Office for the Study of Aging at the University of South Carolina: Promoting Healthy Aging Through Program Development,Evaluation,Education/Training,and Research for South Carolina’s Older Adults

Abstract

The Office for the Study of Aging (OSA) at the University of South Carolina was established in 1988 in conjunction with the founding of the South Carolina Alzheimer’s Disease Registry. Over the last 25 years, the Office for the Study of Aging has furthered its purpose through the development of research and programs for all of South Carolina’s aging population. Examples include the Placemat Strength Training Program, the Dementia Dialogues education program, and the South Carolina Vulnerable Adult Guardian ad Litem program. The work of the office is sustained through a unique government–university–community partnership that supports innovative work and provides direct lines for dissemination, translation, and implementation of programs. The office’s efforts have resulted in two state laws involving aging and older adults as well as recognition through awards and publications. The Office provides a partnership model that offers a dissemination and translation pipeline for programs to be developed, piloted, revised, and enacted into policy.

Keywords

translation community–university partnership programs aging services

Introduction

Aging and gerontological research should assist in guiding the development and promotion of innovative solutions such as programs and activities for the ever-growing aging population. As has been deeply discussed within the public health literature, however, there exists a deep divide between what occurs within the world of research and the translation and dissemination of these activities to the broader public (Glasgow, 2013; Mays, Hogg, Castellanos-Cruz, Hoover, & Fowler, 2013). According to the Centers for Disease Control and Prevention Knowledge to Action Framework, translation refers to “the process needed or taken to ensure effective and widespread use of science-based programs, practices, and polices,” and dissemination refers to the “purposeful and facilitated process of distributing information and materials to organizations and individuals who can use them to improve health p.A46” (Wilson, Brady, & Lesesne, 2011).

The lag between the translation of research to effective and widespread programs has been one of the growing criticisms in a wide array of health science research (Green, Ottoson, Garcia, & Hiatt, 2009; Kessler & Glasgow, 2011). While certainly the issues surrounding translation and dissemination necessitate further discussion, it is important to note that several models of successful collaboration do exist. Community–university partnerships have shown promise in accelerating the translational and dissemination pipeline through the use of stakeholders and interventions that are designed specifically to cross the research-translational divide (Glasgow, 2013; Glasgow, Green, Taylor, & Stange, 2012; Primetica, Menne, Bollin, Teri, & Molea, 2015). Community–university partnerships can and do include a diverse group of stakeholders which include, but are not limited to, academics, governmental entities, private citizens, non-profits, and for-profits (Menne et al., 2015; Mercer et al., 2010). Furthermore, these partnerships, when employed with specific policy or programmatic goals in mind, have shown increasing promise in leading to the adoption of new policies and approaches to address health disparities, and indeed address health-in-all policies (Freudenberg & Tsui, 2014; Glasgow et al., 2012; Naaldenberg, Vaandrager, Koelen, & Leeuwis, 2011).

Demographic Changes

Perhaps the greatest impetus to decrease the translational and dissemination divide between research and practice within aging and gerontological research is the increasing number of older adults, those 65 and above, in the United States. The U.S. Census Bureau has projected that between 2012 and 2050, the number of older adults will double to nearly 83.7 million. This represents an almost doubling of the current status of older adults in the United States. As the population continues to age, the percentage of the population 85 and older, those who consume the most care, is also expected to grow (Ortman, Velkoff, & Hogan, 2014).

It is not only for this aging population that we must begin to address and identify ways to decrease the translational divide but also for future generations as the United States begins to undergo a complete demographic shift (Olshansky, 2015). This includes changes in the structure of the racial and ethnic make-up of the older adult population, including the decline of non-Hispanic Whites as the dominant racial category (Ortman et al., 2014). In examining the projections and estimates, for the current cohort of aging adults, we must also recognize the need to establish systems and processes for year 2050 and beyond.

