inside the IOA

University of North Carolina Institute on Aging
2000-2001 Highlights Report

Division of Health Affairs
June 15, 2001

The Institute's unique contribution to the University System's institutional mission is its efforts to develop cross-disciplinary, pan-university educational and research activities that normally would be considered inappropriate or difficult to manage within the boundaries of a single-disciplinary department or campus. At the same time, the IOA has assumed a leadership position in the field of aging at the UNC-CH, and is a growing center seeking to fulfill its basic mission at this university. Hence, the IOA programs reach out to the state and its host campus and involve budget redistributions within and from Chapel Hill to other universities and agencies in North Carolina. Furthermore, through its Center on Minority Aging Research, funded by the National Institute on Aging and the National Institute for Nursing Research, the Institute on Aging fosters minority-focused research and development projects. These efforts promote quality research specifically targeted at the needs of older minority populations in our state and also strengthen the research and scholarly abilities and experiences of faculty within the UNC System. To pursue its unique mission, the overall goals of the Institute are to:

1. Promote collaborative applied and basic gerontological research and the sharing of research information across the wide spectrum of disciplines pertinent to the field of human aging;

2. Translate relevant theory and research-based knowledge into innovative programs of interdisciplinary gerontological education and practice;

3. Provide state-of-the-art information to policy makers, program managers, service providers, clinicians, and the general public to ensure that research findings are reflected in policy recommendations, in professional practice, and in the health and human service systems serving the needs of older adults and their families.

Program Highlights for 2000-2001

Highlights of the Institute's accomplishments during the past year are summarized into four categories: 1. organization and administration;
2. activities that span and link aging education, public service and research activities;
3. research and research development; and
4. the Institute's information service

1. Organization and Administration

1.1. Change in leadership
Effective July 1, 2000, two changes were made with respect to the senior staff of the Institute. A new half-time position, Associate Director for Public Service was established to be responsible for initiating and implementing programming aimed at the vast expanse of aging services, advocating for campus and community service and research partnerships, and coordinating intra- and inter- community projects that address needs of at risk, older adults, particularly minorities and those in rural and underserved areas of the state. This position was filled by William Lamb, MSW, MPA, who has extensive planning and administrative experience in aging services in the state. The position of Associate Director for Minority Affairs, held by Dr. Elizabeth Mutran, was eliminated and the oversight of minority-related initiatives was incorporated within each of the Institute's main program areas. Professor Mutran has continued on the Institute's management team (The Director's Group) in her capacity as Director of the Center on Minority Aging. In addition, there has been a change in the leadership of the Institute's Advisory Board: Dr. Edward F. Brooks, former Associate Provost for Health Affairs, has become the new Chair replacing Dr. Cynthia Freund, former Dean of the UNC-CH School of Nursing.

1.2 New Interest Group formed
The "older worker" age category (45-64) is currently expanding at a more rapid rate than the "old" category of 65 plus. Meanwhile, age 65 is less and less important as a marker of retirement, because of the elimination of mandatory retirement and the drop in the average age of retirement. There are important social policy issues concerning older workers and the transition to retirement. The IOA established a new Interest Group on Older Workers & Retirement that exchanges ideas, discusses research, program and policy issues, and develops projects based on mutual interests. Meetings are planned every six to eight weeks at UNC-Chapel Hill. The meetings include formal presentations or informal discussions and information sharing. An older workers listserv is used for group announcements and discussion. Currently there are more than 20 active members in the interest group who include academics, state agency representatives and senior advocates and represent a broad geographic region from Charlotte to Elizabeth City.

2. Activities that Span and Link Aging Education, Public Service and Research Activities
The Institute on Aging's community service mission focuses on disseminating information from the Institute's aging-related research and educational efforts, and applying this information to the service and education needs of communities. Several mechanisms are in place for disseminating and applying research findings. These activities include:

