Aging Requires an Ecosystem of Care

Faculty at the Gillings School support older adults across the ecosystem of geriatric care, leading research, training and clinical work that helps people age in healthier and more independent ways.

Empowering home and community-based care

Most older adults want to age in place. But for that to be a reality, many people will require a host of services spanning in-home health care plus cleaning, food preparation and assistance with daily activities like bathing. To address this need, the Gillings School launched the Home and Community-Based Service (HCBS) Leadership Program in partnership with ADvancing States. The program, which launched last year, provides workforce training to those in long-term services and supports-related roles.

We shouldn’t be using a one-size-fits-all approach with anyone, but especially not with older adults who are dealing with complexity upon complexity.

The 10-week course uses online modules written by Erin Kent, PhD, associate professor and associate chair for research in health policy and management, Karen Volmar, JD, MPH, FACHE, professor and associate chair for academic programs in health policy and management, and Anne Jacobs ’93 of Riverstone Health Advisors, with expert consultation from ADvancing States. The course trains participants on the fundamentals of home and community-based services administration, with modules covering HCBS policies, financing and service delivery details. This is helpful to many working in the field who feel that they know the specifics of their individual program but need a better understanding of the overall system and how everything connects in home and community-based care.

“This program facilitates connections for care,” said Volmar. “By helping people receive the services and supports they need where they need them, we’re maximizing their ability to live a life that reflects their goals.”

Improving mobility and function

Maintaining physical function is essential for older adults who want to remain in their own home and enjoy a higher quality of life as they age. The health promotion work of Associate Professor John Batsis, MD, with older adults focuses on maintaining and improving physical function with the help of diet and exercise by using technology. Batsis, who is a geriatrician-researcher and associate professor in medicine and nutrition, currently runs a behavioral weight loss intervention for older adults. The trial compares results from those working with health coaches on behavioral problem-solving strategies to those working with dietitians and physical therapists in a more structured, medicalized approach. Batsis is also working with a startup company to develop a resistance exercise band that is Bluetooth-enabled and can be used by older adults for home-based physical therapy.

His previous projects have explored the use of FitBits and telemedicine, and he is now evaluating how new weight loss drugs affect older adults.

Making diabetes management technology more accessible

Older adults also face more difficulties when it comes to managing chronic diseases. Continuous glucose monitors (CGM) have become the cornerstone of diabetes management for people using insulin. However, studies show that adults aged 65+ adopt CGMs at a much lower rate compared to their youth and younger adult counterparts.

Anna Kahkoska, MD, PhD, Joan Heckler Gillings Assistant Professor in nutrition, is leading a new clinical trial, funded by the American Diabetes Association, that is focused on the education and training that older adults may receive to learn how to use continuous glucose monitoring as part of their diabetes management. As a part of the trial, Kahkoska is studying how to innovate — ultimately to individualize — CGM training to make it most effective.

“We have evidence that the use of CGMs can be a powerful tool for optimized diabetes management and outcomes among older adults with diabetes who use insulin,” said Kahkoska. “But it’s a complex intervention, and we know that older adults may need extra education or support in different areas, especially if they’ve had fewer interactions with technology or have been managing their diabetes with fingersticks for decades. We hope to learn about how we can improve the training provided to older adults to make this technology more accessible to all people with diabetes, regardless of how old they are.”

Understanding neurodegenerative disease

Cognitive decline often adds another layer of complexity in managing older adults’ health. Hongtu Zhu, PhD, Kenan Distinguished Professor in biostatistics, integrates patient data from brain imaging scans, genetic testing, clinical assessments and electronic health records and lifestyle factors to better understand how Alzheimer’s disease develops over time.

“Alzheimer’s is a very complicated, heterogeneous disease,” said Zhu. “We’re integrating data from all available domains so we can look at humans as a dynamic system and model different Alzheimer’s disease trajectories across time. We’re also evaluating which factors are modifiable — such as drugs, exercise and nutrition — and how they can change patient trajectories.”

Zhu and his team hope that a more robust understanding of the disease’s pathways and more nuanced disease subtyping with tailored interventions will improve the standard of Alzheimer’s disease care in the future.

Complex needs require individualized support

Researchers and clinicians at the Gillings School understand that older adults require a connected system of care that should be directed by their unique health goals.

“We shouldn’t be using a one-size-fits-all approach with anyone, but especially not with older adults who are dealing with complexity upon complexity,” said Batsis. “This is an area where we really have to individualize care.”