Q&A’s with NHATS Co-PI Dr. Jennifer Schrack: Featuring NHATS/NSOC Webinars

Dr. Jennifer Schrack is core faculty with the Center on Aging and Health. Among many other outstanding leadership roles, she is the Johns Hopkins University co-PI with the National Health & Aging Trends Study (NHATS). NHATS and the National Study of Caregiving (NSOC) are sponsoring a free 2022-2023 webinar series, which you may learn more about and sign up for here.  As a part of this webinar series, Dr. Schrack will deliver a presentation at 12pm ET on November 18th about “Late-life physical activity:  Early findings from NHATS’ 2021 accelerometry substudy.” The purpose of this interview is to provide a broad overview of Dr. Schrack’s insightful research and about NHATS. 

Tony Teano: Thank you so much for taking the time for this interview. Let’s start by filling in blanks for people who don’t know you. You wear many hats. You’re with several Johns Hopkins centers. You’re a senior leader in the field of aging research and public health. And about a year ago, you were named co-PI of the National Health & Aging Trends Study (NHATS). Tell us more about yourself! What do you do?

Dr. Schrack: That’s a big question. I am an epidemiologist. I study aging, and I like to say movement and health, and so that encompasses how engaging in movement (or physical activity) can affect people’s health. It is also how changes in movement can be a sign of adverse changes in health. Think about physical activity and mobility as a key piece that I’m interested in. We know physical activity is preventative. We know that it can prevent heart disease and obesity. We think it might be able to prevent cognitive decline, and to preserve mobility and prevent disability with aging.  Also changes in the way people move can tell us, perhaps, about subclinical disease and risk of poor outcomes. For example, we think about gait speed as an example that has predicted poor outcomes, disability and death for many years. Now, we’re trying to take that to the next level by having people wear monitors/wearable devices or accelerometers that can help us understand movement in a new dynamic way. We’re looking at a 24-hour movement cycle which can tell us activity, sleep and sedentary time—and all of these things linked together. I study how that influences people’s health, both from a physical side and a cognitive side. And again, how those changes can also help us understand people’s risk of adverse outcomes.

Tony Teano: You have a primary appointment as Associate Professor in the Johns Hopkins Bloomberg School of Public Health in the Division of Epidemiology of Aging, with a joint appointment in the School of Medicine. Maybe it is obvious, but please tell us more about how those appointments enrich and leverage each other?

Dr. Schrack: Actually, it’s a hard question. They complement each other. Epidemiology helps us understand health at the population level. It helps us understand methodological rigor, especially of aging research. But we also have to keep in mind the big questions about why research matters—what does this mean for patients? I think trying to bridge those two schools or those two fields is very, very important—not just for understanding health with aging, but also what are we going to do about it [pertaining to research and translation from bench to bedside application]: What is it? Is it meaningful? Does it matter?

Tony Teano: I appreciate this amazing general overview of your work and your approach to research—and how public health perspectives inform medicine and interventions. Now, let’s turn specifically to NHATS. Please tell us about what NHATS aims to do.

Dr. Schrack: NHATS is a platform for studying late life, disability, and it’s been going on since 2011. Dr. Judy Kasper was the previous Hopkins PI. She unfortunately passed away unexpectedly in August of 2021, and I became a co-PI in September 2021.  NHATS is a large panel study of Medicare beneficiaries—people are identified and recruited through their enrollment in Medicare.  NHATS strives to be representative of the US population, but we’ve oversampled older adults (those over age 90) as well as older Black adults, and now we’re also over sampling older Hispanic adults, because we realize not enough is known about aging in those populations.  NHATS has sampling weights that help us understand the relative contribution of data on people by age, sex, race, ethnicity, and so on, to the study. That’s a way to help make it nationally representative.

Tony Teano: Could you speak more to what types of data NHATS gathers?

