Health Care Innovation award expected to help reduce health care spending costs.

U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced today that UCLA‘s new Alzheimer’s and Dementia Care program has been awarded $3,208,540 as part of the agency’s Health Care Innovation awards program.

The awards, made by possible through the Patient Protection and Affordable Care Act, support innovative projects nationwide aimed at saving money, delivering high-quality medical care and enhancing the health care workforce. The 26 awardees announced today are expected to help reduce health care spending costs by $254 million over the next three years.

“We can’t wait to support innovative projects that will save money and make our health care system stronger,” Sebelius said. “It’s yet another way we are supporting local communities now in their efforts to provide better care and lower cost.”

The new projects include collaborations among leading hospitals, doctors, nurses, pharmacists, technology innovators, community-based organizations, patient advocacy groups and other organizations located in urban and rural areas. The Health and Human Services awards initiative allows applicants to come up with their best ideas to test how the quality and affordability of health care can be improved quickly and efficiently. The awarded projects will begin work this year to address health care issues in their local communities.

UCLA’s Alzheimer’s and Dementia Care program, which launched in March, provides comprehensive care, as well as resources and support, to patients and their caregivers.

David Reuben, UCLA

“UCLA already provides outstanding geriatrics, neurology, psychiatry and primary care clinical services,” said Dr. David Reuben, chief of UCLA’s geriatrics division and leader of the program. “With the launch of this new program, we now have a comprehensive, coordinated dementia care program that spans across UCLA clinical centers and reaches into the community to meet the needs of these patients and their families. We are honored to receive this award, which will help us further our mission of caring for this ever-growing population.”

The Health Care Innovation award will allow UCLA to expand the new program to provide efficient patient- and family-centered care for approximately 1,000 Medicare and Medicaid beneficiaries with Alzheimer’s disease or other forms of dementia in Los Angeles County. By training and deploying professional and non-professional workers and unpaid volunteers, expanding a dementia registry, conducting patient-needs assessments, and creating individualized dementia care plans, the program will reduce and shorten hospital stays, reduce emergency room visits and improve patient health, caregiver health and quality of care, with an estimated savings of approximately $6.9 million.

Over the three-year award period, the UCLA Alzheimer’s and Dementia Care program will train an estimated 2,500 workers. These workers will include nurse practitioners, who will be trained as dementia care managers; they, in turn, will help train primary care providers and patient caregivers in dementia care.

The awardees were chosen for their innovative solutions to the health care challenges facing their communities and for their focus on creating a well-trained health care workforce equipped to meet the need for new jobs in the 21st-century health system. The Bureau of Labor Statistics projects that the health care and social assistance sector will gain the most jobs between now and 2020.

The 26 Health Care Innovation awards announced today total $122.6 million. The Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services at HHS administers the awards through cooperative agreements.

For more information on the awards announced today, visit http://bit.ly/JnrxE4.

To learn more about the UCLA Alzheimer’s and Dementia Care program, visit http://ucla.in/Kj9oXL.

Researchers recommend considering other illnesses, age, before starting treatment.

San Francisco VA Medical Center

In a study of patients 65 and older with non-small-cell lung cancer (NSCLC), younger patients were more likely to receive treatment than older patients, regardless of overall health and prognosis.

The study of more than 20,000 patients, led by a team of physicians at the San Francisco VA Medical Center (SFVAMC) and UCSF, found that, for all stages of cancer, treatment rates decreased more in association with advancing age than with the worsening of other illnesses.

Patients between the ages of 65 to 74 who were severely ill from other illnesses, and thus less likely to benefit and more likely to be harmed from cancer treatment, received treatment at roughly the same rate as patients in the same age range with no co-morbidities. They were more likely to receive treatment than patients between 75 and 84 with no co-morbidities and much better prognoses.

“It’s clear that as human beings and physicians, we fixate on age in deciding whether to pursue cancer treatments, including lung cancer treatments,” said lead author Sunny Wang, M.D., an SFVAMC physician and an assistant clinical professor of medicine at UCSF. “Instead, we should be looking at our patients’ overall state of health.”

The study was based on an analysis of the electronic health records of 20,511 patients age 65 and older who were in the VA Central Cancer Registry from 2003 to 2008. It was published on May 1 in the Journal of Clinical Oncology.

NSCLC is the most common form of lung cancer. The authors cited previous research indicating that older NSCLC patients who are otherwise healthy can benefit from treatment, while those with co-morbidities are more vulnerable to the toxicity of cancer treatments and less likely to complete a course of treatment. Significant co-morbidity can also limit life expectancy, thus undermining the potential survival benefit of treatment.

“The message here is, don’t base cancer treatment strictly on age,” said Wang. “Don’t write off an otherwise healthy 75-year-old, and don’t automatically decide to treat a really ill 65-year-old without carefully assessing the risks and benefits for that patient.”

