History of the Yale Program on Aging

Age-related research began at Yale in the 1970s with studies identifying predictors of stroke (Dr. Adrian Ostfeld) and the effects of bereavement on the health of older persons (Drs. Stanislav Kasl and Selby Jacobs). By the early 1980s, the Department of Internal Medicine was developing active inpatient and outpatient programs for the care of older patients, both at Yale-New Haven Hospital and the West Haven VA Medical Center (Dr. Leo Cooney). Concurrently, Epidemiology and Public Health (EPH) faculty were awarded one of three contracts from the National Institute on Aging (Established Populations for Epidemiologic Studies of Elderly – EPESE) to conduct a large longitudinal community-based study addressing the physical, psychological, social, and cognitive functioning of older persons (Drs. Ostfeld, Kasl, Cooney, Jacobs and Lisa Berkman). This ground-breaking study, along with a major offshoot, the MacArthur Foundation Research Program in Successful Aging – begun in 1988 – established Yale School of Medicine as a leading institution in studies of human aging (Drs. Berkman and Teresa Seeman). In the late 1980s, the Department of Medicine, through the new geriatrics program (Drs. Mary Tinetti and Sharon Inouye), began developing a strong research program built on the foundations of both traditional epidemiology and clinical epidemiology which addressed the common and yet largely neglected health problems of older persons including falls and injury, delirium, elder abuse, and functional decline.

The informal collaborative efforts among the departments of Epidemiology and Public Health, Internal Medicine, and Psychiatry were recognized by the School of Medicine in 1991 with the creation of the interdepartmental, multidisciplinary Program on Aging. In 1992 Program on Aging investigators, under the direction of Dr. Mary Tinetti, competed successfully to become one of the first NIA funded Claude D. Pepper Older Americans Independence Centers for aging research in the country.

Mission of the Yale Program on Aging

Through a combination of multidisciplinary research, support for training of junior investigators, and collaborative relationships with individuals and agencies in the surrounding communities, the objectives of the Yale Program on Aging are:

1. To determine the physical, psychological, and social factors that put older persons at risk for developing geriatric health problems that impede optimal functioning and quality of life.
2. To determine the physical, psychological, and social factors associated with successful aging, defined as maintenance of physical, social, psychological, and cognitive functioning;
3. To develop and test cost-effective interventions aimed at preventing or reducing functional disability among older persons;
4. To train researchers capable of conducting multidisciplinary studies involving older persons;
5. To encourage and facilitate collaborative investigations among researchers throughout Yale University and Connecticut with expertise in fields relevant to understanding, treating, preventing, or reversing functional disabilities;
6. To translate Yale Program on Aging research findings into improved quality of life and health for older persons and improved, more responsive, healthcare delivery.

Present activities of the Yale Program on Aging

At present, over 40 investigators from many departments and more than 50 field, data management and analytic staff are involved in more than 40 research projects ranging from basic molecular investigations to epidemiologic studies to intervention projects and outcome studies. The multidisciplinary, interdepartmental Program on Aging at Yale, directed by Dr. Mary Tinetti and co-directed by Dr. Sharon Inouye, is particularly renowned for its groundbreaking studies on the common, previously ignored, healthcare conditions of older persons. The common thread of the research conducted at the Yale Program on Aging is the development of effective strategies for enhancing optimal function and quality of life among older persons who frequently experience multiple impairments and chronic diseases. Combining scientific rigor with "real world" relevance, investigators approach this task by designing studies to answer questions such as: Who is likely to experience (falls, delirium, etc.)?; What factors put some older persons at increased risk for (falls, delirium, functional decline, etc.)?; Can we prevent or reduce the frequency of (falls, delirium, functional decline, etc.) in older persons at risk?; Can older persons who (fall, develop delirium, experience functional decline, etc.) improve?; And if so, what is the most effective and cost effective strategy?

Over more than a decade, Program on Aging investigators have not only conducted the first studies of the causes and prevention of common health problems such as falls, injuries, delirium, functional decline, and difficulty with driving, but have been the individuals largely responsible for replacing the prevailing opinion that these are inevitable problems of growing older, with the knowledge that these conditions, while common and associated with morbidity, are predictable and, most importantly, preventable.

In recent years the program's ability to conduct sophisticated biostatistical analyses has been enhanced through the participation of Drs. Theodore Helford, Peter Peduzzi, and Heather Allore.

Investigators at Yale are recognized worldwide as the leaders in the study of falls, fall injuries, and immobility (Dr. Mary Tinetti), delirium (Dr. Sharon Inouye), and driving difficulties (Dr. Richard Marottoli) among older persons. Yale is also recognized as one of the leading institutions in studies of functional decline and recovery (Drs. Thomas Gill, Mary Tinetti, Stanislav Kasl), of appropriate treatments and outcomes of cardiovascular disease in older persons (Drs. Harlan Krumholz and Matt Burg), of patients’ goals and preferences in the treatment of chronic and terminal diseases (Drs. Elizabeth Bradley, Terri Fried, Sidney Bogardus), and of the health consequences of bereavement (Drs. Stanislav Kasl and Holly Prigerson).

Unique strengths of the Yale Program on Aging include:

1. A focus on common, potentially modifiable, previously ignored, health problems of older persons;
2. The integration of physical, psychological, and social factors in multidisciplinary studies;
3. The identification and testing of effective diagnostic and treatment strategies for common geriatric problems in "real world settings";
4. The close collaboration and reciprocal relationships between Yale investigators and the surrounding communities.