Dr. Schrack: We have physical function measures. We have a cognitive battery. We have an extensive health interview—and that interview includes things like understanding people’s ability to do things by themselves in their own home, or whether they need care or assistance, and it also goes a step beyond that by trying to understand accommodations. For instance, someone might not be able to bathe on their own. But if they have a shower chair, then they can.  Or they might not be able to walk independently. But if they have a cane, then they can. Understanding accommodations and how they address people’s ability to be independent is valuable information.  Also, there’s a link with NHATS and the National Study of Caregiving. If people have a caregiver, we do what we can to interview the caregiver to understand things like caregiver stress, to what extent caregiving is needed, and the types of care provided. All of those things are really important to understanding people’s ability to stay in their homes.  Also, we sample people who are in facilities—nursing homes, assisted living, etc.—and we interview them. We also interview the facility to try to understand the kind of services they offer and their associated costs. For researchers, one of NHATS’ most exciting things available with enhanced data is the ability to link all of our research to the data that we collect with Medicare claims. In other words, you can incorporate the cost of certain health conditions, of disability, of cognitive challenges, of Alzheimer’s disease, etc., and connect data from filed Medicare claims into your research. NHATS is an amazing study with a vast amount of data, and it’s a great resource because it is publicly available.  Most of this data is freely available on our website. Some of the more sensitive data you have to apply for, but that’s fairly easy to do.

Tony Teano: I noticed a lot of useful and informative information on NHATS’ website—ranging from a new online course for researchers beginning to use NHATS, tutorials, and even a link to 1940 Census data. In particular, I noticed NHATS/NSOC is offering a free speaker series on rich topics such as late-life disability, older adults’ caregiving needs, and new findings in hearing and vision measurements. Please tell us more about these webinars, and what you will talk about as part of it.

Dr. Schrack:  The speaker series was actually thought up by my co-PI, Dr. Vicki Freedman with the University of Michigan, as a way to just draw attention to some of the newer and more exciting research that’s being done in NHATS. We’ve reached out to people who we know are doing great work in NHATS, such as Johns Hopkins University colleagues Drs. Jennifer Wolff, Chanee Fabius, Nicholas Reed, and Katherine Ornstein—all of whom will be presenting at this webinar series—and more amazing researchers using NHATS data.

On November 18th, I will be talking about the introduction of accelerometry to NHATS. This is something we’ve been working on a long time, and it involves a subset of NHATS participants. The study typically runs somewhere around 5,000 to 10,000 older adults. It’s a little bit lower right now, because we need to replenish; we put that off because of COVID-19. In 2021, we selected a substantial number of participants to wear an accelerometer—about 1,000 people—and we got complete and strong data on about 750.  The data are really interesting. Because we go to people’s homes, we access a portion of the population not typically seen in research studies. It’s not your typical study where people come into the clinic, we collect data, and they go home. This is where we’re seeing less active, less healthy people. We get people that wouldn’t normally volunteer to be in a research study. And it is exciting because not a lot of information is known about physical activity and movement in these people. Looking at the data so far, we can already see they seem to be less active than people in other studies and other clinical studies. It also picks up where the National Health and Nutrition Examination Survey (NHANES) leaves off; NHANES is a national cross-sectional health and nutrition examination survey. NHANES doesn’t really have a lot of data on people over the age of 80. We have a lot of people in that age range, and we’re going to follow them longitudinally—which hasn’t been done—to understand decline.  We’re so excited about the data, and we’re hoping to expand it going forward.

Tony Teano: It sounds like a great topic for another blog in the future! For now, I sincerely thank you for your generosity of time for this interview. Your work is fabulous, and I look forward to your NHATS/NSOC presentation on November 18th, and to attending more in the series!

For more information about Dr. Schrack’s research lab team, please visit:

By Anthony L. Teano, MLA
Communications Specialist

 

Image of Lisa M. Walke, MD

Advancing Innovation through Inquiry and Equity

We are excited to kick off our COAH Scientific Seminar series for the academic year on Monday, December 5th with Lisa M. Walke, MD, MSHA, AGSF.  Dr. Walke is an Associate Professor in Geriatric Medicine and Gerontology as well as Chief in the Division of Geriatric Medicine at the University of Pennsylvania Perelman School of Medicine Penn-Ralston Center.  We invite you to join us on Monday, December 5th at 3:30pm for her presentation entitled “Advancing Innovation through Inquiry and Equity”   In person attendance is highly encouraged.  You may also attend via Zoom by registering at https://bit.ly/3NgHX3h.

