THE DUKE LEADERSHIP IN AN AGING SOCIETY PROGRAM NETWORKS AND PARTNERSHIPS: BRIDGES TO THE FUTURE

From the Editors
Leadership in an Aging Society Program Highlights
Senior Leadership Enhancement Initiative
Year 2000 Senior Leader Profiles
Mid-Career Professional Profiles
Presenting the 2000 Interns
Year 2000 Gabel Family Endowment Interns
Glaxo Wellcome LTC Development Awards
Recommendations Released
Announcements
George L. Maddox Annual Lecture

• Dr. Elise J. Bolda, Assistant Research Professor, Muskie School of Public Service, University of Southern Maine, intern alumna and frequent mentor, was leadership consultant for the 1999 convocation.
  
• Meeting with key Washington area alumni and mentors in DC in December 1999. Event hosted by AARP at their headquarters.
  
• Year 2000 participants came together in March for the intergenerational Leadership Seminar. Seminar was professionally videotaped for further dissemination.
  
• Participants also attended the 1999 George L. Maddox Annual Lecture given by Christine K. Cassel, M.D., Professor and Chair of Geriatrics and Adult Development at Mt. Sinai Medical Center in New York City.
  
• Held long term care public policy seminar for new interns with alumna, Michelle Kitchman, Senior Policy Analyst, Kaiser Family Foundation, as guest presenter.
  
• Hosted event in June 2000 to "launch" Senior Leaders ending their year of development and introduce the newly selected Senior Leaders. Guest presenter: Dr. Charles Longino, Director, Reynolda Gerontology Program, Wake Forest University.
  
• Strengthened relationship with the UNC-Institute on Aging and began talks about additional partnership activities.
• Initiated pilot leadership development program for mid-career professionals within the NC Aging Network, with partial support from the NC Division of Aging and the Aging Network in North Carolina.

YEAR 2000 SENIOR LEADER PROFILES

Louise Chut, (Pittsboro, NC) is retired from an academic career as Associate Professor in Health Administration at Kean University in New Jersey. She holds a M.A.T. in Health Education from Trenton State College, a Ph.D. in Health Education from Temple University, and a M.P.H. in Health Administration from Rutgers University. Chut, who remains active in public health professional organizations, is a Board member of the Carteret County Division of the American Heart Association, a Trustee of Carteret General Hospital, and author of a weekly column in the Carteret News-Times on "Staying Healthy".

Diana Hatch, (Cary, NC) has had an extensive communications career covering public broadcasting, media and public relations. She received a BA in Journalism and American Studies from Syracuse University. Hatch recently served as Director of Communications for the University of North Carolina Center for Public Television's (UNC-TV). She has received seven PBS awards, several SECA awards and the 1995 Southern Educational Communications Association's Public Information Council Professional Achievement Award. Hatch is currently head of Wehatch'em.Inc., a public relations firm offering consultative services.

Lamar Moore, (Lexington, NC) is recently retired after forty years as pastor of Baptist churches across North Carolina, serving the last thirty six years in Lexington, NC. Moore was educated at Mercer University and at Southeastern Baptist Theological Seminary in Wake Forest, NC. During his tenure as pastor of Center Hill Baptist, Lexington, NC, Moore worked to organize the first Council on Aging in Davidson County, serving both on the board and as chair. Moore currently serves on the board to oversee the Home and Community Care Block Grant, the Piedmont Triad Area Agency Advisory Committee and represents Davidson County as a Senior Tar Heel legislator.

Howard Stier, (Apex, NC) is retired from a career with IBMs service and planning divisions. He has a BA in Business Management from North Carolina State University. Stier is chair of the Chatham County strategic planning committee and member of the advisory committee to support the county implementation of the strategic plan. His civic contributions also include serving on the county's economic development commission, the Chatham County Small Business Association's Board of Directors, and as county representative for the four county Mid-Carolina Workforce Development Board.