Gerontological Collaboration

Aging, by nature, should not be a siloed field. While certainly specialized areas such as aging and public health or aging and psychology exist, they exist within the interdisciplinary framework of a broader gerontology (Ewen, Rowles, & Watkins, 2012; Pelham, Schafer, Abbott, & Estes, 2012). The existence of a broader interdisciplinary field of study, in association with a medical field of knowledge in geriatrics, creates a powerful and specialized body of knowledge (Bass, 2013). A broader interdisciplinary field of study allows for collaboration across a multitude of specialties utilizing a common language and purpose (Hannawa, Garcia-Jimenez, Candrian, Rossmann, & Schulz, 2015). The field of gerontology must continue to address boundary issues that exist within academic disciplines and the appropriate distinctions between a “gerontologist” and “a public health aging researcher.” Regardless of that, the development of networks of scholars focused on aging and gerontology, within the fields of health sciences, social sciences, and medicine, creates a collaboratory body in which to leverage in developing and advocating for policies and programs that can be easily developed, translated, and shared broadly.

About the Office for the Study of Aging (OSA) at the University of South Carolina

The Office for the Study of Aging at the University of South Carolina is structured through a unique government–university–community partnership model that offers a dissemination and translation pipeline for programs to be developed, piloted, evaluated, revised, and enacted into policy or legislation.

The Office traces its history back to the founding of the South Carolina Alzheimer’s Disease Registry (the registry) in 1988 and the initial pilot project associated with the registry (Macera, Davis, Brandes, & Still, 1991; Macera, Still, Brandes, Abramson, & Davis, 1991; Macera, Still, Thompson, & Brandes, 1990). The South Carolina Alzheimer’s Disease Registry, at the time of its founding through SC 44-36-10, was the first of its kind in the nation, and remains the oldest and most comprehensive of the three such registries currently in existence.

Since the founding of the South Carolina Alzheimer’s Disease Registry, the OSA has extended its focus from Alzheimer’s disease and related disorders to include research and program development for family caregivers, nursing home residents, Medicaid and Medicare recipients, beneficiaries of community long-term care supports and services, long-term care workforce, and vulnerable adults (OSA, 2015b). Today, the OSA’s (2015a) mission statement reflects its multidimensional focus on aging in South Carolina. This mission of the office is

to promote healthy aging through program development, evaluation, education/training and research. OSA seeks to improve long term care service delivery for South Carolina’s older adults by providing evidence-based information to policy makers, health care professionals and the public.

OSA Framework

Pulling directly from the mission of OSA, the translational model of research that has been developed focuses the office’s work into four interdisciplinary and overlapping areas: research, program development, education/training, and evaluation. Circular in design, the objective of the office is structured, so that research discloses opportunities for program development, education and training activities, and evaluation of current programs that will then inspire additional research opportunities. Activities related to the office’s focus areas, such as request for program evaluation and policy formation, might enter into the process at any point. The OSA model has demonstrated that often following the development of a program and the evaluation phase, education and training for the long-term care and aging workforce becomes the next logical step as the innovative solution is enacted into policy. Due to the nature of the office’s work, regardless of where activities enter into the process—such as a request for program development or to evaluate an established program—opportunities for additional research and revisions are often the outcome.

Figure 1.

Office for the Study of Aging translational research model.

Funding

As a research office within a major university, funding is provided by grants and contracts with local, state, and national partners. Primary funding comes through an established contract and work plan with the South Carolina Department of Health and Human Services (SC DHHS), the state’s Medicaid agency. This contract was established during the initial pilot program of the South Carolina Alzheimer’s Disease Registry in 1988 and has grown to include a variety of new and innovative programs that SC DHHS pilots within South Carolina’s aging communities Additional funding is sought/provided through national and state foundation grants and state and federal agencies.

Partnerships

A government–university–community partnership model requires the engagement of a multitude of stakeholders and partners. The importance of partners in the interdisciplinary nature of aging and gerontological research cannot be overstated (Bass, 2013). Partners provide insight, advice, and opinions on the development of new and innovative solutions. In addition, through the government–university–community model, partners are able to leverage capacity to accelerate the translation and dissemination process (Glasgow, 2013; Glasgow et al., 2012; Simmons, Reynolds, & Swinburn, 2011).

