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We had the pleasure of speaking with Dr. Virginia Boccardi, Editorial Board Member of Geriatrics (ISSN: 2308-3417), who shared her point of view as a researcher and caregiver, including her experience with Alzheimer's disease within her family.

Dr. Virginia Boccardi, born in Caserta, Italy, on 11 August 1983, graduated with an M.D. in 2007, completed her residency in geriatrics in 2012 and her Ph.D. in metabolism and aging in 2015, at the University of Campania Luigi Vanvitelli, Italy. She is an Assistant Professor at the Institute of Gerontology and Geriatrics of the University of Perugia and medical director at the Section of Geriatric (Santa Maria della Misericordia Hospital, Perugia). During her career, she has spent almost 2 years as a research fellow at the University of Medicine and Dentistry of New Jersey (USA), focusing her research on aging, cancer, cellular senescence and telomere biology. She is working on different projects on molecular and metabolic aspects of aging, with particular interest in cognitive impairment and diabetes with the development of intervention strategies mainly focused on nutrition. She has published more than 130 peer-reviewed articles in reputable journals and contributed many books/chapters (actual h-index: 28). She has also been serving as a respectable Editorial Board Member. Indeed, as a young investigator, she received many awards and acknowledgments. She is nationally and internationally recognized for her efforts in promoting progress and innovation in geriatric medicine.

1. As an Editorial Board Member of the journal Geriatrics, how do you view the evolving landscape of geriatric research and its impact on the field?
Modern geriatrics does not currently have the recognition it deserves. It fails to emerge in the field of research despite being of interest to everyone. Even today, many people do not know what geriatricians do and what research they are involved in. However, this journal receives many submissions, so it is up to us to promote the culture and dissemination of our research.

2. What motivated you to join the Editorial Board of this particular journal, and what do you hope to contribute to its mission and objectives?
I was prompted to join as an Editorial Board Member just by reading the name of the journal Geriatrics, which gave me a very significant scientific sign. A journal dedicated to the medicine of complexity in all its facets: community-based, hospital-based, palliative care, and so on.

3. In your opinion, what are some of the most pressing challenges faced by researchers in geriatrics today, and how can the journal address these challenges?
The main challenges include the low popularity of this specialization, the absence sometimes of specific medical courses that teach this discipline, and the mistaken perception of geriatrics as a field limited to end-of-life care. Currently, the number of geriatricians is still limited, and often in places like Italy, they are found in emergency departments or other settings, losing their specificity and specialized skills. At present, there is a lack of a strong presence of geriatrics at the community level as well as in acute geriatric settings: the paradoxical decline of geriatric medicine as a profession. This journal must attract young readers to clinical and geriatric research, disseminate them in a modern and scientific manner through social media, and create, for example, concise videos that can summarize each published research article. It is important to engage young individuals through communication so that they can choose geriatrics as their specialization.

4. In the context of the Geriatrics journal's mission to advance knowledge in gerontology and geriatric medicine, how do you see the role of research into Alzheimer's disease in shaping our understanding and approach to providing care for older adults?
The role of research into Alzheimer's disease in shaping our understanding and approach to caring for older adults is fundamental. However, it is important not to confuse this disease with dementia in the older person. While it can certainly be a contributing cause, the term “dementia” often encompasses various forms of cognitive decline in older individuals, which are often expressions of physical and cognitive frailty. In the absence of a cure, dementia should be considered as a geriatric syndrome where multifactorial causes often form the basis, and addressing the underlying factors (metabolic risk, cardiovascular risk, hearing loss, and other sensory disorders, for example) by identifying and managing them can reduce the risk. This is known as the geriatric paradox—managing comorbidities to prevent the disease, in this case, dementia.

5. Could you please tell us about your personal journey and experiences as a family member of someone affected by Alzheimer's disease? How did this impact you emotionally and as a researcher in the field of geriatrics?
My personal journey and experiences as a family member of someone affected by Alzheimer's disease (a case of early-onset Alzheimer’s disease which lasted 14 years, from the age of 55) have changed the way I provide care to patients and their families. Very often, perhaps always, the patient becomes the caregiver. Family members are no longer recognized by the person, but also mothers and fathers are not recognized by their families because they are transformed. It is as if the person is slowly dying, drifting further away until they become a suffering body, alive but not really living.
All of this has emotionally impacted me more as a clinician than as a researcher in the field of geriatrics. I strive to be a fundamental source of support to the families, as there is no cure available for the patient. For the person affected by such a disease, I apply all my skills to manage behavioral disturbances, promote proper nutrition, encourage socialization in the early stages, and provide pain control in the terminal stages, for example, in order to promote dignity and quality of life. However, often the hospitalization timelines and the lack of community-based geriatric care complicate things.

6. How do you strike a balance between maintaining objectivity as a researcher and experiencing the emotional burden of caregiving simultaneously?
Finding a balance between maintaining objectivity as a researcher and clinician while simultaneously dealing with the emotional burden of caregiving is often very challenging for me. It seems like a dead end at times. I don't hide the fact that, when I communicate the diagnosis, I often become emotional. Every time I say, “Enjoy your mom or dad as much as you can, for example, talk to each other and tell each other how much you love each other. There won't be time later.”. But, unfortunately, daily life is complicated; we often take things for granted. And, someday, when the person can no longer recognize us or understand the meaning of our words, we feel guilty for all the time not lived. Memories may fade with time, but love doesn't. But we must say it while there is still time.

7. What aspects of caregiving for those with Alzheimer's disease do you find particularly challenging?
Caregiving for individuals with Alzheimer's disease can be physically, emotionally, and mentally demanding. What makes this path exceptionally challenging is the relentless progression of the disease, the heartbreaking loss of communication, and the hard task of managing the behavioral symptoms that can emerge. It is important for Alzheimer's caregivers to seek support, whether from support groups, healthcare professionals, or respite care services, to help them cope with these challenges and provide the best possible care for their loved ones.

8. In what ways has your role as a caregiver influenced your perspective on the disease and its management?
It is extremely complicated to observe the person gradually changing and moving away from us. Behavioral disturbances are devastating. We find ourselves facing a stranger. Similarly, seeing them sit motionless in a chair with an empty look, consumed by the disease in the final stages, makes us feel powerless. It has made me feel powerless as both a daughter and a physician.

9. Have you encountered any common misconceptions in society or stigmas surrounding Alzheimer's disease that you wish researchers and caregivers were more aware of?
Certainly. The few times we entered the hospital and saw “dementia” written as the first piece of information in the clinical diary, it was devastating. What does that mean? Are they different from others? Why shouldn't they receive care? Of course, care must be proportionate, especially in the final phase, but the stigma of dementia exists. I can assure you that seeing it from the outside and as a physician is devastating.

10. As a researcher and caregiver, what key message or insight would you like to share with fellow researchers and individuals about the emotional aspect of Alzheimer's disease?
As a researcher and caregiver, I wouldn't know what advice to give, honestly. I would just like for dementia patients not to be seen as numbers, and for research to be unrestricted and not necessarily follow the financially advantageous path but open up to various hypotheses and invest in this field as much as in oncological treatments.

Dr. Virginia Boccardi’s contact information:
Email: [email protected]