JHU Researchers Presenting at GSA 2022

You are cordially invited to attend these exciting presentations at 2022 Annual Scientific Meeting of The Gerontological Society of America (GSA) with Johns Hopkins University faculty, staff, fellows, and students; here is a complete list, which you may download and/or print out.

Many thanks to Monique L. Lee, COAH Administrative Coordinator, for compiling this list.

Also, don’t miss COAH Director Dr. David L. Roth’s outstanding address at GSA on Thursday, November 3rd, from 4:30 p.m. to 6:00 p.m. in Room 120-121; titled, “From Stressed Caregivers to Healthy Caregiving: The Implications of Balanced Perspectives and Updated Findings,” Dr. Roth will briefly review updated findings on mortality and inflammatory biomarkers among caregivers.

We wish everyone a great experience at GSA 2022!

By Anthony L. Teano, MLA
Communications Specialist

COAH Champion: David L. Roth, PhD

David L. Roth, PhD, MA is a professor in the School of Medicine, Division of Geriatric Medicine and Gerontology. His research focuses on epidemiological studies of family caregiving, applied statistical analysis, and psychosocial influences on health and healthcare utilization. Dr. David Roth has been at the helm of the center as director for more than a decade. And now Dr. Roth is doing something the likes of which revered leaders, such as George Washington and Cincinnatus, have done—Dr. Roth is stepping down from power and making way for an emerging leader. Let’s learn more about him as a person as well as a professional.

Tell us about your background, education, and path to COAH. 

Young David Roth

was born and raised in Minot, North Dakota.  I have always had a dual fascination with numbers and with how the mind works.  I combined those in my undergraduate studies, majoring in both mathematics and psychology at the University of North Dakota.  I received a PhD in psychology from the University of Kansas and then took my first faculty position at the University of Alabama at Birmingham.  My interests and skills in statistics and data analysis has led me into all kinds of interesting projects and collaborations, including into gerontology.  In 2012, I applied for the COAH Directorship and was fortunate to be offered that position.

Your research focuses on applied geriatrics—analyzing data/statistics mostly on family caregivers and on the broader social resources of older adult populations. What about working with numbers appeals to you? 

Quantifying behavioral and social factors is a big challenge, but this kind of rigorous measurement is critical for science to advance in these areas.  Numbers convey a certain precision, but statistical analysis also incorporates the uncertainty of those numbers and the probabilistic nature of any conclusions we might draw.  It’s fascinating to be able to work with colleagues and test hypotheses in research projects that have the potential to greatly improve the lives of older adults and their families.

You have about 270 original peer-reviewed research articles, 229 papers that have been cited 10 or more times, and you are the most cited researcher in the field of applied gerontology according to Google Analytics—currently cited more than 25K times. What advice do you have for junior investigators about becoming a prolific and well-cited researcher in this space?

I think too many researchers with quantitative or data analysis skills are trying way too hard to be as sophisticated as possible in their analytic approaches.  This leads to papers with analysis methods that very few colleagues, not to mention the general public, actually understand.  I try to emphasize that we want our readers to understand what we are doing and how we are testing our ideas.  Let’s not overly complicate things if that is not necessary.  Write as clearly as possible, and use conventional analytic methods when they are acceptable.  There is no advantage to confusing people, or to conveying a “trust us” attitude on analyses that others don’t comprehend.  If colleagues understand your work, they are more likely to cite it, and this increases the potential impact of your work.

You are most well-known for your 2015 paper “Informal caregiving and its impact on health: A reappraisal from population-based studies.” This and other papers led New York Times writers to interview you.  Why was this paper so exciting? 

