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A Fresh Approach to Addressing the Challenges of Aging and Caregiving

The number of older adults in the U.S. will dramatically increase in the coming decades as baby boomers age and medical advances make it possible for people to live longer than ever. According to Tina Savla, professor of human development and research methodologist at the Virginia Tech Center for Gerontology, this unparalleled demographic shift will have significant impacts on American society and family life as more spouses, adult children and other relatives spend a significant portion of their time, emotional energy and financial resources in providing care for their loved ones.

Savla, who cares passionately about older adults and the men and women who support them, has spent her career focusing on the challenges older adults and their caregivers face as well as ways to improve their quality of life and well-being. 

“Over 60 million Americans are caregivers, providing support and assistance with activities of daily living for loved ones each day. I want to understand their challenges and daily experience, especially caregivers of individuals with dementia,” Savla explained. With a predicted 14% increase in the number of persons living with dementia over the next decade alone, the effect on families, especially those caring for their aging relatives, will continue to be substantial.

“Previous research has shown the act of caregiving is associated with negative changes in the health and wellbeing of the caregivers themselves,” Savla said.  “In some of my past research, I have combined a daily diary interview approach with biological indicators of stress to explore how everyday life stress and daily hassles impact emotional and physical health of caregivers.” Savla found that both care and non-care related stressors contributed to increased activity in stress-sensitive biological systems, which in turn can contribute to a variety of health conditions.  

Savla and colleagues Karen Roberto, University Distinguished Professor, and Rosemary Blieszner, Dean of the College of Liberal Arts and Human Sciences, both also fellows at the Center for Gerontology, and Aubrey L. Knight, Professor of Internal Medicine and Family and Community Medicine, and Program Director of the Geriatric Medicine Fellowship at Virginia Tech Carilion School of Medicine and Research Institute, are now conducting a study funded by the National Institutes of Aging called Families in Appalachia Caring for Elders with Alzheimer’s Diseases, or FACES-AD.

“The aims of the study are to understand how families cope with and manage the daily demands of caregiving as well as their current and future formal service use,” Savla said. The personal, social and economic costs of caregiving are compounded for rural, underserved communities, such as Appalachia, where caregivers face even greater challenges due to lack of resources and access to healthcare as well as socioeconomic barriers.

Savla and her team are using several methods to uncover individual and family characteristics, circumstances and cultural beliefs that influence family care roles, responsibilities and formal care usage among Appalachian families who have loved ones with dementia, including Alzheimer’s disease.

“A team of trained undergraduate and graduate students in human development and public health conduct hour-long telephone interviews with caregivers to learn about their family situation, the extent of the family member’s dementia and overall demands on the family,” Savla explained.

This initial interview is followed by a 7-day diary interview that documents the day-to-day experience of the caregivers and their loved ones. Interviewers ask questions about care provided that day, whether the caregiver was able to leave the house to work, run errands or take time for themselves, or if they have a home health worker who provides assistance on a regular basis. They also ask about other topics such as the caregivers’ general health and mood as well as interactions with other family members and relationship stressors.

The project team plans to enroll 120 families into the study. Once this phase of the study is completed, “We will conduct in-depth, face-to-face interviews with a subset of 25 families to further explore the different characteristics and needs of the families,” said Savla.  

The FACES-AD project builds on the results of an analysis of interviews with older adults conducted by Savla and colleagues that was recently published in the Journal of Aging and Healthcare that posits “where you age matters.”  In this earlier study, which also took place in rural Appalachia, they found that individuals living in communities characterized by strong family beliefs and less positive attitudes towards community services preferred informal help over formal care services.

“People who lived in counties where more formal services were available, however, were more likely to use these services, regardless of their beliefs,” Savla said. She and colleagues also found that significant health disparities existed within the counties studied depending on demographic, economic and personal factors.  For example, according to Savla, “women who lived in counties with a higher percentage of older adults below the poverty line were more likely to receive no help than men.”

Savla expects the FACES-AD study will shed additional light on these factors and expand understanding of when and why families do and do not access services, even when available. “Often families wait until there is a crisis before they seek services. Yet, research shows if they access services earlier, they and their loved ones have better outcomes,” said Savla.

If families do not obtain resources and services, either by choice or lack of availability, their loved one may be more likely to go into a nursing home more quickly – often a greater personal, economic and societal cost.

Savla anticipates the results of the FACES-AD study will enable the team to identify ways to destigmatize services in rural communities that often rely on informal support networks and develop more effective and targeted strategies to connect families with services, particularly in regions such as Appalachia and other similarly underserved areas.

She also hopes the study will reveal ways to better address caregiver needs since many caregivers feel overwhelmed with responsibility and constrained in pursuing their own life opportunities. This aspect of the study ties into another area of research that interests Savla – translating research findings into prevention strategies and intervention programs that help to reduce stress, anxiety and depression in caregivers.

