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An interview with PLOS ONE Geriatrics and Gerontology/Palliative Care Section Editor Professor Edison Vidal

PLOS ONE is holding a Call For Papers on Aging in Health and Disease to highlight the latest research in this field. We interviewed Professor Edison Vidal, PLOS ONE Geriatrics and Gerontology/Palliative Care Section Editor, to learn about his research in Geriatric Medicine, and to gain his perspective on the societal impact of aging research.

Section Editor Professor Edison Vidal

Professor Edison Vidal is an Associate Professor at the Geriatrics Division of Internal Medicine Department of Botucatu Medical School at São Paulo State University, and a Professor of Public Health and Clinical Research at the same institution. His main research focus is the “Health of Older Adults, Chronic Diseases and Palliative Care”. He holds a Medical degree from the Federal University of Rio de Janeiro, and an MPH and PhD in Public Health from the State University of Campinas.

PLOS: You currently act as a Section Editor in Geriatrics and Gerontology for PLOS ONE, can you provide us with more information on this topic?

EV: I joined PLOS ONE as an academic editor at the end of 2019 and was invited to become Section Editor for Geriatrics and Gerontology in July 2021. I felt honored by that invitation, which I accepted hoping to gain more editorial experience and to get more involved with PLOS ONE. I feel grateful for the opportunity to collaborate with the journal as a Section Editor.

PLOS: Can you tell us about any new and exciting projects you are currently working on, and what inspires you about your research?

EV: My team and I have been working on a number of interesting projects. One of them is a qualitative study where we are comparing the views of people living with dementia in the UK and Brazil on what a good death might look like in light of their diagnoses. In that project I have been enjoying the opportunity of working with a brilliant team of interdisciplinary researchers including nurses, an anthropologist, a psychiatrist, a speech therapist, and a psychologist. It is a gift to be trusted by study participants with their thoughts on such sensitive matters and to be able to analyze their words through a cross-cultural perspective enriched by the expertise of my colleagues from Brazil, the UK, and the Netherlands who are involved in this project. This has been one of those research experiences where we learn to see things through different lenses. It is part of the beauty of cross-cultural research: as you start to understand how people from other cultures see the world differently, the way you see the world changes a little bit and that can lead to both small and big changes.

We have also been studying other exciting and diversified subjects in the field of aging, including religiousness, shared decision making, and frailty, which is really a tiny example of the richness of the research opportunities in this area.

I feel inspired by many things. One inspiration involves “trying to see the invisible”. By that, I mean recognizing how some elements from the reality around us that remain hidden in plain sight influence behaviors and people’s health and illness trajectories. Here I’m thinking of things that we take for granted and/or don’t even have names for. For example, frailty has certainly been one of the most important research topics in the field of Geriatrics and Gerontology over the last two decades to such an extent that nowadays it is hardly possible to talk about aging without also talking about frailty. However, before 2001, when two important papers offering new and divergent perspectives on frailty were published, most studies on aging and healthcare professionals treating older adults saw older adults through a lens that classified them mostly in terms of their comorbidities and functional status. Research on frailty inspired by Fried’s Frailty Phenotype model allowed us the possibility of “seeing” how things such as slowness, decreased strength, weight loss, exhaustion and low physical activity could reflect a state of reduced physiologic reserve and influence health outcomes among older people. It is not that there weren’t previous studies showing that those factors in isolation were associated with worse clinical outcomes, but that overall, they remained relatively unnoticed in clinical practice. The emergence of the concept of frailty allowed healthcare professionals to see beyond comorbidity and functional status and recognize a new state of health that inaugurated novel possibilities of prevention and scientific investigation.

Indeed, most of my heroes in Geriatrics and Gerontology are people who saw problems that are still common among older adults and which were often perceived as unavoidable such as falls, delirium, and suffering and dared to try to change that picture.

Another major inspiration is the work of Dame Cicely Saunders, founder of the palliative care movement, and who, when asked about what single medical advance would benefit most people, responded straightforwardly: “A universal drive to listen better to patients’ needs and goals”.

PLOS: What are the main challenges facing the multidisciplinary field of Geriatrics & Gerontology?

EV: There are several formidable challenges facing this field. They range from the increase in the number of people with dementia to ageism, multimorbidity and social inequities related to how people age around the world. Aging does not happen in the vacuum. It happens within complex cultural, social, economic and political contexts that are replete with interconnections with the health of individuals and populations.

I often think of population healthy aging as the enigma that the Sphinx from the legend is constantly asking our societies to decipher lest it will devour us. Individual healthy aging is not in itself an enigma anymore. The conundrum lies in how to change societies in ways that favor healthy aging. The good news is that if we are able to create a world that truly supports healthy aging, that world will be a better place not only for older people but for everyone else. For example, decreasing the future prevalence of dementia demands improving access to quality education early in life and the promotion of healthier lifestyles throughout life, which is good for children, adolescents, and young adults as well.

Communication also remains a major challenge in healthcare and one that is particularly fundamental in the care of older people. Short consultation times are often insufficient to address the complexities related to the care of older adults with several health problems. Reimbursement systems that reward high tech medical procedures and undervalue the time needed to properly listen to patients, negotiate goals of care and perform shared decisions add up to the challenge.

PLOS: How do you think Open Access can help with overcoming these challenges?

EV: Open access can help by facilitating the sharing of knowledge and research partnerships, both of which are essential to scientific progress. I believe that the famous African proverb below epitomizes the spirit of Open Access in science:

“If you want to go fast, go alone. If you want to go far, go together”.

PLOS: What major improvements in clinical decision making related to this topic have you seen during your clinical career?

EV: I believe that I only started learning how to listen to patients’ goals and needs after beginning to learn palliative care. Indeed, much of what has been written about the art and science of negotiating goals of care and advance care planning comes from palliative care research and textbooks. Importantly, the concept of advance care planning has undergone major changes over the last two decades, evolving from a process that aimed at making healthcare decisions in advance to preparing families and clinicians as well as possible to make real-time decisions in future situations where the patient is no longer able to participate in the shared decision-making process. Yet, I must agree with Dame Cicely Saunders that listening to patients’ goals and needs still remains a major challenge for healthcare professionals and systems. In that regard, I am particularly excited about Professor Mary Tinetti’s work with the Patient Priorities Care program, which has been advancing how to incorporate patients’ values into their day-to-day care.

PLOS: Other than your own research focus, what do you think is the most exciting area in aging research at the moment?

EV: I believe that the whole field of dementia research is one of the most exciting areas in the study of aging at this moment. On the one hand, it is likely that biomarker-guided treatments will become a reality in the future not so far away. On the other hand, new developments related to systems of care (e.g., integrating art therapy, access to admiral nurses, advance care planning, and early palliative care) may substantially contribute to improvements in the quality of life of that population.

PLOS: Why should researchers studying aging in health and disease submit to PLOS ONE?

EV: PLOS spearheaded the Open Science revolution and lives by its ideals as a nonprofit committed to the mission of accelerating progress in science and medicine by transforming research communication. PLOS ONE is a highly-respected international multidisciplinary journal that has transparent publication policies focusing on methodological rigor and which avoid subjective judgements regarding the intrinsic value of a manuscript.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS

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