2.1 Distinguished Lectures Series and Seminars
The Institute's Distinguished Lecture Series is intended for scholars, providers, and activists in the aging field throughout the state. Distinguished lecturers now visit multiple campuses in the UNC system to offer lectures and confer with faculty and students. Audiences for various presentations across the state have ranged from small groups of students to lecture audiences up to 150 faculty, students, providers, and older adults. During 2000-2001, three Distinguished Lecturers were sponsored at the UNC-CH campus. In December 2000, Dr. Robyn Stone, Associate Professor of Geriatrics and Adult Development and Department of Health Policy, Mt Sinai School of Medicine and Executive Director, Institute for the Future of Aging Services, American Association of Homes and Services for the Aging, presented on "The Future of the Long-Term Care Workforce: It's Not 'Just the Economy, Stupid!'" The program also included a recognition ceremony for the First Annual Gordon H. DeFriese Career Development in Aging Research Awards presented to UNC-CH faculty member, Dr. Sheryl Zimmerman, and Mr. Joe Sharkey, doctoral student in the Department of Nutrition in the UNC-CH School of Public Health. Dr. Stone presented another lecture, co-sponsored by the IOA and the North Carolina Division on Aging, titled "Integrating Supportive Services into Family Caregiving" to an audience of aging services providers and advocates at the legislative building in Raleigh.

In conjunction with the IOA third annual poster symposium in January 2001 (see Section 3. Research and research development for details), Dr. Rosalie Kane, Professor, Division of Health Services Research and Policy and Director of the National Long Term Care Resource Center, University of Minnesota, lectured on "In the Eye of the Beholder: Quality of Life for Long Term Care Consumers." She also lectured on "Getting a Long-Term Care System We Can Live With (and in): Towards User-Friendly Long-Term Care," at UNC-Wilmington that was co-sponsored by the Gerontology Program and the Department of Psychology.

In March 2001, Dr. Malcolm Johnson, Professor of Health and Social Policy and Director of the International Institute on Health and Aging, University of Bristol, presented a lecture on "Long Term Care in Turmoil: Comparing Britain and America." He also presented the same lecture at UNC-Charlotte's Gerontology Program.

In addition, the Institute sponsored a seminar titled "Three Ways to Simulate Age-related Changes in Memory" by Dr. Fergus I. M. Craik, Professor in the Department of Psychology and member of the Rotman Research Institute, University of Toronto, to an intercampus audience of Duke University and UNC-CH faculty and students.

2.2 Curriculum development activities at UNC-CH
For the third year, the Institute provided the administrative and fiscal support for the offering of three-credit, interdisciplinary Aging and Health course to UNC-CH undergraduate and graduate students of all disciplines. Coordinated by Dr. Sheryl Zimmerman, Assistant Professor in the School of Social Work, Dr. Philip Sloane, Goodwin Distinguished Professor of Family Medicine, and Dr. Leigh Callahan, Research Assistant Professor in the Department of Epidemiology, the course consisted of lectures, seminars and demonstrations by a multi-disciplinary faculty drawn from the UNC-CH campus. The course is cross-listed in pharmacy, nursing, dentistry, medicine, family medicine, physical therapy, social work and epidemiology. In the Spring Semester 2001, William Lamb, Dr. Zimmerman, and Dr. Altpeter coordinated the first offering of the graduate level interdisciplinary course in Aging and Policy; 21 students enrolled and the course was well-received. All three faculty have received UNC-CH's FITAC awards to learn skills to infuse computer technology into the Aging and Policy course. In addition, Dr. Altpeter has received a Lupton grant to develop an interdisciplinary, introductory course on aging targeted at advanced undergraduate and graduate students. We anticipate offering this course in the Spring Semester of 2002. In addition, the Institute received another special initiatives grant from the Provost Office to develop web-based modules on aging. To date, two modules have been designed: one on the biology of aging and the other on retirement.

The Institute also continued to support the interdisciplinary graduate Certificate In Aging program administratively housed at the UNC-CH School of Social Work. As of the Spring Semester of 2001, 42 graduate students enrolled in this highly successful program representing pharmacy, information and library science, and nursing along with the disciplines named above

2.3 Outreach support for leadership development
The Institute assumed administrative and financial support of the Senior Leadership Initiative from the Duke University Center for Aging and Human Development. This program recognizes the importance of older adult leadership in addressing issues affecting themselves and the supports necessary to complement the skills and experiences brought by the participants to the program. Participants engage in a year-long program that includes a series of seminars, tutorials, and networking opportunities related to emerging aging issues in North Carolina and they design an individualized personal leadership development plan. Participants receive a stipend of $2000 to assist in the implementation of the personal leadership development plan. The program is open to any older person currently residing in North Carolina. Six seniors participated in the 2001 program and graduated this June. The 2002 class has been accepted. This group includes:
Beverly Wheeler, Greenville
Nancy Hall, Winston-Salem
Rita Spina, Pittsboro
Calvin Underwood, Asheville

