Clin-STAR Journey Story

Cultivating Cross-Disciplinary Collaboration to Improve Mobility Equity Among Older Adults: One Physical Therapist’s Experience on a Clin-STAR Mini-Sabbatical

Jason Falvey, DPT, PhD, is an Assistant Professor and board-certified geriatric physical therapist in the Department of Physical Therapy and Rehabilitation Science at the University of Maryland School of Medicine. He is also director of the ENhancing Rehabilitation to Improve Community Health (ENRICH) lab and principal investigator on a study evaluating associations between neighborhood socioeconomic disadvantage and the impact on disability outcomes among older adults with new disability. He has focused on improving functional outcomes and quality of life for older adults who are recovering from hospitalizations for serious illness or other major medical events that lead to sudden disability, such as hip fracture or head injury.

Dr. Falvey recently participated in a Clin-STAR Mini-Sabbatical at the University of Wisconsin School of Medicine and Public Health, Center on Health Disparities Research. During this week-long mini-sabbatical, Dr. Falvey was immersed in the Center’s ongoing research focused on the relationship between geographic healthcare disparities and health outcomes in older adults. He worked with a unique team of physicians, occupational therapists, historians, and geographers who were developing residential histories for older adults, which included their current living situations as well as their historical exposures to poverty.

According to Dr. Falvey, “The mini-sabbatical provided the opportunity to learn from and collaborate with other experts who are studying how cumulative exposures to neighborhood deprivation can impact the health and well-being of older adults in late life.” This allows more enriched study of the ways that recovery from traumatic injuries in older adults are affected by local neighborhoods. As a first-generation college student who grew up in severely economically deprived areas of rural Maine, Dr. Falvey says, “I saw first-hand how cumulative exposures to poverty in the local community potentially contributed to poor health outcomes for older adults. Later, in my work as a home-care physical therapist, I recognized that living in an area with limited or no resources contributes to higher rates of long-stay nursing home admission for older adults with complex care needs.”

Throughout his research, Dr. Falvey has been surprised at how poorly many existing large data sources capture this information. Prior health services research has largely used county data, but some counties are very large (such as the entire city of Baltimore), and neighboring areas within large counties can vary quite a bit in terms of available resources. There are a lot of open questions about how neighborhood environments over a life course affect older adult health. For example, do exposures related to neighborhood socioeconomic disadvantages experienced as a child have an impact on health resilience, or the ability to bounce back as adults? The innovative methods being implemented at University of Wisconsin School of Medicine and Public Health to help overcome these gaps were one major motivator for Dr. Falvey’s mini-sabbatical visit.

With the experience gained in the methods being used by Wisconsin’s Center on Health Disparities, Dr. Falvey looks forward to being able to conduct more sophisticated analyses. He plans to begin with a large dataset analysis studying the impact of proximity to poverty on trauma and identifying the most important needs in individual neighborhoods, such as access to care, transportation, or dealing with local crime. Specific barriers are typically very different in urban and rural areas. For example, in the city, the fear of falling on broken sidewalks or needing to walk in a high-crime area, may make older adults reluctant to keep appointments, while in rural areas, access to public transportation may be limited or nonexistent. In his role as a member of the Transportation CORE of the Baltimore Metropolitan Council, Dr. Falvey provides input on public transportation infrastructure and accessibility specific to the needs of older adults. He states, “Understanding and addressing neighborhood-level barriers to community mobility, including transportation availability and accessibility, among older adults may inform better care pathways to aid recovery from traumatic injuries like hip fracture.”

Once the data on at-risk neighborhoods have been collected and analyzed, they can be leveraged to develop new treatment pathways. The multicomponent care pathways may include specific rehabilitative interventions to help overcome neighborhood-built environmental barriers, such as gait training on uneven surfaces or guidance on how to maintain balance on a moving bus. Dr. Falvey plans to develop and pilot test these interventions in partnership with community stakeholders.

Dr. Falvey was especially appreciative of the Clin-STAR Mini-Sabbatical opportunity because physical therapists, as allied health professionals, are often not eligible for other training programs that are more physician-specific, such as the NIA GEMSSTAR program. Through Clin-STAR, there is opportunity to highlight the unique training of allied health professionals and how well it intersects with the physician and nurse models. In Dr. Falvey’s words: “This type of opportunity is great exposure for people to train outside their own discipline. It allows you to put your stuff in front of a diverse audience and receive feedback from multiple disciplinary areas. The tremendous culture of collaboration and innovative research I observed at Wisconsin on this mini-sabbatical shows the power of cross-disciplinary work.”