The OSA has established several long-standing partnerships, with specific emphasis on the longest-standing partnership with the SC DHHS. Additional partners include South Carolina organizations serving older persons, national associations, South Carolina governmental agencies, and partner universities (a list of partners is available in Table 1). In addition to these more formal partners, the OSA is the coordinating body of the South Carolina Aging Stakeholders Group (SCASG). This group is composed of provider networks, consumers, community members, advocates, researchers, academia, elected officials, geriatric physicians, faith-based organizations, and governmental agencies who seek to

enhance services and programs that promote aging with dignity for South Carolinians through collaboration on training, research, program development, and evaluation with representation from diverse statewide stakeholders.

Table 1.

Partnerships.

South Carolina aging-focused groups	South Carolina governmental agencies
Caregiver Coalition of the Midlands	Department of Health & Human Services
Long-Term Care Provider Association	Department of Health & Environmental Control
South Carolina Respite Coalition	Department of Mental Health
Institute of Medicine & Public Health	Lt. Governor’s Office on Aging
Carolina’s Center for Medical Excellence	Revenue and Fiscal Affairs Office
Adult Protection Coordinating Council	Department of Disabilities and Special Needs
National associations	Partner universities
AARP	Clemson University
Alzheimer’s Association	Medical University of South Carolina
Center for Medicare and Medicaid Services	Winthrop UniversityWest Virginia University

The existence of the Aging Stakeholder Group (SCASG) furthers the translational and dissemination capabilities of the office as well as the potential for research collaboration.

Translation and Dissemination Pathways

Through a combination of governmental support and engaging stakeholders, community buy-in and involvement, and academic integrity and research, the OSA has developed a translation and dissemination pipeline that directly infuses the work of the office into the policy and activities of the state of South Carolina’s government, especially within the South Carolina Department of Health & Human Services and their Division of Community Long-Term Care. Through this partnership, the office has been able to directly work with providers along the care continuum, associations, and state and federal governmental entities to introduce new and innovative solutions to aging in South Carolina.

Due to this approach, the office has been able to narrow the gap between research and practice by quickly transitioning activities from research to policy.

Activities and Selected Program Results

Over its 25-year history, the office in conjunction with its partnerships with stakeholders in South Carolina has carried out a variety of activities and research. Through research, the office has completed projects related to caregiving burden and stress (Macera et al., 1992; Macera, Eaker, Jannarone, Davis, & Stoskoph, 1993), strength training (Brill et al., 1999; Pope, Lane, Tolma, & Cornman, 2008), disaster preparedness (S. Laditka, Laditka, Cornman, Davis, & Chandless, 2008; S. Laditka et al., 2007), elder mistreatment (Dehart, Webb, & Cornman, 2009), medication management (Schulz, Porter, Lane, Cornman, & Brannon, 2010), community long-term care assessments (Williams et al., 2009), and the epidemiology of Alzheimer’s disease and related disorders (J. Laditka, Laditka, Cornman, et al., 2008; J. Laditka, Laditka, Eleazer, et al., 2008; Macera, Davis, et al., 1991).

This magnitude of research and publications has, in turn, informed innovative programs developed through the OSA that have been supported and adopted throughout the state of South Carolina; the very first supported initiative is the South Carolina Alzheimer’s Disease Registry (the registry). Since its inception in 1988, the South Carolina Alzheimer’s Disease Registry has identified more than 225,000 cases of Alzheimer’s disease and related disorders in South Carolina. The registry has produced 25 annual reports and has supported countless grant requests. Fulfilling an average of five data requests per year, the registry plays an integral role in supporting Alzheimer’s and dementia research in South Carolina and beyond.

The South Carolina Alzheimer’s Disease Registry supports the majority of the research activity within the offices translational model. Falling in line with the other areas of program development, evaluation, and education/training, the office has developed additional activities, including the award-winning Placemat Strength Training Program, the Dementia Dialogues education program, and the South Carolina Vulnerable Adult Guardian ad Litem (SCVAGAL) program. In each instance, the office moved these programs through each of the four areas of research, program development, education/training, and evaluation before translating and disseminating the activities largely throughout South Carolina’s aging communities.

