A young woman places her hand over the hand of an older woman holding a cane.

Scripps Gerontology Center research fellows study effects of social services on patient outcomes

John Bowblis and Amy Roberts discuss data they see on a computer screen.
John Bowblis (left) and Amy Roberts (right) are working with Medicare data to determine whether social services staffing affects patient outcomes.

Wellness is about much more than physical health. Even people in top physical condition can experience the ill-effects of depression, isolation. Those things can have an even greater impact on people with a recent illness or injury. Sometimes, these so-called psychosocial factors can even be the difference between temporary and permanent nursing home care.

“Most people who go into a nursing home are short-stay residents,” says John Bowblis, associate professor of economics and Endres Associate Research Fellow in Miami University’s Farmer School of Business and a research fellow with the Scripps Gerontology Center. “Residents go to a nursing home for rehab after some type of hospitalization, and the goal for most of those people is to go back home.”

With physical and psychosocial functioning so intertwined, whether a patient is, in fact, able to return home depends not just on the nursing services these facilities provide, but also on the social services. Yet, while there are many regulations for professional nursing staff in nursing homes, there are few for social services staff. In practice, according to a study by the Centers for Medicare and Medicaid Services (CMS), the typical nursing home resident has about 3 hours of contact with CNAs, LPNs, and RNs each day, but only about 6 minutes of contact with social workers.

Whether changes in public policy related to social services staff might lead to better outcomes for patients is a question Bowblis and his collaborator, Amy Roberts, also a research fellow with the Scripps Gerontology Center and assistant professor of family science and social work, would like to answer. The pair are currently leading one of the first national studies to assess the impact of social services staffing in nursing homes.

The data Bowblis and Roberts are working with comes from CMS’s Minimum Data Set (MDS), merged with the Certification and Survey Provider Enhanced Reporting (CASPER) system. Together, these data sets document every Medicare fee-for-service admission to a nursing home, along with the staffing characteristics of those facilities. Bowblis applies statistical methods to this data to identify statistical relationships between social services staffing data and patient outcomes. Roberts then helps interpret the practical implications of those insights for organizational and public policy.

One concern for Roberts is credentialing. “Nursing homes do not always hire licensed social workers but instead hire unlicensed paraprofessionals for social services positions,” she says. “In this study, we want to see if having qualified social workers in such positions leads to better psychosocial functioning for residents.”

Bowblis and Roberts expect to have the first results of their study sometime this summer, with publications and presentations to follow. When their findings are released, policy wonks will not be the only ones paying attention. Advocacy groups, including the Retirement Research Foundation – which provided the $50,000 grant to fund Bowblis and Roberts’ study – and professional organizations, such as the National Association of Social Workers, will take note as well.

The same is true for nursing home providers. “Nursing homes don’t necessarily want to spend money on this type of staff,” Bowblis says of social workers. “But they’re willing to do things that produce good returns on investment. If managers know that hiring qualified social workers is going to get patients back into the community, they know that will enhance the quality of their services and attract more people to their facility. That’s a good thing.”

For Roberts, that kind of win-win-win for patients, providers, and society would be a natural extension of a win-win research partnership. When she and Bowblis met at a networking event at the Scripps Gerontology Center, they quickly realized their individual areas of research – his on the quality of care provided by facilities and hers on residents’ quality of life – could complement each other.

“The interdisciplinary work we’re doing together is innovative and mutually beneficial,” Roberts says. “Teaming up has worked out even better than we’d hoped.”

Written by Heather Beattey Johnston, Associate Director of Research Communications, Office for the Advancement of Research and Scholarship, Miami University.

Hands photo by Government of Alberta, via Flickr, used under Creative Commons license. Photo of Bowblis and Roberts by Scott Kissell, Miami University Photo Services.

An older man checks his weight on a scale.

Research may lead to healthier aging for older adults

An older couple holding hands walks in a park in the autumn.
Dr. Kyle Timmerman is leading a study to determine whether weight loss and physical activity might help older adults avoid sarcopenia.

