 |
|
|
| Featured Faculty (archive) Dr. Arbaje is a frequent speaker and enjoys providing education around eldercare issues- she recently presented at the annual JHU Women’s Health Conference in November 2009 and discussed medication management in older adults. In October 2009, she was invited to present at the University of the Third Age (Universidad de la Tercera Edad) in Santo Domingo, Dominican Republic where she gave a talk to psychology students on the role of geriatric medicine and gerontology in the management of psychological issues in older adults. We recently had the opportunity to sit down with Dr. Arbaje to talk about her research and what she hopes to accomplish over the coming years. Here are some highlights from our conversation: I became interested in the field of aging after looking back at my personal and professional experiences thus far. I grew up with my grandmother as an integral figure in our household. I saw the important role she played in our family, and I also saw the care giving difficulties that arose as she got older. As I progressed through my clinical training, I was struck by challenges older adults face as they navigate through our fragmented healthcare system. I also recognized healthcare providers' challenges in caring for older adults with complex medical disease and even more complex medical regimens. I also found it to be a privilege to be with older adults and their families at critical moments in their lives, including at the end of life. What do you hope to accomplish in the field of transitional care? What advice might you have for junior faculty and students in Geriatric Medicine and Gerontology who are interested in pursuing similar research? Ravi Varadhan, PhD (November 2009) Dr. Varadhan, an Assistant Professor at COAH, will serve as the leader of an investigative team that includes Drs. Carlos Weiss and Cynthia Boyd from the Division of Geriatric Medicine and Gerontology, Drs. Jodi Segal, Al Wu and Susan Zieman from General Medicine and Cardiology, and Dr. Constantine Frangakis from the Department of Biostatistics. The investigators will review existing approaches to address heterogeneity of treatment effects and to develop new methods to facilitate applicability of trial evidence to target populations, such as older adults, who are poorly represented in clinical trials. We recently had the opportunity to speak with Dr. Varadhan about this award and his research interests. Here are some highlights from our conversation: Can you describe your unique background which spans engineering, statistics and aging research? I have always been most fascinated by mathematics and its power to communicate and illuminate profound concepts in science. Unfortunately, in India the bright young minds are discouraged from pursuing careers in pure disciplines such as mathematics, physics, and chemistry, and are made to choose applied fields such as engineering, medicine, and computer science. The most mathematically inclined students end up pursuing a career in engineering. In my case, I took up chemical engineering. I then came to United State and obtained a PhD in environmental engineering and worked as a research engineer for the U.S. EPA for almost a decade doing mathematical modeling of fate and transport of contaminant chemicals in the groundwater. It was then that I started appreciating the importance of being able to describe and manage the uncertainty in our knowledge of the world. If mathematics is the language of science, then probability and statistics is the language of uncertainty. So, I gave up my career in engineering and pursued another doctorate in biostatistics. During my doctoral program, I was offered a position as a post-doctoral fellow in the Epidemiology and Biostatistics of Aging training program. This was the catalyst for my research interests in aging. What are your key research interests? I have research interests in three areas. I am working on developing a mathematical framework for characterizing the geriatric syndrome of frailty. This involves integrating the idea of dynamical systems from my engineering background, with concepts from stochastic processes from my statistics training. I am also working on developing statistical methods to address the evaluation of effectiveness of treatments and interventions in older adults in the presence of competing causes of death. Last, but definitely not least, I am passionate about developing new computational techniques, as well as implementing existing ones for solving complex modeling problems in biostatistics and aging research. As a former trainee on the Center’s EBA training grant can you speak to how the program influenced your research track? I was fortunate to be offered a position as a post-doctoral fellow in the Epidemiology and Biostatistics of Aging training program. I am convinced that our EBA training program is one of the very best training programs around. Dr. Linda Fried, who was the director of the program, had a very broad outlook on research. She had the foresight to see that the aging research needed infusion of ideas and techniques from a variety of disciplines. In particular, she truly appreciated the critical role of rigorous quantitative thinking. Her leadership, along with that of Dr. Karen Bandeen-Roche, who is now the chairperson of the Department of Biostatistics, is really the foundation for the success of our training program. Linda and Karen constantly challenged me to step out of my comfort zone of statistical modeling and address the real underlying scientific issues of import in any given problem that I happen to be dealing with. Linda called this the “360-degree” approach to thinking about scientific problems. This is best exemplified by the biweekly the Research-in-progress (RIP) meetings at the Center on Aging and Health. These sessions were highlighted by healthy and lively discussions on the statistical, epidemiological, clinical, and social aspects of the