Clin-STAR Journey Story

Young Patients, Old Bodies: How a Clinical Puzzle Launched a Research Career

Until the last decade, medical and surgical subspecialists have not focused much on the needs of older adults. Rather, a traditional path to research on aging usually included training in geriatrics. An alternative route might be specializing in a disease that affects older patients, like prostate cancer.

More and more, however, subspecialists in many disciplines are joining forces with the aging research community. Clinician-scientist Jennifer C. Lai, MD, MBA, is a leader in this trend. After earning a combined medical degree and masters in business administration at Tufts University School of Medicine, and completing internship and residency at Columbia University Medical Center, Dr. Lai went to the University of California, San Francisco (UCSF). Already on a research path, she completed a fellowship in gastroenterology, followed by an additional year of transplant hepatology clinical training, during which she received advanced training in clinical research.

At that time, her research focused on gender disparities in liver transplantation. But she made an observation during her first rotation on the UCSF Liver Transplant Unit that led her to a new interest—research on aging. Dr. Lai was taking care of patients with chronic liver failure who were waiting for liver transplants. They were not old in terms of chronological age. "When I first started a decade ago, the median age of a transplant recipient was about 55—hardly what someone would consider geriatric," says Dr. Lai. "But what I saw as I was in training, very early on, was that they were definitely physiologically old.”

And as she began to specialize in liver transplant, she became aware of just how rapidly patients declined. "Some of them went from being teachers or active construction workers to being too debilitated to even be able to get to the bathroom without assistance in the span of three months. But there was no word to describe it, there was no tool to measure it in our specialty." In fact, as many as 25 percent of patients on waitlists for liver transplants die before receiving one—and Dr. Lai sensed that it was these patients who were debilitated who were more vulnerable to dying.

For Dr. Lai, finding a mentor was a turning point in putting a name to her clinical observations—frailty—and finding a theoretical framework for research. Connecting with a mentor was in part serendipity. Dr. Lai happened to talk with a colleague in lung transplant who was being mentored by Kenneth Covinsky, MD, head of UCSF's Geriatrics research, and Principal Investigator of the UCSF Older Americans Independence Center, a Pepper Center. But it was also the result of Dr. Covinsky's concerted effort to integrate aging research at UCSF into surgical and medical specialties.

Soon after Dr. Lai sent Dr. Covinsky an email, they met in person, and within three months she had her first career development award listing Dr. Covinsky as one of her mentors."Dr. Covinsky really took me under his wing and introduced me to core geriatric principles including frailty and functional impairment and disability. When I learned about these formal aging constructs, a light bulb went off. It ignited my career in aging research," says Dr. Lai.

With research support from an NIA Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) award, followed by a Paul B. Beeson Emerging Leaders Career Development Award (K76), Dr. Lai laid the groundwork for understanding the role of frailty in patients with end-stage liver disease and developing a Liver Frailty Index to identify cirrhosis patients who are at highest risk of death while waiting for transplants. Her Beeson award enabled her to expand her study to nine other transplant centers in the U.S. to validate her findings. Her research program continues to apply core principles of geriatrics to improving the lives of people with end-stage liver disease.

Today Dr. Lai herself mentors individuals who are interested in gaining experience in clinical research at the intersection of hepatology, surgery, and geriatrics. For those early in their careers, her advice is:

1. "Do it! Aging research principles are broadly applicable to all patients with serious chronic medical conditions, even if they aren't considered old by age."
2. "Tap into the resources that AFAR has put together. There are so many resources and funding programs. Attend their conferences—for which there are many opportunities to apply for travel awards—to cross fertilize and learn about new aging research principles that are very likely to be applicable in your field. Because it's not organ-specific, the aging research community is particularly well-positioned for cross-disciplinary research."
3. " Whatever you decide, do something you feel very passionate about. Identify that unmet need for your patients that you can really empathize with. If you're passionate about it, then you will make a big impact."