When Sheryl Zimmerman started her PhD in social work at the University of Illinois in the early 1980s, dementia care was a new topic in her field.Dementia has been in the vernacular for about 300 years, first described in the mid-1700s as “madness or melancholia” and eventually recognized as a brain disease by the end of that century. In 1910, after engaging in numerous case studies on people with dementia, German psychiatrists Emil Kraelin and Alois Alzheimer became the first to identify Alzheimer’s disease, a type of dementia that started earlier in life and progressed over time.
So while the term was not new in the 1980s, research on the care of people with dementia living in nursing homes and assisted living was. And Zimmerman saw this as an opportunity to dive into the field and uncover best practices for working with this community of people.
“I heard a presentation about it at a national conference, and I thought, That’s where I can make a difference,” she shares. “People weren’t talking about it like they were talking about patients with cancer or rheumatoid arthritis and how they can still have quality of life. Dementia wasn’t even on people’s radar screens in terms of having quality of life.”
Today, dementia is an umbrella term for a collection of symptoms —memory loss, language decline, and reduced problem-solving ability — that are severe enough to impede daily activities. The most common cause of dementia is Alzheimer’s disease, a progressive disorder that causes these symptoms to worsen over time.
Impact Report
In 2024, 1.8 million North Carolinians were over age 65 — a number that’s expected to double by 2040, according to the N.C. Office of State Budget and Management. Sheryl Zimmerman’s research on how to better support people in nursing homes and assisted living communities helps protect this population.
Federal funding propels projects like this forward. Most of Zimmerman’s funding for this work comes from the National Institutes of Health.
Now at Carolina, Zimmerman is the nation’s top-ranked social work scholar on aging and long-term care. She is a distinguished professor in the UNC School of Social Work; co-director of the Program on Aging, Chronic Illness, and Long-Term Care at the Cecil G. Sheps Center for Health Services Research; and executive director of CEAL@UNC — a national center advancing the well-being of people who work and live in assisted living communities.
She has written five books and published over 450 peer-reviewed studies, and her work has been cited nearly 31,000 times. In 2022, she was recognized for her incredible contributions to the field with the Kleemeier Award from the Gerontological Society of America, and in 2024, she received the Distinguished Career Achievement Award from the Society for Social Work and Research.
“The welfare of older adults affects everyone,” Zimmerman says. “We’re all growing older, and we all have someone in our family who already is older, from parents to aunts and uncles. And in the next 10 years, the number of older adults is going to exceed the number of people aged 18 and younger.”
A researcher at heart
Growing up as a middle child in the suburbs of Chicago, Zimmerman would watch her family’s daily interactions. She’s always been tuned into how people affect each other within systems.
“In some ways, having a psychosocial perspective was the core of who I was from a young age,” she says.
Psychosocial research explores the intersection of psychological and social conditions — and how those factors impact behavior, physical health, and well-being.
Inspired by her intro to psychology class at the University of Illinois Urbana-Champaign and her older brother’s research with police departments, Zimmerman decided to major in social work and minor in criminal justice. She began conducting research as a first-year undergraduate student and went on to earn a master’s and PhD in social work. Her dissertation assessed interactions between police officers and social workers affiliated with police departments.
When Zimmerman landed her first faculty position in the epidemiology department at the University of Maryland in 1989, she attended a gerontological conference that provided insight about the huge gap in research in assisted living, now the largest residential long-term care provider overall and for people with dementia.
“At that point, I was a strong psychosocial and health services researcher — and I think someone who’s a researcher at heart can find passion to study almost anything,” she says. “As soon as I started getting involved in research with older adults, I realized it’s a population where so much could be done and where a little would go a long way. And so from the beginning, I saw it as a place where I could make the most impact.”
Life-saving interventions
With 40 years in the field and hundreds of studies to her name, Zimmerman has worked on countless projects, from the impact of reducing antibiotic prescribing in nursing homes to dementia prevalence in assisted living to how this demographic was affected by the COVID pandemic.
One of her most impactful projects to date is an oral health intervention.
