America’s Going Gray

UA’s New Center for Mental Health and Aging Meets Growing Need

by Chris Bryant, Suzanne Dowling and Bill Gerdes

Drs. Lucinda Roff and Lou Burgio are among the leaders in studies on aging.

In America, the population age 65 and older is expected to double by 2030. At that rate, this group is projected to comprise 20 percent of the population while utilizing 50 percent of the nation’s health care resources.

This tremendous increase in the graying population of America has led to increased research in all areas of aging, and The University of Alabama has emerged as one of the nation’s leaders for studies on aging.

Dr. Lucinda Roff, professor of social work, and Dr. Lou Burgio, professor of psychology and director of UA’s Applied Gerontology Program, are among the leaders in these aging-research efforts — efforts that have led to the funding of the Center for Mental Health and Aging at The University of Alabama.

“What we’re hoping to accomplish is to develop a focal point on the UA campus where researchers and practitioners of all disciplines concerned with mental health and aging can study, learn and teach together,” said Roff who, along with Burgio, will serve as the center’s co-director.

The Substance Abuse and Mental Health Services Administration, a public health agency within the U.S. Department of Health and Human Services, recently awarded UA a $500,000 grant to create the center.

Faculty and students from the College of Arts and Sciences, the School of Social Work, the College of Nursing, the Culverhouse College of Commerce and Business Administration and the College of Community Health Sciences will be involved.

“If you want to effectively address problems in aging, you have to understand it from an interdisciplinary approach,” said Burgio. “The issues are multi-faceted.”

“We want the center to be very user-friendly and to have real-life applications,” Roff said. “We hope to be able to provide service to, and have interaction with, practitioners in Alabama, so we can be aware of what their needs are, and so we can share what’s known throughout the world about the best practices.

“Also, we’re training and developing new leaders for the future among our own graduate students in social work and psychology and other helping fields who will be strong scholars and practitioners to serve future generations of older people.”

A major issue facing current, and most likely future, generations of the elderly is Alzheimer’s disease. Burgio is the principal investigator in a project, funded by the National Institute on Aging and the National Institute of Nursing Research, that is designed to improve the well-being of the Alzheimer’s caregiver while increasing his or her knowledge and skills in dealing with the patient.

Under the Resources for Enhancing Alzheimer’s Caregivers’ Health II, or REACH II, project, Burgio received some $1.2 million to study Alzheimer’s caregivers within their homes. Overall, UA researchers have numerous federally funded research projects ongoing.

Spiritual Boosts

Dr. Martha Crowther, assistant professor of psychology in the College of Arts and Sciences, said the fields of psychology and medicine have begun realizing some of the health benefits associated with a person’s religion and/or spirituality. A person’s spirituality can play a positive role for those dealing with depression, anxiety, stress and even cancer and heart disease, she said. “The research is showing that it does make a difference in terms of coping,” said Crowther. “It’s the ability to believe in something outside of one’s self. It really can be an effective tool to be used in treatment.”

The UA psychology professor, who is also heavily involved in efforts to support grandparents who are the primary caregivers of their grandchildren, is researching ways to learn more about spirituality’s impact, particularly among African-Americans, and how health care professionals might best be able to tap into this potentially underutilized resource.

Rural Roadblocks

Underutilized is one way to describe mental health services in relation to the rural elderly, although unavailable might be more accurate.

The combination of poor physical health and an isolated residence makes it particularly difficult for the rural elderly to attend adequate mental health therapy sessions. So, UA is taking mental health services to them.

In a five-year study funded by the National Institute on Aging, UA researchers are measuring the effectiveness of cognitive behavior techniques, administered during brief, inhome visits, in improving the mind frame and overall quality of life among the rural elderly.

“A lot of our clients have pretty significant health problems,” said Dr. Forrest Scogin, professor of psychology in the College of Arts and Sciences, and co-principal investigator in the Project to Enhance Aged Rural Living, or PEARL.

“Because of their impairments, their range of opportunities has become much more limited,” Scogin said “It’s easy for them to believe they will never do some of those things they most enjoyed, and some people also have a tendency to trivialize those things they can do.” This can lead to stress and depression.

Clinical social workers visit the patients in their homes, involving the patient’s caregiver, and during therapy sessions help the patient consider a different perspective.

“You may not see that what you are involved in can be enjoyable,” Scogin said.

“And some things that might be pleasurable, they might not have considered.”

Other UA researchers, along with Scogin and Burgio, who are involved in the study are Dr. Allan Kaufman, professor of social work; Dr. Robert Pieroni, a physician and professor of internal medicine and family medicine in the College of Community Health Sciences; and Dr. Jeri Dunkin, professor and holder of the Martha Saxon Memorial Endowed Presidential Chair in UA’s Capstone College of Nursing.

