Spending Time in the Weeds, But for Worthy Outcomes

How does that old saying go, if you want something done then ask a busy person? That is exactly what happened when we asked Bonnie Ewald and Claire Ankuda to guest edit this complex issue, “Advancing Applied Research in Aging,” of Generations.

Turns out that adage is repeated for good reason. These two incredibly busy people with taxing day jobs and full lives off the clock pulled together a substantial, meaningful issue quickly.

Bonnie Ewald is managing director of the Center for Health and Social Care Integration (CHaSCI), a training and policy center at Rush University Medical Center in Chicago, with academic appointments in Rush’s Departments of Social Work and its Health Systems Management department, and leadership roles developing health equity initiatives.

She volunteers for ASA, convening the bi-monthly virtual Chicagoland ASA Roundtable, among other activities. She also won the 2023 Emerging Leader Award from the Health & Medicine Policy Research Group and helped to get the bipartisan Integrating Social Workers Across Healthcare Settings Act introduced in summer 2023.

Claire Ankuda, MD, is an associate professor in Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, has a baby and is building a house in rural Vermont after having recently relocated from New York City. Her current work is funded by a Paul B. Beeson Emerging Leaders Career Development Award from the National Institute on Aging and she was in 2023 awarded the Terrie Fox Wetle Rising Star Award in Health Services and Aging Research.

‘It’s so important that we keep that broad scope to understand the barriers to real-world implementation, and what the unintended consequences are of anything we do.’

These guest editors’ determination to get this valuable information into the hands of our members won the day. Ewald focuses on supporting teams in implementing, refining, and sustaining care that addresses health-related social needs and mental health concerns, for which she needs to use information to best steward limited time and resources. And in her work managing the Coalition for Social Work and Health, Ewald aims to amplify the value and expertise social workers bring as team members in healthcare.

“Social workers do so many things to get people what they want and need—often skillfully weaving many activities and clinical skills together into one intervention—so it can be particularly insightful and impactful to research social work services,” she said.

But it has always been hard to get federal research funding on social work services and most practice-based demonstrations rolled out by the Center for Medicare and Medicaid Innovation have not studied who is really implementing the models and how team members collaborate to make it happen.

“I look forward to more applied research on models that leverage interprofessional team members and cross-sector partnerships to attend to what matters most for people’s health and well-being as we age and navigate caregiving roles—to help us better understand how collaboration is happening and the unique contributions of team members across the care continuum,” she added.

As a palliative care physician and health services researcher, Ankuda said her “clinical work has shown me that the end of life can be a time of meaning, of deep connection in families and friendships, and can honor and celebrate the lives that people have lived.”

But, “it can also be a time of fragmentation and abandonment by our healthcare and social support systems, where patients and families are left to muddle through incredibly difficult situations without the appropriate supports.” This is apparent with insurance coverage, home-based supports, medication access, and nurse and aide staffing, which can determine what the dying experience might really entail.

“Applied research is an important way to show us what policies and programs can improve care, and which are threatening highest-quality care at the end of life,” Ankuda said. Her work focuses on Medicare Advantage plans, which hold promise in innovation and delivering social services, and also substantial risks of reduced care quality for elders with serious illness, due to aggressive cost-control mechanisms.

She’s excited by the varied nature of this issue’s approaches to applied research—from pragmatic trials in a clinical setting to community- and state-based research.

“I also think we bring forward some excellent pieces to outline how to think about funding and evaluation that are really important for those less experienced in applied research,” Ankuda said.

‘For people newer to data and evaluation we hope this issue will help demystify some of the language and processes to get started.’

As applied research frames research in the real-world, it allows for a wide range of intervention impacts. “It’s so important that we keep that broad scope to understand the barriers to real-world implementation, and what the unintended consequences are of anything we do,” said Ankuda. “These lenses are key to effective research that reduces the dramatic disparities we see in the care older adults receive.”

Ewald hopes this issue will inspire readers to incorporate applied research in their own work in some way—whether at the patient/family level, at the program/organization level, and at the community level. “For people newer to data and evaluation we hope this issue will help demystify some of the language and processes to get started.”

As part of CHaSCI’s work at Rush, “applied research has been integral to developing and refining our models of care, and we have consistently seen how important it is to have outcomes research to increase recognition of our services’ value and to influence policy change. There are so many opportunities for better alignment of systems at the community level too, with applied research helping guide these changes,” said Ewald.

Ankuda spoke of some other real-life impacts of the research they both do. “Living in rural America, I am reminded again and again how much place impacts care and aging. Communities here are much stronger than many in the cities I’ve lived in, but we also lack a lot of the aging resources that are focused in urban places. The challenge of better understanding rural disparities in aging and how policies can reduce them is a very compelling current focus of mine, and I’m particularly interested in applied research that can address some of these regional aging disparities.”

“I envision a world where there is parity in how we care for physical health, mental health, and social health throughout people’s lives—and applied research can help is get there by improving our care models and by building buy-in among stakeholders to invest in this redesigned care system,” said Ewald.

Alison Biggar is ASA's editorial director.

Photo credit: Shutterstock/Annette Shaff