scientific topic. I learned a lot from them and I continue to do so. What are the main goals of the AHRQ grant and how do you see this impacting aging research? Currently, randomized clinical trials (RCTs) are considered to provide the most reliable evidence on whether a drug or a medical procedure or any other intervention works. However, it is not clear whether this evidence also applies to groups of people who differ from those participating in the RCTs. If they do differ, can we use additional sources of information (e.g. a prospective observational study) to obtain evidence on the efficacy of the interventions in such groups? If we can, how do we do it? My AHRQ grant is to develop a methodology to address these questions. My research was particularly motivated by the fact that most RCTs do not enroll older adults with multiple chronic health issues, and hence the existing evidence on the efficacy of therapeutics and other interventions is of questionable relevance for them. Therefore, my research has the potential to provide the relevant evidence and also to assess the reliability of that evidence. What advice might you have for junior faculty and students who have similar research interest? It took me a while to figure out my calling in life. So, my advice for junior faculty and students would be that they should keep seeking. Never settle for the easy solution. In the words of my idol Socrates, “the unexamined life is not worth living.” Cynthia Boyd, MD, MPH (October 2009)
Dr. Boyd is an assistant professor at the Johns Hopkins University School of Medicine in the Department of Medicine, Division of Geriatric Medicine and Gerontology, and is a core faculty member at the Johns Hopkins Center on Aging and Health and the Roger C. Lipitz Center for Integrated Health Care. She is trained in internal medicine, geriatric medicine and epidemiology with research interest in the prevention and progression of disability among older adults, the clinical care of comorbid chronically ill and frail older adults both chronically and during acute illness such as hospitalization. The Paul B. Beeson Career Development Award is given to scholars who are laying clinically relevant groundwork in aging, health outcomes, health services and clinical management issues, with the goal of enhancing the health and quality of life of older adults. As a Beeson Scholar, Dr. Boyd will focus on "Treatment Burden in Older Adults with Diabetes and Multimorbidity.” We recently had the opportunity to sit down with Dr. Boyd to talk about the Beeson Award, her research and what she hopes to accomplish over the coming years. Here are some highlights from our conversation: What led you to a research career in aging? I became interested in the field of aging during my internal medicine residency. I was drawn to my older patients, particularly those with complex health status. First and foremost, I was drawn to my patient’s life stories and how the person I was meeting had decades of life experience that had made them the person in front of me. Their stories reflected the history of Baltimore – the experience of working for Bethlehem Steel, the migration of the descendents of former slaves from the South to Baltimore City, talking to veterans of WWII who traveled all over the world. I learn so much from my patients, and who they are informs the treatment decisions that we make, together. From a clinical perspective, I was intrigued by the complexity of the treatment decisions we needed to make for people with multiple co-existing conditions, and how our current evidence-based framework does not really address their needs and health issues in a way that allows us to make individualized and evidence-based decisions. What do you hope to accomplish as a Beeson scholar? I aim to develop the appropriate tools to measure treatment burden among older adults with multiple co-existing conditions for clinical decision-making encounters between a patient, their health care provider, and often, a family member or friend. The ultimate goal is to inform the treatment decision-making process to ensure feasible and evidence-based treatment regimens for older adults with multiple diseases. Ultimately, I would like to help inform the process of developing clinical practice guidelines for treatment decisions for complex patients. What advice might you have for junior faculty and students in Geriatric Medicine and Gerontology who are interested in pursuing similar research? I would argue passionately for pursuing those research questions that keep you up at night or you think about while driving or jogging … (I have missed my exit on the way home or to work more than once!) It is important to know that you need to be in it for the long-haul – this Beeson Award work has been in the works for years. I feel incredibly fortunate that my passion for how we best make treatment decisions for older adults with multiple co-existing conditions has caught the interest of the Beeson Award – and I am thrilled to be able to do the work. For me, every time I see a patient, the experience informs the research questions that I am most passionate about. For more information on Dr. Boyd’s work, please visit: Dr. Jeremy Walston (August 2009) We recently had the opportunity to sit down with Dr. Walston and talk about his research interests, what he hopes to accomplish over the coming years. Here are some highlights from our conversation: What led you to a research career in aging? I was fortunate to know 3 of my great-grandmothers, and lived very close to my 4 grandparents. In fact, these grandmothers were frequent babysitters for my siblings and me at an early age. Because of this, I was exposed to aging and its consequences early in life and became very interested in the processes that lead to functional decline and chronic illness as I went through school. When I was in college, I did yard work for Lucille Curtis, who had been the first woman to ever serve in the U.S. foreign