Currently, Wang and her fellow researchers are conducting a follow-up study looking at survival outcomes among the same cohort of patients.

Co-authors of the study are Melisa L. Wong, M.D., of UCSF; Nathan Hamilton and J. Ben Davoren, M.D., Ph.D., of SFVAMC and UCSF; Thierry M. Jahan, M.D., of UCSF; and Louise C. Walter, M.D., of SFVAMC and UCSF.

The study was supported by funds from the Department of Veterans Affairs, UCSF, the National Cancer Institute and the National Institutes of Health. Some of the funds were administered by the Northern California Institute for Research and Education.

NCIRE – The Veterans Health Research Institute – is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

UC Irvine experts will train staff and support nursing home residents.

Kerri Burnright, UC Irvine

UC Irvine staff will provide training and support related to elder neglect and abuse awareness in Orange County nursing homes under the settlement terms of a class-action lawsuit alleging inadequate staffing at 22 long-term-care facilities in California.

Training will be handled by UC Irvine’s Elder Abuse Forensic Center and funded by a $375,000 grant from the trustee of the $62.8 million settlement in Vinnie Lavender et al. v. Skilled Healthcare Group Inc. et al.

“This grant allows us to fill a need that has distressed us for years — the recognition and integration of the needs of vulnerable older adults in long-term care into all aspects of our work,” said Kerry Burnight, associate professor of family medicine at UC Irvine and co-director of the Elder Abuse Forensic Center.

The funding is intended to:

1. Train professionals who interact with nursing home residents to identify and prevent elder abuse and neglect;
2. Provide resources and support to elder abuse victims and their loved ones; and
3. Furnish direct services to residents of long-term-care facilities through the Elder Abuse Forensic Center.

Orange County’s long-term-care ombudsman’s office annually receives approximately 3,000 complaints ranging from dissatisfaction over cold food to allegations of sexual abuse. At least 30,000 county residents live in about 1,000 nursing homes. In addition, Orange County Adult Protective Services gets more than 4,000 reports a year of elder abuse.

Burnight said that UC Irvine’s Elder Abuse Forensic Center team — comprising a gerontologist, geriatrician, geropsychologist and elder abuse prevention coordinator — will train staff and administrators in Orange County’s 78 skilled-nursing facilities and 930 assisted-living facilities. The team also will train the county’s 76 volunteer ombudsmen on aging issues and how to detect and report elder abuse and neglect.

“The sad fact is that elder abuse is a common phenomenon that more often than not goes undetected and underreported,” said Dr. Laura Mosqueda, chair of UC Irvine’s Department of Family Medicine, director of the geriatrics program and Ronald Reagan Chair in Geriatrics. “Millions of older Americans are abused each year, and many die as a result, often in the most deplorable conditions one can imagine.”

Abuse can be financial or physical or stem from neglect, she said, with many seniors suffering multiple types.

Mosqueda and the faculty and staff of UC Irvine’s Program in Geriatrics spearheaded the nation’s first Elder Abuse Forensic Center in 2003. It aids victims of elder and dependent-adult abuse and brings together legal, medical, social services and law enforcement experts to better understand, identify and treat such abuse; help prevent it; and determine more efficient ways to successfully prosecute offenders.

In September 2011, the U.S. Administration on Aging designated UC Irvine’s Program in Geriatrics as the site of the National Center on Elder Abuse, the country’s authority on elder abuse, neglect and exploitation. UC Irvine serves as a clearinghouse of practical information to support federal, state and local efforts to prevent, identify and effectively respond to elder abuse.

The class action lawsuit against Skilled Healthcare Group Inc. alleged that the nursing homes chain’s failure to meet California’s minimum staffing requirements led to several wrongful deaths. The defendants deny these charges.

About UC Irvine Medical Center: Orange County’s only university hospital, UC Irvine Medical Center offers acute- and general-care services at its new, 482,000-square-foot UC Irvine Douglas Hospital and is home to the county’s only Level I trauma center, American College of Surgeons-verified regional burn center and National Cancer Institute-designated comprehensive cancer center. U.S. News & World Report has included UC Irvine for 11 consecutive years on its list of “America’s Best Hospitals,” giving special recognition to its urology, gynecology, kidney disorders and cancer programs.

UCSF researchers find higher risk of heart attack when abnormalities are detected.

Can a simple diagnostic test used to measure a heart’s electrical activity help predict heart attacks? And can that knowledge help doctors reroute their patients away from coronary heart disease?

These are the questions researchers at UC San Francisco asked in a comprehensive eight-year study focused on senior citizens in the United States. Researchers found a higher risk of heart attack when abnormalities showed up on electrocardiogram (EKG) results of healthy elderly people.

“We did not include them if they reported a previous heart attack,” said lead author Reto Auer, M.D., a research fellow at UCSF’s Department of Epidemiology and Biostatistics. “So we looked at people who lived independently — not in assisted living facilities — with no history of heart attacks or coronary heart disease.”

