Abstract
A major emphasis of applied gerontology is the translation and implementation of research into various real-world settings where services and programs are provided. Translation is often defined/understood according to the T0-T4 pathway of clinical research: T0 includes basic science discovery, T1 involves translation of basic science to humans (e.g., human physiology, proof of concept/Phase 1 clinical trials), T2 includes the testing of new interventions in controlled conditions to generate evidence (Phase 2 and Phase 3 randomized controlled trials), and T3 focuses on the identification of approaches to apply evidence into practice and yield findings about how interventions work in clinical/real-world settings. T4 translational research then seeks to determine how interventions influence the health of populations (https://catalyst.harvard.edu/pathfinder/). Implementation science is defined as “the scientific study of methods to promote the systematic uptake of research findings . . . into routine practice to improve the quality and effectiveness of health services and care” (Nilsen, 2015, p. 2). With the advance of gerontological science across the T0-T2 translation continuum (e.g., dementia caregiving; see Gitlin et al., 2015) and the strong desire of various practice and community settings to improve the well-being of an aging population, best practices in the translation and implementation of gerontological evidence have become urgent (i.e., T3 and T4).
This issue features some excellent examples of translational efforts in applied gerontology. McCurry and colleagues (2015) describe the translational activities and findings of the Staff Training in Assisted-Living Residencies Community Consultants (STAR-C) program. STAR-C, developed and tested by Linda Teri and her associates at the University of Washington in a series of rigorous controlled evaluations, includes eight weekly in-person sessions followed by four monthly telephone calls. The intervention sessions focus on education related to dementia, practice of behavior management strategies, communication skills, pleasant events, and family/professional caregiver support. McCurry et al. (2015) trained staff in two Area Agencies on Aging in Oregon to deliver STAR-C, and the effects of the program were evaluated over a 6-month period among 96 caregiver–care recipient dyads. In addition to demonstrating benefits similar to the original evaluations, a number of excellent recommendations related to program replication, provider training, and recruitment are provided to help guide future translational efforts. Menne et al. (2015) also features a replication of an evidence-based program originally developed by Teri and colleagues called Reducing Disability in Alzheimer’s Disease (RDAD). The intervention includes 12 1-hr sessions delivered over 11 weeks followed by three sessions provided over the subsequent 3 months. The RDAD intervention combines exercise training for persons with Alzheimer’s disease with training for family caregivers to effectively manage behavioral issues in the former. Menne et al. (2015) features a replication of RDAD with 508 individuals with dementia over a 3-month period, and found that individuals who participated in more exercise sessions experienced increases in function. However, greater use of education and behavioral management sessions resulted in mixed outcomes. The value of this replication is in its analysis of various RDAD components, which provides important guidance for community agencies when determining how and which aspects of an intervention to translate and implement for their clients.
Danilovich, Hughes, Corcos, Marquez, & Eisenstein (2016) tested the successful implementation of Strong for Life (SFL), a resistance exercise intervention. The program was administered by 32 home care aides who delivered SFL to 42 older adults in the community enrolled in a Medicaid 1915(c) waiver program. Multiple methods were utilized, and SFL was found to be implemented safely by home care aides, with some suggestion that administering SFL was associated with high job satisfaction among home care aides. Older participants were highly satisfied with SFL. Overall, the implementation effort was feasible, amenable to adaptation by home care aides, and linked to positive outcomes for both home care aides and older adults.
This issue also features a translation of another well-established, evidence-based program for dementia caregivers: Partners in Dementia Care (PDC; Darlak et al., 2016). PDC is a care coordination and support intervention for Veterans with dementia and their family caregivers; an innovative aspect of PDC is that the intervention is delivered in partnership with Veterans Affairs medical centers and local Alzheimer’ Association chapters. The intervention is delivered by telephone and is rooted in assessments, development of a personalized care plan, and ongoing monitoring and reassessment. The focus of the process evaluation by Darlak and colleagues (2016) examined engagement on the part of persons with dementia in PDC; 80% of people with dementia demonstrated at least minimum engagement in PDC. These findings are of importance, particularly when attempting to ensure that persons with memory loss are adequately involved in dementia care support programs that focus on family caregivers.
A key issue when considering the translation and implementation of evidence-programs is sufficient enrollment to ensure the greatest reach possible. Manson, Tamim, and Baker (2015) explored approaches to facilitate enrollment among low-income, ethnically diverse older adults into a 16-week Tai Chi program. Focus groups with 87 such individuals identified several factors that could facilitate or hinder enrollment into evidence-based programs, including health concerns of potential participants, time of day, socialization, and similar factors. The results offer suggestions for successfully tailoring enrollment efforts to ensure adequate representation in evidence-based programs.
Gendron, Pryor, and Welleford (2016) provide challenges and lessons learned when delivering evidence-based gerontological training to assisted living and adult day staff in Virginia. The consistency and rigor of education and training to care staff in these settings varies considerably. Over 6 years of data were evaluated to identify effective methods to deliver and refine such education for assisted living and adult day staff. Nishita and Trockman (2015) similarly explored outcomes and the importance of culture, health literacy, and rurality in the Hawaii Community Living Program. This participant-directed program (similar to “consumer-directed” programs/options now being administered in individual states of the United States) yielded important potential benefits for users, but the importance of cultural tailoring and creativity among coaches when delivering the Hawaii Community Living Program emerged as key drivers of its success.
I currently serve on a research committee for a local organization that includes faculty from a number of institutions with diverse missions (e.g., small private liberal arts colleges, regional public universities, flagship research universities). An objective of this committee is to plan webinar topics and presenters for the organization. A committee member had shared that one of the recent webinar presenters, a practitioner, had mentioned that she or he “never bothers to read scientific journals any more” or a similar statement to that effect. Upon further reflection, such sentiments make clear to me the critical need for effective translation and implementation in the life cycle of our scholarship. Otherwise, our work is at risk of being relegated to obscurity in the mind of service providers and practitioners who we must partner with, as these individuals are often in the best position to implement our work and have it positively influence the lives of those who could benefit. There is little doubt the articles in this issue of the Journal of Applied Gerontology have taken the crucial steps to disseminate scholarship that is “applied” in the best sense, and I believe these efforts can continue to bridge the ongoing chasm between gerontological science and practice.