MID-CAREER PROFESSIONAL PROFILES

Wendy Sause is currently State Long-Term Care Ombudsman with the North Carolina Division of Aging in Raleigh. Responsibilities include oversight for 26 Regional Ombudsman and over 1200 volunteers in the development of program policy, evaluation and budget management. Previously, she was Regional Long-Term Care Ombudsman for Triangle J Council of Governments,and Director/Administrator of Clare Bridge of Cary. Sause holds an MSW from UNC-CH, and a BA from UNC-Charlotte. She concentrated in Psychology, Gerontology and Women's Studies.

Terri Taylor, is currently the Aging Program Administrator for Triangle J Area Agency on Aging in the Research Triangle Park. Taylor has responsibility for performance and quality assurance reviews of county aging service providers funded through the Home and Community Care Block Grant in Region J. Taylor's role also includes advocating with community organizations and the state Division of Aging for the older population and their caregivers. Previously, she was an analyst with a health care resource firm. She is currently completing her MA thesis on Aging and Re-employment of Displaced/Downsized Workers at North Carolina Central University

PRESENTING THE 2000 INTERNS

UNZILA ALI, Senior, Economics, Duke University
Mentors: Ranjan Duara, Warren Barker and Deborah Hurwitz
Site: The Wien Center, Mt. Sinai Medical Center, Miami

This past summer I interned at the Wien Center for Alzheimer's Disease and Memory Disorders at the Mt. Sinai Medical Center in Miami Beach, Florida. Through my internship, I not only learned a great deal about the clinical presentation of memory disorders and diagnoses, but also became aware of the policy issues affecting the elderly.

I spent the first week meeting doctors, nurses, and social workers and observing these healthcare professionals at work. Through sitting in on patient clinics and follow-ups, learning to perform memory screenings, and observing neurological and neuropsychological testing for dementia, I was exposed to patients suffering from memory disorders and learned the process of reaching a final diagnosis of memory impairment. My most meaningful and enjoyable activity at the Center was performing memory screens on elderly people from the community. As part of the screening process, I not only conducted the standard tests for memory, language, and reasoning but also administered a test for depression.

With the population of the United States aging, the prevalence of Alzheimer's Disease and dementia is rapidly increasing. As a result, developing a memory screening that is brief, sensitive, and specific is paramount. The advantages of the early recognition of Alzheimer's disease are numerous and include benefits to patients, caregivers, and society at large. From an economic standpoint, studies have shown that there are large savings in costs for caring resulting from early intervention. The emphasis on making memory screening widely available and easily accessible to the elderly is an important aging policy issue. As part of my internship, I worked on a project pertaining to these issues. After reading related journal articles, I studied the effectiveness of certain tests as screening measures for mild cognitive impairment and dementia in the elderly and then determined the most significant predictors of memory impairment. Through my study, I concluded that tests for delayed recall (i.e. recall of information after a delay, which includes an intervening task), orientation, and verbal fluency were the earliest signs of dementia. Determining that there is a subgroup of tests that indicates cognitive loss is important for developing a screen that is brief and effective. At the end of my project, I wrote a manuscript which will be transformed into an abstract to be submitted for review for the upcoming annual neurological meeting.

Working with the neurologist, clinical researchers, nurses, and social workers, I came across many aging policy issues, in addition to the importance of memory screenings. Elderly driving is an issue of particular significance in South Florida due to its large elderly population. While shadowing the neurologist, I witnessed the anger of elderly patients when they were told to stop driving. Situations such as these highlighted questions related to elderly driving: Should there be a maximum age for driving? Should elderly drivers have to take driving tests to keep their licenses? In addition to the driving issue, I was exposed to other aging issues such as benefits of adult day care, restrictions by HMO's or Medicare/Medicaid in financing the medical care of the elderly (especially the hot topic of prescription drug coverage for the elderly), and long-term care issues.

