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THE January 2012 issue of the journal marks the beginning of my term as the editor of the Journal of Gerontology: Medical Sciences. I am grateful for the tireless efforts of my predecessor, Dr. Luigi Ferrucci, who brought the journal to its current position of prominence, and deeply appreciate the trust in me shown by the Gerontological Society of America when they selected me to succeed him. I am committed to maintaining the journal’s high standard of publishing rigorous and significant research in medical gerontology and will be supported by a strong editorial board, exceptional associate editors, and Dr. James Goodwin, who will serve as deputy editor. Although the prospect of taking over the journal is somewhat daunting, it is an exciting time to be stepping into the role. Gerontology has never been more important than it is right now. The journal’s readership scarcely needs reminding that we are in the midst of a remarkable demographic shift. In 1910, 1 in 23 U.S. residents were over the age of 65, 100 years later, this ratio was 1 in 8, and 20 years from now it will be 1 in 5 (1). A similar story is being played out in the rest of the developed world. In spite of this rising tide, the political debate in the United States centers upon how spending on behalf of older adults can be limited or reduced. In this light, the central questions of medical gerontology—how environmental, behavioral, and physiologic factors interact to affect functional health, what can be done to affect the rate of age-related functional decline, and whether aging-related functional decline can be reversed or compensated for—have become critical questions for the society as a whole. These questions have been at the journal’s conceptual core and will remain so. However, given the current societal context, there is a pressing need for the application of research to benefit a broader community of older adults both in and out of clinical settings. There are many aspects of this issue, but I would highlight two as being particularly germane to the journal because they follow directly from the journal’s core concerns. From the clinical perspective, the question is: how should functional considerations affect medical decision making? There is currently a great deal of emphasis on comparative effectiveness research as a strategy to increase the efficiency of the health care system. In the evaluation of effectiveness, the process of care is the independent variable. What is the dependent variable? For the gerontologist, the answer would be function as it is the primary health concern of older adults. A challenge for our discipline is to develop and promote functional status as the central focus of comparative effectiveness in older populations. For community-dwelling older adults, there is a need to apply our understanding of the determinants of functional change to develop to strategies to reduce the demand for health care services. Community-translational research evaluating feasible and affordable approaches to promote health and functional independence is particularly important. The process by which biomedical research gets done is evolving in ways that should be quite agreeable to the gerontologist. The scientific world has come to understand that many important health problems do not respect the boundaries of scientific disciplines, and therefore, their solutions will require the integrated knowledge of a variety of disciplines. The journal has traditionally been a home to multidisciplinary research because it has always been understood that functional problems of older adults do not cleanly map to the expertise of a single discipline. With that said, there are some purposeful strategies that will promote the further development of multidisciplinary science on behalf of older adults that the journal is eager to support. Our knowledge of what pathways are important to maintaining function is incomplete and so bringing novel or underappreciated pathways to wider attention will continue to be a journal priority. To some degree, the disciplines involved in “multidisciplinary” research reflect the departmental organization of medical schools and the subspecialty divisions within departments of medicine. Medical gerontology has a strong tradition of being inclusive of a variety of disciplines, but there are still some areas that appear to be underrepresented as a consequence of their lack of a strong departmental tradition within medicine or the health sciences; examples include: nutrition, pain, oral health, foot health, functional vision, bioinformatics, and engineering. Finally, there is a need for better conceptual frameworks to guide the integration of measures derived from different disciplines. Even armed with measures of muscle strength, nerve conduction velocities, and oxygen consumption, there is still substantial unexplained variation in gait speed. This residual unexplained variance might mean that we do not understand all the relevant physiologic component systems involved in function, which is undoubtedly true, but it also may mean that we do not know how to put these components together in a way that adequately represents the functions we are trying to understand. A challenge for multidisciplinary research is to develop models that represent the interactions and coordination of the components of integrated physiologic networks. A sense of the potential of this approach is seen in the strength of circulating cytokines as biomarkers of functional health. Apart from their specific biologic effects, cytokine biomarkers can be considered as a gauge of intercellular information exchange. In times of physiologic stress, this network traffic markedly increases. Another direction consistent with a more integrated system view is the consideration of the brain beyond its role in mood and cognition. There is a growing body of literature that links these two domains with physical and metabolic functioning in older adults. Like the joke about the drunk who searches for his keys under the street lamp because that is where the light is, research on brain–body connections has emphasized mood and cognition because of the ease in accessing these aspects of brain function. Fortunately, with recent developments in brain imaging, it is becoming possible to directly address hypotheses regarding the brain’s role in noncognitive functional domains (eg, coordination of movement). The world’s rapidly changing demographic profile is the result of success in overcoming important health challenges of the past, a fact that bodes well as we address the future challenges that an aging population entails. One cannot predict specific advances, but we can predict that many will result from a widely inclusive and broadly translational approach that incorporates both technological and conceptual innovation. Scientists who take on these challenges on behalf of older adults will find a champion in the journal.
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