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A Vision for Aging Inquiry

Ted Johnson, MD, MPH

Given the many University-wide assets for inquiry on aging, we have the potential to be a top-five national leader in inquiry on aging, given the breadth and depth of the current resources.  Having so many options demands direction.  As one consultant to the Emory Charter Committee for the Center for Health in Aging said, "You have a great portfolio and lots of opportunities- perhaps too many opportunities.  You need to decide what you want to do."  This letter outlines my proposed sharper focus for aging at Emory. 

Emory needs a bold and audacious goal.  Despite the ambitious nature of this goal, Emory is uniquely positioned to accomplish this- in partnership with other community and university programs -over the next 12 years. 

I propose that we commit to eliminating by the year 2020 the need for long-term nursing home institutionalization as a routine destination for older adults in Georgia.

Older adults fear a loss of independence.  For us as geriatricians and gerontologists, this should focus our struggle; this goal should drive our research, clinical, educational, and outreach efforts. 

A 12-year framework allows for this goal to be broader in scope than the identifying community alternatives to nursing homes approach (move services from institutions to the homes), but new basic science, translational science, predictive health initiatives, and clinical knowledge on the treatment of the root causes (dementia, stroke, urinary incontinence, congestive heart failure, immobility) that contribute to nursing home admission.  A goal of eliminating the routine need for longitudinal, life-long Nursing Home care for elderly adults is consistent with the message of the 2008 Institute of Medicine report (Retooling for an Aging America- Retooling the Health Work Force) for developing new systems of care, is financially important to many health systems and all payers, provides a focus for clinical demonstration projects (i.e., a pre-nursing home outpatient consultation clinic, for example) and educational interventions. 

The organizing principles would be to: 1) seek out medical breakthroughs in the treatment of chronic and disabling conditions, such as stroke, dementia, congestive heart failure, Parkinson's disease, and urinary incontinence; 2) develop interventions that stress nutrition and diet and exercise, not just in the very old, but in the frail, young-old individuals (those 60-65) who will in 15 years time potentially be bound for nursing home admission; 3) initiate investigations into the basic biological mechanisms that are the root causes of these conditions, such as inflammation, cell senescence, protein processing, and cell signaling, that allows these conditions to be prevented or the effects to be significantly post-poned; 4) develop care models (such as palliative care) that take elements of care now routinely provided in nursing homes, and more fully develop these programs within the home, community, and alternative institutions; and 5) address social issues, including re-development of our communities, including the incorporation of faith-based communities, development of livable communities where there is easy access to food, health care, and meaningful activity, and supporting care-givers. 

What does this lead us to do?  Read about our focused activities . . .