, a member of the Duke University Health System Evidence-based Practice Nursing Council, and was a co-investigator of Duke’s AHRQ funded Evidence-based Practice Center. She is also the principal investigator for School of Nursing’s ADAPT Center research project studying cognitive status changes among stroke patients receiving acute rehabilitation.

Dr. Michael Cary Each year, one in every three adults age 65 and older falls. Falls can cause injuries such as hip fractures, and significantly increase the risk of death among older adults. Fall-related injuries are associated with disability, functional dependence, and substantial economic costs including hospital and nursing home care, rehabilitation, and use of assistive devices.

One of the newest additions to the School of Nursing faculty, Dr. Cary is researching elderly falls and quality care delivered to older adults in institutional settings including hospitals and nursing homes. Past work has used systems engineering tools to better understand organizational factors including the physical environment of hospital units and nursing processes in order to identity problems related to patient falls. Currently, Dr. Cary has developed a research proposal which he plans to submit to the National Institute for Nursing Research in May 2013. In this research, he proposes to describe patient and system-level management practices that selected nursing homes use to ensure safety and reduce falls and subsequent risks among short-term patients. He plans to conduct a pilot study examining the trajectories of physical and cognitive functioning during a 30-day period among a cohort of short-stay patients receiving post-acute care in nursing homes and prospectively record occurrence of falls, recurrent falls, and injurious falls. In addition, he is the recent recipient of an Office of Research Affairs small grant which will examine community, organizational, and patient factors associated with outcomes following inpatient rehabilitation for older adults with hip fracture.

Dr. Cary also co-teaches a course, Nursing Care of Older Adults and Their Families, in the ABSN program. Dr. Cary has more than eight years of nursing experience in long-term care, rehabilitation, and community health settings.

Dr. Kirsten Corazzini Dr. Kirsten Corazzini’s research examines the differences of quality of care within a nursing home related to how registered nurses (RNs) direct other nursing staff, such as licensed practical nurses (LPNs) and nursing assistants. The phrase “nursing home” suggests that the facility is a nurse-run institution. However, RNs provide less than 10% of direct care in nursing homes; the majority of care is provided by assistive nursing personnel. Her research has examined and compared the quality of care in nursing homes where roles between RNs (registered nurses) and LPNs are strictly defined or where LPNs are taking on roles traditionally held by RNs.

Through her research, Dr. Corazzini has found that nursing homes with clearly defined roles and high quality relationships between LPNs and RNs, and adequate RNs to provide clinical expertise, have better quality of care. Her team also has found that State Nurse Practice Acts affect these practice patterns and quality of care.

Dr. Corazzini joined the School of Nursing after completing a National Institute on Aging Postdoctoral Research Fellowship at the Duke University Center for the Study of Aging and Human Development in 2002.

Dr. Cristina HendrixEvery day, thousands of family members and friends, often with little or no health care experience, are suddenly placed in the role of a caregiver for a loved one with serious and chronic health care needs. Caregiving is especially stressful after hospital discharge since many patients are discharged home with lingering effects of their illnesses and medical treatments. Most of these patients turn to their family and friends for assistance at home.

Dr. Hendrix saw a need to create a way to help these informal caregivers (often the spouses or adult children) learn basics about providing in-home health care. Dr. Hendrix has researched and tested nurse-led training for family members to learn about in-home care. This training is given before patients are discharged from the hospital. Through this training, Dr. Hendrix hopes to improve patients' well-being and reduce costly hospital readmissions. Furthermore, the training may also help the caregiver feel more confident and better prepared to provide care at home.

To date, Dr. Hendrix has four National Institutes of Health funded studies as the principal investigator to conduct testing of a caregiver training intervention before hospital discharge of their loved ones. Dr. Hendrix has also conducted a similar study with caregivers of older Veterans at the Durham Veterans Affairs Medical Center. Dr. Hendrix’s background includes experience as a critical care nurse and as a family nurse practitioner. She presently practices as a gerontological nurse practitioner in addition to teaching at the School of Nursing. Dr. Hendrix is also a nurse investigator at the Geriatric Research, Education, and Clinical Center at the Durham Veterans Affairs Medical Center and serves on the Nursing Research Advisory Group of the Department of Veterans Health Affairs, Office of Nursing Services.