Obesity and sedentary lifestyles put people at greater risk of developing a familiar list of health conditions, including type 2 diabetes, high blood pressure, high cholesterol, and cardiovascular disease. But for older adults, the list includes another, lesser-known condition: sarcopenia.

Sarcopenia is a loss of muscle mass, strength, and function associated with aging. It is thought to be a major component of the frailty syndrome that puts older adults at risk for falls, impaired healing after trauma or surgery, and other adverse health outcomes.

Inflammation may lead to sarcopenia

While studies have shown correlations between sarcopenia and obesity and sedentary behaviors, very little is known about what actually causes sarcopenia. Among the researchers working to change that is Kyle Timmerman, an associate professor in Miami University’s Department of Kinesiology and Health.

Timmerman was recently awarded over $430,000 by the National Institute on Aging, part of the National Institutes of Health (NIH), to explore the role chronic low grade inflammation might play in the development of sarcopenia in obese and sedentary adults age 55 and older.

“The body’s ability to generate a short-term increase in inflammation is a critical component of immune function and wound healing,” Timmerman says, “but as we age, baseline levels of inflammation start to creep up, especially if we gain weight and are less physically active.”

Timmerman believes chronic low-grade inflammation may interfere with signals that tell the body to create the proteins that form muscles. Normally, he says, eating or exercising acts as a “switch” that turns on muscle protein synthesis in our bodies. But as we age and inflammation increases, our bodies don’t always seem to get the message that we’ve eaten or exercised, so muscle protein synthesis doesn’t get turned like it did when we were younger.

Weight loss and exercise could help

Although it may not be possible to completely eliminate age-related inflammation, Timmerman thinks weight loss and exercise might help reduce it in obese, sedentary seniors. As part of the NIH-funded study, he will test his theory using volunteers who are at least 55 years old, are relatively inactive, and have body mass indexes (BMIs) of 27 or higher. Each volunteer will be assigned to one of four groups:

• Diet-induced weight loss – Participants in this group will receive nutritional counseling designed to help them lose between 5% and 10% of their body weight over a six-month period.
• Aerobic exercise – Participants in this group will be coached in an exercise training program. The goal, after a period of conditioning, is for participants to meet American College of Sports Medicine guidelines, which call for vigorous intensity aerobic exercise three days per week.
• Diet-induced weight loss + aerobic exercise – Participants in this group will receive both the nutritional counseling and exercise training described above.
• Control – Participants in this group will not receive any nutritional counseling or exercise training.

To determine what effect weight loss and/or exercise has on inflammation, Timmerman will measure levels of the protein he suspects to be responsible for the impaired signaling for muscle protein synthesis, TNF alpha converting enzyme (TACE). Any reduction of TACE levels in the intervention groups, as compared with the control group, will suggest that weight loss and/or exercise do effectively reduce chronic low-grade inflammation in older adults. They will also determine if reductions in inflammation are associated with an improved ability of nutrient intake to “flip the switch” that activates muscle protein synthesis.

“That will allow us to see what interventions help minimize the loss of muscle mass and function in older adults, and then help us better understand the mechanisms that underlie the development of sarcopenia,” Timmerman says.

Student involvement is a win-win

Timmerman and his co-investigator and departmental colleague, Beth Miller, will involve a number of graduate and undergraduate students in their research. Timmerman’s students will help implement the exercise assessment and training, while Miller’s will assist with dietary assessment and counseling.

Having students involved in the project is a win-win, Timmerman says. The students – many of whom aspire to careers in dietetics, physical therapy, and other health professions – benefit from the hands-on experience working with real people who are similar to the patients they will encounter as professionals. In turn, the students improve the quality of the research, not only by taking on some of the workload, but also by encouraging volunteers to stick with the study.