Placement Strength Training Program

The Placemat Strength Training Program was developed as a means of maintaining and improving muscular strength and endurance in older adults (Brill et al., 1999). The program consists of 10 different exercises that can be completed within the older adult’s home by sitting in or standing behind an armchair. The physical placemat was used to manually record the completion of each activity. The exercises are designed to increase safety, decrease falls, and increase hip strength to assist in preventing or delaying nursing home placement. Following development, pilot testing, and evaluation, more than 10,000 placemats were ordered through SC DHHS and distributed across South Carolina accompanied by a home training guide and workbook. The placements became well known and utilized across South Carolina leading to the development of an additional strength training program Move for Life, a DVD-based program designed for individuals above age 50 to increase physical activity that was distributed and adopted by facilities in the state.

Dementia Dialogues Education Program

Dementia Dialogues is a five-session no-cost training course designed to educate individuals who care for persons exhibiting signs and symptoms associated with Alzheimer’s disease or related dementias. The program curriculum consists of 7.5 hr of instruction, with an emphasis on signs and symptoms of Alzheimer’s disease and related dementias, communication challenges, preparing the environment (activities of daily living), challenging behaviors, and creative problem solving. Participants include, but are not limited to, family caregivers (paid and unpaid), care partners/direct support staff, activities directors, allied health professionals, medical professionals, first responders, and advocates. Anyone who completes all five sessions of Dementia Dialogues is awarded a Dementia Specialist certificate. Recognizing the need for structured Alzheimer’s and dementia education and training for the growing Certified Nursing Assistant program in the state of South Carolina, the SC DHHS tasked the office to develop a set of dementia training modules that focused on the disease process and how the process affects the ability to care for persons living with all causes of dementia in long-term care communities. Throughout the piloting of Dementia Dialogues in long-term care facilities, the office was able to gather necessary feedback to further develop applicable information within each module. Once Dementia Dialogues gained momentum in the long-term care community, the program quickly expanded to include family members, community care providers, allied health professionals, and other parties interested in learning more about dementia care. The program was recognized by the Alzheimer’s Association States National Resource Center as a “promising practice” under their home and community-based services consumer-directed care program (RTI International & Alzheimers Association, 2008).

Since its inception, the Dementia Dialogues program has been managed by the office and supported financially through a contract with the SC DHHS. More than 21,000 South Carolinians of varying backgrounds and interests have participated in Dementia Dialogues. To date, more than 10,000 South Carolinians have completed all five sessions of Dementia Dialogues and have become Dementia Specialists. Table 2 provides a background of participants.

Table 2.

Dementia Dialogues Participants.

Category	Attendees^a	Graduates^b	Total	%
Certified nursing assistant/personal care attendant	2,288	2,589	4,877	24.3
Family	1,975	1,443	3,418	17.1
Administrator/program coordinator	958	1,522	2,480	12.4
Nurse	1,095	1,240	2,335	11.6
Paid caregiver	612	591	1,203	6.0
Instructor/student	431	740	1,171	5.8
Social services	551	584	1,135	5.6
Administrative support	258	386	644	3.2
Rehabilitation	236	317	553	2.7
Environmental services and transportation	307	247	554	2.7
Volunteer	202	194	396	2.0
Clergy	61	100	161	0.8
Emergency Medical Technician/Police/Fire	22	39	61	0.3
Counselor/therapist	25	35	60	0.3
Medical professional	42	8	50	0.2

Those who completed at least one Dementia Dialogues session.

Those who attended all five Dementia Dialogues sessions and have been awarded a Dementia Specialist certificate.

Participants in the program, through program evaluation and end-of-session questionnaires, have stated that as a result of attending the program they now have a better understanding of the disease process, more effective communication strategies, and the foundational knowledge necessary to facilitate person-centered quality dementia care. One participant, who completed the program as part of their employment, stated that they walked away from the program “feel[ing] more competent in my abilities to bond with my clients and families.” Institutional partners as well as families have stated they believe the program offers individuals with Alzheimer’s disease or related dementias a better quality of life and the opportunity to age in place.

To ensure reach across the state of South Carolina, Dementia Dialogues employs a train-the-trainer model in which individuals who earned their Dementia Specialist certificate and have documented experience working with individuals with dementia may express interest in receiving additional training to become a volunteer Dementia Dialogues Instructor. Through the train-the-trainer model, Dementia Specialists can be approved to facilitate Dementia Dialogues throughout their communities. There are currently 24 active Dementia Dialogues Instructors. The Dementia Dialogues model is currently preparing for national implementation beginning with pilots sites in other states.

