Oregon Health Sciences University (OHSU) and Portland State University (PSU) School of Public Health

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27
Dec

Opportunity leads to purpose

A chance connection and an invaluable faculty mentor lead Sarah Dys to a PhD in Community Health

By any measure, Sarah Dys sets a remarkable standard. Considering that she had no prior degree in public health before coming to the OHSU-PSU School of Public Health as a doctoral student in Community Health in 2016, her achievements have been, and continue to be, impressive. She has brought a critical, researcher’s eye both to her field and to the academic world she works within.

Over the past five years, she has co-authored over ten articles in peer-reviewed journals, authored multiple reports, presented at national conferences, and holds a leadership position with the Social Research, Practice, and Policy (SRPP) section of the Gerontological Society of America, where she collaborates on engagement events such as webinars and curates symposia for the annual conference. She has built a network of public health professors, practitioners, and professionals in the field of gerontology across the U.S. and internationally.

This December she presented her dissertation, “Antipsychotic Medication Administration in Oregon Assisted Living: Analyzing an Action Situation.” Her dissertation and her research already have immediate, real-world implications on how older adults and people with disabilities are treated with antipsychotic medications in assisted living facilities across the state.

Assisted living and residential care is a type of community-based setting where older adults and people with disabilities live and can receive some health and social services, including assistance with activities of daily living, health conditions, and medication management. Unlike nursing homes, assisted living settings are regulated at the state-level and have significant variation in policies and resident populations, so focusing in on a single state can provide important context. Additionally, assisted living settings can be endorsed to provide dementia-specific care for people living with Alzheimer’s disease or related dementias.

“Antipsychotic medications are often prescribed ‘off-label,’ meaning for reasons they are not approved, in older adults living with dementia, often to manage behavioral expressions,” explained Sarah. “There has been attention on antipsychotic medication use in older adults living with dementia due to an increased risk of stroke and death. Nursing facilities have national incentives to reduce antipsychotic medication use, but these incentives and policies don’t necessarily translate to assisted living.

“The Quality Metrics Council, appointed by Governor Kate Brown, is developing quality indicators for long-term care settings, antipsychotic medication use is one of them. I wanted to try and understand how and why antipsychotic medications are used in Oregon’s assisted living populations, for all intents and purposes my ‘action situation.’ If legislation is going to be made about these communities, we should understand the nuances and context of these settings. They are not nursing facilities.”

Her advisor and mentor, Dr. Paula Carder, is understandably proud of the newly minted PhD. “Dr. Dys brings a critical public health lens to aging policy and practice. I’m delighted when I hear from professionals in other states how impressed they are with Sarah’s skills, as it reflects well not only on her work, but also on the excellence of our faculty at the School of Public Health,” she noted. “Sarah’s commitment to sharing the research done by the Institute on Aging will be missed!”

East coast meets west coast

Born and raised in Massachusetts, Sarah is the eldest of three children, as well as part of a large, multigenerational extended family, most of whom lived within a 20-mile radius of her childhood home. In addition to her immediate family, she grew up around all of her grandparents, a great-grandparent, and several great aunts and uncles. Those early childhood experiences would catalyze her interest in working with older adults.

Education was highly valued in her family. Her mother, who emigrated from Lebanon, has a PharmD and her father has an MBA. “Growing up, my dad would say that his dream was to be ‘the least educated in the family,’” Sarah recalled. “Mom thought my personality was best suited to being a lawyer, but I’ve always thought of myself as a scientist.”

Enrolling in Clark University, a private research university in Worcester, Massachusetts,

Sarah became what is known as a “straight through” student, earning her undergraduate degree in Psychology in 2015, followed immediately by her Masters degree in Public Administration in 2016. By September of that year, she was in Portland and beginning her pursuit of a PhD in Community Health at OHSU-PSU School of Public Health.

Even as a full-time student throughout her undergraduate and graduate careers, she also worked continuously outside of the classroom. As an Injury Prevention Coordinator at the University of Massachusetts Medical School, she had her first taste of public health education, presenting educational injury prevention workshops for children ages 3 to 18, including teaching basic safety, protective driving, and working gun buy-back programs in the central Massachusetts area.

“Since high school I wanted to be a bench scientist on the frontiers of research and medicine related to brain health. My paternal grandmother lived with Parkinson’s disease for many years before she died,” she noted. But, like many pre-med students who are on the track to medical school, Sarah’s introduction to public health changed her career plans.

A chance connection

“My sophomore year of undergraduate school, I had an opportunity to volunteer my time at a community flu vaccination clinic. The folks running the clinic separated us into groups, and I got placed with a bunch of medical students who were practicing vaccine administration,” Sarah said. “Obviously, I had no training to do such a thing, so I went and found the person in charge: the leader of the city division of public health and chief pediatric trauma surgeon, Dr. Michael Hirsh.

“That grouping mistake initiated an amazing connection. Dr. Hirsh introduced me to public health. He facilitated an internship with the City of Worcester’s Division of Public Health, as well as my job with UMass Medical School. Though he himself is an MD, he took me on as a mentee and pushed me to see beyond the white coat. My experiences working at the DPH and applied experience implementing health promotion programs gave me the bug. I was hooked.”