2.4 International, regional, statewide, and inter-campus conference activities
The Institute has co-sponsored and supported or agreed to cosponsor or support several conferences that help to establish its role in North Carolina, nationally and internationally, as a leader in aging-related activities. On September 26-28, 2001, the Institute on Aging will co-sponsor an international symposium to be held at the Universität Bremen in Germany. The symposium will focus on life course research and is entitled, "Institutions, Interrelations, Sequences: The Bremen Life-Course Approach." Cornell University's Careers Institute and the Life-Course Center at the University of Minnesota are also co-sponsoring the symposium. The Institute also supported the 22nd annual meeting of the Southern Gerontological Society held in Lexington, Kentucky and the annual conferences of the Gerontological Society of America and the Association for Gerontology in Higher Education. IOA staff made poster and panel presentations at each of these conferences as well.

Closer to home, the Institute supported (administratively and financially) the Fifth Annual North Carolina Summer Symposium on Aging, held in July in Asheville and is currently supporting the Sixth Annual Summer Symposium that will be held in Wilmington in July 2001; Victor W. Marshall, IOA Director, was co-chair of the program committee. The Symposium brings together faculty, students, service providers and consumer advocates from around the state. The Institute also provided administrative, organizational and financial support to the Symposium on Rural Aging, for the Governor's Advisory Council on Aging that was held in April 2000 to audience of about 75 participants from throughout North Carolina. The Institute also published the proceedings of this symposium. The Institute also co-sponsored the annual conferences of the UNC School of Medicine Program on Aging and the NC Division of Aging. The IOA has established an administrative structure that is comprised of the Division of Aging, the NC Association on Aging, the Summer Symposium on Aging, the Coalition on Aging and the Governor's Advisory Council on Aging that would oversee an annual NC Conference on Aging that would replace the annual summer symposium and the DOA conference. The administrative group is currently seeking funding to support this conference initiative.

2.5 Strengthening gerontology on the UNC-Chapel Hill Campus
In September, the Institute co-sponsored its second UNC-CH campus-wide retreat for faculty with interests in aging-related public service and education and in May, another retreat for faculty with interesting in aging-research. An outcome of the education retreat was the proposal to develop more interdisciplinary coursework on aging on the campus (see Section 2.2 for further details.) The goal of the research retreat was to encourage proposal development in aging research at UNC-CH. More than 40 campus researchers heard information from funding organizations, presentations of experienced, funded investigators, and had the opportunity to build community and interdisciplinary linkages. External guest speakers at the retreat included:

Marcia Ory, PhD, MPH, Chief, Social Science Research on Aging, National
Institute on Aging

John Feather, PhD, Director, AARP Andrus Foundation; President,
Grantmakers in Aging

Ilene Siegler, PhD, MPH, Professor of Medical Psychology, Duke
University; member, Advisory Council, National Institute on Aging

William Applegate, MD, MPH, Professor of Medicine, Chairman,
Department of Internal Medicine, Wake Forest University School of
Medicine; Editor-in-Chief, Journal of the American Geriatrics Society,
1993-2000

UNC-CH faculty who talked about their research experiences included:

David Blau, PhD, Professor, Department of Economics, and Director,
Demography and Economics of Aging Research (DEAR), University of North
Carolina-Chapel Hill

Robert DeVellis, Research Professor, Health Behavior and Health
Education, University of North Carolina at Chapel Hill

Jean Kincade, PhD, RN, Research Associate Professor, School of Nursing,
and in the Program on Aging in the School of Medicine, University of North
Carolina-Chapel Hill

Philip Sloane, MD, MPH, Elizabeth and Oscar Goodwin Distinguished
Professor Family Medicine, and Co-Director, Program on Aging,
Disablement, and Long-Term Care at the Cecil G. Sheps Center for Health
Services Research

The Institute will continue to hold these events on a periodic basis, working in partnership with other campus aging-related entities including the School of Medicine's Program on Aging, the School of Social Work's Certificate in Aging program and its Center for Aging Research and Educational Services (CARES), the Carolina Population Center, and the Program on Aging, Disablement and Long Term Care of the Cecil G. Sheps Center for Health Services Research.