The findings, scheduled to be published tomorrow in the Journal of the American Medical Association (JAMA), help answer the question of whether or not EKGs can be used to detect heart disease earlier in patients who don’t have chest pain or other symptoms.

“This research is taking the information from an EKG and adding it to other traditional risk factors to better predict who is going to have a heart attack,” said second author Douglas Bauer, M.D., director of the UCSF Division of General Internal Medicine Research Program.

Focus on healthy senior citizens

Researchers studied 2,192 healthy adults aged 70 and older for eight years in Memphis, Tenn., and Pittsburgh. Those with EKG abnormalities had more heart attacks. The results were consistent even when researchers took into account known risk factors for heart attacks, such as smoking, high cholesterol, high blood pressure and diabetes.

At baseline, 276 (13 percent) participants had minor and 506 (23 percent) major EKG abnormalities. During follow-up, 351 participants (16 percent) had coronary heart disease (CHD) events (96 heart-related deaths, 101 heart attacks, 154 hospitalizations for chest pain or a procedure to restore blood flow to the heart). Both baseline minor and major EKG abnormalities were associated with an increased risk of heart disease after adjusting for traditional risk factors.

Each abnormality was categorized in terms of the level of experienced risk. High risk markers included left bundle branch block, a cardiac condition in which the left ventricle contracts later than the right ventricle, as well as major ST-T wave changes in an EKG, among others. Low risk markers included subtle ST-T wave changes and T-wave abnormalities.

“There was a trend towards increased coronary heart disease (CHD) risk from no abnormality to minor, and from minor up to major abnormality,” Auer said. “But both minor and major EKG changes were significantly associated with an increased risk of CHD.”

Gender and racial variations?

Researchers were also interested in whether or not gender or self-reported racial differences played a role in determining a healthy person’s likelihood of a future heart attack among the 2,192 participants who identified themselves as either Caucasian or African American. Researchers found no correlation between elevated risk factors and gender or race.

“It was a good surprise,” Auer said. “It shows that it’s really the EKG changes that predict risk.”

Researchers say it is premature to advocate for the widespread use of their findings in a clinical setting, but that their initial evidence suggests there may be a role for EKG in adding to traditional risk factors, to better predict who is at risk for a heart attack.

“Anytime someone goes into the emergency room, especially elderly people, they typically get an EKG,” Auer said. “So in the patient’s electronic record system, you could include these EKG abnormalities as part of the patient’s overall risk — but we’re not there yet.”

For now, though, researchers recommend patients become familiar with well-established risk factors that health care providers use to counsel individuals for their risk of future heart attacks and other heart problems.

Controversy surrounding EKGs

Organizations such as the American Academy of Family Physicians recommends against ordering annual EKGs or any other cardiac screening for low-risk patients without symptoms. They say “there is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes.”

The American Heart Association (AHA), however, recommends that EKG is reasonable for assessing the risk of coronary heart disease events of adults with hypertension or diabetes even though the U.S. Preventive Services Task Force (USPSTF) found that there is insufficient evidence to recommend for or against routine screening in adults at increased risk of heart disease. For adults at low risk, the AHA recommends that it may be considered while the USPSTF recommends against screening. However, prediction of heart attack by major cardiovascular risk factors is not as reliable in elderly adults as in younger individuals.

“Our view is that novel screening interventions should be tested on clinical outcomes,” Auer said. “Just because you know you might be at increased risk does not mean that you will be better off if your treatment is modified as a consequence of the test.”

This finding, still, could help an estimated 785,000 Americans who will have a first heart attack this year, and 470,000 who will have a recurrent attack. Heart disease remains the number one killer in the United States, accounting for one out of every three deaths, according to the American Heart Association.

Auer is the lead author of the paper; Bauer is the second author; co-authors are  Pedro Marques-Vidal, M.D., Ph.D., and Jacques Cornuz, M.D., M.P.H., of the University of Lausanne, Switzerland; Javed Butler, M.D., M.P.H., of Emory University School of Medicine; Lauren J. Min, Ph.D.; Suzanne Satterfield, M.D., of the University of Tennessee Health Science Center; Anne B. Newman, M.D., M.P.H., of the University of Pittsburgh’s Department of Epidemiology; Eric Vittinghoff, Ph.D., of the UCSF Department of Epidemiology and Biostatistics; and Nicolas Rodondi, M.D., M.A.S. of the University of Lausanne, Switzerland.

The Health ABC cohort study was supported by funds from the U.S. National Institute on Aging (NIA) and the National Institutes of Health (NIH). Additional funding came from the Swiss National Science Foundation and the Swiss Heart Foundation.

Young Scholars Program offers mentorship to students interested in caring for older adults.

Janet Mentes, UCLA

As America ages, the health care industry will be increasingly challenged on how to train and prepare professionals to care for older patients and for the unique and complicated attention they often require.

