TAG: "Geriatrics"

Groundbreaking 90+ Study will continue


National Institute on Aging renews funding for UC Irvine’s study of the “oldest old.”

Claudia Kawas, UC Irvine

Claudia Kawas, UC Irvine

UC Irvine’s trailblazing 90+ Study, launched in 2003 to learn more about the “oldest old,” the fastest-growing age group in the U.S., will continue for at least another five years, thanks to a $9.5 million renewal grant from the National Institute on Aging.

Previously funded by two five-year NIA awards totaling $20 million, the 90+ Study is the longest continuing research effort focused exclusively on the distinctive health and lifestyle issues of Americans in their 90s or older.

It’s among the largest studies of the oldest old in the world, with clinical, pathological and genetic research being conducted on more than 1,600 participants. Based at the Clinic for Aging Research & Education in Laguna Woods, the project is co-directed by Dr. Claudia Kawas, a geriatric neurologist and professor of neurology and neurobiology & behavior, and Maria Corrada, an epidemiologist and associate adjunct professor of neurology.

“We are fortunate in this time of sequestration that our comprehensive and robust study continues to receive federal funding,” Kawas said. “There truly isn’t anything like the 90+ Study. Results obtained thus far have provided researchers across the globe with valuable information about aging.”

While there are currently nearly 2 million nonagenarians in the U.S., that number is projected to increase to 10 million to 12 million by the middle of the century, raising concerns that the current health care system may not be able to accommodate this population.

The UC Irvine study is among the few to look at dementia in people over age 90. The progressive brain dysfunction gradually curtails daily activities. The most well-known type of dementia is Alzheimer’s disease. Symptoms include memory loss, cognitive disorientation and behavioral changes. Dementia affects not only patients but also people surrounding them, as long-term care is often required.

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UCLA, MPTF plan health system integration


Partnership will strengthen relationship between the two organizations.

David Feinberg, UCLA

David Feinberg, UCLA

The UCLA Health System and the Motion Picture and Television Fund have signed a letter of intent that would bring MPTF’s six outpatient health centers under the UCLA umbrella.

This partnership between two of Los Angeles’ iconic institutions will mean that entertainment industry members and their families can continue to get health care at MPTF facilities, with the added advantage of being able to access UCLA’s world-renowned specialty care and inpatient services.

This partnership strengthens the relationship between the two organizations, which are already working together on a geriatric psychiatry unit at MPTF’s Wasserman Campus in Woodland Hills.

“We couldn’t have found a better partner than UCLA Health System to future-proof the provision of high-quality health care for our entertainment industry community — care that they deserve and have come to expect from our doctors,” said Bob Beitcher, CEO of MPTF. “UCLA has committed to operating the health centers exclusively for the use of industry members, with the same physician group and same clinical staff at the same locations. This is a winner for all stakeholders.”

After completing a definitive agreement and securing board approval, the MPTF and UCLA plan to integrate the two operations in late spring 2014.

“We are excited and energized about our partnership with the Motion Picture and Television Fund,” said Dr. David Feinberg, president of the UCLA Health System and CEO of the UCLA Hospital System. “UCLA recognizes its obligation to help provide the highest quality patient care to residents throughout Los Angeles County, and affiliating with MPTF, which has a long history of community-based, skilled patient care, is a significant step toward helping us achieve that goal.”

Under the arrangement, the UCLA Health System would assume the leases for the MPTF sites, and all 43 primary care physicians at the clinics would join the UCLA Faculty Practice Group, with many also joining the faculty of the David Geffen School of Medicine at UCLA.

All other MPTF programs and services, including “The Home” (all levels of residential care), the 40-bed long-term care unit, the 30-bed memory impairment unit and all social services programs, such as financial assistance, Elder Connection, the Home Safety Program and many others, will still be solely operated by MPTF.

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Lack of parental warmth, childhood abuse linked to health risks in adulthood


Study finds biological link for how negative early-life experiences affect physical health.

