| HOME | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
| ||||||||||||||||||||||||||||||
Correspondence: Address correspondence to Karl Pillemer, Cornell Gerontology Research Institute and Department of Human Development, MVR G44, Cornell University, Ithaca, NY 14853. Email: kap6{at}cornell.edu
In recent years, it has become common to highlight the positive aspects of "successful aging." Both popular and scholarly reports emphasize pathways to optimal health, well-being, social integration, and life satisfaction in later years. Indeed, it is the case that some individuals retain high physical and mental function into very advanced old age. However, it is also unfortunately true that many people spend the final years of their lives with serious limitations resulting from chronic illness or disability.
Although many Americans are living longer and healthier than ever before, the risk of chronic disease increases dramatically with age (Jette, 1996; Manton, 1996). The strong correlation between advanced age and the incidence of cognitive impairment, as well as the prevalence of psychiatric disorders (cf., Roberts, Kaplan, Shema, & Strawbridge, 1997), suggests that hazards to mental health are also tied to the aging process. Further, negative life transitions such as widowhood, loss of meaningful roles, and admission to a nursing home are likely to occur in old age. These transitions often lead to social isolation and decreased well-being. (Pillemer, Moen, Wethington, & Glasgow, 2000).
The dichotomy between the ideal of optimal physical and mental functioning and the unfortunate reality of the vulnerability that many older people face has provided the impetus for a strong applied focus in the field of gerontology. Gerontology, like psychology (Izard, 2002), has from its beginnings comprised both a science and a profession. Unlike other disciplines in which the researcher–practitioner relationship has been characterized by animosity (Gillan & Schvaneveldt, 1999; Weisz, Donenberg, Han, & Weiss, 1995), there is a tradition within gerontology of communication and cross-fertilization between the scientific and practice communities.
Throughout its history, gerontology has grappled with applied and practical questions, such as How can the lives of older persons be improved? What services and resources work well to solve the problems experienced by older individuals and their families? and What strategies are best for promoting independence, reducing physical vulnerability, and easing psychological distress? In an attempt to answer these questions over the past half century, a vast array of programs has been developed to moderate the negative effects of aging and to foster individuals' adaptation to inevitable age-related changes in function. In concert with such efforts, gerontologists have experimented with changing the structure of tasks and activities and the contexts and environments in which older people live, including families, housing arrangements, and communities.
Despite the limited evidence of animosity between gerontological researchers and practitioners, the connection between research and application still leaves much to be desired. Although social scientists are fond of quoting Kurt Lewin's famous dictum that there "is nothing so practical as a good theory," relatively few have attempted to translate their theories into actual practice. Similarly, there is generally a failure to use research results to guide the design of social interventions and programs (Levy-Leboyer, 1988). Within this context, it is not surprising that there has been a call for more rigorous, research-based approaches to intervention development (Ory, 2000; Schulz, Maddox, & Lawton, 1998). To put it simply, with the aging of the population, it is more important than ever to know what works, why it works, and with whom it works best.
 |
Challenges for Intervention Researchers |
|---|
 TOP Challenges for Intervention... The Edward R. Roybal...Solving Problems in Applied...ConclusionReferences |
|---|
With rare exceptions (cf. Schulz et al., 1998), little has been written about such special problems that arise in conducting intervention research with older adults. Although general guidance on intervention research is available in various disciplines, we believed it would be useful to highlight major challenges that specifically arise in gerontological settings. Further, we anticipated that researchers would find concrete examples of problems and solutions to be helpful in guiding future work. Therefore, the charge given to the authors in this special issue was to identify key problems they have encountered in conducting applied gerontological research as part of the Edward R. Roybal Centers for Research on Applied Gerontology and to describe ways in which these problems were addressed.
|
The Edward R. Roybal Centers for Applied Gerontology |
|---|
|
TOPChallenges for Intervention...The Edward R. Roybal...Solving Problems in Applied...ConclusionReferences |
|---|
Within this broad mission, each of the centers focuses on applied problems in a variety of practical domains, including such issues as driving behavior, the fit between older persons and technology, exercise and well-being, and social integration in later life (see Table 1). To meet NIA's charge, the applied programs developed by the centers are firmly grounded in theory and basic research. Given the proliferation of programs to help older persons, NIA has attempted through the Roybal Centers to assure that the search for practical solutions to problems of aging is based on sound science.
|
|
Solving Problems in Applied Research: Lessons From the Roybal Centers |
|---|
|
TOPChallenges for Intervention...The Edward R. Roybal...Solving Problems in Applied...ConclusionReferences |
|---|
A key challenge in applied aging research is to capture representative tasks and environments and meaningful outcome measures. Several Roybal Centers seek to improve functional performance across a range of settings. Areas addressed include use of technology, driving, and compliance with medication orders. In each case, the following dilemma arises: How can intervention researchers capture real-world tasks and environments, but also maintain scientific rigor? As Czaja and Sharit (p. 9 of this issue) note, various techniques can be used to address this issue, including task analysis and simulation.