RASHELLE BROWN, Senior, Psychology, Economics, Duke University
Mentors: Christina Cavallo, David Sadowski and Helen Winn
Site: Crater District Area Agency on Aging

The Experience : Over the summer I had the wonderful opportunity to participate and work on my internship at Crater District Area Agency on Aging near my hometown in Petersburg, Va. This agency is one of 25 in the state of Virginia whose primary function is to provide leadership regarding supportive services and functions as an advocate for people over 60 years of age. The agency offers a wide variety of much needed programs and services for the elderly including a Foster Grandparent program; health insurance, tax, and pension counseling; legal services; a daily adult day care program; housing repair and homemaker services; long term care ombudsman advocacy; transportation and much more. Through these services and the friendly atmosphere of being in a local area agency on aging, I believe I gained insightful experiences of leadership and knowledge within the field of aging and long term care.

The majority of my time at CDAAA was spent learning and familiarizing myself with issues within the aging field. I shadowed the local ombudsman visiting recipients of care in nursing homes and participated in their work. I familiarized myself with the legal services provided by the agency's attorney and my mentor, including how wills, power of attorneys, guardianships, and protections against potential scams on the elderly were handled. I also did some research for a grant proposal to fund more services and education specifically for the minority population within our area. At times, I also accompanied the agency's caseworker to a client's home to assess any homemaker services that the client would potentially need. An exciting aspect of my internship was being able to participate in the local activities that the agency's adult day care program had scheduled, from volunteer organization's meetings, luncheons, educational programs, to picnics. I also was able to attend the 6th annual Virginia Elder Abuse Conference in which I was able to realize that this field of aging encompasses a wide range of topics from prescription drugs, Medicaid, psychiatric diagnosis, to policy issues.

Amongst all of this, my main project after familiarizing myself with the field was with Adult Care Residences (ACRs). As a student in the field of psychology and who has an interest with the elderly, I am interested in research. I piloted a satisfaction survey for the agency to a handful of residents in some neighboring ACRs mainly so that the agency can use the results to help their future clients. Carrying out this type of community based research had several advantages for me. First, it allowed me to practice leadership skills specifically when talking to administrators for permission. It also allowed me to gain more of a hands-on/personal experience talking to the many residents. The surveys were all in the interview format. Because I talked to residents in both public and private home settings and even a home focusing on Alzheimer's Disease, I found that there is a wide range of care that the elderly need and that policy should work toward making all ACRs' services more universal and not so distinct amongst each other. I also potentially found that the level of satisfaction of a resident could increase more if their family and the home itself had more contact.

Overall, I thoroughly enjoyed my internship experience at CDAAA. The opportunity has cultivated my interests within the field of aging. It was a very stretching experience as far as leadership and has allowed me to gain knowledge that I will definitely need in my future career. I learned that a person cannot successfully work in a field without doing an amount of learning and background research first.

My other job was with the Planning Department under the Senior Vice President for Planning and Program Development, Mary Beck. A task force for geriatric services had been created, and I was responsible for collecting data and information for the group to use. Using internal and external data sources, I compiled statistics on the current and future aging population in UNC's service areas. This included demographics; hospital inpatient costs, discharges and length of stay, service line usage; outpatient counts and costs; home health, hospice and nursing home usage; payer mix; discharge status, etc. Observations and interviews with healthcare organizations, community agencies, and prominent aging activists and advocates were also conducted. I also expanded on the Orange County Aging Directory by including similar resources and information for the counties surrounding UNC Hospitals.

Additionally, I was interested in developing a further understanding of the vast array of aging/senior related organizations and agencies in the community. My preceptors were very understanding of this interest and allowed me the flexibility to visit health care related sites/meetings. Some of the places I visited and activities I attended included the Long Term Care Task Force symposium, Orange County Master Aging Plan meeting, Chapel Hill Senior Center, Division on Aging, UNC Home Health, UNC Social Work and Continuity of Care, Carolina Meadows Continuing Care Retirement Community, Chapel Hill Rehabilitation and Health Care Center, and various UNC Health Care meetings.

My internship with UNC Health Care far exceeded my expectations. I was able to observe two different aspects of elder healthcare. On the one hand, I was able to view outpatient geriatric care and offer recommendations to increase the effectiveness of the GEC program. On the other hand, I was able to contribute to the planning process for future geriatric services. My mentors provided invaluable information and ensured that my learning was just as important as the projects that I worked on.