Virtually every research study experiences volunteer attrition. Sometimes the reasons can’t be helped: a participant might move or develop a health condition that makes them ineligible to continue in the study. But because any loss of participants affects the integrity of the data being collected, researchers work hard to avoid preventable reasons for dropping out of a study, such as a participant’s losing interest or becoming overwhelmed by a study’s requirements. That’s where Timmerman says student involvement is invaluable.

“Having worked with older adults before, I know they love working with college students,” says Timmerman. “It really helps them stick with the program. I’ve been part of exercise training studies before where we just said, ‘Hey, show up,’ and there wasn’t much of a community feel, so a lot of people ended up dropping out.”

In the end, keeping people engaged is an overarching theme of Timmerman’s work. As a researcher, he seeks to keep older adults healthy and active so they can continue contributing to their communities. As a teacher and research mentor, he helps strengthen communities of research and professional practice by inspiring and shaping the next generation of members.

Written by Heather Beattey Johnston, Associate Director of Research Communications, Office for the Advancement of Research and Scholarship, Miami University.

Weight check photo by Senior Airman John Gordinier via U.S. Air Force. Walk in the park photo via Max Pexel. Both used under public domain. 

Several people work at a bank of computers in a classroom. In the front of the frame is an older man and and a younger man in discussion.

Research team sets out to find keys to college success for older students

Phyllis Cummins and two doctoral associates have a discussion at a conference table in a library.
Dr. Phyllis Cummins (center), a senior research scholar in the Scripps Gerontology Center at Miami University, is leading a study on the college success of students between the ages of 40 and 64.

Employers can no longer afford to discriminate against older workers, and the reason might surprise you. It’s not lawsuits; it’s demographics.

According to the Bureau of Labor Statistics (BLS), labor force participation by Americans age 55 and older grew at a faster rate between 1994 and 2014 than it did for younger Americans. The BLS projects that between 2014 and 2024, labor force participation by those 55 and older will grow at a rate of 2.1%, while participation by those 25-54 will grow much more slowly, at a rate of just 0.4%, and participation by those 20-24 will actually decline by 0.8%. Given these statistics, it’s clear that employers’ success in the coming years will depend on older workers.

Far from taking this demographic reality for granted, however, more and more workers between the ages of 40 and 64 are working to stay competitive in the job market by enrolling at the nation’s community colleges. And community colleges – vulnerable to the same demographic pressures affecting employers – are happy to have them.

“There are a lot of reasons to want to try and facilitate continued labor force participation by this age group,” says Phyllis Cummins, a senior research scholar in the Scripps Gerontology Center at Miami University.

The problem, she says, is that not much is known about what contributes to college success for older students. To help solve that problem, Cummins and her co-principal investigator, Peter Bahr, an associate professor in the University of Michigan’s School of Education, along with the rest of their team, will analyze data collected by the Ohio Department of Higher Education and the Ohio Department of Job and Family Services. They will contextualize this data by listening to focus groups of students and faculty at three Ohio community colleges: Clark State Community College, Rio Grande Community College, and Cuyahoga County Community College. Finally, they will round out the picture by interviewing key informants at all of Ohio’s community colleges.

In addition to Cummins and Bahr, other members of the team are Kathy McGrew, a senior research scholar in the Scripps Gerontology Center, Scott Brown, an associate professor in Miami’s Department of Sociology & Gerontology, Mike Hughes, manager of Miami’s Statistical Consulting Center, and Jing Zhang, an associate professor in Miami’s Department of Statistics. The team’s work is supported by a $1.4 million grant from the U.S. Department of Education’s Institute of Education Sciences (IES).

“We’re especially interested in looking at the kinds of programs older students enroll in,” says Cummins. “We suspect that it’s going to be more short-term certificate programs and credentials other than an associate’s degree. A lot of older students might not want to spend two full years in school. They might just want to sharpen up their skills so they can get a promotion or get a job.”

Cummins hopes her team will be able to identify patterns that suggest successful approaches to educating older students. That could eventually lead to an IES development and innovation grant, which would allow the team to test specific initiatives to see whether implementing them on a broader scale will positively affect outcomes for older students. Because her research is just getting started, Cummins doesn’t know exactly what those initiatives will be, but she says they could include things like offering more evening classes, or expanding options for accelerated learning.

