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The National Institute on Aging (NIA) has awarded Weill Cornell Medical College a $2 million grant over the next five years to fund an Edward R. Roybal Center for Research on Applied Gerontology, one of 12 such centers nationally. The grant will create the Cornell-Columbia Translational Research Institute on Pain in Later Life (TRIPLL), a multi-institutional and interdisciplinary collaboration focused on implementing innovative strategies for improving pain management among older adults.

One of the country's most extensive community-centered research initiatives in the field of aging, TRIPLL is expected to reach more than 300,000 New York metro-area seniors.

The new Institute is an expansion of the Cornell Institute for Translational Research on Aging (CITRA) in Ithaca, N.Y., a Roybal Center active since 2003. Weill Cornell's Division of Geriatrics and Gerontology in New York City will serve as the program's hub, with other principal members comprising Cornell University College of Human Ecology in Ithaca — and, for the first time, Columbia University Mailman School of Public Health, a leader in healthy aging and palliative care research. Other newly added members include the Memorial Sloan-Kettering Cancer Center, which offers expertise in oncology and palliative care, and the Hospital for Special Surgery, an authority on arthritis and rehabilitation, and the Visiting Nurse Service of New York, the largest provider of home care services in the country. TRIPLL will provide support to a diverse population of older adults in the New York metropolitan area in hospital settings — through NewYork-Presbyterian Hospital and NewYork-Presbyterian Healthcare System — and via senior centers, retirement communities, home care aides and long-term care facilities.

"Pain is a prevalent, costly and woefully under-addressed cause of suffering in older adults. Its deleterious consequences are far-reaching and include impaired quality of life and sleep, as well as decreased immune function, cognition and mobility," says TRIPLL co-director Dr. Cary Reid, the Joachim Silbermann Family Clinical Scholar in Geriatric Palliative Care and associate professor of medicine at Weill Cornell Medical College, and a practicing physician at the Irving Sherwood Wright Center on Aging at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "Through the Institute's expanded nexus of participating researchers and care providers, we will be able to implement an array of new interventions aimed at improving the health and well-being of older New Yorkers in pain."

Dr. Reid's current research projects include testing non-pharmacologic and culturally appropriate strategies for managing pain among older persons.

"A major advantage of the new center are the links it will create between social and behavioral science and various specialties in medicine, as well as its strong ties to community health and social service agencies," says Dr. Karl Pillemer, TRIPLL co-principal investigator and the Hazel E. Reed Professor in the Department of Human Development at Cornell University and professor of gerontology in medicine at Weill Cornell Medical College. "The problem of pain in later life is so complex, it requires such an integrated network of scientists and practitioners working together to develop innovative solutions." Elaine Wethington, Associate Professor of Human Development at Cornell University, will direct the Center's extensive pilot studies program.

Dr. Pillemer is also collaborating with Weill Cornell's Dr. Mark Lachs and Columbia's Dr. Jeanne Teresi on a large NIA R01 grant studying interpersonal aggression in long-term care facilities.

Dr. Linda Fried, dean of the Columbia University Mailman School of Public Health, is a member of the TRIPLL External Advisory Board. A leading geriatrician, she has conducted groundbreaking work in community intervention studies.

"This substantive and novel collaboration of Cornell and Columbia with these prominent research centers and community agencies in New York City to improve translational research on pain will result in one of the most extensive community-centered integrated research partnerships nationally in the field of aging," says Dr. Fried. "By leveraging the intellectual, fiscal and clinical resources of the academic collaborators we can achieve results that would not be attainable by any one institution alone, and improve the health and well-being of older adults who suffer from or are at increased risk for pain."

Additional TRIPLL co-investigators include Dr. Steven D. Passik of Memorial Sloan-Kettering Cancer Center, an authority on palliative care and symptom management; Dr. Laura Robbins, of the Hospital for Special Surgery, whose research focuses on developing culturally sensitive strategies to meet the needs of underserved, diverse communities; and Dr. Christopher M. Murtaugh of the Visiting Nurse Service of New York, an expert in geriatric home health care. Key community partners include the New York City Council of Senior Centers and Services, the Arthritis Foundation, and the Visiting Nurse Service of New York.

