NJISA: Successful aging through research, innovative care and education

By the year 2035, 78 million Americans will be older than 65, with an array of unique medical, mental health and psychosocial needs.

The New Jersey Institute for Successful Aging (NJISA) at the Rowan University School of Osteopathic Medicine (RowanSOM) is at the forefront in helping them remain healthy and active, focusing on research, clinical services and education.

Bench to bedside

The NJISA’s research teams conduct investigations that may influence how disease is diagnosed and treated in the future.

Since 2000, noted researcher Dr. Robert Nagele, an NJISA and RowanSOM professor of geriatrics and gerontology and director of the Biomarker Discovery Center, has been investigating how Alzheimer’s disease develops in the brain of older people, determining that the disease results from the breakdown of blood vessels and deterioration of the blood-brain barrier.

With funding from the National Institute on Aging and other sources, he and his team are building on these investigations, continuing to develop a blood test that will diagnose Alzheimer’s disease years before symptoms appear and also allow physicians to monitor disease progression in patients. Using protein micro-arrays, the test detects auto-antibodies that accumulate in the blood in response to the breakdown of neurons in the body.

The team not only has developed tests for Alzheimer’s but also for Parkinson’s disease and multiple sclerosis. Members also are working on a test for early-stage breast cancer.

“If you want to stop a disease with a drug or therapy, it’s always easier to stop it when it is just beginning,” he said. “If we can come up with a diagnostic test that can detect Alzheimer’s disease 10 years before symptoms emerge, then we will have a good chance of being able to find a drug that could easily stop it.”

Meanwhile, NJISA behavioral researchers also are studying factors that impact successful aging.

Dr. Rachel Pruchno, director of research at NJISA, and her colleagues have examined issues impacting older citizens using data from nearly 6,000 New Jersey residents between the ages of 50 and 74. Participants were recruited through telephone cold calls and enrolled in the Ongoing Research on Aging in New Jersey: Bettering Opportunities for Wellness in LifeSM (ORANJ BOWLSM) study.

Completing baseline and five follow-up telephone questionnaires, researchers asked participants about their physical and mental health, health behaviors and more. Based on data from this panel, researchers are uncovering critical findings about how people can age successfully. They have also learned much about the long-term impact of disaster on older people, since many of the ORANJ BOWL respondents were affected by Hurricane Sandy.

As the population ages, health care providers need to understand more about this population and what can help them most. “We all want to age successfully. How do we do it?” Pruchno said.

Pruchno encourages Rowan faculty and staff to use the ORANJ BOWLSM panel for their own research. Interested scholars should contact her.

“It is an incredible resource,” she said. “The baseline data that we collected regarding physical and mental health are very broad.”

Advancing care in the community

A nationally recognized center of excellence, the NJISA also is enhancing clinical services on a daily basis. Interprofessional teams provide individualized care for geriatric patients in the South Jersey area who are living independently in the community, as well as those in acute and post-acute settings, assisted living facilities and long-term care facilities. “Our clinical services span the continuum,” said Elyse Perweiler, NJISA co-director.

To address memory concerns in this population, the Memory Assessment Program team provides a complete assessment and plan of care for patients experiencing memory-related difficulties, working with the patient’s primary care physician and family.

Other clinical programs and services include comprehensive geriatric assessment, the Huntington’s Disease Family Service Center, neuropsychological testing, House Calls Program and hospital geriatric consultation. The NJISA also provides a variety of aging-related community-based education programs for families and caregivers.

Foundation for the future

While the NJISA’s programs provide broad care today, they also focus on extending that care far into the future. For instance, to prepare future physicians to care for this changing population, RowanSOM fully integrates geriatrics into each year of its undergraduate medical education. The training continues into residency and fellowship training, as the NJISA faculty are committed to sharing expertise with all levels of learners in South Jersey. U.S. News & World Report has consistently ranked RowanSOM as one of America’s top medical schools for geriatrics.

A few highlights of the undergraduate program include a mandatory year 2 classroom-based geriatrics course. Medical students also are taught to perform skills learned in the classroom on actors and actresses who are trained to portray older adults.

In year 3, medical students participate in a four-week mandatory clinical clerkship, with a specific focus on gerontology, where they rotate with geriatricians. “They get to meet not just the nursing home patients who are at the end of their lives, but they also get to meet many patients who are in their 90s and still living independently in the community,” said Dr. Kevin Overbeck, year 2 course director. Some of these patients are authoring books or exercising at the gym while in their 90s and beyond. “When you meet these people who are thriving, you get a different mindset of what aging can be,” he said.

“Whatever specialty they go into, our goal is that they bring their positive experience in the care of older adults to their field,” he said.

The NJISA also supports and educates medical and psychiatry fellows who will go on to become geriatricians. It remains intimately involved in the family medicine and internal medicine residency training programs. In addition, it provides interprofessional training in aging and geriatrics for health care professionals in multiple disciplines.

“The NJISA has a team approach that improves the quality of care we can provide to older individuals, and it enables us to meet a whole array of needs — not only their physical needs, but their psychological, decisional and mental health needs, and others as well,” Perweiler said. “We can provide education and training for families and caregivers, and we have a venue to train a health care workforce to be better prepared to care for the growing number of older individuals.”