“You can tell the quality of care in a nursing home by looking at someone’s mouth,” she says.
Consider what happens sometimes while eating dinner with friends. While talking and chewing, food might go down “the wrong pipe,” meaning it enters the lungs and we, in response, cough until it comes out. That’s called aspiration.
Older adults who experience coughing or trouble breathing can aspirate bacteria from their mouth into their lungs, which could lead to an infection like pneumonia — which affects more than 250,000 nursing home residents annually, according to Zimmerman. The likelihood of pneumonia is higher when the teeth and gums harbor bacteria, and people who have experienced stroke or are living with Alzheimer’s disease or other cognitive impairments may not be able to brush their teeth.
In response, Zimmerman and Carolina colleagues Philip Sloane, John Preisser, and Patricia Poole developed an evidence-based training program for people with cognitive and physical impairment called “Mouth Care Without a Battle.” In a 2020 study, they found that training nursing home staff to provide daily mouth care using this program reduced pneumonia by 26%.
This toolkit provides information about cleaning older people’s teeth — like gentle brushing for broken teeth, dentures, and sensitive gums — and has been provided free of charge to nursing homes across North Carolina, Connecticut, Florida, and West Virginia.
“It’s not rocket science, but someone with dementia might back away and close their mouth when someone approaches them with a toothbrush,” Zimmerman says. “So staff need to learn sensitive care practices, like approach from the front and go slow.”
Zimmerman is equally proud of her research on a lighting system for doorframes that’s reduced falls at night by 34%. Falls are the leading cause of injury for adults 65 and older, according to the Centers for Disease Control. They can lead to muscle strains, bone breaks, and even death.
Not only was Zimmerman’s intervention successful, but it’s low-cost and easy to implement.
“I told my friend about it, and she decided to string Christmas lights around her mom’s bedroom door,” she shares with a laugh. “It’s a good start. Our lighting system is more fine-tuned than that.”
A center of aging expertise
For hundreds of years, families have taken care of older adults themselves. It wasn’t until the mid-1900s when private and public nursing homes started to develop nationwide, partially due to a shift in hospital rehabilitative care after World War II. As Medicare and Medicaid expanded coverage for care, more and more nursing homes were built.
By the 1980s, it became clear that not everyone needing supportive care required nursing care, and so assisted living — a model more focused on person-centered care rather than medical care — mushroomed. Assisted living communities help people with housekeeping, medications, and other daily tasks, but don’t provide nursing care. Between 1990 and 2002, the number of assisted living beds grew by 97%.
In the early 2000s, the U.S. Senate Special Committee on Aging convened a hearing on assisted living to better understand this burgeoning industry, resulting in a workgroup to address guidelines for policy, regulation, and operations. One recommendation was to create a national Center for Excellence in Assisted Living (CEAL). Founded in 2003, the center brought together experts from across the country to inform care practices — from medication management to information disclosure — and policies for the people who work and live in these communities.
Zimmerman has been involved with CEAL since its founding, and in 2023, oversaw its transition to Carolina. Today, she leads CEAL@UNC, which strives to bridge the gap between academic research, practice, policy, and public understanding; develops tools for medical and mental health care in assisted living; confers with legislative representatives to inform policy; and works with more than 100 organizational representatives and researchers involved in assisted living.
“I’ve never done research solely to publish papers,” Zimmerman says. “I do research because I want to inform practice and policy — and CEAL is all about that.”
Real-world application is key for Zimmerman. She wants to supply caregivers with knowledge they can implement immediately. We all know someone who is aging and needs care, even if they’re not dealing with decline from dementia.
After four decades of working with these communities, and taking care of her own parents, Zimmerman offers advice to anyone who might benefit from it.
“First, take a deep breath, and take stock of your capacity and well-being,” she advises. “If you over-tax yourself, no one wins. Second, learn about the issues affecting your family member or friend, which can inform how you interact on a day-to-day basis. Third, learn about and take advantage of the resources that are available. As the population has grown, so too have the resources to support their care and yours.”