As discussed in the article by Ball and colleagues (p. 29 of this issue), collaboration with agencies in field research settings can be problematic. Findings may emerge from intervention research that strongly support a new process or procedure that requires a change in standard agency practice. However, implementing the novel research-based practice in an applied setting, such as a service agency, can result in a variety of practical obstacles. Critical tasks include (a) training field personnel in the agency, (b) overcoming obstacles to participation by agency clients, and (c) managing data collection.
Intervention research also typically involves recruiting subjects who are willing to expend amounts of time and effort that exceed those required in conventional experimental or survey studies. Intervention designs used by the Roybal Centers required that subjects carry out activities over days, weeks, or months, and to complete extensive data collection instruments. Although recruitment under such circumstances is generally challenging, attracting and keeping members of underrepresented groups, such as racial and ethnic minorities and disabled persons, poses special challenges. As discussed by Warren-Findlow and colleagues (p. 37 of this issue), strategies for increasing participant recruitment and retention include attention to person-based factors, environmental factors, and program intervention factors.
Consistent with the program's mission, the Roybal Centers have also given particular emphasis to widespread dissemination of information to practice audiences. It is clear that the results of interventions are often underutilized, and practitioners may be unaware that the programs exist or of their specific benefits to clients. As Farkas and colleagues (p. 47 of this issue) note, a strategic approach to dissemination of findings is required, which includes activities to achieve four goals: (a) exposure, (b) experience, (c) expertise, and (d) embedding. They describe successful dissemination strategies that include presentations, print and Web-based information, videotapes, and targeted training programs.
Finally, an underlying premise of the Roybal Centers is that interventions should be grounded in theory and basic research findings. However, as noted earlier, in gerontology, the connections among theory, research, and intervention are often tenuous. Brown and Park (p. 57 of this issue) provide an example of the benefits of making such connections within the field of cognitive science. They demonstrate how theories and mechanisms of cognitive aging provide fertile ground for investigating practical issues such as how adults process medical information and how performance of medical behaviors can be improved. Findings can be used both to improve health care of older patients and to ameliorate the effects of cognitive impairments. In a different topical area, Pillemer and colleagues (see Pillemer, Suitor, and Wethington, p. 19 of this issue) demonstrate that attention to theory and basic research can shed light on the mechanisms of the effects of family caregiver interventions and can lead to creative intervention designs.
|
Conclusion |
|---|
|
TOPChallenges for Intervention...The Edward R. Roybal...Solving Problems in Applied...ConclusionReferences |
|---|
As this special issue demonstrates, the potential hazards of poor driving ability, lack of medication compliance, inability to access technology, poor fitness and lack of exercise, and serious caregiver stress can have obviously negative effects on the lives of older adults. A new generation of intervention projects, based on a strong tie to basic science and using improved methods, is greatly needed in these and other areas.
Taken together, the strategies and techniques reported in the present issue should be encouraging to policy makers as well as to investigators and practitioners, and ultimately to older persons and their families. Strong and significant intervention effects can be obtained, and these findings can be translated to the settings in which older persons live, interact, and receive services. More germane to the topic of this issue, the challenges that arise in conducting intervention research are not insurmountable, but can be addressed by systematic and creative problem solving.
We believe there is much to be gained by additional discussion and analysis of what the sociologist Erving Goffman (1959) would characterize as the "backstage region" of intervention research activity. The setbacks and difficulties encountered by intervention researchers often do not find their way into research reports and publications. It is our hope that the present issue provides evidence of successful translational research and sets the stage for additional discussion of key problems and solutions in intervention research with older persons.
|
Footnotes |
|---|
2 University of Miami School of Medicine, Department of Psychiatry and Behavioral Sciences, Center on Adult Development and Aging, Miami, FL.
3 Department of Psychiatry and University Center for Social and Urban Research, University of Pittsburgh, PA.
4 Behavioral and Social Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD.
|
References |
|---|
|
TOPChallenges for Intervention...The Edward R. Roybal...Solving Problems in Applied...ConclusionReferences |
|---|
This article has been cited by other articles:
 |
|
 |
|
  E. Wethington, R. Breckman, R. Meador, M. C. Reid, M. Sabir, M. Lachs, and K. A. Pillemer The CITRA Pilot Studies Program: Mentoring Translational Research: Kathleen Walsh Piercy, PhD, Editor Gerontologist, December 1, 2007; 47(6): 845 - 850. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Sabir, R. Breckman, R. Meador, E. Wethington, M. C. Reid, and K. Pillemer The CITRA Research-Practice Consensus-Workshop Model: Exploring a New Method of Research Translation in Aging Gerontologist, December 1, 2006; 46(6): 833 - 839. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Schacke and S. R. Zank Measuring the Effectiveness of Adult Day Care as a Facility to Support Family Caregivers of Dementia Patients Journal of Applied Gerontology, February 1, 2006; 25(1): 65 - 81. [Abstract] [PDF]
|
|
| ||||||||||||||||||||||||||||||
| HOME | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