“We know from previous research that older people who are medically frail and have emotional issues tend to make more use of medical services that are not necessarily for medical reasons,” explained Kaufman. “What we’re predicting is that if we’re successful in improving their emotional well being, they will make fewer demands on the medical system. If that proves to be the case, the potential savings realized in medical costs could more than pay for the cost of the home-delivered cognitive behavior therapy,” he added.

At-Home Care Not Always Best

Participants in facilities like Caring Days use mental activities to help offset some effects of aging.
Participants in facilities like Caring Days use mental activities to help offset some effects of aging.

In conjunction with the University of Georgia, Dr. Jordan Kosberg, the endowed chairholder in the School of Social Work, is also working on the Alabama component of a separate proposed National Institute on Aging study. In addition to Kosberg, Dr. Debra Nelson-Gardell, assistant professor of social work, and Scogin are involved in this study.

“We will be looking at the quality of care given to older populations and the existence of abuse and maltreatment, as well as the relinquishing of the caregiving role and the possibility of institutionalization of older individuals,” said Kosberg. “This study will challenge the assumption that family care is always the best option for an older person. We’re trying to show that in some cases, family caregiving may result in poor or abusive care and that institutional care may be the best place for the care of an impaired older individual,” he said.

Home Can Be Far Away

Dr. Michael Parker, UA assistant professor of social work and John A. Hartford Geriatric Scholar, is helping military careerists and, subsequently, other adult children, prepare to meet the needs of their aging parents.

“We’re helping military families first because they are a higher risk for problems due to the long distances from their parents,” said Parker, a retired Army lieutenant colonel.

“The needs of elderly relatives can erupt in periodic crises and stretch for several years,” said Parker, who is also a professor of geriatrics at The University of Alabama at Birmingham. “Such crises can thrust caregivers into a bureaucratic maze of trying to make successive care arrangements in a badly fragmented long-term care system.”

Parker is developing ways to train military families in medical, legal, financial, social, familial, spiritual, and emotional areas, in hopes these personnel will be better prepared to face the challenges of caring for their parents. Once the study is complete, Parker plans to develop a CD-ROM that will assess an individual family and provide a tailored intervention.

Improving Memory

Dr. Sheila Black, associate professor of psychology, is interested in episodic memory and how it changes over a person’s lifetime, how memory training techniques can assist the elderly, and in learning more about how elderly people process information in social situations. Black is particularly interested in the two types of memories — episodic and semantic.

Episodic memories are associated with autobiographical events. Recalling an event that occurred during your 50th birthday is an example. Semantic memory, alternatively, is associated with the definition of words or historical facts — things you would learn through education. Semantic memory generally improves with age, but episodic memory tends to decline. “I’m interested in what strategies are most effective in improving episodic memory,” Black said.

Society’s Problems Reflected in Nursing Homes

While most of society’s challenges are also challenges for the elderly, they often have unique aspects in relation to the aged. Dr. Jullet Davis, assistant professor of health care management in the Culverhouse College of Commerce and Business Administration, conducted a study of nursing home segregation that revealed higher levels of segregation by race than by other characteristics such as gender, payer, or physical condition.

She analyzed data from over a six-year period that included 361,000 nursing home residents in 2,040 nursing homes in six states. Davis said segregation limits access to needed long-term care services and may increase the use of alternative health care. Such segregation in nursing homes may cause elderly minorities to choose in-home care that may not be appropriate and that may delay needed care, which “results in poorer outcomes because needed health care is not delivered at the appropriate level,” she said.

As I Lay Dying

A University of Alabama assistant professor of psychology is researching ways to improve hospice care in hopes of providing more comfort to the dying and enabling caregivers to better manage the associated stress. The National Institute on Aging awarded Dr. Rebecca Allen, who is also the associate director of UA’s Applied Gerontology Program, some $450,000 for the five-year project.

“There are places to go for information and answers when someone you love has been diagnosed with a terminal illness,” Allen said. “There even is an opportunity for growth and healing.” Sometimes strained relationships can be mended in a person’s final stage of life, she said.

“It’s something that we all go through, and it’s important to plan for,” Allen said of death. “Make your plans and then communicate them to your family and your physicians.”

While nothing except death can stop the aging process, there are things people can do to increase the chances of making those golden years more pleasant. “The biggest factor,” Burgio said, “is probably exercise — a combination of aerobic and weight-resistance exercise. It will, to a certain extent, delay the effects of aging.” Remaining mentally active is also important, he said. “We are learning more and more about how to age successfully.”


Suzanne Dowling, 205/348-8324,