“I am running another study with Dr. Mamta Sapra at the Salem Veteran’s Affairs that is testing the effectiveness of mindfulness meditation in reducing negative and intrusive thoughts among caregivers of veterans with dementia and traumatic brain injury,” Savla explained. “If this intervention is successful, the mindfulness components will be added to the U.S. Department of Veteran Affairs’ caregiver support and skill building program used by Veteran families across the nation.”

Savla hopes the findings from the FACES-AD study will likewise result in intervention strategies for older adults and their caregivers that can have a regional reach in Appalachia but also in other underserved areas of the U.S.

For more information about Tina Savla and her research, including the FACES-AD study, visit her web page at  

Online Extremism in a Global Society

Extremism is always evolving, and so is the research of Jim Hawdon, Professor of Sociology and Director, Center for Peace Studies and Violence Prevention.  When he started his work, he was interested in the influence of communities on crimes and community responses to crime. For example, the perpetrators of the September 11th attacks all lived in communities in which it was easy to hide and go unnoticed. With the world rapidly embracing the internet and social media, Hawdon has adapted his definition of community to keep abreast.

“The virtual world is a community,” he explains, “and social media is the perfect environment in which to hide. You can create a whole new identity. And I’m afraid of—and there’s evidence of this—that it has socially shrunk us.”

The phenomenon is called the echo-chamber: Facebook and other social media automatically filter information, posts, and advertisements to align with each user’s views. This constant loop of like-mindedness helps people become entrenched in their opinions.

“People like to be around people who think like themselves. We’ve always done that. The problem with the internet is its efficient at it and people don’t realize it is happening.”

This environment in turn ushers in a new era of hate speech and online extremism.

“The pathway from confident in views to dogmatic to becoming extreme is a relatively easy path to go down,” warns Hawdon.  “I’ve become fascinated by what social media has done to civil society.”

Hawdon, the recipient of several ISCE awards and most recently a 17-18 ISCE Scholar award, works with international collaborators across the globe to study online extremism. In 2014, he partnered with colleagues in Finland. In the years since, he has expanded his scope. His new work as an ISCE Scholar  will replicate data from Finland, Germany, the U.S., and the United Kingdom, as well as expanding to France, Spain, and Poland.

Hate speech in the United States differs from hate speech in Europe. Hawdon explains: “Here its race, and in Europe it is religion—anti-Muslim. The unifying factor is anti-immigrant sentiments.”

This broad geographic focus also allows Hawdon to look at all of the types of the Western welfare state: Nordic, continental, Mediterranean, Eastern Bloc, and the capitalistic nature of the U.S. model. Hawdon is curious to see whether the social security that a welfare state provides could reduce radical Islam, anti-immigrant, or other threats that residents perceive.

And while the internet, too, is evolving—Hawdon has marked a downtick in hate groups but an uptick in people without ties to terrorist organizations committing crimes in the name of terrorist organizations—there is hope.

“When you stand up to the bully, the bully often punches you. You have to have the courage. But when you do that, it makes that little piece of the internet a safer spot. The community of users can police themselves,” encourages Hawdon.

Corporations such as Facebook, YouTube, and Twitter can also make large impacts on civil society by cracking down on hate speech, fake news, and the like. Government also has to be a piece of the solution—Germany has strict hate laws and also significantly lower rates of hate speech.

“The internet is a challenging environment. We have a tendency to think it’s different from anything we’ve seen before and that’s not true. It still follows the same laws of social interaction. Like other communities, we can make them safer through our interactions and our willingness to look out for each other,” says Hawdon.

Cultivating Research Practices and Collaborations

Often, a successful application for external funding has a watershed effect on future research endeavors and funding. Such is the case for Thomas Ewing, Professor of History and Associate Dean for Graduate Studies and Research in the College of Liberal Arts and Human Sciences. An award by the National Endowment for the Humanities (NEH) and matching funds provided by ISCE and other university programs was the start of the flood. ISCE funds helped support a GRA for two years for the project Epidemiology of Information, which examined American and Canadian newspaper reports about the Spanish Flu in 1919.

“That was the first project we had that connected the humanities and the sciences,” said Ewing of the project that included a team of faculty and students from English, computer science, the library, history, and a Canadian expert.

While the project resulted in a website that is now dormant, the main product was the algorithm that the computer science team created to mine for the data. The project also resulted in a public forum, published articles, and features in newsletters and media pieces. Most importantly, though, it positioned the researchers to win more grants.

“There were five subsequent NEH grants that I trace back to that first one,” confirms Ewing. “The process of the research and the connections that were made not only made the three grants I’ve received possible, but also two others.”