Dr. Ellie McConnell One of the School’s preeminent researchers, Dr. McConnell is Director of the Center of Excellence in Geriatric Nursing Education and Lead Faculty for the gerontology specialties in the MSN Program. She has a joint appointment at the Geriatric Research, Education, and Clinical Center of the Department of Veterans Affairs Medical Center, where she is both clinical nurse specialist and nurse scientist. Dr. McConnell is also a Senior Fellow at the Duke Center for the Study of Aging and Human Development and has been a critical member of the School of Nursing faculty for more than 20 years. Her research has focused on frailty in the aged, the role of the physical environment in promoting function, and the conduct and testing of interventions to prevent decline in those with chronic illness.

Her current research focuses on factors that influence implementation of evidence-based care practices to prevent functional decline in very frail older adults. She’s currently a co-investigator in revising the existing MSN family nurse practitioner curriculum at Duke School of Nursing in an effort to address the critical shortage of primary care providers, skilled in primary care of older adults, in rural and underserved communities. She is also an instructor in the Grand Challenge Institute that is working to enhance understanding of dementia among healthcare providers in various fields.

Dr. Tracey Yap Bedsores, also known as pressure ulcers, are localized areas of soft-tissue injury resulting from compression between a bony prominence and an external surface, and can lead to septic infections and thousands of premature deaths each year. Pressure ulcers affect elderly persons living in all settings, but for residents of long-term care facilities prevention is an ongoing challenge. The least mobile residents are deemed at highest risk and should receive individualized repositioning schedules; however, low risk residents can also develop pressure ulcers, a problem that cannot be addressed by prevention initiatives that target only residents classed as high-risk. Furthermore, inconsistency in adherence to repositioning protocols has been implicated in the continuing occurrences pressure ulcers with many considered avoidable. The estimated cost of treatment is much greater than the cost of prevention.

With funding from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative, Dr. Yap and her team aimed to reduce facility-acquired pressure ulcers and developed a cost-effective, nurse-led intervention that used musical cues to prompt a multidisciplinary team of staff to consistently implement the minimum of every two hours repositioning guideline for anyone considered at risk. All residents were to move because being a resident in long-term care is a risk, pressure ulcers can develop in any resident who cannot or does not move enough to redistribute pressure, and even minimal movement is beneficial to health. This intervention had a 45% protective effect for those individuals in the treatment facilities.

In the course of this study, Dr. Yap’s research team recognized that the occupational subculture of nursing in each facility played an important role in implementing the intervention, a discovery which led to development of the Nursing Culture Assessment Tool (NCAT), a new psychometric tool for evaluating nursing culture. She is a current currently refining the NCAT as part of fellowship with the John A. Hartford Foundation. Furthermore, she has been selected by the International 2014 Pressure Ulcer Guideline Development Group as a member of the working groups for both older adults and positioning.

Dr. Bei Wu Dr. Wu is on the forefront of examining the correlation between oral health and cognitive impairment and depression, and through research that examines the interrelationship between individuals’ oral health and cognitive decline (e.g., memory loss) Dr. Wu is also conducting a pilot study to develop an intervention to improve oral health for individuals with early stage dementia.

There is already an established association between oral health and heart disease, stroke, and diabetes, but there has been little study on how the health of an older person’s teeth and gums is related to their mental function. Many oral diseases, if left untreated, can be extremely painful and impact a person’s most basic parts of their life, such as eating, speaking, and social interactions. For many elderly people, when their quality of life is negatively impacted, so are many other facets of health.

Dr. Wu is currently engaged in a NIH-funded study examining this relationship between mental and oral health. She is a professor at the School of Nursing and the director for International Research at the School of Nursing and a member of the Global Health Institute. She is also the Methods Core Director for the School’s ADAPT Center. Dr. Wu has authored 74 journal articles and 17 book chapters and has co-edited two books. She has been a principal investigator for research grants totaling more than $4.4 million focused on long-term care, dementia care, oral health disparities, cognitive health, and global aging.

ABOUT A diverse community of scholars and clinicians, Duke University School of Nursing is educating the next generation of transformational leaders in nursing. We advance nursing science in issues of global importance and foster the scholarly practice of nursing. In 2011, U.S. News and World Report ranked Duke among the top seven graduate schools of nursing in the nation. The National Institutes of Health awarded $4.3 million in research funding to the Duke School of Nursing (Oct. 1, 2011 through Sept. 30, 2012) making it one of the top 10 nursing schools engaged in NIH-funded research. The School offers masters, PhD, and doctor of nursing practice degrees, as well as an accelerated bachelor of science in nursing degree to students who have previously graduated from college. More than 840 students are enrolled in the Duke School of Nursing, one of the largest numbers in the School's 80-year history.

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