Barry J. Gurland, M.D., Chief of Psychiatric Research, Sidney Katz Professor of Psychiatry
Jeanne A. Teresi, EdD, PhD, Research Scientist V
John A. Toner, EdD, Mphil, Research Scientist V

Mission
The Stroud Center is an endowed interdepartmental center of the Columbia University Faculty of Medicine and New York State Psychiatric Institute. It incorporates the Sidney Katz Professorship. The Center’s mission is to foster scholarly activities contributing to the prevention or delaying of losses in the qualities of living that may accompany chronic diseases and life course changes.

The basic themes underlying all departmental activities include: expanding concepts of the whole person; delineating the continuum from full functional and emotional health to advanced impairment; mapping the domains of quality of life; reconciling the objective and subjective perspectives on living; working with participants in health care to improve quality of life outcomes; early intervention for decline in quality of life; improving communication on quality of life between care-giver and care recipient; applying whole person principles in services; and tracing the historical evolution of adaptive qualities of life.

Programs and Projects
Early prevention of functional decline: Center studies show that subjective and objective markers of inefficiency precede failure in the performance of daily tasks. These markers may signal opportunities for preventive intervention. That hypothesis is being tested in collaboration with the Division of Cardiology, Programs in Occupational Therapy, and Hospital Services.

Comprehensive evaluation: A combination structured and open-ended interview has been developed to take account of a patient’s strengths, values, preferences and sense of identity as well as their problems in health and living. It is being computer-assisted in collaboration with the Department of Informatics.

Care-giver views on Alzheimer’s disease: In collaboration with the Alzheimer’s Disease International (ADI) and the Institute of Psychiatry in London, care-giver views on quality of life in dementia are being cumulatively gathered. At the ADI meeting in 2000 (Washington DC) the participants inventoried those qualities; in 2001 (Christchurch NZ) the topic was actions that seem to improve the previously listed qualities; in 2002 (Barcelona SP) the participants will address services that could enable those care-giver actions.

Clinical hermeneutics: Through participant observation and technical assistance activities with quality assurance and ethics committees in long term care settings the Center aims to strengthen the person’s ability to meet adaptive challenges and the role of self-identity in this process. Guidance is provided to enhance sharing of information and decision initiatives between care-providers and care-recipients.

Interaction of genes and the environment: A report of a twin study on male military veterans in their eighth decade has been completed in collaboration with the Medical Follow-up Program of the Institute of Medicine. Analyses showed that only a modest proportion of impaired function among elders is attributable to genetic influence, suggesting an important role for public health, personal initiatives, and service interventions in lengthening the period of active life.

Person’s with Down’s syndrome (trisomy of chromosome 21) are vulnerable to early development of dementia and advanced functional dependence. A pilot study will examine patterns and sequences of functional declines in this group.

Culture Fair Assessment: The Center’s Laboratory on Culture Fair Assessment in Research (CFAIR) is refining assessment methodologies for qualities of life, with a concentration on affective suffering, cognitive decline, and functioning in daily living. One recent product is a volume of reviews of substantive and methodological issues relating to cross-cultural measurement.

Finding connections between early and late life: A survey project in collaboration with colleagues in Puerto Rico is planned to examine the hypothesis that restricted access to childhood education increases the risk of impairment in qualities in later living. This study strategy circumvents the confounding of educational ability with educational achievement. Pilot analysis of Puerto Rican Census data supports the hypothesis.

Community reintegration: In collaboration with the Program of Occupational Therapy a pilot phase is in progress for a clinical trial of an intervention aimed at encouraging community reintegration of housebound elders. A first step is distinguishing between those who have the potential to be reintegrated into the community and those who are irreversibly housebound. Stroud Scholarship Awards for Occupational Therapy graduate students are linked to this project.

Overcoming impediments to communication: Recent work has involved reorganizing the procedures of home care agencies to ensure that the client’s own expression of their quality of life needs is systematically assessed and entered into case planning discussions. For this purpose an instrument (the QoL-100) was constructed to cover 10 important qualities of life on a single sheet.

Within the long-term mental health system there are many patients who are not able to convey their depressive symptoms and suffering through conventional means of inquiry. The ‘Feeling Tone Questionnaire’ (FTQ) is intended to ease communication with these persons. FTQ data from a national study of dementia in nursing homes are being analyzed. A further study is taking form for psychiatric patients in long term care.

Suffering in Illness: The center’s Index of Affective Suffering is a measure of a continuum of levels of mood. Its epidemiology and reciprocal effects with physical functioning was documented. Current analyses deal with cross-cultural differences in coping with affective suffering.

Training of Graduate Students in Public Health: A three-credit course entitled `Health-Related Quality of Life Across the Adult Years’ is given in the School of Public Health. The scope of the lectures covers history, theory, assessment, and policy as well as selecting instruments, integrating quantitative and qualitative measures, inferring from empiric data, and creating new approaches.

Post-Professional Education of Health Care Professionals: This program provides interdisciplinary geriatric education in each of three strategic projects:

The Statewide Geriatric Psychiatry Residency and Research Fellowship: An accredited two-year full time training experience based at Binghamton and Middletown Psychiatric Centers with rotations in New York City. The first year focuses on serving a public mental health system in transition. Fellows are appointed for a second year to conduct research related to chronically mentally ill elders.

Statewide Geriatric Grand Rounds Series: A 12 session series of Grand Rounds and Clinical Case Conferences by the Center’s Geriatric Psychiatry faculty, presented at Binghamton Psychiatric Center.

The Geriatric Scholar Certificate Program: The Columbia-New York Geriatric Education Center, a collaboration with New York University and the Center for Healthy Aging in Upstate New York, provides a five day post-professional training course in interdisciplinary Geriatrics and Gerontology. It is offered at a variety of sites across the metropolitan region and in upstate New York.

Resource site for consultation on instrumentation: A two-hour audio-visual self-operated program introduces the desired features in a quality of life instrument for a given purpose, and a list of `best fit’ generic and context-specific instruments. Customized advice is then given in person to take into account theoretical, value-perspective, clinical stance and pragmatic requirements.