On Oct. 12, 2008, Dr. Marie Bernard joined the NIA as Deputy Director. She previously held the Donald W. Reynolds Chair in Geriatric Medicine and served as professor and chair of the Donald W. Reynolds Department of Geriatric Medicine at the University of Oklahoma College of Medicine in Oklahoma City. She was also the associate chief of staff for Geriatrics and Extended Care at the Oklahoma City Veterans Affairs Medical Center. She recently served as president of the Association for Gerontology in Higher Education and as president and chair of the board of the Association of Directors of Geriatric Academic Programs. Dr. Bernard was a member of the NIA’s National Advisory Council on Aging from 2002 to 2005. She spoke recently with Spotlight on Aging Research editor Barbara Cire.
Basically, I’m involved with everything. I’m chief policy advisor to Director Dr. Richard Hodes, and I assist him with the direction of the Institute. Specifically, the Office of Planning, Analysis, and Evaluation, the Office of Special Populations, and the Legislative Liaison report to me. Since I’ve been here, I’ve enjoyed getting to know the people in each of the divisions and the people in the Intramural Research Program.
I have a real interest in the pipeline of future scientists. My previous life was as a geriatric medicine department chair, and we helped prepare a broad range of health professionals. I was very impressed during that time, particularly when I was serving on the National Advisory Council on Aging, that we need to be concerned about our future aging-research scientists. I was privileged to serve on an Institute of Medicine panel whose report came out in April 2008 that also emphasized the need to prepare for the future of aging research and care of older people. So that’s an area in which I might be able to assist here.
On the other end of things, again because I was a practicing geriatrician for 20 years, I’m very interested in how research from the NIA gets disseminated and implemented in the community. There are a number of seminal findings from the NIA that have helped with the care of elderly patients. For example, the Diabetes Prevention Program demonstrated that lifestyle modification was effective in decreasing the likelihood of the development of diabetes. That is powerful information to bring into a clinical encounter with a patient.
One of my goals is to assure that relevant information such as this is widely disseminated in academic and practice settings. I am fortunate to have colleagues in a number of organizations, such as the American Geriatrics Society, the Association of Directors of Geriatric Academic Programs, the Gerontological Society of America, the Association of Gerontology in Higher Education, and the American Medical Association, that can augment the NIA’s already robust dissemination activities.
I think that I bring the perspective of a person who’s utilized research from the NIA from the time I first entered the field. As someone who has worked on NIA-funded research projects, I’ve also helped generate some of the data, but it’s never the same when you’re an individual researcher or even in a research group in an academic medical center. It’s a fascinating process to be here where all of the ideas come together. I think that the thing that I can help contribute to that process is that real-world view of what is needed and how it is likely to get implemented. For instance, in my former academic group practice, we used outcomes from NIA-funded falls and frailty research to screen patients referred for initial assessments. This allowed the clinicians to more efficiently provide targeted interventions during the encounter.
As you look at people in academic positions across the country, the same sort of phenomenon that we see in general is present in research. There are a lot of baby boomers out there who are aging and will eventually—one of these days—retire. We will need people to fill in those gaps. Additionally, new people who come into the field bring different viewpoints and fresh ideas.
When you look at the numbers, I think the NIA is doing a wonderful job of trying to encourage new and early-stage investigators to pursue the field of aging research. But the reality of the matter—particularly in a time when you have financial challenges—is that a scientific research career may not be so attractive to young people. There are so many other options that lead to compensation at an earlier stage. For example, the first R01 is often earned when researchers are in their late 30s or early 40s. Young people look at that and make other choices. So, those are things we’ll have to be attentive to.
My perspective, having been out in the field, is that the NIA is doing a good job, but many other fields are a lot more attractive to young people, whether they’re going into clinical practice or research.
I’m particularly interested in physician-researchers. Now, I realize I’m biased because I am a physician, but the physicians who are doing research tend to ask somewhat different questions than those who have a Ph.D., or even those who have an M.D. and a Ph.D., because the physician-researcher generally is more focused on clinical research. For example, a physician-researcher is more likely to focus on questions regarding the most effective means of caring for older individuals with multiple illnesses, rather than taking a single-disease approach. Such questions are engendered from providing clinical care and seeing the challenges of managing multiple illnesses in frail elders.
Additionally, that physician-researcher may be more likely to pose, and be best positioned to ask, questions about proper configurations of systems of care as a result of being a participant in those systems. But, when I look at the progressive decline in the number of people who do more than 1 year of geriatric medicine fellowship training, it does not bode well for the future, from my viewpoint. This is not to say that other physicians and other aging researchers cannot address the clinical questions that I think are pressing. However, I think that physicians who have spent significant time in specialized training and care of the elderly may have a unique perspective to add to the aging research agenda that would not otherwise be available. So, I’d like to see what the Institute can do to increase the number of physician-researchers interested in aging.
Actually, there isn’t a shortage of training programs. But, there are a number of slots in those training programs that go unfilled each year. The challenge is encouraging people to pursue geriatrics. I think that the young people who are coming through medical training recognize that if they complete a year of geriatric medicine fellowship training, they get paid no more than their colleagues who just did training in internal medicine, family medicine, or psychiatry, for example. If they do more than 1 year, the return on their investment is even less. So, that’s part of it.
Part of it, too, is that the field of aging is not as seductive to some young physicians as specialties where you do a lot of interventions—cardiology, pulmonology, that sort of thing. And unfortunately, there may still be a bit of age bias in our society. A lot of young people these days grew up not knowing older relatives or other older people, and they may have outdated stereotypes of older people. It’s encouraging that a number of medical schools now have programs to introduce students to healthy, community-dwelling older adults so that they can understand that they are the norm rather than the exception, but there’s still a lot of work to be done to get away from some of those biases that exist.
There are so many good things that are happening here at the NIA that it’s hard for me to single out any one area. I’m impressed that the Division of Aging Biology  is working to figure out what really causes aging and what things are changeable in that process. I’m impressed that the Division of Neuroscience is supporting outstanding research in Alzheimer’s disease and other neurodegenerative changes, as well as looking at normal changes in the neurologic system with aging. And I’m very hopeful that as a result of these combined efforts, I, as an aging boomer, will benefit from their outcomes. I have a strong history of vascular dementia in my family, so I’m looking forward to some good answers.
The Division of Behavioral and Social Research  has conducted pioneering research in what we can anticipate as boomers age and transition to retirement and in how systems of care need to be configured to provide optimal care to frail elders. And the Division of Geriatrics and Clinical Gerontology has been looking at clinical issues related to healthy aging and the clinical pathology that occurs with aging. This was the bread and butter of what we taught our medical students when I was at the University of Oklahoma.
Since I’ve joined the NIA, I’ve seen the impressive range of projects that are being pursued by the scientists in the Intramural Research Program, all the way from very basic to clinical and epidemiologic research.
This is an exciting time for the NIA, particularly with the American Recovery and Reinvestment Act. There will be opportunities for our scientists to be innovative and to work on projects that we hope will bring about outcomes in a relatively short period of time. The ways in which that will advance science will be fascinating to see.