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Sarah
Kagan Lectures at Hong Kong University
Keynote Address to Frontiers in Biomedical Research - HKU 2002
and
Scientific Meeting of the Department of Nursing Studies, Hong
Kong University
http://www.hku.hk/nursing/Gallery/
Theoretical and Methodological Opportunities for Gero-Oncology
Research in Aging Societies
Sarah H. Kagan Ph.D., RN, CS, AOCN
The Doris R. Schwartz Associate
Professor of Gerontological Nursing, School of Nursing
Gerontology Clinical Nurse Specialist, Hospital of the University
of Pennsylvania
Secondary Faculty, Department of ORL:HNS; University of Pennsylvania
Cancer Center
University of Pennsylvania, Philadelphia, PA
Purpose:
This paper analyzes theoretical and methodological opportunities
to address the challenge of designing and implementing gero-oncology
research in aging societies.
Background: Attention to cancer and aging as
a distinct field has grown steadily since the 1980’s.
Current calls for research lack specificity in theoretical and
methodological direction and fail to support research with cultural
and social relevance that create impact across aging societies.
Analysis and Conclusions: Gero-oncology has
only recently become a priority within nursing and bio-medicine.
Sporadic papers in the last 20 years created attention for age-related
research but did little to refine inquiry. Current calls for
research, centered through a strong voice from bio-medicine,
draw  attention
to complex problems of co-morbidity, treatment tolerance, and
survival analysis. Nursing, with less articulated voice, lags
behind in arguing for a focus on the responses of older cancer
patients.
Implications: The name gero-oncology affords
the distinction of using gerontology – with emphasis on
age, health, and function – to lead research development.
Borrowing theory used in gerontology accentuates human development;
physical, cognitive, and emotional function; and decision making.
While existing research uses quality of life (QOL) as both theory
and method, approaches to QOL that reflect the unique nature
of elder’s lives in culturally disparate communities and
aging societies must  be
delineated. Several disease and treatment specific models (e.g
prostate cancer, radiation therapy) are used but do not consider
larger epidemiological, genetic, and cultural concerns imbedded
within them. For example, prostate cancer is a limited global
model given the low incidence of that disease in Asia. New models
must feature integration of age-related disease (i.e. non-melanoma
skin cancer), demography, and epidemiology with attention to
genetics and culture, with function status, QOL, and resource
use. Measures of survival, tolerance, and treatment effects
are complex and must be dissected quantitatively and qualitatively.
Survival methods and accommodation for attrition are useful
in redefining population outcomes research for this group in
which survival may not stand alone. Redefining tolerance to
include function and co-morbidity are important to advancing
measurement. Highlighting symptoms of co-morbid disease and
the experience of chronicity may be better addressed through
qualitative work. Finally, the full scope of gero-oncology seems
best explored through collaborative interdisciplinary work that
pioneers new directions in theory and methods leading to developments
on this frontier.
Funding:
The Frank Morgan Jones Fund at the School of Nursing of the
University of Pennsylvania
The John A. Hartford Foundation Center for Geriatric Nursing
Excellence at the School of Nursing of the University of Pennsylvania.
Abstract:
Medical and Health Research Network Seminar, University of Hong
Kong
Aging Societies and Nursing Workforce:
Age, Chronicity, and Unmet Need
Sarah H. Kagan Ph.D., RN, CS, AOCN
The Doris R. Schwartz Associate
Professor of Gerontological Nursing, School of Nursing
Gerontology Clinical Nurse Specialist, Hospital of the University
of Pennsylvania
Secondary Faculty, Department of ORL:HNS; University of Pennsylvania
Cancer Center
University of Pennsylvania, Philadelphia, PA
Purpose:
This seminar outlines current health care delivery and policy
concerns for aging societies given the global shortfall of nursing
education, service, and research. Several demonstration initiatives
are discussed in relation to short and long term achievements
and global translation.
Background: Hong Kong and the United States
have similarly aging demographic profiles despite disparate
population size. Worldwide, the nursing workforce is experiencing
what has been termed a shortage of unparalleled proportion.
In part, nursing is currently unable to meet burgeoning regional,
national, and global demands for care, evidence to support care,
and systems development given the  size
of its workforce and available supports. Yet nursing remains
the discipline most critical to meeting the needs of individuals,
families, and communities in aging societies now and in the
future.
Implications: The disparity between need for nursing care and
the nursing workforce is most sharply demarcated in aging societies
where the burden of chronic and acute illness related to age
and disease escalates daily. An important body of literature
illustrates the dangers of overextending nursing services in
the face of this growing need. Consequently, several initiatives
to address expanding capacity for geriatric nursing are underway
in the United States. These initiatives tend to be privately
funded, piloting models of care and training scientists, educators,
and clinicians through those new models. Evaluation is concurrent
and shows promising results. Yet the congruence of these programs
with existing need in the United States and other aging societies
and with a broadly available, well managed workforce has yet
to be established. The issue that remains is how to merge short
and long term achievements with policy appropriate to aging
societies to insure that congruence.
Funding:
The Frank Morgan Jones Fund at the School of Nursing of the
University of Pennsylvania
The John A. Hartford Foundation Center for Geriatric Nursing
Excellence at the School of Nursing of the University of Pennsylvania.
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