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Featured Researcher: Gerda Fillenbaum, PhD

gerda-fillenbaumEleven years after the Duke Center for the Study of Aging and Human Development was founded, the postdoctoral research training program began. I was a fellow in the first year, and have been affiliated with the Center ever since. Being new, the program was very flexible, allowing fellows to pursue their interests without first having to submit a formal proposal. I came to it with academic qualifications in clinical and social psychology, and an interest in industrial psychology.

The initial topic I planned to examine, the social structure of a nursing home, turned out to be infeasible, since the home seemed likely to close. Based on a positive experience with an older employee of a local mortgage company (in contrast to the behavior of his younger co-worker), I decided to look at why people continue to work after retirement when they have no financial need to do so.  This issue, using both new data and data already available, and with funding from Social Security’s extramural grant program and the National Institute on Aging (NIA), engaged me and my colleagues for many years, resulting in multiple publications, including a book on retirement.

Midway during this era, the Aging Center obtained funding to examine alternatives to institutionalization. Because of a conversation on my interest in institutions nearly 10 years earlier, I was invited to participate. We enjoyed the luxury of a planning year, during which a thoroughly multidisciplinary group of Duke faculty came together, learned each other’s language, and developed the OARS (Older Americans Resources and Services) program. This program included a multidimensional functional assessment and service use questionnaire, together with a means for classifying people to determine need, evaluate programs, and make policy decisions regarding service allocation.  Importantly, we assessed the reliability and validity of the OARS questionnaire. Consequently, the GAO (General Accounting [now Accountability] Office), interested in determining the impact of government services, selected the OARS questionnaire for its longitudinal study of Cleveland elderly.

OARS continues to be used widely in the U.S. and abroad (with translations into multiple languages), to ascertain both population and individual clinical status, determine service needs, and assess program impact. Interest abroad has resulted in unexpected outcomes. On one occasion (before the days of e-mail), a physician from Brazil, studying in the UK, requested OARS information. Since I was going to London, I took the materials with me to save him postage costs.  We met, found much in common, he translated OARS into Portuguese, ran a survey, analyzed the data, and then developed the first course on aging in Brazil. I was invited to speak. While there I met a psychiatrist who determined the suitability of one of the OARS scales as a measure of depression in Brazil. After a lapse of 15-20 years contact was renewed. We have been writing papers together ever since, analyzing data from Brazil.

Involvement with OARS had additional consequences – participation in the 10-year Duke Established Program for Epidemiologic Studies of the Elderly, which led to determining the incidence and prevalence of dementia in older African Americans and Whites (no significant differences were found); working with the World Health Organization and the Pan American Health Organization to develop functional assessments of the elderly, used in major international surveys; and becoming the project director of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), which started in 1985.

CERAD, funded by the NIA, was mandated to develop a uniform set of measures to assess Alzheimer’s disease, for use in all NIA-funded Alzheimer’s Disease Centers, a move which permitted aggregation of data.  The most broadly used measures continue to be the clinical/neuropsychological battery, neuropathology assessment, and Behavior Rating Scale for Dementia, but others are also available. CERAD measures have been translated into many languages, and norms developed. In addition to individual clinical use, CERAD has been used in epidemiological surveys to ascertain the prevalence and incidence of dementia, and in pharmaceutical trials.

Finally, I am also a member of the Duke Pepper Older Americans Independence Center, responsible for arranging monthly research seminars, and engaged in studies of obesity and health service use.

When I first came to Duke, both administrators and faculty offered an open door. Everyone was willing to offer help and advice. I learned from this, and have ever since tried to do the same. My feeling is that information is not information if it is not shared. For me, the Aging Center has been a welcome home, where members try to take care of each other. My initial physical introduction to the Aging Center was accidental – no office space was available in the Department of Psychology. For me, that lack was serendipitous.

References

For information on CERAD, and CERAD measures and data, go to: cerad.mc.duke.edu

For information on the OARS program and measures click here.

Fillenbaum GG. The wellbeing of the elderly: approaches to multidimensional assessment. Geneva: WHO Offset Publication No. 84, 1984.

Fillenbaum GG. Multidimensional functional assessment of older adults: the Duke Older Americans Resources and Services procedures. Originally published by Lawrence Erlbaum Associates, Hillsdale, NJ, 1988; now only available from the Duke Aging Center.

Fillenbaum GG, van Belle G, Morris JC, Mohs RC, Mirra SS, Davis PC, Tariot PN, Silverman JM, Clark CM, Welsh-Bohmer KA, Heyman A. CERAD (Consortium to Establish a Registry for Alzheimer’s Disease): The first 20 years. Alzheimer’s and Dementia:  The Journal of the Alzheimer’s Association, 2008, 4(2), 96-109. Palmore EB, Burchett BM, Fillenbaum GG, George LK, Wallman LM. Retirement: Causes and consequences. Springer Publishing Co., New York, 1986.