2. 7 Proposed Pre and Post-doctoral training in aging at UNC-CH
A specific concern of the IOA is the preparation of both researchers and practitioners in the field of aging; hence, it has emphasized advanced academic programs for those preparing for careers in the clinical and service professions, as well as programs for person preparing for investigative careers in the field of aging. To this end, the Institute has brought together UNC-CH faculty from various departments to develop plans for an externally-funded, pan-University graduate and post-graduate training program in aging. The first task was to apply for a National Research Service Award (NRSA) institutional training grant through the National Institute on Aging of the National Institutes of Health. This training grant can provide tuition, fees, and stipend support for pre- and post-doctoral trainees representing multiple disciplines. Graduate students who receive traineeships through this program will be required to participate in a research project under the direction of an approved preceptor. Students affiliated with the Institute will participate in a research seminar series involving faculty, students and outside speakers. The IOA is currently awaiting notification of approval and funding; if granted, the program will begin in the Fall of 2001.

2.8 Statewide workforce educational needs survey
An overarching educational initiative of the Institute on Aging is to stimulate the development and expansion of formal coursework offerings on aging on all UNC System campuses to meet the growing demands of a rapidly aging population within the state. These efforts have focused on "concentrations" on aging and gerontology at the graduate and undergraduate levels within current degree tracks as well as exploring the feasibility of inter-institutional, interdisciplinary degrees in aging that could be offered through distance learning. As part of this activity, the Institute established an Educational Consortium of eight campuses to investigate the feasibility of offering a coordinated degree program in aging. To lay the foundation for building intercampus course offerings the IOA has launched a multi-phased workforce and student survey of aging educational needs and capacities in distance technology. This effort has entailed building additional partnerships with state regulatory agencies serving older adults, and with the numerous trade associations whose membership provide long term care in North Carolina. To provide the resources needed for this project, the IOA applied for and received special funds designated by the UNC-CH Provost's office for the development of distance education programs. To date, all Adult Services Units within the County Departments of Social Services and all agencies funded under the Home and Community Care Block Grant administered by the NC Division of Aging have been surveyed. The report of the findings of this phase of the analysis is available on the IOA's website. The current phase of the survey is focusing on the long term care workforce; 10,580 surveys have been mailed to a stratified sample of 402 agencies out of a pool of 2,048 agencies that provide home and institutional care to the frail elderly. Data entry of the first 1000+ completed responses is underway and reminder postcards have been distributed to those agencies that have not responded as yet. We anticipate completing the data analysis of the second phase by late summer.

2. 9 Public Service
IOA's public service mission focuses on disseminating information from the University's aging-related research and teaching efforts, and applying this information to the service and education needs of communities. During the short tenure of this new position of the new part-time Associate Director for Public Service position, significant strides have been made in achieving dissemination of information pertaining to timely aging-related issues within the state and the training of the workforce in aging. For example, 12 presentations have been made explaining the preliminary recommendations of the state's Institute of Medicine Task Force on Long Term Care to audiences of state regulators, senior citizen advocates, seniors, regional aging and local aging services staff and advisory committees, faculty in aging, and other state-appointed task forces. In addition, two regional training sessions on leadership and aging were presented to Department of Social Services Directors and Adult Services Directors. Other training sessions have spanned such topics as "Unscrambling the LTC Continuum," and the differences across counties in the utilization of the Community Alternatives Program (CAP-DA), and have been delivered to diverse audiences such as personal care aides, nursing home staff and citizen advocates.

The IOA has been engaged in numerous events to bring awareness to the general public about aging-related issues. For example, the IOA has participated in a project with UNC Public Television to spotlight aging issues in May (Older Americans Month). IOA staff have also been featured on local television programming focused on aging issues. Further, the IOA collaborated in an interdisciplinary effort within the UNC-CH Health Affairs Division to apply for a CASE Fellowship grant to train media personnel from around the country about national and state-specific aging issues; several IOA staff participated in the two-day workshop that was funded. The IOA as participated in a workshop aimed at sensitizing media personnel within the UNC viewing area about aging issues and possible story lines. Along with numerous associations, consumers' groups, universities, and state or local service providers, the IOA has also cosponsored a variety of public educational programs for long term care advocates, family caregivers and women with osteoporosis.

