Aging, the Medical Subspecialties, and Career Development: Where We Were, Where We Are Going

Arti Hurria, MD; Kevin P. High, MD, MS; Lona Mody, MD; Frances McFarland Horne, PhD, MA; Marcus Escobedo, MPA; Jeffrey Halter, MD; William Hazzard, MD; Kenneth Schmader, MD; Heidi Klepin, MD, MS; Sei Lee, MD, MAS; Una E. Makris, MD, MSCS; Michael W. Rich, MD; Stephanie Rogers, MD; Jocelyn Wiggins, BM, BCh; Rachael Watman, MSW; Jennifer Choi, BS; Nancy Lundebjerg, MPA; Susan Zieman, MD, PhD

Disclosures

J Am Geriatr Soc. 2017;65(4):680-687. 

In This Article

Looking Ahead: Opportunities

National Institute on Aging

The NIA furthers its mission to improve the health and well-being of older Americans in part by supporting and conducting research on aging processes and physiological changes that affect vulnerability to and management of disease; the effects of the processes underlying age-related diseases; and age-associated complexities such as comorbidity, polypharmacy, and geriatric syndromes such as frailty. Like other institutes at the NIH and like the research community in general, the NIA is undergoing a philosophical shift from a disease-specific focus to a collaborative, problem-based one. Specific priorities and interests are outlined in NIA's Strategic Directions (https://www.nia.nih.gov/about/living-long-well-21st-century-strategic-directions-research-aging), which was developed through extensive communication within NIA and with the research community.

NIA also furthers its mission by training and developing highly skilled researchers and clinician–scientists. Funding opportunities are available at various time points in a research career and can help particularly with the challenges associated with transitioning to independence. Although TFWS Scholars and the analogous JAHF-sponsored process in the surgical specialties (Dennis W. Jahnigen Scholars) funding is ending, GEMSSTAR (https://www.nia.nih.gov/research/dgcg/grants-early-medical-surgical-specialists-transition-aging-research-gemsstar), which was initiated in 2010 and is co-funded by NIA and several other partners, is a unique funding opportunity targeting early-career physician–scientists focused on aging research in the specialties. These annual awards, which combine a small, 2-year NIA-funded research project (R03) and a professional development plan funded by other sources such as specialty society partners, continue to gain popularity, and several awardees have successfully garnered subsequent K awards, including the NIA Beeson Award and R01s. A biennial GEMSSTAR conference series, launched through an NIA U13 conference grant to the AGS, convenes all past and current GEMSSTAR awardees with several past TFWS and Jahnigen scholars as mentors. Each conference includes sessions on aging research, mentoring, and career development, along with a poster session and an opportunity to interact with NIA and NIH staff and leaders in specialty aging research. These conferences, as well as TFWS and Jahnigen activities at AGS (e.g., the session on Medical Subspecialties) and resultant mentorships, have been integral to the success of the TFWS, Jahnigen, and GEMSSTAR programs. Together, these activities remain the most-supportive mechanisms for reaching out to the medical and surgical specialties. Mentored career development awards, such as the K08 and K23 mechanisms (including Beeson awards), are also available, as well as the underused K99/R00 Pathway to Independence award. For investigator-initiated awards such as the R03 Small Research Grant, the R21 Exploratory/Developmental Research Grant, and the R01 independent Research Project Grant, special consideration, in the form of percentage points added to the priority score, is given to new and early-stage investigators. Other NIA-supported resources include longitudinal cohorts, clinical trials, large databases, online resources, Older Adults Independence Centers (Pepper Centers), and the NIA research blog: "Inside NIA." Sample federal resources are listed in Table 2. Nonfederal opportunities are available from AGS, the Gerontological Society of America, the American Federation for Aging Research, and others.

In addition to expanding the GEMSSTAR program, NIA staff meet annually with the leadership of professional societies to communicate on research priorities and to assist in implementing interest groups and sections in geriatrics and aging research. Investigators are also encouraged to keep society leadership informed of aging-related research, clinical and training developments, and needs in their fields. NIA encourages researchers to contact staff to discuss ideas for workshops and research projects and offers several specific infrastructure grants (R24) to build communities that will advance the science of aging and geriatrics around a particular problem (e.g., delirium, human immunodeficiency virus in aging, multiple chronic conditions), and it welcomes input for similar collaborative resource-building initiatives for the future. Spearheaded by NIA staff, the NIH has recently launched a trans-NIH interest group on aging, the GeroScience Interest Group, and is considering the establishment of a clinically focused, trans-NIH interest group in aging and geriatrics. NIA is also interested in augmenting its cadre of reviewers with expertise in aging research to serve on review committees for the GEMSSTAR program and for NIA-assigned applications and aging-related applications in general. The NIH Center for Scientific Review has launched a program (https://public.csr.nih.gov/ReviewerResources/BecomeAReviewer/ECR/Pages/default.aspx) to help early-stage investigators gain experience as reviewers.

The John A. Hartford Foundation

Like other funders, the John A. Hartford Foundation (JAHF) has historically funded aging-focused faculty development efforts in siloed programs in the fields of medicine, nursing, and social work, although congruent with its new strategic vision to improve care of older adults, the JAHF now aims to bring together investigators, educators, and clinicians from across these disciplines to enhance the way care is delivered to older Americans. Building on the ongoing work detailed in this article, a new initiative—the Hartford Change AGEnts—was launched in 2013 to provide the skills, tools, and resources to effect changes in health care through offerings such as an online platform, a small grants program, and training institutes. The program was successful in engaging and assisting leaders in aging research and practice. Concluding at the end of 2016, the initiative included a number of subspecialists who wanted to contribute to real and sustained change in the care of an aging society. Additional efforts to support TFWS program scholars and other subspecialists will continue through JAHF co-funding of the NIA U13 conference series mentioned in the previous section. The JAHF is also engaging subspecialists in its three new priority areas: age-friendly hospitals and health systems, end-of-life and serious illness care, and family caregiving. For example, cardiologists and oncologists are actively engaged in the development, testing, and dissemination of models of care that align clinical decisions with health outcome goals and preferences.

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