CELEBRATING THIRTY YEARS OF AGING
AND HEALTH 2012 ANNUAL REPORT
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2012 ANNUAL REPORT

Exploring Issues and Testing Solutions

The early years of funding in Aging and Health represented a period of experimentation. The Foundation Trustees and staff had identified the foremost challenges in the health care system, but the most effective methods for addressing them were not yet clear. Several small one- and two-year grants were made for a variety of programs in three areas: geriatrics training, assessment of older adults, and community-based care of older adults.

Building the field of geriatric medicine
In the early 1980s, several of the nation’s medical schools created training programs in geriatric medicine, but a lack of fully trained geriatricians to serve as faculty frustrated their efforts. The Hartford Geriatric Faculty Development Awards were created to encourage mid-career medical school internal medicine faculty to pursue advanced training in geriatrics to fill these positions.

Supporting one individual at a time, however, could not possibly meet the pressing challenges of building up academic geriatric medicine programs across the country. A more robust, institution-based approach made more sense. With support from the Foundation, the Institute of Medicine convened a group of leading experts in the field to formulate a national strategy for strengthening academic geriatrics. The group was led by John W. Rowe, MD, then Director of Harvard Medical School’s Division on Aging. They recommended concentrating resources on leading geriatrics programs. These “centers of excellence” would train academic geriatricians.

The Academic Geriatrics Recruitment Initiative funded ten medical schools with outstanding divisions of geriatrics to encourage medical students and practicing physicians to become academic geriatrics faculty members. “We were not focused on producing geriatricians,” says Richard S. Sharpe, Program Director of the Hartford Foundation from 1985 to 1995. “We wanted to produce the trainers of the geriatricians.” This program grew and evolved over the years as more medical schools became centers of excellence. The “train the trainers” concept has been used repeatedly in other Foundation initiatives.

The contribution of the Hartford Foundation in putting geriatrics and gerontology on the map has been monumental. It is emblematic of what foundations should be doing in the sense of changing the field for the benefit of older Americans.” Claire Fagin, PhD, RN
Former Dean
School of Nursing
University of Pennsylvania

Assessing and addressing the unique needs of older adults
Early grants in Aging and Health were also aimed at changing health care delivery to assess and address the specific needs of older adults. For example, the Foundation concentrated on addressing their medication challenges (Geriatric Pharmacology). This led to the creation of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The Beers Criteria remain in wide medical use today, protecting older patients from medications that can cause adverse reactions or dangerously interact with one another.

By this time, the Trustees and staff had decided to be even more strategic in their grantmaking. Rather than sift through many applications to find and fund the best ones, the Foundation began to hand-craft its grants and co-design proposals with applicants who had been invited after a careful vetting and strategic assessment.

Two areas of grantmaking defined
By the late 1980s, the three areas of grantmaking had narrowed to two: increasing the supply of academic geriatricians through the centers of excellence and improving delivery of health care services to older adults. “We felt it was important to focus on both training and services,” says Donna I. Regenstreif, PhD, Senior Program Officer of the Hartford Foundation from 1987 to 2005. “You could train someone superbly and then send them out into the world, and they would die on the vine; and if you focus exclusively on service and have nobody trained adequately to provide those services, that won’t work either.”

The Foundation ultimately focused on training health care professionals and improving health care services for older adults.

One way to make an immediate impact on the health of older adults is to improve their hospital care. Starting in 1992, the Foundation provided a series of grants under the Hospital Outcomes Program for the Elderly (HOPE) initiative to alleviate the negative effects of hospitalization and emergency care on older patients. A model that equips nurses with the knowledge and tools to improve care for hospitalized older adults and another to create specialized units for elders were funded under this program, and both continue today (Reducing Adverse Effects of Hospitalization for Older Adults).

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