As a service to nursing home facilities statewide, Institute provided funding for the reproduction and distribution of 635 copies of a videotape titled, "Antecedents and Problem Solving of Assaultive Behavior in Alzheimer's During Bathing" that was prepared by Wilaipun Somboontanont, doctoral student in the UNC-CH School of Nursing.

As an ongoing activity to maintain currency with the issues of the older adult population in North Carolina, the IOA staff maintain regular contact with the state legislative representatives and are members of numerous statewide groups and boards of organizations, including the Governor's Advisory Council on Aging, the North Carolina Coalition on Aging, Friends of Residents in Long Term Care, Wake County Community Advisory Committee, Wake County United Way Senior Task Force, Shepherd House in Orange County, AARP Capital City Task Force, the Orange County Coalition on Aging, and the NC Association on Aging.

3. Research and Research Development
The Institute is attempting to expand its in-house research activities, while also promoting research activities and linkages across the state. The Institute is carrying out its research mission by partnering with several other problem-focused centers and institutes co-located in the Division of Health Affairs on this campus, and through its Center on Minority Aging, collaborating with other campuses in the state.

3.1 Current research activities
The Institute on Aging is carrying out its research mission by partnering with several other problem-focused centers and Institutes co-located in the Division of Health Affairs on the UNC-CH campus, local agencies, and with other campuses in the state. Examples, funded through several mechanisms, include:
· a grant from Carol Woods Retirement Community to develop a community intervention strategy with the Durham Council of Senior Citizens and the Durham Public Housing Authority to improve health care status and physical function of economically disadvantaged and underserved minority elders living in the Durham Senior Public Housing Community;
· a contract with the NC Division of Aging to develop county profile data for planning community-based aging services, including health promotion and preventive services, for all 100 counties in the state;
· a collaboration on a five-year grant to UNC Carolina Population Center from the National Institute on Aging for a Career Leadership Award in the demography and economics of aging. This new project provides substantial resources for faculty investigators interested in studying issues, including health care economics, pertinent to the state's policy development for its rapidly growing older adult population.
· a contract from Canada Policy Research Networks to produce a paper on the usefulness of the life course perspective for policy development concerning older workers and retirement.

The Center on Minority Aging, in addition so supporting research development through its seed grants program, has continued to analyze data from the Durham Elders Survey

3.2 Research development
With respect to collaborative research projects, the Institute has four pending grant applications including:
1. an RO1 application to the National Institute on Aging involving an interdisciplinary and inter-campus team of investigators from the Department of Health Behavior and Health Education, the Thurston Arthritis Center, the Departments of Statistics and Biostatistics, Duke University and the Institute. This project will investigate the mechanisms through which socioeconomic status and "social standing" influences health. This project would entail county, neighborhood and household assessments in 30 counties to better understand the role of social and physical environments on health status;
2. an R21 Application to the National Center for Complementary and Alternative Medicine involving an interdisciplinary team of investigators from the School of Pharmacy, the Institute on Aging, Cecil G. Sheps Center for Health Services Research and Duke University Divinity Program. The proposed program, titled "Improving Physician-Older Patient Communication about Complementary and Alternative Medicine (CAM)" would investigate multiple methods for encouraging older patients to discuss CAM with their physicians and to assess their satisfaction in these encounters;
3. an RO1 application to the National Institute on Aging involving an interdisciplinary and inter-campus team of investigators from the Institute and the ECU Center on Aging. This project will investigate psychosocial dynamics of screening mammography among at-risk, older minority women; and
4. a Special Interest Project grant application to the Centers for Disease Control involving an interdisciplinary group of faculty, state agencies and local services providers interested in conducting research about and designing educational outreach about health promotion and aging. This project will be co-lead by the IOA and the Program on Aging of the UNC-CH School of Medicine and has the potential to influence state and federal policy and programs pertaining to promoting healthy life styles and functional status among older adults.

The Center on Minority Aging (Professor E. Mutran, Director) is also submitting an application for continuation funding for the Center.

