Tell us about your career path and what motivates you to do what you do?
Like many people in the field of geriatrics, I became interested in pursuing a career as a geriatrician because I had a close relationship with my grandparents, which grew into a love for working with and learning from older adults. I had also always wanted to be able to address inequities and injustice as part of my career. Those two threads – aging and addressing injustice – came together during my intern year when I was training in internal medicine. I cared for several older adults who were experiencing homelessness. I was shocked that people in their 70s and 80s were living in homeless shelters and on the streets, and I wanted to understand why this was happening, what the impacts were on health, and how to prevent it. That led me to a career as a geriatrician-researcher focused on improving health and functional status for vulnerable older adults and understanding housing as a social determinant of health.
What questions are at the core of your research?
I focus on understanding how housing serves as a social determinant of health, and how we can use housing as a platform to improve health outcomes for vulnerable populations. I also examine why people who are socioeconomically disadvantaged experience accelerated aging (i.e., the early onset of aging-related conditions like functional impairment, cognitive impairment, and falls) and how we can prevent and delay onset of those conditions.
"People often think of homelessness as a problem that affects mainly younger adults, but in fact the homeless population is aging. More than one-third of people experiencing homelessness are age 50 and older, and nearly half of homeless adults aged 50 and older become homeless for the first time after age 50."
Can you speak a little more about the differences or similarities in doing research in the community versus clinical setting? What role does community play in the process of aging?
There is obviously a wide range of research that can be conducted in these settings. As a geriatrician, I am particularly interested in how older adults interact with clinical versus community settings and how these environments can be best leveraged to promote health. Community-dwelling older adults typically spend only a small amount of their time in clinical settings versus the vast majority of their time in their communities. That means that for clinical settings, it’s important to consider how we can optimize care during the brief window when an older person interacts with the healthcare system. That points to the importance of using approaches to optimize clinic-based detection of functional impairments and other geriatric syndromes and risk factors for functional decline, so we can identify appropriate resources and interventions to help older adults thrive in the community.
On the other hand, older adults spend most of their time in their community environment, and interventions that modify aspects of the physical or social environment hold promise for improving health. Geriatrics research and practice has always had a strong focus on developing and implementing home- and community-based interventions, and I’m interested in developing such interventions specifically for vulnerable older populations.
If you could take a spotlight and shine it on a problem that older and more vulnerable adults in the U.S. face, what would it be?
People often think of homelessness as a problem that affects mainly younger adults, but in fact the homeless population is aging. More than one-third of people experiencing homelessness are age 50 and older, and nearly half of homeless adults aged 50 and older become homeless for the first time after age 50. This highlights major gaps in our social safety net and problems with housing affordability in the U.S. To address this issue, we need policy approaches to prevent and end homelessness among older adults, including efforts to identify those at risk for homelessness and intervene early to prevent homelessness, increase housing affordability, and increase supplies of housing for people experiencing homelessness.
What are the policy implications of your research? And, what solutions would you point to help address the major problems aging, vulnerable populations face?
My research points to the importance of housing as a social determinant of health among older adults. Because housing is a cornerstone of health, we need policies that support access to safe, affordable housing. In terms of broader solutions, we need to develop and implement interventions that can address the social and environmental determinants of health, which play a major role in the health of vulnerable older adults. I am a huge fan of the home-based CAPABLE intervention developed by Sarah Szanton at Johns Hopkins University. CAPABLE employs a multi-disciplinary team which works with older adults with low incomes to modify their home environment and enhance their self-care skills, ultimately improving function and aging in place. We need more interventions like CAPABLE and broader implementation of these interventions – coupled with “upstream” interventions that are implemented earlier in the life course – to help prevent, delay, and mitigate geriatric syndromes in vulnerable groups.
"This work gives me the opportunity to collaborate with housing providers and policy makers, which keeps my research grounded in real-world issues while allowing me to provide evidence-based input to these groups."
Tell us about an accomplishment or milestone that is important to you.
One of the aspects of my job that I enjoy the most is the opportunity to work with and learn from community organizations. I serve as a board member for an organization focused on ending homelessness among older adults, as well as on the research council for an organization focused on ending homelessness. This work gives me the opportunity to collaborate with housing providers and policy makers, which keeps my research grounded in real-world issues while allowing me to provide evidence-based input to these groups.
What obstacles have you run into and overcome in terms of the perception and/or implementation of your research?
In the field of geriatrics, we typically use the age cut-off of 65 years to designate “older age,” and there is a belief that geriatrics-trained clinicians, who are already a limited resource, should only focus on caring for this age group. Sometimes there is also a perception that it isn’t really “geriatric” if people younger than age 65 develop aging-related conditions. I feel it’s important to acknowledge that for vulnerable groups, aging-related syndromes often develop earlier in the life span, and that models of care from the field of geriatrics and gerontology hold promise for benefiting these younger populations. Some of my future projects will focus on moving that work forward.
What piece of advice would you give someone who is trying to balance life as a practicing clinician and active researcher?
In talking about this challenge with other clinician-researchers, a common thread is that when you’re doing clinical work, it is hard to do research, and vice versa. For myself, I try to compartmentalize and do each type of work in blocks, so I can focus better. That said, the patients I care for inform my research and the questions I ask, so I am still wearing my “researcher hat” even when I’m doing clinical work.
Tell us something about yourself most people would not know.
I love birdwatching and I have a tendency to get distracted during Zoom meetings by birds flying by the window. You never know what you will see!
Learn more about Rebecca Brown on her Penn Medicine profile.