Teresa Seeman, UCLA

Teresa Seeman, UCLA

The effects of childhood abuse and a lack of parental affection can last a lifetime, taking a toll both emotionally and physically.

Many reports have assessed the psychological damage resulting from childhood abuse; the effects of such abuse on physical health have also been well documented. The “toxic” stress resulting from abuse has been linked to elevated cholesterol, cardiovascular disease, metabolic syndrome and other physical conditions that pose a significant health risk. But research into the physical effects of abuse has so far focused on separate, individual systems rather than on the body as a whole.

Now, a UCLA-led study examines for the first time the effects that abuse and a lack of parental affection have across the body’s entire regulatory system and finds a strong biological link for how these negative early-life experiences affect physical health. But the researchers also found that parental warmth can mitigate some the health impact of early abuse.

The study is published online in the journal Proceedings of the National Academy of Science.

“Our findings suggest that there may be a way to reduce the impact abuse has, at least in terms of physical health,” said Judith E. Carroll, a research scientist at the Cousins Center for Psychoneuroimmunology at UCLA and lead author of the study. “If the child has love from parental figures, they may be more protected from the impact of the abuse on adult biological risk for health problems than those who don’t have that loving adult in their life.”

The researchers studied 756 adults who had participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study They measured 18 biological markers of health risk, including blood pressure, heart rate, stress hormones, cholesterol, waist circumference, inflammation and blood-sugar regulation. They added up participants’ risks across these markers to create a summary index called “allostatic load.” Values at the upper range across these markers indicated they were at higher biological risk for disease.

Previous research has shown that higher levels of allostatic load are associated with an increased likelihood of a negative health event, such as a heart attack or stroke, and with declines in physical or cognitive functioning.

To determine the study subjects’ childhood stress, the researchers used a well-validated self-report scale called the Risky Families Questionnaire.

They found a significant link between reports of childhood abuse and multisystem health risks. But those who suffered abuse and reported higher amounts of parental warmth and affection in childhood had lower multi-system health risks than abused individuals who didn’t experience such warmth and affection. Conversely, individuals reporting low levels of love and affection and high levels of abuse in childhood had the highest multi-system risk in adulthood.

The researchers suggest that toxic childhood stress alters neural responses to stress, boosting individuals’ emotional and physical arousal to threats and making it more difficult for that reaction to be shut off.

“Our findings highlight the extent to which these early childhood experiences are associated with evidence of increased biological risks across nearly all of the body’s major regulatory systems,” said the paper’s senior author, Teresa Seeman, a professor of medicine in the division of geriatrics at the David Geffen School of Medicine at UCLA and a professor of epidemiology at UCLA’s Fielding School of Public Health. “If we only look at individual biological parameters such as blood pressure or cholesterol, we would miss the fact that the early childhood experiences are related to a much broader set of biological risk indicators — suggesting the range of health risks that may result from such adverse childhood exposures.”

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Lifestyle changes may lengthen telomeres, a measure of cell aging


Diet, meditation, exercise can help key element of immune cell aging, UCSF scientists report.

A small pilot study shows for the first time that changes in diet, exercise, stress management and social support may result in longer telomeres, the parts of chromosomes that affect aging.

It is the first controlled trial to show that any intervention might lengthen telomeres over time.

The study will be published online today (Sept. 16) in The Lancet Oncology.

The study was conducted by scientists at UC San Francisco and the Preventive Medicine Research Institute, a nonprofit public research institute in Sausalito that investigates the effect of diet and lifestyle choices on health and disease. The researchers say they hope the results will inspire larger trials to test the validity of the findings.

“Our genes, and our telomeres, are not necessarily our fate,” said lead author Dean Ornish, M.D., UCSF clinical professor of medicine, and founder and president of the Preventive Medicine Research Institute.

“So often people think ‘Oh, I have bad genes, there’s nothing I can do about it,’” Ornish said. “But these findings indicate that telomeres may lengthen to the degree that people change how they live. Research indicates that longer telomeres are associated with fewer illnesses and longer life.”