Wrapping up her Masters, Sarah was applying to both career options in public administration and PhD programs that drew her budding interest in public health. While most of her work as an injury prevention coordinator focused on children, she began to be interested in the area of how to prevent falls, a serious threat to the health and independence of older adults. “My writing sample for these applications was a policy brief investigating community-based falls prevention programming and services for older adults,” she recalled. “I had applied to the Community Health program at the OHSU-PSU School of Public Health and the focus on older adults made my application find its way onto Dr. Paula Carder’s desk. A few emails and phone calls turned into a visit to Portland from the east coast. She essentially said that if gerontology was even a smidge on my radar, I had a home here.

“I owe so much to my relationship with Paula. In addition to being a primary formal mentor throughout my doctoral program, she has always been so considerate of me and my journey. Paula is always willing to sit down and brainstorm an idea, extend out into her network, make connections, and facilitate opportunities. I remember not even one full month of starting school, she told me she had funds to pay for me to attend the Gerontological Society of America’s Annual Scientific Meeting. And if I wanted to bring an idea for a paper to present, she would find a way to mentor me through it. If we were attending a meeting with state policy folks, she would make sure to introduce me to them. If we were attending a conference with her colleagues at other universities, she would talk up my work to them. Paula has taught me so many tangible skills related doing research, but perhaps more importantly she showed me what it looks like to be a meaningful and impactful role model.”

Dr. Paula Carder

From her arrival at SPH in the fall of 2016, Sarah has worked alongside Paula Carder as a research assistant at the Portland State University Institute of Aging (IOA). While the opportunity to pursue a doctoral degree, moving across the country to study with a leader in the field first drew her to study gerontology, the IOA is where she learned the basics of social science research, nourished a passion for the intersection of public health and aging, and developed the skills necessary to working in a research environment.

“In my public health classes, so much focus and attention is spent on kids, young adults, and then the discussions sort of stop around adults in their 40s. As a student just getting my bearings in gerontology, I found myself injecting the aging perspective into public health education, said Sarah. “It felt like no one else was talking about it or cared in the public health world. That really lit a fire under me. What began as opportunity slowly and surely developed into passion.

“In addition, gerontology is the most interdisciplinary field I can think of. Biology, health, social science, history, art, literature, entertainment, finance, business, you name it, it can intersect with aging,” she pointed out. “I am so happy I discovered the field of aging when I did, because now I want to dedicate a career in service to older adults. Our population is aging so fast, and it has been for decades. Folks can’t be discovering gerontology for the first time during a terminal degree program. We should be injecting a life course perspective in our physical environment, education, and media.”

Public health education’s lifelong impact

During her career at SPH, she has served as guest lecturer, a peer mentor, and a peer learning assistant. Sarah also shared how over the course of her degree, she has spent just as much time unlearning as she has learning, particularly around racial and health equity.

“Just a few years ago I was so proud to ‘claim the title’ of ally, like it’s some award rather than a way of life. I was 100% the kind of person to be like ‘I’m not a racist, I hate racism! Also, I am Lebanese, I’m not white.’ See the posturing, virtue signaling, and distancing there?” she asked. “Let’s be honest, I am a white cis-woman who grew up with significant economic resources. Not only have I benefited from being white (and a host of other things), but I certainly have had to acknowledge how I have been socialized to be racist. And owning that in a way that doesn’t cause harm to people is something I am still learning to do.”

“It wasn’t until a few peers and professors generously called me in to the fact that I was taking up A TON of space in environments and interactions where I should have been listening, and why my tendency to be vocal was problematic. I was so focused on my intentions, and my feelings, and how I was perceived,” she continued. “Not until very recently, within the last two years, did I really internalize how I, my family, and white people in general benefit from systemic, unearned privileges. I could articulate racial/ethnic disparities in an academic sense, but only from the vantage point of disadvantage, not the reciprocal fact that for some to be disadvantaged others must be at an advantage.” Sarah attributes these “unlearning” opportunities, in large part, to a core Community Health faculty within SPH and students who never fail to critique, question, and demand better.

Sarah described transparency, accountability, compassion, and humility as key personal values. She carries these values with her into the public health workforce. She has accepted a position as Research Associate II with Vital Research, a social science research and evaluation firm based in Los Angeles. They do research and program evaluation projects across the spectrum, including education, arts, and social services. In her role, she will be working with a team to implement the National Core Indicators and National Core Indicators- Aging and Disabilities studies for several states. These surveys are meant to assess satisfaction with social services used by older adults, people with physical disabilities, and people with intellectual or developmental disabilities.

How does she see the impact her degree in public health will make? How will she help to change the world? “I would love to center aging in the public health discourse, particularly at the intersection of housing, health, and social services,” she replied. “People over age 85 are the fastest growing population in this country. People are living longer, but not always healthier or meaningful lives.

“I want to contribute to a world where aging is an experience that is valued and respected, not feared and disdained. We need to radically shift how society is structured, our cultural view of the life course, and how to expand opportunities for intergenerational interaction.”