The Poster Symposium held in January 2001 in conjunction with a Distinguished lecture, featured the findings of eight of the nine grant projects funded during the prior year cycle. This interdisciplinary and group of presenters representing multiple campuses, their topics and affiliations included:

Establishing Felt Needs for Effective Support Programs for Grandparents
Parenting "At Risk" Grandchildren
Rosemary Closson, PhD, MBA, NC Agricultural & Technical State University,
Dept. of Human Development & Services

Effect of Aging on Oxidative DNA Damage in Leukocytes
Cindy J. Fuller, PhD, UNC-Greensboro, Dept. of Nutrition and Food Service
Systems

Interpersonal Health Communication and Self-Management of Heart Disease
Among Older Adults
Megan Lewis, PhD, MA, UNC-Chapel Hill, Dept. of Health Behavior & Health
Education

Lung Surfactant and Aging
Lin Liu, PhD, East Carolina University, Dept. of Physiology

Reforming Medicare: An Analysis of the Premium Support Model
Jonathon Oberlander, PhD, MA, UNC-Chapel Hill, Dept. of Social Medicine

Environment, Occupation of Time, and Quality of Life in Dementia
Wendy Wood, PhD, MA, UNC-Chapel Hill, Dept. of Allied Health Sciences

Application of Health Belief Model in Hypertension Management among
Korean-Americans
Miok Lee, PhD, Post-Doc, UNC-Chapel Hill, School of Nursing

How Managed Care Affects Clinical Preventive Services for Elderly
Ying-Chun Li, MHA, MS, UNC-Chapel Hill, Dept. of Health Policy & Administration

Protein-Energy Interactions and Long-Term Change in Muscle and Fat Mass
Jodi Dunmeyer Stookey, MSc, BA, UNC-Chapel Hill, Carolina Population Center

During the 2000-2001, the Institute launched its new Small Research Grants Program for faculty of any rank, with priority given to proposals with active student involvement, interdisciplinary and intercampus linkages, and linkages between the academic and service sectors. The five awardees and their projects totaling $33,730 are:
Strategy Differences and Age Effects on Spatial Learning
Dunlosky, John T., UNC-G

Walking and Talking: Shared Task Performance in Older Women
Hinton, Virginia, UNC-G

Changes in Ability to Use Paretic Lower Extremity During Recovery
From Stroke
Mercer, Vicki Stemmons, UNC-CH

XBP-A Novel Protein of the Amyloid Precursor Complex
Teller, Jan K., ECU

Older Adults Participation in and Barriers to Educational Activities
Uhlenberg, Peter, UNC-CH

4. The Institute's Information Service
In 1999-2000, the Institute established an Information Center that has become a central source of aging-related information for researchers, educators, legislators, and service providers in North Carolina. The Center houses the Institute's collections of aging-related materials, and offers an on-line catalog of aging-related resources, research tools in aging, and technical assistance services to conduct searches. Initiatives have focused on structuring new and innovative ways of bringing the expertise of aging research together with the experience base of provider agencies in the interest of seeking more effective translations of research-based knowledge into practical applications of benefit to older adults in our state. In support of the education, service and research activities noted above, the Information Center continues to update and add to the Institute's world wide web home page, <www.aging.unc.edu>. This web page is designed to provide information to the public about aging resources, campus-based and community-oriented educational programs, aging-related events, aging-related databases and other state and national resources on aging. Brochures describing the Information Center's services available through the web page were distributed to the NC General Assembly by Representative Verla Insko. To date, the web page averages about 2500 "hits" per week.

The Center continues to provide a statewide Community of Science (COS) "funding alert," available to providers and faculty across the state. The COS is a database available on the worldwide web, but requiring membership to access its extensive national and international listing of funding opportunities and directory of individuals engaged in a wide variety of research endeavors. Each week the Institute's Information Center posts funding alerts in aging for its associated faculty and campuses and service providers to notify them of new grant initiatives for aging-related education or research projects.

In a collaboration between the Information Center and the North Carolina Department of Health and Human Services, the Senior Phone Directory is now available online through the IOA website. Published in hard copy each year by the Older Adult Health Unit at DHHS, the Senior Phone Directory is an invaluable resource for people across North Carolina. It is a compilation of contacts, names, organizations, and agencies across the state that provide services to the aging population.