Dr. Roth introduces Mason F. Lord Staff Award recipients at the divisional town hall, May 2022

This paper challenged a common narrative in family caregiving research that the chronic stress of caregiving results in many serious threats to the caregivers’ health.  A few early studies suggested that caregivers have elevated mortality rates, with mortality effects similar to those of smoking.  However, many subsequent, large, population-based studies have not only failed to confirm the mortality threat, but actually found that caregivers tended to live longer than many comparison samples of non-caregivers.  This has led to an increased attention on the positive aspects of caregiving, how caregiving is a type of social engagement, a form of volunteerism provided within your own family or social network.  Caregiving can still be stressful, and caregivers deserve to have services to help them manage their responsibilities, but fortunately, some of the early dire predictions about the physical health consequences of caregiving appear to have been overstated.  This paper played a major role in re-balancing the perspectives on the long-term health effects of caregiving.

Last year, you were named the M. Powell Lawton Award recipient from the Gerontological Society of America (GSA). This November, you will deliver the M. Powell Lawton lecture at the GSA Conference in Indianapolis, Indiana, on November 3rd, from 4:30 p.m. to 6:00 p.m. in Room 120-121.  Please whet our appetite and give us a teaser about the topic you will discuss and its implications in applied gerontology.

The title of my address is “From Stressed Caregivers to Healthy Caregiving:  The Implications of Balanced Perspectives and Updated Findings.”  In the talk, I will briefly review the mortality findings discussed above and also review similar findings on inflammatory biomarkers.  In both areas, the caregiving literature shows a bias pattern that is often found in other areas—particularly in the social and behavioral sciences, where early studies with relatively small sample sizes and alarming results are widely cited–whereas numerous subsequent studies with larger samples and better methods that don’t support the original alarming results are usually given much less attention.  Science slowly corrects these biases over time, but it shouldn’t take as long as it often does.

Dr. Roth (center) with Mason F. Lord Staff Award recipients and COAH colleagues Talan Zhang (left) and Monique Lee (right), June 2022

I heard you say that one of your favorite quotes about leadership is from Lao Tsu: “To lead people, walk beside them… As for the best leaders, people do not notice their existence. The next best, people honor and praise. The next, people fear; and the next, people hate…. When the best leader’s work is done, people say, ‘We did it ourselves!’” Tell us about a few examples in your personal or professional life where you think you lived up to this value.

As the Director of the Center on Aging and Health, I have tried to expand our breadth and to recruit and retain outstanding investigators.  I have then tried to mostly stay out of their way as they do their exceptional work.  They did do it themselves.  If I had some small role in creating an environment where that could happen, and where they could expand their collaborative networks, then I have done a good job as a leader, but it’s really more as a facilitator than anything else.

This October, COAH turns 25, and you have been at its helm for more than a decade.  What are a few of the most significant things to have developed at COAH over the past 10 years?

It’s hard to give a short answer to that.  We have grown and expanded, while maintaining and advancing our historical strengths.  We are well-known for our work on frailty, and rightfully so.  That group continues to thrive and improve the lives of many older adults.  We have established about 8 distinct working groups.  We are much more active in analyzing national databases and examining trends in healthcare utilization using Medicare claims data as part of our Linked Administrative Data Resource (LADR).  We have become very active in work on mobility, on international approaches to harmonizing cognitive aging data, on sensory changes associated with aging, and this is just a small sampling of the many innovative projects and collaborations that are ongoing.  I apologize to the many productive and outstanding scientists we have whom I have failed to mention in this brief response.

If you didn’t have the position/career you’re in now, what would you be doing instead?

image of COAH staff
Dr. Roth surrounded by many of the COAH team at the Center’s Spring Award Luncheon, May 2022

That’s a scary question.  I have been blessed to have a rewarding and stimulating career.  My biggest fear is boredom, but that never happens in my job.  Research is always challenging and changing.  It keeps you fresh and always striving to improve. I’m afraid that a lot of other careers, where you do similar things over and over again, would bore me.

Recently, you decided to step down as director of COAH. What will you do next?

That’s a good question.  I will still collaborate, but spend more time away from work and enjoying the great outdoors.  I love nature and being in the countryside.