An original educational program at the UCLA School of Nursing designed with just such goals in mind will be the focus of a presentation at the Western Institute of Nursing Conference, which runs from April 18 to 21 in Portland, Ore.

Administered through the UCLA School of Nursing’s Center for the Advancement of Gerontological Nursing Science, the Young Scholars Program identifies students early in their pre-licensure program who are interested in caring for older adults and offers them the opportunity to participate in a highly personalized and engaging one- to three-year mentorship experience.

Students accepted into the program are matched with faculty mentors and participate in a variety of projects, including co-authorship of research and clinically focused articles, podium and poster research presentations, and involvement as paid research assistants on faculty research grants.

“The Young Scholars Program has been thoughtfully designed to help bachelor’s and master’s entry clinical nurse students develop exceptional research, educational and professional skills focused on caring for older adults,” said Janet Mentes, an associate professor at UCLA and one of the faculty members who will be presenting at Western Institute for Nursing conference. “These students develop specialized ‘gero-smart’ nursing skills and accelerate into a Ph.D. program after completing their basic nursing coursework.”

Mentes points out that along with an aging society, the current nursing education workforce is also aging, with an average age of 58, and the retirement of many experienced educators is expected. That makes it essential, she said, to “develop programs that will prepare the faculty necessary for educating future generations of nurses in the care of aging persons. UCLA’s Young Scholars Program does just that.”

In the three years since its inception and initial funding through a federal Health Resources and Services Administration grant, UCLA’s Young Scholars Program has mentored eight students, five of whom have been accepted into Ph.D. programs and two who have entered the gerontological nursing practice. There are currently three young scholars who will be graduating this year and another four who will join the Young Scholars in September — a program that Mentes says has been “embedded” into the fabric of the UCLA School of Nursing.

Other UCLA School of Nursing faculty members who take a leadership role in the Young Scholars Program and who will be co-presenting at conference include Linda Phillips, a professor who holds the Audrienne H. Moseley Endowed Chair in Nusring; adjunct professor Mary Cadogan; and assistant professor Lynn Woods.

The Western Institute of Nursing is a professional organization of registered nurses and other health care professionals dedicated to advancing nursing science, education and practice to improve health care outcomes.

The UCLA School of Nursing is redefining nursing through the pursuit of uncompromised excellence in research, education, practice, policy and patient advocacy. Rated among the nation’s top nursing schools by U.S. News & World Report, the school also is ranked No. 4 in nursing research funded by the National Institutes of Health and No. 1 in NIH stimulus funding. In 2010–11, the school received $24 million in total research grant funding and was awarded 26 faculty research grants. The school offers programs for undergraduate (B.S.), postgraduate (M.S.N. and M.E.C.N.) and doctoral (Ph.D.) students.

UC Santa Barbara researchers find baseline testosterone level of Tsimane men is one-third lower than U.S. men.

Tsimane men play soccer in central Bolivia

As part of an isolated indigenous group in central Bolivia, Tsimane men spend much of their time hunting, foraging, fishing and clearing land by hand to grow crops. Their ability to maintain the physical activity required to survive each day might imply they have higher than average male testosterone levels.

Anthropologists at UC Santa Barbara and the University of Washington have found, however, that the baseline testosterone level of Tsimane men is 33 percent lower than that of men living in the United States, where life is physically less demanding. Also, in contrast to men in the U.S., the Bolivian foragers-farmers do not show declines in testosterone as they age. The researchers’ findings appear today in the Proceedings of the Royal Society B.

According to Michael Gurven, the lives of the Tsimane offer a glimpse of how humans survived before industrialization and modern amenities. “Our lifestyle is now an anomaly, a major departure from our species’ long-term existence as hunter-gatherers,” said Gurven, professor of anthropology at UCSB and co-author of the paper. Gurven is also co-director of the Tsimane Health and Life History Project, a collaboration between UCSB and the University of New Mexico.

“Maintaining high levels of testosterone compromises the immune system, so it makes sense to keep it low in environments where parasites and pathogens are rampant, as they are where the Tsimane live,” said Ben Trumble, a graduate student in anthropology at the University of Washington, and the paper’s lead author.

That men living in the U.S. have greater levels of circulating testosterone represents an “evolutionarily novel spike,” Trumble continued. The spike reflects how low levels of pathogens and parasites in the U.S. and other industrialized countries allow men to maintain higher testosterone levels without risk of infection. He also pointed out that while men in the U.S. show a decline in testosterone as they age, and the drop serves as a sentinel for age-related disease, Tsimane men maintain a stable testosterone level across their lifespan, and show little incidence of obesity, heart disease and other illnesses associated with older age.

Despite lower levels of circulating testosterone under normal conditions, the forager-farmers do have something in common with U.S. men — short-term spikes of testosterone during competition.