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Healing harmonies


UCSF community project will launch choirs in San Francisco to study elder well-being.

Music – as poets have noted – has the power to wash away the dust of everyday life, and medical experts believe it may also imbue physical and social benefits.

Now a UC San Francisco research project is exploring whether singing in a community choir can provide tangible health advantages to older adults.

Over the next four years, a dozen choirs will be created at senior centers around San Francisco. The first group already has launched at the Mission Neighborhood Centers, and recruitment of choir members is under way in the Bayview and Western Addition neighborhoods.

To join Community of Voices, choir members must be 60 years of age or older – no prior choral experience is needed. Altogether, approximately 400 seniors will take part in weekly, 90-minute singing sessions over the course of a year.

The project will assess the impact on participants’ cognition, mobility and overall well-being during their choral year. The researchers also will examine whether singing in a community choir is a cost-effective way to promote health among culturally diverse older adults.

Community of Voices is a collaboration among UCSF, the nonprofit San Francisco Community Music Center, and the San Francisco Department of Aging and Adult Services. The Community Music Center is providing choir directors and other professional music leadership.

“We evaluate a variety of health outcomes and try to measure the mechanism of health changes – we’ll look at mood, loneliness and memory,” says principal investigator Julene Johnson, Ph.D., a cognitive neuroscientist and professor at the UCSF School of Nursing’s Institute for Health & Aging. Johnson, who studies mild cognitive impairment in older adults, also is an amateur musician who plays flute and has sung in community choirs.

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Obituary: David Solomon, UCLA leader in geriatrics and medicine


Hailed as a legendary figure, he was 90.

David Solomon

David Solomon

Dr. David H. Solomon, who led a major expansion of the UCLA Department of Medicine, created the campus’s geriatrics program to deal effectively with the unique health care needs of the elderly, and was the first board-certified endocrinologist in Los Angeles, died July 9 at his home in Thousand Oaks. He was 90.

Solomon received many awards from various medical societies in recognition of his contributions and was the author of 220 scientific papers in peer-reviewed journals, four books, 49 book chapters and 32 editorials, letters and popular articles.

“Dr. Solomon is a legendary figure at UCLA and nationally in internal medicine, endocrinology and geriatrics,” said Dr. David Reuben, chief of the geriatrics division at the David Geffen School of Medicine at UCLA. “His legacy will live on.”

Solomon was born March 7, 1923, and raised in Brookline, Mass. He graduated from Brown University in 1944 and entered Harvard Medical School that year. By taking courses year-round, he was able to complete medical school in two years, graduating magna cum laude in 1946. After graduation, Solomon married his wife, Ronda Markson. He completed his internship and residency at the Peter Bent Brigham Hospital in Boston and fulfilled his two-year military commitment in the U.S. Public Health Service at the Gerontology Research Center in Baltimore.

Solomon was recruited to the new UCLA School of Medicine in 1952. He became the first board-certified endocrinologist in Los Angeles and led the development of the division of endocrinology in the new department of medicine at UCLA. In 1966, he was named chief of medicine at Harbor General Hospital, where he expanded UCLA’s training program. He returned to UCLA’s main campus in 1971 as executive chair of the department of medicine, holding that position until 1981.

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Women suffer higher rates of decline in aging, Alzheimer’s disease


UC San Diego study finds women experience greater regional brain loss over time than men.

The rates of regional brain loss and cognitive decline caused by aging and the early stages of Alzheimer’s disease (AD) are higher for women and for people with a key genetic risk factor for AD, say researchers at the UC San Diego School of Medicine in a study published online July 4 in the American Journal of Neuroradiology.

The linkage between APOE ε4 – which codes for a protein involved in binding lipids or fats in the lymphatic and circulatory systems – was already documented as the strongest known genetic risk factor for sporadic AD, the most common form of the disease. But the connection between the sex of a person and AD has been less-well recognized, according to the UC San Diego scientists.