Relieving Pain in NYC Seniors

The TRIPLL team will take the best of what is known through basic behavioral and social science — some of which was identified through CITRA — and translate these findings into treatments, intervention programs and policies. These will encompass the full spectrum of pain disorders, from chronic cancer-related and non-cancer pain to acute pain and pain occurring in the context of palliative care. They will also specifically address the needs of New York City's multi-ethnic and lower-income older adult populations with culturally sensitive programs toward redressing treatment disparities.

One promising avenue for improving pain control in older adults is education outreach aimed at boosting health literacy and communication in medical encounters. Older patients are frequently and significantly less knowledgeable about pain-relieving medications compared with younger patients. Socio-cultural factors also impact pain-control; for example, cultural backgrounds that value stoicism and suffering may act as barriers to pain management. Patients may be reluctant to bring symptoms to their providers' attention because of fears that their request will take attention away from more important health care issues, or they may have multiple illnesses and be uncertain which symptoms merit presentation. Cultural expectations that the clinician should initiate all medical discussion may also be limiting.

TRIPLL will also seek to implement an array of strategies known as self-management — for example, exercise classes and visualization techniques — that reduce pain and improve function by altering how individuals respond to pain. Research has shown these approaches are beneficial in conjunction with prescription pain medication; however, few have been adopted into clinical practice. In one planned intervention, TRIPLL will train home health workers to put self-management strategies into action and measure their results.

Pain in Older Adults

Prevalence studies estimate that as many as 40 percent of older people experience persistent non-cancer pain, with arthritis and arthritis-related diseases the most common causes. Diabetes, shingles and frailty are also common causes. Approximately half of seniors receiving home care services and up to 80 percent of nursing home residents report daily pain. Under-detection and under-treatment are most pronounced in the nursing home setting, which is particularly problematic given recent estimates that up to 42 percent of older persons will spend time in a nursing home. A vast majority of cancers are diagnosed in order persons, and as many as 80 percent of cancer patients experience pain during the course of their illness. Pain is also a highly prevalent symptom occurring in the advanced stages of many diseases (e.g., congestive heart failure, stroke) that are not responsive to curative treatment. Older adults are also at increased risk for acute pain problems, often occurring as a consequence of trauma, surgery and non-traumatic fractures. Approximately 2 million joint-repair and replacement surgeries are performed annually, and more than 700,000 vertebral compression fractures occur annually, the vast majority in women over the age of 65 who also experience substantial pain and suffering because of it. Pain is by far the most frequently cited symptom linked to disability in later life. Persistent, unrelieved pain also creates a mortality risk, as evidenced by a recent study that found severe pain (when compared with other common chronic conditions) was by far the strongest predictor of suicide in later life.

Edward R. Roybal Centers for Research on Applied Gerontology

Authorized by Congress in 1993 and named for former House Select Committee on Aging Chair Edward R. Roybal, the Centers are designed to move promising social and behavioral basic research findings out of the laboratory and into programs, practices and policies that will improve the lives of older people and the capacity of society to adapt to societal aging. The Roybal Centers are part of NIA's Behavioral and Social Research Program, which supports basic social and behavioral research and research training on the processes of aging at both the individual and societal level. A small grants program administered by TRIPLL will support translational research on pain and pain management in later life, focusing both on new and established researchers who wish to translate basic research findings in psychology, epidemiology, sociology, public health and other disciplines into application and intervention. More information on these programs, as well as consumer-oriented publications on healthy aging, can be found on the NIA's Web site www.nia.nih.gov.

Weill Cornell Medical College

Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in areas such as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, transplantation medicine, infectious disease, obesity, cancer, psychiatry and public health — and continue to delve ever deeper into the molecular basis of disease and social determinants of health in an effort to unlock the mysteries of the human body in health and sickness. In its commitment to global health and education, the Medical College has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, the Medical College is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances — including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, the first indication of bone marrow's critical role in tumor growth, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. For more information, visit www.med.cornell.edu.