Dr. Roth, this is an amazing track record of success! Thanks for sharing your thoughts on these professional matters.

Now, let’s turn to who you are when you’re not at work—and get a glimpse into your private world.

What is your earliest memory?  How does it make you feel?

Pulling up in a pickup truck with my Dad to the new house my parents bought when I was 3 years old.  It is a warm memory.

Is there any fun fact to know and tell you’d like us to know about your home life, family, where you grew up, etc.?

I came from a great family.  A strong Catholic family.  My parents were married for over 63 years, until my Dad passed away a few years ago in 2020 at the age of 90. My Mom is 86 and is still with us. She has a great sense of humor, and it is very fun to visit her, which I do every chance I get. Also, I have 3 great sisters, and a brother, too.

Dr. Roth and his mom

It sounds like your parents may have some secrets to healthy aging. With your expertise in this field, what have you observed about them to this extent?

They’re both from strong, midwestern farming families.  They learned to work hard at an early age and to also take good care of themselves.  When you were out on the farm 70-80 years ago, you had to be self-sufficient.  They mastered that.  They lived fairly simple, healthy lives, and had active lifestyles, not necessarily from exercise classes, but from everyday physical activities.

 Tell us about when you think you first became aware of aging as an important health topic. 

 In graduate school, I received training in both neuropsychology and behavioral medicine.  Both fields alerted me to the importance of aging, and to the importance of disease prevention and building optimal functioning over time.  Then, when I started doing more collaborative work as an applied statistician, I became very impressed with the social dimensions of aging, the advantages of having a strong family, a robust social network, and the perils of social isolation.  These interests grew and merged over time to create the scholar I am today.

What are some of your favorite, ordinary guilty pleasures?

  • Jackson and Dr. Roth on the Magothy River

    TV show… I’m sure I’ve seen every Seinfeld episode multiple times, and still sometimes watch those reruns even now.

  • Meal you cook… I love roasted duck, with acorn squash, a good green veggie, and an excellent bottle of red wine.
  • Daytrip getaway destination…  I take my boat out on the Magothy River frequently.  There is a little island that I pull up to and let my dog swim and play. I have named it “Jackson island” after my dog.
  • Quote… “The perfect is the enemy of the good.”  Most attribute this to Voltaire, and I really agree with it.  If we try to be perfect, we fail.  We should try to be good, and always try to improve, but, as humans, we can never achieve perfection.

What is the top item on your bucket list?

To travel a lot more and see places in the world that I haven’t visited yet.

Where would you vacation if money was not an issue? 

I have this fantasy to go camping in the Himalayas.

What advice did you receive as a young person that has served you well?

Finish what you started.  Don’t quit on people.  You want others to know that they can rely on you.

What advice do you have for young people today?

Be true to yourself.  Try different things, partly to discover what you are good at, and what you enjoy doing, and then figure out a way to get paid to do those things as part of your career.

From a “COAH Coffee” Zoom early in the pandemic, Dr. Roth brought the COAH team together virtually for social interaction, Sept 2020

In my humble opinion, Dr. Roth treats the COAH team as members of an extended family brought together around core values of excellence and a commitment to inquiry into matters impacting older adults and their caregivers. Since COVID-19, he has found creative ways to bring his team together—whether it is for an occasional luncheon when pandemic conditions permitted, or virtually for periodic “COAH Coffee Hour” Zoom meetings to just banter and share what’s going on as real people. Ukulele, guitar, and even a xylophone was involved. To me, a hallmark of Dr. Roth’s leadership has been to cultivate cohesive camaraderie and to facilitate creative connections among passionate people whom he celebrates. He has consistently nominated COAH team members for various awards. As he gracefully vacates the director position, it is reassuring to know Dr. Roth is not leaving this wonderful community of people that he has mentored and nurtured, but rather he is becoming a different kind of collaborator and peer—and Dr. Roth will most certainly remain a champion of and among COAH champions.

 You may also be interested in the following blogs by or about Dr. Roth:

By Anthony L. Teano, MLA
Communications Specialist