Heather E. Whitson, MD, MHS, new director of the Duke Center for the Study of Aging and Human Development, begins her tenure by launching a more focused study of resilience among geriatric patients, coordinating the Duke School of Medicine’s approach to Alzheimer’s disease and dementia research, and promoting innovative care models, such as a long-standing community outreach program to strengthen support for families facing the challenges of memory-related diseases.

Pledging to continue the innovation that has characterized the center’s history since its creation as a visionary institution in 1955, Whitson will embrace a mission based in social and biological sciences. Before being named director in July 2019, she led a strategic planning process bringing together stakeholders to assess and fine-tune operations to shape a comprehensive, coordinated mission. Whitson offers an early look at her priorities for the center:

Question: What is the center’s research focus on resilience within the geriatric community?

Whitson: Researchers have long been interested in resilience to stressors. It’s part of our ongoing look at aging over the lifespan. In the past, the focus has been mostly on psychological resilience to life challenges, but recently, we have incorporated the study of physical resilience, which refers to individual functional changes following a health stressor. We want to know the biological, molecular-level determinants that explain why people who are exposed to the same stressors often respond differently. Some become sick; others do not. We all know individuals who become sick but who bounce back strongly, while others never return to full health after fracture, surgery, or pneumonia. Their health trajectory is changed dramatically by the stressor, often with negative consequences.

The center has been working to understand the biological and physical mediators that underlie those different responses. We will use our expertise in sociology and gerontology coupled with our knowledge of the biological processes of aging to try to understand the ways in which these knit together. We all recognize the interplay between biological and psychosocial factors.

Question: How will the center structure its mission to become a central hub for Duke’s work in memory-related diseases?

Whitson: Duke’s School of Medicine has a long history of leadership in Alzheimer’s disease and dementia research. A Duke team described the role of the APOE gene that confers risk for the disease, for example. We are working now to consolidate the great work going on across Duke and organize it within the center. We will work with the same entities and individuals, but we will bring the work that is now spread among many departments under a single roof. Various resources around Duke will be centered and coordinated here, with those leaders working together to build the infrastructure of the essential research we will undertake.

Questions: How will the center’s work related to innovative care models look in the future?

Whitson: We already have exciting models to build on. Innovative, successful care models in the health system include the Perioperative Optimization of Senior Health (POSH), a program whose leaders include Sandhya A. Lagoo-Deenadayalan, MD, PhD, Shelley R. McDonald, DO, PhD, and Mitchell T. Heflin, MD, MHS, as well as the Health Optimization Program for Elders (HOPE), led by Heidi K. White, MD. POSH reduces hospital stays and readmissions through coordinated care before and after surgery, while HOPE reduces avoidable hospital readmissions by engaging patients, families, hospital staff, and skilled nursing professionals and easing the transition from discharge to rehabilitative care.

In the community, one existing innovative model developed here by Lisa Gwyther, MSW, and her team provides much needed support for patients and families diagnosed with Alzheimer’s disease and dementia. The statewide Duke Dementia Family Support Program is already helping families. Memory disorders involve a long window of disease management during which the patient may not be fully able to manage his or her care, so friends and family members play a critical role as informal caregivers. This award-winning program organizes a number of initiatives, including a hotline and educational and social support programs for patients and families. The Center has long served as an incubator for these kind of forward-thinking programs. In the future, we want to evaluate and disseminate models like this to extend the benefits beyond Duke.