The researchers organized a soccer tournament for eight Tsimane teams, and discovered that Tsimane men experienced a 30 percent increase in testosterone immediately after a soccer game. An hour after the game, testosterone was still 15 percent higher than under normal conditions. Similar increases have been shown in men living in the U.S. or other industrialized countries following, sports competitions.

The study suggests that competition-linked bursts of testosterone are a fundamental aspect of human biology that persists even if it increases risk of sickness or infection. “What’s interesting is that in spite of being in a more pathogenic environment, it’s still important to raise testosterone for short bursts of energy and competition,” Gurven said.

As to whether higher levels of the male hormone would offer a competitive advantage in sports, Trumble suspects that because U.S. men are “taller and weigh more than Tsimane men, and tend to be exposed to fewer parasites and pathogens, they would probably have a competitive advantage, regardless of circulating testosterone.”

Other co-authors of the paper include Christopher von Rueden, a postdoctoral scholar and researcher in the Department of Anthropology at UCSB; Kathleen O’Connor and Eric Smith of the University of Washington; and Daniel Cummings of the University of New Mexico.

The work was funded by the National Institute of Child Health & Development and the National Institute on Aging.

Patti Davis, daughter of Ronald Reagan, to co-facilitate support groups

Alzheimer’s disease affects an estimated 5.4 million people in the U.S., some 480,000 of them in California. Nearly half of all people 85 and older will be stricken with the disease. The overall burden of dementia is still higher, with Alzheimer’s accounting for only 60 to 80 percent of dementia cases.

Yet as devastating as these disorders are to the afflicted, they also have a tremendous impact on family members, friends and caregivers. And while many health systems provide excellent care, and community-based organizations offer supportive services, no comprehensive programs exist to meet patients’ health needs and the needs of those around them.

Family members are often at a loss to find appropriate care and services for their loved ones, and they typically have few, if any, resources to help them navigate their way through the complex health care system.

“UCLA already has top-notch geriatrics, neurology, psychiatry and primary care clinical services,” said Dr. David Reuben, chief of UCLA’s geriatrics division. “But we do not have a comprehensive, coordinated dementia care program. As a result, the many needs of UCLA patients with dementia and their families are commonly unmet.”

To address those needs, UCLA is launching its new UCLA Alzheimer’s and Dementia Care program, which will provide comprehensive, coordinated care, as well as resources and support, to patients and their caregivers.

Patti Davis

Patti Davis, the daughter of former President Reagan and Nancy Reagan and a longtime advocate in the fight against Alzheimer’s, will be an integral member of the program.

Very little was known about Alzheimer’s when President Reagan was diagnosed in 1994. Sufferers and their families were left in the dark about what to expect and how to cope with the ravages of the disease, said former first lady Nancy Reagan.

“People didn’t really talk about their loved ones with Alzheimer’s, as if it were something that had to be kept secret,” Reagan said. “There was no place to go to learn more, no one to talk to and share our feelings with. It was a very lonely — and frightening — time for us. It’s still a lonely time for a lot of people, which is why I’m so glad this new program exists.

“I’m pleased and very proud that Patti is a part of it, and I am confident it will help a lot of people.”

The program, which could serve as a model for other health centers around the country, is being funded by Ronald Reagan UCLA Medical Center; the division of geriatric medicine in the UCLA Department of Medicine; the division of geriatric psychiatry in the UCLA Department of Psychiatry and Biobehavioral Sciences; the David Geffen School of Medicine at UCLA; and a generous donor.

Davis, along with Linda Ercoli, director of geriatric psychology in the UCLA Division of Geriatric Psychiatry, will lead support groups for families affected by the disease.

“It’s a role I’m familiar with because my family went through a decade of my father’s illness under the glare of the public spotlight,” Davis said. “The program of support groups will do a lot to ease the loneliness and fear that come with being in a family with Alzheimer’s.”

The UCLA Alzheimer’s and Dementia Care program will have three main components: the creation of a dementia registry; a needs-assessment of patients listed in the registry; and individualized dementia-care plans based on those assessments.

• Consultations with neurology, psychiatry and geriatrics staff.
• Monitoring for disease progression and complications for all patients.
• Support groups through Patti Davis’ Beyond Alzheimer’s program.
• Advanced-care planning, with consultations from the UCLA Ethics Center.
• Intensive dementia-care management by a nurse practitioner.
• Hospitalization, when needed, at the Santa Monica–UCLA geriatrics special care unit for medical problems, or at the Stewart and Linda Resnick Neuropsychiatric Hospital at UCLA’s geriatric psychiatry unit for psychiatric or behavioral problems.
• Referrals to UCLA’s Mary S. Easton Center for Alzheimer’s Disease Research for appropriate clinical trials.
• Referrals, as appropriate, to the Los Angeles chapter of the Alzheimer’s Association or other community-based organizations for services.
• In-home visits, if needed, with modifications of the patient’s physical home environment.