MICHAEL EHRLICH, Senior, Public Policy Studies, Sanford Institute, Duke University
Mentors: Jon Dauphine and Martin Burns
Site: AARP/VOTE

I spent this past summer working at AARP/VOTE, the association's volunteer voter education and issue advocacy program. Its purpose is to educate and involve voters on issues of concern to older Americans and the community at large. Although based at the AARP headquarters in Washington, D.C., AARP/VOTE recruits, organizes, and trains a grassroots network of volunteers and members to support and enhance AARP's legislative goals.

Although my internship focused on health related issues, I worked on a variety of interesting projects. The hot topic at the AARP this summer was prescription drugs coverage. My responsibilities on this issue were three-fold. First, each morning I would search the newspapers for news or editorials related to prescription drugs. I carefully read these articles, complied them together, and emailed the document to the AARP/VOTE state representatives. If these articles raised questions by AARP/VOTE members, I would try and answer them, or find someone who could. Second, as the different prescription drug plans were introduced, I produced a side-by-side comparison of the key parts of each plan, and developed a time line of all the prescription drug happenings. Third, I cataloged all of the polling data on prescription drugs so AARP/VOTE members could keep award of changes in public opinion. These projects were updated throughout the summer and were also sent to the AARP/VOTE distribution list. Because it was the summer of an election year, it was quite interesting to observe how the candidates' stances on the issues developed throughout the summer.

My mentor, Martin Burns, is the political analyst at AARP/VOTE. Members of the organization flood Martin with questions, many of which I was able to help answer. While working on the projects outlined above, Martin would spice up my day with smaller projects such as "Find me a map of the 23rd Congressional district of California" and "Which counties in the U.S. have the oldest percentage elderly population." Through access to on-line databases, I was not only able to answer these questions, but also became more knowledgeable regarding how to find information on the aging population.

Near the end of my summer experience all of the AARP/VOTE state representatives gathered in Washington for a week-long session of review and planning. I was able to assist the AARP/VOTE headquarters department during this week by preparing documents regarding prescription drug advertising and polling. When the AARP/VOTE members planned a 16-day voter advocacy bus trip, I was given the task of creating a "Prescription Drug Wheel of Fortune" to be played at each stop of the trip. Although not in my "job description" per se, I even had the opportunity to copy-edit the issue of Modern Maturity which contained the candidates' stances on issues important to seniors.

Although my internship was not in federal affairs directly, I was often lucky enough to get sent to Congress or think tanks to cover aging related issues. I attended committee hearings on topics such as end of life care, long-term care insurance and prescription drug coverage. I also heard testimony on campaign finance reform, the social security surplus and voter apathy. These hearings and seminars were very educational, from both a political and policy viewpoint. Particularly, I am now much more aware of the how partisan politics are played out in Washington, and how a non-partisan advocacy organization can express its viewpoints in such a volatile climate.

I also assisted in helping to conceptually define how we were going to measure patient satisfaction among demented elderly. Because this is a population that cannot readily speak on its own behalf, I conducted extensive literature searches on how best to measure satisfaction among this population. This work not only further expanded my knowledge about dementia, but it again spoke to the fact that many patients can retain a level of cognition far beyond what we have previously believed.

Overall, my summer practicum was an incredible experience. I enjoyed the diversity of responsibilities that I had, and the mix of research and patient interaction was exactly what I was looking for. From a policy standpoint, I found it interesting to grapple with a new set of policies rather that to be creating them as it stressed the need for clear, interpretable approaches to change that can be operationalized by many different sets of people. This is an important lesson to keep in mind for any future endeavors I may have in the policy arena. With regard to the practice and research aspect of this summer, I was struck by how leaders within the field are gradually shifting their focus on health from one which is centered primarily on individual patient behaviors to one which considers the impact of the environment on health outcomes and behavior. This is a crucial foundation of public health and it is satisfying to see that such ideas are becoming mainstreamed within the larger medical community.