Ewing later received a second grant from the NEH to host a summer seminar on the Spanish Flu, deepening the connections he had made during that first grant. The team took K-12 teachers to Washington, DC and conducted research there, which included similar methods as Epidemiology of Information. Another NEH grant that made use of the algorithm originally developed for a different subject soon followed.

Ewing’s projects have had direct impact on Virginia Tech students. After the grant, Ewing taught both a seminar in history on the Spanish Flu and an undergraduate course on epidemics in world history. From the first GRAs funded by ISCE and others, now Ewing’s projects also include undergraduates. Both graduate and undergraduate students have had the opportunity to work on federally-funded projects that allow them to dig deeply into the data.

ISCE’s focus on interdisciplinary team-building and collaboration by integrating the human element into technology-based research is evident throughout this five grant portfolio.

For more about Professor Ewing, go to:

Risk Decision-Making and Substance Use in Adolescents

Jungmeen Kim-Spoon, an associate professor of psychology, is conducting the first-ever large-scale longitudinal study of U.S. adolescents designed to determine youth’s risk for substance use and risky health behaviors through annual brain scans and a battery of cognitive ability and personality tests.

Kim-Spoon’s current research has its foundation in the ISCE Summer Scholars program. In 2012, she and her research team received funding to study 24 late adolescents.

“This funding was so important,” Kim-Spoon remarked. “When you consider 1-2 hours in the MRI machine and all the tests, it was not a small project just a small sample size.”

That summer, the 24 study participants performed several cognitive tests, and even did gambling tasks inside the MRI machine to see which brain regions activated when a person took or avoided a risk. Personality factors, such as impulsiveness, self-regulation, and substance use, risky health behaviors, and risky sex behaviors, were also measured.

“We found that it’s important to measure their cognitive control ability, especially when they have a high sensation-seeking or reward-seeking propensity,” explains Kim-Spoon. Those personalities are likely to take risks and enjoy thrilling experiences. This in turn can help predict drinking, smoking, and other risky health behaviors.

With that pilot data in-hand, Kim-Spoon and Co-PI Brooks King-Casas, assistant professor of psychology in the Virginia Tech Carilion Research Institute, applied for an NIH grant that fall, and received funding the following year.

“I’m so grateful for the ISCE grant that provided the groundwork for our proposal,” says Kim-Spoon. “Otherwise I don’t think it would have been possible to be funded. Empirical evidence showing that we could do the work and some preliminary data showing that the results were promising made a stronger proposal.”

This five year multi-million dollar NIH grant is currently in year two. The investigators are following young adolescents through their development. “13 is the national average when adolescents start drinking. With four time points, we can see how their brain develops from 13 or 14 years of age to 16 or 17 and how their substance use behaviors change. We are examining how their brain changes and their personality developments. By focusing on sensation-seeking, impulsiveness, cognitive ability, and emotion-regulation skills, we will be able to explore who successfully adjusts versus youth who start using alcohol early, start using alcohol a lot, and who become addicted,” explains Kim-Spoon.

This first of its kind data will provide valuable insights about which adolescents are more vulnerable to alcohol use and the kind of factors health professionals should look for. Ultimately, the hope is that the study findings can be used to inform the development of preventions and interventions for the highest risk youth.

Global Education and Cultivating Creativity

Educational trends are shifting in the United States and internationally. A focus on teaching to the test has limited curriculums, minimized creativity, and even changed the very culture of countries. Carol Mullen, a professor in the School of Education specializing in education policy and learning innovations, has grown concerned with what she describes as “a culture of risk-averse test-taking that has gripped the globe.”

Mullen is the recipient of a Fulbright scholarship and an ISCE-GII research support grant. She traveled to China in summer 2015 to study “the significant disconnect between creativity and accountability in education.” While in China, Mullen was able to see for herself the dichotomy of creativity and strict STEM-centric curriculums. She collected data during site visits to various schools (rural elementary, special education school, kindergarten school, Montessori K-12 school, and high school), in addition to universities. In China she lectured at seven universities and research institutes, and she also taught two courses (undergraduate education at Southwest University in Chongqing and in graduate education at Virginia Tech), and designed a third course for online delivery.

The ISCE-GII grant allowed Mullen to hire a Chinese-speaking Virginia Tech PhD candidate to travel with her for one month as a translator, which was a critical supplement to her Fulbright-funded endeavors. “I could not have done this trip without the vital support of ISCE,” she says.

In China, Mullen was able to see how they are reforming their educational systems to foster creativity. After years of rigorous and restrictive educational policy, China unfortunately saw the ill effects of such standards: high suicide rates, children with extreme test anxiety, and an economy that is more about big business than creative endeavor. The reform is a top-down decision from the government, which is coming to see creativity as a means of fostering economic opportunity and development.

Ironically, the U.S. has been inspired by China’s high rankings in international educational scales and has adjusted its policies to be more test-oriented.