Brief yoga chant cuts stress and depression, improves cognition and slows cellular aging.

Helen Lavretsky, UCLA

For every individual who’s a victim of Alzheimer’s — some 5.4 million persons in the United States alone — there’s a related victim: the caregiver. Spouse, son, daughter, other relative or friend, the loneliness, exhaustion, fear and most of all stress and depression takes a toll.

While care for the caregivers is difficult to find, a new study out of UCLA suggests that using yoga to engage in very brief, simple daily meditation can lead to improved cognitive functioning and lower levels of depression for caregivers.

Dr. Helen Lavretsky, professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, and colleagues report a further benefit as well: a reduction in stress-induced cellular aging.

The report appears in the current online edition of the International Journal of Geriatric Psychiatry.

As the U.S. population continues to age over the next two decades, the prevalence of dementia and the number of family caregivers who provide support to these loved ones will increase dramatically. Currently, at least 5 million Americans provide care for someone with dementia. The detrimental burden on them, in terms of their own lives, can be severe.

For example, says Lavretsky, who also directs UCLA’s Late-Life Depression, Stress and Wellness Research Program, “We know that chronic stress places caregivers at a higher risk for developing depression. On average, the incidence and prevalence of clinical depression in family dementia caregivers approaches 50 percent. Caregivers are also twice as likely to report high levels of emotional distress.” What’s more, many caregivers tend to be older themselves, leading to what Lavretsky calls an “impaired resilience” to stress and an increased rate of cardiovascular disease and mortality.

While medication can improve depression, many caregivers may be opposed to the use of medication because of the associated cost and drug side-effects. That consideration motivated Lavretsky and her colleagues to test a brief mind-body intervention for stress reduction.

The researchers recruited 49 family caregivers who were taking care of their relatives with dementia. Their ages ranged from 45 to 91 years old and included 36 adult children and 13 spouses. The participants were randomized into two groups. The meditation group was taught a brief, 12-minute yogic practice that included an ancient chanting meditation, Kirtan Kriya, which was performed every day at the same time for eight weeks. The other group was asked to relax in a quiet place with their eyes closed while listening to instrumental music on a relaxation CD, also for 12 minutes every day at the same time for eight weeks.

At the end of the eight weeks the researchers found that the meditation group showed significantly lower levels of depressive symptoms and greater improvement in mental health and cognitive functioning, compared with the relaxation group. In the meditation group, 65 percent showed a 50 percent improvement on a depression rating scale, and 52 percent of the group showed a 50 percent improvement on a mental health score. This compared to a 31 percent depression improvement and a 19 percent mental health improvement for the relaxation group.

The researchers also found that meditation increased telomerase activity and thus slowed cellular aging. Telomerase is an enzyme that maintains the DNA at the ends of our chromosomes, known as telomeres. Telomeres are associated with a host of health risks and diseases, which may be regulated in part by psychological stress. In the absence of telomerase activity, every time our cells divide, our telomeres get shorter and shorter, until eventually, they become so short the cells die. If high telomerase can be maintained or promoted, though, it will likely promote improvement in telomere maintenance and immune cell longevity.

In the study, the meditation group showed a 43 percent improvement in telomerase activity compared with 3.7 percent in the relaxation group.

“Although the relation between mental and physical health has been previously documented, the mechanistic links are beginning to be understood at the cellular level,” said Lavretsky.

“To a varying degree, many psychosocial interventions like this have been shown to enhance mental health for caregivers,” she said. “Yet given the magnitude of the caregiver burden, it is surprising that very few interventions translate into clinical practice. The cost of instruction and offering classes may be one factor. Our study suggests a simple, low-cost yoga program can enhance coping and quality of life for the caregivers.”

The pilot results were “striking,” she said, given the improvements that were shown in mental health, cognition, and telomerase activity over a short eight weeks at a mere 12 minutes a day. “We found that the effects on cognitive and mental functioning and telomerase activity were specific to the Kirtan Kriya. Because Kirtan Kriya had several elements of using chanting, mudras (finger poses) and visualization, there was a ‘brain fitness’ effect in addition to stress-reduction that contributed to the overall effect of the meditation.” Lavretsky plans a follow-up study to provide further confirmation of this potential mechanism in a neuroimaging study of Kirtan Kriya.

Recently, UCLA launched its new Alzheimer’s and Dementia Care Program, which provides comprehensive, coordinated care as well as resources and support to patients and their caregivers. Lavretsky has incorporated yoga practice into the caregiver program.

Funding for the study was provided by the Alzheimer’s Research and Prevention Foundation grant, the National Institutes of Health, the UCLA Cousins Center at the Semel Institute, the UCLA Older Americans Independence Center Inflammatory Biology Core, and the Bernard and Barbro Fund. Other authors of the study included P. Siddarth, N. Nazarian, N. St. Cyr, and M.R. Irwin, UCLA; E.S. Epel, J. Lin, and E. Blackburn, University of California, San Francisco; and D.S. Khalsa, Alzheimer’s Research and Prevention Foundation, Tucson, Ariz. The authors report no conflict of interest.