SCVAGAL Program

Finally, the SCVAGAL program was developed as a pilot program in coordination with other agencies, including the South Carolina Department of Social Services and SC DHHS, to recruit and train volunteer Guardians ad Litem to act as an unbiased representative for vulnerable adults under Adult Protective Services custody in cases of abuse, neglect, and exploitation. Beginning as a pilot following extensive research of other states’ programs, the SCVAGAL program has grown from serving a few counties to being implemented statewide, primarily through the use of volunteers, in only 4 years. The SCVAGAL program has served 739 adults since August 1, 2011, with 31% of these cases occurring since January 1, 2015. The vast majority of the cases directed to the SCVAGAL program (59%) involve issues of self-neglect. While open to anyone 18 and above, nearly 70% of all cases have been individuals 60 and above. Following the early success of the program, including nearly a third (31%) of all cases being able to return home by themselves or in the care of a family member or caretaker, legislative recommendation was made to make the program a permanent fixture. The program was signed into South Carolina law (43-35-200) in May 2014 and placed administratively within the Lt. Governor’s Office on Aging.

Discussion

From the three programmatic examples illustrated above, it is possible to illustrate the different approaches that translation and dissemination can take place and influence the health and well-being of aging adults (Green et al., 2009).

Originally developed following an identified need for increased mobility, the Placemat Strength Training Program was able to be adapted and adopted into policy through inclusion in statewide health and fitness plans by the SC DHHS, which then disseminated the program throughout South Carolina (Brill et al., 1999). The research could be quickly adopted with buy-in through established stakeholder relationships and translated for widespread use.

Dementia Dialogues was developed through a need identified by external partners, but whose knowledge and relationship with the office’s model allowed the idea to come to fruition. Originally developed solely for certified nursing assistants in long-term care settings, the application of the education series was soon realized, and it was quickly adopted for use across the state of South Carolina. Now, over a decade since its initial development, the program is seeing resurgence and is preparing for a second translation activity of expanding nationwide.

The SCVAGAL program provides an example of a program moving from research, to pilot, to program, through legislative action. Much like the Alzheimer’s Registry, the SCVAGAL program has moved through the research pipeline to becoming a permanent feature of the aging environment in South Carolina (Glasgow, 2013; Green et al., 2009).

Translation and Dissemination Through Partnership

In each instance, the research, development, evaluation, and associated education and training of these three highlighted programs included a mixture of government, academic, and community stakeholders and partners who assisted in differing phases of the development of innovative solutions. Without buy-in from the long-term care facilities, the Placemat Strength Training Program and the Dementia Dialogues program could have been stifled. Today, however, the Placemat Strength Training Program is an award-winning program, and plans are underway for updates to the program. The Dementia Dialogues Program has received local and national attention with a growing demand for on-site training. The OSA is actively advocating for the implementation of structured dementia training programs, such as Dementia Dialogues, in community-based and long-term care settings. Likewise, the development and adoption of the SCVAGAL program could have been hindered had partners not supported the initial research in elder mistreatment (Dehart et al., 2009) that assisted in placing the program within the office. In addition, had organizations such as the South Carolina Bar Association, AARP, and SC Silver Haired Legislator, an elected body of individuals above the age of 60 who identify and develop solutions to age-related issues, not supported the initial steps to develop the pilot program in the state, the program would not have been able to take the needed steps to be enacted into policy.

Through collaboration with multiple partners and stakeholders, it was possible to develop innovative solutions to aging issues in South Carolina, and then to translate and disseminate these novel programs to broader audiences. The nature of government–community–university partnerships creates environments in which the capacity and infrastructure to leverage these innovative solutions through buy-in and support can be achieved (Baker et al., 2005; Simmons et al., 2011). Furthermore, it creates existing relationships in which the government partners, university partners, or community partners can identify existing needs that can then be further explored and developed by the university partner, the OSA. Utilizing several approaches seen through community-based participatory research and community–university research, the office has been able to stay abreast of emerging topics by performing needs assessments of aging issues in South Carolina, and through the involvement and support of the SC DHHS. The office has responded to and developed programs that quickly cross the research to practice paradigm.