Both countries are struggling to find a happy-medium: an educational system that is competitive and provides children with 21st century skills, but also has a curriculum that lets children exercise creativity in practice, play, and decisions.

Mullen’s research has the ability to positively impact education on a national and international scale: her focus in educational leadership equips policy makers, stakeholders, principals, teachers, and other leaders to have a larger impact on their schools. As she says, “Change that sticks often comes from the top. Children need adults who honor and provide a platform for creativity.”

Mullen’s research is already expanding. Her book proposal has been approved; she has presented at national conferences and created interdisciplinary ties to research collaborators. Her goal is “to further develop my capacity as an international scholar specializing in global education.” 

Shaping the Engineers of 2020

Aligning student preparedness with workplace demands is a common goal amongst universities and colleges; however, engineering industries repeatedly report that that their recently graduated new hires do not possess many attributes necessary for their jobs.

Denise Simmons hopes to change that. Simmons came across this pervasive problem while completing her doctoral work in civil engineering at Clemson University—she read The Engineer of 2020, a book detailing the concepts of competencies that engineers would need by the year 2020, and it captured her imagination. Now she is focusing her research efforts on preparing engineering students for their future careers. 

Simmons is the recipient of a National Science Foundation (NSF) Career Award and drew inspiration for her current project from the NSF’s interest in competencies across engineering. One day she was having an informal conversation with Dr. Nicholas Clegorne, the Director of the Residential Learning Community, about leadership.

“I had heard industry individuals talk for over twenty years about how students were lacking in leadership,” remarked Simmons. “He [Clegorne] thought that it was interesting and together we thought, ‘Let’s form some formal research questions—let’s find why these deficiencies still exist.’”

The Institute of Society, Culture and Environment provided direct seed money to Simmons and Clegorne to look at the problem at its most basic level: how engineering leadership is defined.

“Our hypothesis is that this is where the disconnect will be. The school and industry will define leadership differently, or industry will want X, Y, and Z and the school will only include X. There are missing nuances.”

Simmons and Clegorne preformed an extensive literature review and developed a meta-synthesis of that data. They plan to submit it as a manuscript and have it serve as support for a September NSF application.

The team is looking to build the project out beyond their initial research questions to form a multi-phase interdisciplinary research project to explore engineering leadership competencies. Simmons also has plans for future collaborations to focus on the other competencies of that The Engineer of 2020 promotes, particularly communication.

“Ultimately, what I think the result is, is better prepared students. The common theme of my research is preparing 21st century STEM workforces.”

Antineutrino Research to Provide International Assurance

Scientists and defense personnel have long struggled with nuclear proliferation monitoring in hostile countries. Of particular concern is the heavy water reactor I-40, located in Arak, Iran. Patrick Huber, of the physics department, along with Thomas Shea and graduate students Eric Christensen and Patrick Jaffke, has shown that antineutrino reactor monitoring is feasible and provides otherwise unavailable capabilities.

Neutrinos are subatomic particles created by the decay of radioactive materials, nuclear reactions, or when cosmic rays hit atoms. Antineutrinos are similar to neutrinos, yet they spin in a different direction. Nuclear reactors produce such a quantity or neutrinos and antineutrinos, neither of which cannot be disguised, that measuring neutrino production could help defense agencies monitor reactors to which they have little, irregular, or no access to.

“Nuclear weapons had and continue to have a profound impact on the relation of nations. Nuclear non-proliferation, especially after 9/11, has become a focus of US foreign policy both under Republican and Democrat administrations and continues to drive decisions,” said Huber. “Having better technical tools ultimately provides more elbow room for diplomacy. In the particular case of Iran, our method would provide the international community with a high-level assurance that nothing is amiss, in a timely fashion. And it would provide Iran with a means to demonstrate its peaceful intentions with respect to the reactor at Arak.”

Huber and his team’s most current work was recently published in the prestigious physics journal Physical Review Letters and named “Editor’s Suggestion.” But before all the research, writing, and editing could take place, the Institute for Society, Culture and Environment assisted Huber.

“To pursue this interdisciplinary, high-risk project, I needed time,” said Huber. “The seed grant from ISCE most importantly allowed me to buy out of teaching to create time for this research project. [It] also provided resources to travel and interview experts and witnesses... we performed detailed analysis based on reactor simulations and advanced modeling techniques.”

Those modeling techniques have led the research team to definitely prove that antineutrino monitoring can be done.

“I believe that this work and the attention it got stimulated a lot of thought of how to actually build suitable detectors. It also highlights the strong but often hidden relation between basic science and national security.”

With such interest and need in the current scientific and political landscape, Huber believes this project will focus research and defense activities towards a practical system of reactor monitoring. Currently Huber is part of a collaboration called PROSPECT which seeks to address the problem of how to actually build those detectors.

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Faculty Spotlight

NEW! Tina Savla's research on aging and caregivers.