The UCLA Department of Psychiatry and Biobehavioral Sciences is the home within the David Geffen School of Medicine for faculty who are expert in the origins of and treatments for disorders of complex human behavior. It is part of the Semel Institute for Neuroscience and Human Behavior, a world leading, interdisciplinary research and education institute devoted to the understanding of complex human behavior and the causes and consequences of neuropsychiatric disorders.

Structural brain aging associated with lack of omega-3 acids in diet.

Fish and omega-3

FINDINGS:
A new study by UCLA researchers shows that a diet lacking in omega-3 fatty acids, which are commonly found in fish, may cause your brain to age faster and lose some of its memory and thinking capabilities. The research demonstrated that people with lower levels of omega-3 fatty acids have lower brain volumes — equivalent to approximately two years of structural brain aging.

Short telomeres associated with increased risk for chronic diseases, UCSF study finds.

Elissa Epel, UC San Francisco

The ability to anticipate future events allows us to plan and exert control over our lives, but it may also contribute to stress-related increased risk for the diseases of aging, according to a study by UC San Francisco researchers.

In a study of 50 women, about half of them caring for relatives with dementia, the psychologists found that those most threatened by the anticipation of stressful tasks in the laboratory and through public speaking and solving math problems, looked older at the cellular level. The researchers assessed cellular age by measuring telomeres, which are the protective caps on the ends of chromosomes. Short telomeres index older cellular age and are associated with increased risk for a host of chronic diseases of aging, including cancer, heart disease and stroke.

“We are getting closer to understanding how chronic stress translates into the present moment,” said Elissa Epel, Ph.D., an associate professor in the UCSF Department of Psychiatry and a lead investigator on the study. “As stress researchers, we try to examine the psychological process of how people respond to a stressful event and how that impacts their neurobiology and cellular health. And we’re making some strides in that.”

The researchers also found evidence that caregivers anticipated more threat than non-caregivers when told that they would be asked to perform the same public speaking and math tasks. This tendency to anticipate more threat put them at increased risk for short telomeres. Based on that, the researchers propose that higher levels of anticipated threat in daily life may promote cellular aging in chronically stressed individuals.

“How you respond to a brief stressful experience in the laboratory may reveal a lot about how you respond to stressful experiences in your daily life,” said Aoife O’Donovan, Ph.D., a Society in Science: Branco Weiss Fellow at UCSF and the study’s lead author. “Our findings are preliminary for now, but they suggest that the major forms of stress in your life may influence how your respond to more minor forms of stress, such as losing your keys, getting stuck in traffic or leading a meeting at work. Our goal is to gain better understanding of how psychological stress promotes biological aging so that we can design targeted interventions that reduce risk for disease in stressed individuals. We now have preliminary evidence that higher anticipatory threat perception may be one such mechanism.”

The study will be published in the May issue of the journal Brain, Behavior and Immunity.

Research on telomeres, and the enzyme that makes them, was pioneered by three Americans, including UCSF molecular biologist and co-author on this manuscript Elizabeth Blackburn, Ph.D., who co-discovered the telomerase enzyme in 1985. The scientists received the Nobel Prize in Physiology or Medicine in 2009 for this work.

The research related to anticipation was funded by grants from the Division of Behavioral and Social Research at the National Institute of Aging/National Institutes of Health and Bernard and Barbro Foundation as well as by a Society in Science: Branco Weiss Fellowship.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, please visit www.ucsf.edu.

UCLA Health System, Resnick Neuropsychiatric Hospital join with Motion Picture Television Fund on new facility.

The Motion Picture and Television Fund, the 90-year-old charity supporting members of Hollywood’s entertainment industry, today announced a first-of-its-kind affiliation with the UCLA Health System and UCLA’s Resnick Neuropsychiatric Hospital to establish a geriatric psychiatry unit at the MPTF’s Wasserman Campus in Woodland Hills.

The unit, co-branded by the MPTF and UCLA, will provide inpatient and outpatient services to individuals 55 years and older with emotional or behavioral disorders. It will accommodate up to 12 patients and is anticipated to be fully operational, pending regulatory approvals, by the first quarter of 2013.

“This historic linkage with the UCLA Health System is another key piece in the larger strategy we have developed for our organization,” said the MPTF’s CEO Bob Beitcher. “Among our many goals, we are focused on building a health care campus capable of delivering a broad set of services to our industry members and, selectively, to the San Fernando Valley community.”

“UCLA feels privileged to contribute its world-class geriatric expertise to MPTF’s storied campus,” said Dr. David Feinberg, president of the UCLA Health System. “UCLA has enjoyed a long and productive relationship with the entertainment community, and this new affiliation will be a welcome extension of that.”