Policy Implications

While the work of the OSA has directly resulted in two pieces of legislation being signed into the code of law of South Carolina, it is important to not simply associate policy with legislation (Gase, Pennotti, & Smith, 2013). The activities of the office, through each of the four areas, research, program development, education/training, and evaluation, have also sought out and improved internal organizational policies, departmental policies, and training policies for the aging care continuum in South Carolina. Non-legislative policy impacts have included revising nursing home bed locators, evaluation of SC’s complex care program, implementing consumer-directed care across South Carolina, and improving retention and hiring of long-term care staff in the state. Directly through Dementia Dialogues, the Office was able to infuse dementia training and education into the long-term care workforce in South Carolina. In addition, through SCVAGAL the office has been able to develop a program to recruit and make available a Guardian ad Litem for vulnerable adults and implement this process into practice across the state.

The work in influencing policy continues through the use of the SCASG, as well as invitations through committee membership, stakeholder participation, and the continued development of programs, trainings, and, as of 2015, the technical assistance with the states Centers for Medicare and Medicaid Services (CMS) dual-eligible demonstration project. Through this work, the office is able to further translate and disseminate the findings of research into programs and policies that will have a lasting impact on the health of aging South Carolinians.

Future Activities

South Carolina is aging. In the decade between 2000 and 2010, the older adult population grew by nearly 32.5% (Stein, Waldrep, & Pearson, 2015). The South Carolina Long-Term Care Report, a report convened by the SC DHHS and helmed by the South Carolina Institute of Medicine and Public Health, estimates that by 2029, nearly 1 and 5 South Carolinians will be above the age of 65—nearly 1.1 million (Stein et al., 2015). The experience of South Carolina is not unique. Across the nation, the influx of older adults aging into systems is leading to an overextension and a question of the vitality of those systems. At the same time, researchers, academics, and organizations are conducting research, developing innovative solutions, and discovering answers that allow for easier transitions, while seeking to bridge the research/practice divide.

It is necessary that there be a bridge built between research and practice that constantly informs, improves, and delivers new innovations to continue to affect our aging population’s health. In this sense, the areas mentioned in the OSA’s mission also serve as their translational research model, providing an ongoing and cyclical process of research, program development, training, and evaluation that affects the lives of South Carolina’s older adults. The office, in coordination with their partners, will continue to support South Carolina’s aging population. Current activities include a focus on Medicare/Medicaid dual-eligible, caregiver training and support, vulnerable adults, and expanded reporting of the epidemiology of Alzheimer’s disease and related disorders in South Carolina. Through the use of formal legislative policy as well as organizational policy, it is further possible to institutionalize and promote these government–community–academic derived solutions.

Footnotes

Acknowledgements

The authors wish to thank the many collaborators and supporters who have made the work of the Office for the Study of Aging possible over the years.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

M. Aaron Guest, MPH, MSW is a PhD student in gerontology within the Graduate Center for Gerontology at the University of Kentucky. He served as a research assistant in the Office for the Study of Aging while at the University of South Carolina. His primary research interests revolve around community-driven approaches to address health inequalities among older adults in rural populations.

Margaret C. Miller, MS, PhD is the epidemiologist for the Alzheimer’s Disease Registry and related projects in the Office for the Study of Aging at the University of South Carolina. She also does program coordination and evaluation. Her research interests are in aging, Alzheimer’s disease, caregivers of individuals with Alzheimer’s disease, survey development, and social capital.

Macie P. Smith, Ed.D is the program development and training manager of the Office for the Study of Aging at the University of South Carolina. She conducts research, develops training programs, and coordinates program design and implementation. Her focus revolves around identifying innovative means to improve the quality of life of South Carolina’s aging population through applicable education practices.

Brenda Hyleman, MSW is the former director of the Office for the Study of Aging at the University of South Carolina, where she retired from following a 30+ career in aging services. She is particularly interested in prevention, wellness, caregivers (both formal and informal), social determinants, retirement planning, and advanced care planning.

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