FROM THE COLLECTIONS
Vincent Mor, PhD
Sidney Katz, MD
This year saw the passing
of a giant in the field of medical research. Sidney Katz, MD, died at his home in Michigan with Beverly, his wife of more than 60 years at his side, along with his daughter. Born in Cleveland, Ohio, in 1924, he attended medical school at Case Western University. He earned a Bronze Star for his work in Korea running a MASH unit, caring for soldiers who came down with hemorrhagic fever, ultimately reducing the mortality rate from the disease from 10 percent of those infected to below 1 percent. After a stint at the Walter Reed hospital in Washington, DC, where he continued his research on hemorrhagic fever, he returned to Cleveland, as Case Western had one of the best departments of preventive medicine. There he became interested in rehabilitation and set about trying to measure the functioning of older persons engaged in rehabilitation efforts at the Benjamin Rose Institute.
He spent a decade at Michigan State University leading their Department of Preventive Medicine and in 1983 came to Brown University as associate dean of medicine for external affairs, where he founded the Center for Gerontology and Healthcare Research. After five very productive and influential years at Brown, he returned to Case Western and the Benjamin Rose Institute, where he spent the last 20 years of his career, continuing to influence young people devoted to making a difference in applied geriatrics and rehabilitation.
Always a pioneer, Dr. Katz’s insights were rooted in his own experience and in a deep understanding of how knowledge is accumulated and communicated. His original focus on measuring how humans regain function following a stroke or other health event became the basis for all his major contributions to medical research.
Most scientists do not have even one “great” idea in their careers; they add to the sum of knowledge confirming and/or refining the insights of others. Sidney Katz had not just one, but at least three big ideas. The first was to establish a measure of physical functioning that became known as the Activities of Daily Living (ADL). Dr. Katz was not the first physician to acknowledge the importance of documenting how patients function as part of the treatment process, but his index was the first to combine carefully constructed descriptive categories across several discrete areas of basic human functioning rather than merely relying upon a clinical judgment. First published in 1956 and followed by a highly cited paper published in the Journal of the American Medical Association i n 1 963, t his i ndex b ecame t he i nstrument of choice for the burgeoning field of geriatrics. Subsequent measures of human functioning and quality of life have been influenced by the Katz Scale of Activities of Daily Living and it continues to have influence, as evidenced by the hundreds of references to it even in 2012.
Not content with merely transforming how clinicians thought of their patients’ outcomes—from focusing only on survival to focusing on functioning— Dr. Katz went on to change how epidemiologists and demographers think about life expectancy. He advanced the notion that we should be equally concerned about the “active life expectancy” of a population since once they are no longer “active” they will be dependent upon the assistance and care of others. This paper, published in the New England Journal of Medicine, stimulated some of the major demographic and epidemiologic researchers of the day to establish longitudinal studies of the elderly and disabled in order to document annualized rates of functional decline in the population. The National Institute on Aging based several major research program announcements on the concept of “Active Life Expectancy” and several US and cross-national longitudinal surveys of the elderly were initiated to improve our understanding of the determinants of what it is that enables some elderly persons to remain independent.
Dr. Katz had been a member of the Institute of Medicine (IoM) for much of his career and in 1983 he was tapped to chair what was to become one of the most influential of all IoM panels, one focused on the quality of nursing home care and the role of governmental regulation. The study was stimulated by repeated scandals in the nursing home industry and a perception that government regulation was inadequate. Dr. Katz was able to negotiate universal agreement of the committee membership for a comprehensive set of recommendations that amazingly enough were incorporated into the Omnibus Budget Reconciliation Act of 1987, which became known as the Nursing Home Reform Act. While there were many notable features incorporated into the Act that had been IoM report recommendations, none was more uniquely the product of one person than the mandate that there be a comprehensive clinical assessment of each resident admitted to a nursing facility that would be periodically updated so that the individual care plan recommended for the resident would reflect the assessed needs of the individual. The existence of a standardized assessment made it possible to develop measures of nursing home quality rooted in the outcomes experienced by residents. This, in turn, is at the root of numerous reimbursement innovations in the long-term care arena.
A version of the assessment instrument has been translated into dozens of languages and is being used for care planning, quality monitoring, and policy formulation in countries as diverse as Spain and Finland, New Zealand and Canada.
These three “big ideas” have largely defined the domain of geriatrics in the US. There would be little argument that Dr. Katz has been the most influential thinker in geriatrics in the US, but it is likely that his influence has been felt, at least indirectly, far beyond the domain of geriatrics into medicine in general. While most studies of the impact of new treatments continue to have as their primary end points mortality and diseaserelated events, many now include measures of functioning, often based upon principles that Sidney Katz originally articulated.
Alpert Medical School