Even before they get to that point, though, Cummins hopes to influence the marketing and policies affecting older students by sharing her team’s findings with community college officials as well as state and federal policymakers. She points to community college websites as an example.

“Are the websites’ text and pictures conducive to encouraging enrollment by older students? Are they portraying just young, 18- to 20-year-olds?” asks Cummins.

Cummins says the answers to those questions matter because it’s as important for older students to see models of their college success as it is for members of other traditionally underrepresented groups. And the success of older students in college matters because the future of our economy depends on it.

This post was updated November 1, 2016 to correct typographical errors.

Written by Heather Beattey Johnston, Associate Director & Information Coordinator, Office for the Advancement of Research & Scholarship, Miami University.

Photo of Phyllis Cummins by Kim Logsdon, Scripps Gerontology Center, Miami University. Classroom image by the Knight Foundation via Wikimedia Commons, used under Creative Commons license.

A woman with short reddish hair and glasses is in the center of the frame, facing the camera. She sits at the head of a conference table and is listening to a woman seated to her right. The speaker has long dark hair and is gesturing as she talks. To the speaker's right, we see the back of a man's head.

Director of Scripps Gerontology Center receives national award

A softcover textbook with the title "Global Aging" sits on top of a stack of papers on a conference room table. A person whose face is not visible sits at the table, facing the book. She has one hand on the bottom of the book. The other hand sits on top of the first one. A laptop computer is visible in the left side of the background.
Suzanne Kunkel co-edited Global Aging: Comparative Perspectives on Aging and the Life Course, a text that provides a much-needed resource to faculty and introduces students to the topic of global aging.

Miami University’s Suzanne Kunkel received the 2015 Clark Tibbitts Award from the Association for Gerontology in Higher Education for her outstanding contributions to the advancement of gerontology as a field of study.

The award is the highest honor given by the association annually to educators, scholars and leaders in the field.

“Dr. Kunkel is recognized throughout the world as a leading scholar in aging and gerontological studies,” said Jim Oris, the associate provost for research and scholarship and dean of the Graduate School. “This is a fitting honor for one of our top leaders and scholars at Miami University, and we are proud of her accomplishments.”

Kunkel has served as director of the Scripps Gerontology Center since 1998. In addition to her leadership and scholarly work at the center, she has mentored a number of students while serving as a faculty member in the department of sociology and gerontology for the past 24 years.

Alumna Dawn Carr (Miami ’09) said, “As a doctoral student, Suzanne provided a supportive and loving environment, giving me the tools I needed to find my voice as a scholar and cultivate a passion for gerontological research.”

Kunkel is a respected researcher and scholar in areas of demography, global aging, long-term care needs of aging populations and the aging network. She has authored or edited nine books, 40 journal articles and book chapters, and more than 40 research reports and other publications. She has given more than 200 professional presentations.

In his introduction of Kunkel for the Tibbitts award, Frank Whittington of George Mason University lauded “… Suzanne Kunkel’s work as an observer and interpreter of the field of gerontology and as one of its foremost educators.”

Kunkel’s book, Aging, Society, and the Life Course, co-authored with Leslie Morgan and entering its 5th edition, has introduced countless students to the study of aging since 1998. Some of those students first exposed to gerontology through this textbook have subsequently earned advanced degrees and are now educating others about social gerontology.

Her recently published text Global Aging: Comparative Perspectives on Aging and the Life Course, co-edited with Frank Whittington and J. Scott Brown, is already providing a much-needed resource to faculty and will be introducing students to the topic of global aging in years to come.

Kunkel received the award from the association at its annual conference in Nashville, Tennessee, in February.

Written by Matt Cable, Coordinator of Research Dissemination & Communication, Scripps Gerontology Center, Miami University. Originally appeared on Miami University’s News and Events website.

Photos by Scott Kissell, Miami University Photo Services.