Aging: Medicine's Poster Child

Practicing geriatricians were offered an extensive, almost bewildering, selection of programs at the 65th Annual Scientific Meeting of the Gerontological Society of America in San Diego in November 2012.

Paul Kleyman, Director Ethnic Elders Newsbeat, New America media, an amiable editor who is guiding the new MetLife Foundation Journalists in Aging from his own experiences, broke down the meeting’s format. The choices included Symposiums where leading scholars gave their views on a single theme, but GSA12 also offered less academic Paper sessions (panel presentations) where researchers presented new research.

The Workshops tended to be more interactive and attracted gerontologists working in similar areas. Finally, there were Posters sessions, where graduate students or senior-level scholars would stand beside their bulletin boards ready to explain the research they had posted there literally with push pins.

“Poster sessions are the farmer’s market of gerontology scholarship — and the marketplace is in constant motion,” Kleyman says.

The poster sessions were fascinating for anyone interested in aging. They were identified and numbered in the program book and attendees could pick and choose subjects as if selecting dishes from a Chinese restaurant menu.

A poster, for example, from Indiana University South Bend on Narrating Wisdom: Exploring the Link Between Generalized Slowing and Wisdom in Aging has, in age X speed analysis, a conclusion that “Faster older adults displayed greater tendency to give advice compared to slower older adults,” and “Older adult narratives demonstrated greater focus on others and greater religious themes than did younger adult narratives.”

Many of the graduate students are earnest and young and the conclusions their research creates might have been anticipated by experienced clinicians. The reference to religious themes in the elderly surely ties to the comment “in war there are no atheists in the foxholes.”

Matthew Costello, Assistant Professor of Psychiatry at Indiana University gives his thoughts on the impact of the emotions on wisdom.

“People who are more anxious,” he says, “are presumably not in the present moment and less capable of exhibiting wisdom, whereas persons who are more depressed score high in wisdom, because they have greater burdens and are more reflective of their life.”

The poster produced by the Department of Epidemiology & Public Health, University of Miami Miller School of Medicine on Health-Related Quality of Life in Older U.S. Adults: A Regional Comparison is a pleasant surprise for this physician, who had practiced in New Hampshire for 21 years.

Doctoral Student Diana Kachan, BS, formerly from the Republic of Belarus but with 12 years’ residence in the United States, explains that Health-Related Quality of life is an important predictor of morbidity and mortality and gives a HALex rank based on the Health and Activities Limitation Index. The mean HALex ranking was 0.73 in USA. The higher the score the better.

Conclusions: “Older residents of Alaska, Alabama, West Virginia, Mississippi, Arkansas and Tennessee had the lowest mean score (0.62-0.68) and older residents in New Hampshire and Nevada and Delaware had the highest (0.79).”

One of the disclosures in Kachan’s poster was that among the issues contributing to poor quality of life in the elderly (such as unemployment, low physical activity level, low education and smoking) was the factor of being a non-drinker!

Attendees stop by a poster showing work carried out at Columbia University School of Social Work in the City of New York: The Need for Professional Training in Geriatric Mental Illness. No physician would challenge that argument, of course, but gerontologists who are sociologists seem to despair at the constant lack of funding to get things done right. Geriatricians toiling in the trenches often have to accept what is and deal with it.

An intense and caring Daniel B. Kaplan, LICSW, discusses his disappointment the elderly don’t always get the best of care. He outlines the barriers: institutions treating the elderly receive reimbursements so low they can’t afford to send their staff for adequate training or even pay them while they take it.

“It’s chaos,” he says. “They can’t afford to train mid-level managers to supervise quality of care. They simply promote them to be the supervisors. And what training a staff might get is not specialized enough; it’s too generic.”

Kaplan believes organizations like the Geriatric Mental Health Alliance of New York, which has over 3,000 members in more than 40 states, might have the answer of training centers without walls. Seed money would be helpful.

Asked if he had been surprised by anything in his research, this recipient of the prestigious Hartford Doctoral Fellowship in geriatric social work hesitates then says, “I was not surprised to find quality of care suffers as a result of inadequate funding.”

It seems every illness or problem can become medicine’s poster child, but at GSA12 it was wonderful to wander those temporary corridors in the ballroom of the San Diego Convention Center, peer at the posters and chat to the gerontologist whose work it covered.

Many different themes were presented in more than 1,500 posters pinned up over the four days — not counting the 120 or so that went up in the hallways as late-breaking posters. The GSA12 was well organized with all posters numbered and their locations specified.

“The [poster] boards are changed every conference session,” Kleyman explains. “If you try to go back in two hours [for the one you saw before] it will be gone. Scan the Poster titles in subject areas that interest you. Try to get to the ones you want during breaks at the start or end of a conference session… Manage your time.”

Poster themes varied from Adult Protection and Elder Abuse to Family Relations; from Life Satisfaction to End-of-Life; from Dementia/Delirium to Money Matters; from Fall Risk to Epidemiology; from Death and Bereavement to Work and Retirement. How could clinicians not find this a fantastic treasury from the GSA fodder for their next personal journey?

Eric Anderson, MD, lives in San Diego. He is the one-time president of the NH Academy of Family Practice. His commentaries on aging are part of the MetLife Foundation Journalists in Aging Fellows Program organized by The Gerontological Society of America and New America Media. Anderson was a senior contributing editor at Physician’s Management from 1983 until 1998 (when the magazine ceased publication). He wrote a monthly column for both Postgraduate Medicine and Geriatrics for many years. Anderson is the only physician in the Society of American Travel Writers. He has also written five books, the last called The Man Who Cried Orange: Stories from a Doctor's Life.