service in 1916. She also rode the rails for women’s right to vote in the early 1920s, and had traveled around the world many times. Her stories were absolutely amazing to me, and she inspired me to study hard and get a degree in medicine. It was ultimately her rapid decline over those 4 years of college that inspired me to learn more about aging and Geriatric Medicine. What are your current research interests? I am currently interested in the biological factors that link aging with vulnerability to chronic disease and functional decline. It is likely that there are a common set of biological changes that contribute to late-life vulnerability. My interests lie in uncovering that common biology, and in the development of interventions that slow this biology and that help to prevent late-life functional decline. This involves research on mouse models of frailty, and human subjects research. What direction do you envision the Biology of Frailty program and the Pepper Center going in the next couple of years? I think one of our most important functions is to excite and train younger investigators and students in the study of aging and Geriatric Medicine. In order to do this, I envision having a series of animal models and human populations that students and other trainees can ask important questions related to aging and frailty. We hope to have a series of clinical interventions related to inflammation and nutrition that make some impact on late-life vulnerability and decline. What advice might you have for junior faculty and students in Geriatric Medicine and Gerontology who are interested in pursuing similar research? My advice is to find a solid mentor with a good track record of funding and publications, and work closely with that individual. This mentorial relationship allows trainees the time to develop a skill set that not only enables them to perform research studies, but also trains them to develop significant and meaningful scientific questions. I also recommend that trainees stick to something for the long-haul. Research does not generally offer short termed rewards, rather it takes months and often years of hard work to see real accomplishment. The long-term work we are performing is highly significant to the health and well-being of older adults, which provides a high level of job satisfaction and an opportunity for intellectual and personal growth. Dr. Sarah Szanton (July 2009) As a Claire M. Fagin Fellow, Sarah Szanton, RN, MSN, CRNP, PhD will further develop her skills as a researcher and educator and contribute to improving the health of older Americans. This two-year Fellowship is awarded to select nurse researchers by the Building Academic Geriatric Nursing Capacity (BAGNC) program. Now in its seventh year, the BAGNC program focuses on enhanced research, education and practice as the keys to better nursing care for older adults. The BAGNC program is administered by the American Academy of Nursing and the John A Hartford Foundation, which supports education and research in the field of geriatric nursing. I recently had the opportunity to sit down with Sarah and talk about her research interests, what this fellowship means to her and what she hopes to accomplish over the next two years and beyond. Here are some highlights from our conversation: What led you to a research career in nursing? I became interested in the field of nursing after being Director of Government Relations at a National organization that represented reproductive health Clinics. I found my calling in gerontological nursing after a House Call rotation for low-income adults. After witnessing firsthand the health impact of stress experienced by older adults of low socioeconomic status I became passionate about the issue. I would like to help erase socioeconomic and racial health disparities among older adults. What are your current research interests? My current research activities are centered around understanding and decreasing health disparities among older adults, particularly focusing on the role of chronic psychological strain. Specifically, I am examining the role of psychological stress in oxidative stress, the role of financial strain in older adult health outcomes, and the effect of a meditation intervention with low income minority older adults. How will this fellowship allow you to expand on your current research? I plan to conduct a randomized controlled trial of a quality of life intervention with low income older adults with both psychological and psychosocial outcomes and lay a foundation to conduct future nursing intervention studies to decrease the health related stress of poverty and its consequences in older adults. I believe that achieving these aims will result in significant contributions to the field of geriatric nursing research with a platform for increasing contributions in the future. What advice might you have for students in nursing or public health who are interested in pursuing similar questions? Dive in. Identify people you can learn from. Conduct research to improve people’s lives and make the world a fairer place to live. |
This month's featured faculty is Dr. Alicia I. Arbaje. Dr. Arbaje is an Assistant Professor at the Johns Hopkins University School of Medicine in the Department of Medicine, Division of Geriatric Medicine and Gerontology, and Associate Director of Transitional Care Research. Her research interests include:
"Congratulations to Dr. Ravi Varadhan on his recent AHRQ award titled, 'Methods to Study the Heterogeneity of Treatment Effects in Comparative Effectiveness Research.'"
"Congratulations to Cynthia Boyd, MD, MPH, on her 2009 Paul B. Beeson Career Development Award."
"Congratulations to Dr. Jeremy Walston, Director of the Older Americans Independence Center and Co-Director of the Biology of Frailty research group, on his recent promotion to Professor of Medicine."
"Congratulations to COAH faculty member, Sarah Szanton on her recent Claire M. Fagin Fellowship award."
|
|