The new unit’s medical director will hold a faculty position at the David Geffen School of Medicine at UCLA and will participate in the academic and research activities of the university. The MPTF will provide the unit’s clinical caregivers, and MPTF medical staff will collaborate with UCLA at the Wasserman Campus to integrate the practices of geriatric medicine and geriatric psychiatry for industry members. In connection with the MPTF’s social services program, there will also be a focus on the impact of psychiatric illness on caregivers and families.

“UCLA’s Department of Psychiatry is very pleased to be part of this extraordinary affiliation with MPTF,” said Dr. Thomas Strouse, director of the Resnick Neuropsychiatirc Hospital. “We will be bringing specialized faculty and our state-of-the-art geriatric psychiatry treatment program to the MPTF facility in Woodland Hills, and we look forward to a creative alliance that will also encompass wellness, prevention, and health-maintenance clinical research activities,” Strouse added.

The MPTF will make this new service available on a preferential basis to entertainment industry members, as well as to the community. The organization’s previously announced 40-bed long-term care unit and Harry’s Haven, its 30-bed dementia care unit, will remain exclusive to members of the entertainment community.

“The MPTF board is committed to management’s new health care roadmap, and we could not have a higher regard for Dr. David Feinberg, Dr. Gary Small, Dr. Thomas Strouse and the UCLA geriatric psychiatry program,” said Casey Wasserman, an MPTF board member. “UCLA and this team represent the best possible partner for MPTF as it moves into this new service.”

The Motion Picture and Television Fund has served for 90 years as a beacon of hope for entertainment industry members in their time of need. As a charitable organization, the MPTF provides financial assistance and services essential to the well-being of the community and is a leader in the development and implementation of services and programs for seniors and those who care for them. The charity is supported by the generosity of corporate donors and fellow entertainment industry members who contribute their time and money, knowing if they were ever in a tight spot, the MPTF would be there for them too.

The UCLA Health System, which comprises the UCLA Hospital System and the UCLA Medical Group and its affiliates, has provided the best in health care and the most advanced treatment options to the people of Los Angeles and the world for more than half a century. UCLA’s preeminence in health care – a strength that comes from the union of research, teaching and excellence in patient care – continues to be recognized nationally, internationally and in numerous forums. Ronald Reagan UCLA Medical Center, the Resnick Neuropsychiatric Hospital at UCLA, Mattel Children’s Hospital UCLA, and UCLA Medical Center-Santa Monica (which includes the Los Angeles Orthopaedic Hospital) deliver hospital care that is unparalleled in California. Ronald Reagan UCLA Medical Center is consistently ranked one of the top five hospitals in the nation and the best in the western United States by U.S. News & World Report, and the UCLA Medical Group has been ranked among the best in Southern California for four successive years by the Integrated Healthcare Association. UCLA physicians and hospitals will continue to be world leaders in the full range of care, from maintaining the health of families to the diagnosis and treatment of complex illnesses.

New website puts prognostic indices in one central location.

Alexander Smith

A team led by researchers from the San Francisco VA Medical Center and the University of California, San Francisco, has completed the first systematic review of prognostic indices used to calculate a patient’s life expectancy, and created a website that puts these indices in one central location.

The review concludes that the most accurate and usable indices might have value when used in conjunction with other clinical information.

The review appears in the Jan. 11 issue of the Journal of the American Medical Association. The prognostic indices are collected at www.eprognosis.org.

Many medical interventions have guidelines recommending that doctors take a patient’s life expectancy into account, said senior investigator Alexander K. Smith, M.D., M.P.H., a palliative medicine doctor at the UCSF-affiliated SFVAMC.

Given this goal, he said, “It would be ideal if there were one index that would allow you to plug in your patient’s information – age, diseases, functional impairments – and get an accurate long-term prognosis,” Smith said. “Unfortunately, there is not. In the absence of that, we have this systematic review and corresponding online compendium, which we hope physicians will find a useful adjunct, along with patient preferences and their own professional judgments, in making clinical decisions that involve life expectancy.”

The authors note that the 16 indices need further independent testing for accuracy in different settings, and that further studies are needed to show whether use of the indices improves clinical outcomes. In the meantime, they have made the indices more accessible to clinicians and patients who are interested in the information they provide.

“We often don’t talk about prognosis with our patients, and, as clinicians, we are, frankly, not trained to think about it,” said lead author Lindsey Yourman, M.D., a medical student at UCSF at the time of the study. “This can lead to unnecessary suffering when we order invasive interventions for patients who may not live long enough to benefit from them.”

At the same time, she noted, prognostic indexes are not intended to limit care for elders. “In some instances,” she said, “they may lead to more interventions. For example, some older patients may not be offered cancer screening due to their age, but a prognostic index may suggest they are healthy and likely to benefit from cancer screening because of long life expectancy.”

Read more