“APOE ε4 has been known to lower the age of onset and increase the risk of getting the disease,” said the study’s first author Dominic Holland, Ph.D., a researcher in the Department of Neurosciences at UC San Diego School of Medicine. “Previously we showed that the lower the age, the higher the rates of decline in AD. So it was important to examine the differential effects of age and APOE ε4 on rates of decline, and to do this across the diagnostic spectrum for multiple clinical measures and brain regions, which had not been done before.”

The scientists evaluated 688 men and women over the age of 65 participating in the Alzheimer’s Disease Neuroimaging Initiative, a longitudinal, multi-institution study to track the progression of AD and its effects upon the structures and functions of the brain. They found that women with mild cognitive impairment (a condition precursory to AD diagnosis) experienced higher rates of cognitive decline than men; and that all women, regardless of whether or not they showed signs of dementia, experienced greater regional brain loss over time than did men. The magnitude of the sex effect was as large as that of the APOE ε4 allele.

“Assuming larger population-based samples reflect the higher rates of decline for women than men, the question becomes what is so different about women,” said Holland. Hormonal differences or change seems an obvious place to start, but Holland said this is largely unknown territory – at least regarding AD.

“Another important finding of this study is that men and women did not differ in the level of biomarkers of Alzheimer’s disease pathology,” said co-author Linda McEvoy, Ph.D., an associate professor in the UCSD Department of Radiology. “This suggests that brain volume loss in women may also be caused by factors other than Alzheimer’s disease, or that in women, these pathologies are more toxic. We clearly need more research on how an individual’s sex affects AD pathogenesis.”

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Guidelines help doctors answer question: ‘How long do I have to live?’


Clinicians can use framework in communicating uncertain prognoses.

“How long do I have to live?” is a question senior citizens and those battling terminal illness often ask their doctors.

Now, a UC San Francisco-led team of physicians publishing in today’s (June 26) New England Journal of Medicine have created a set of guidelines for doctors and other clinicians to use for communicating uncertain prognoses to patients.

Prognosis – the science of predicting how long a patient will live – can be a complex undertaking because uncertainty is an inherent part of predicting medical outcomes.

Alexander Smith, UC San Francisco

“It used to be that making a prognosis was a fundamental part of what we did, and that’s waned over time as we’ve focused more on diagnosis and treatment,” said senior author Alexander K. Smith, M.D., M.P.H., assistant professor of medicine in the UCSF Division of Geriatrics. “But providing a prognosis is still an essential part of what we do. Patients ask about it. It is important for nearly every medical decision in older adults.” (See an earlier video with Smith about assessing life expectancy of older patients.)

Smith and his colleagues at University of Pittsburgh assessed what clinicians’ responsibility should be for providing a prognosis. “On the one hand,” he said, “they should not use uncertainty as an excuse to avoid the conversation entirely.  On the other hand, how should they help patients deal with uncertain information, given that uncertainty tends to produce so much anxiety in patients?”

The co-authors developed several guidelines for clinicians to use in addressing the issue with patients.

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Nurse practitioners can help boost quality of primary care for older patients


Study highlights key role nurse practitioners can play in treating chronic geriatric conditions.

David Reuben, UCLA

U.S. residents today are living longer than previous generations, thanks to improved public health and medical treatment. But they’re also living longer with chronic geriatric health conditions like dementia, urinary incontinence, depression and debilitating falls, which often require complex medical care.

Doctors spend significant time and resources treating individuals with chronic conditions, and the average family physician can become severely overtaxed managing care for such patients. The picture becomes even worse with chronic geriatric conditions.

Several heath care treatment models have been designed over the years to improve medical care for chronic geriatric ailments. One model, for instance, helped improve patient care by teaming geriatricians in an academic medical center setting with nurse practitioners to co-manage care. But can the same model work in community-based primary care settings?

The answer is yes, according to a UCLA-led study published in the June issue of the Journal of the American Geriatrics Society. The study’s findings highlight the crucial role nurse practitioners can play in treating chronic geriatric conditions.

“It is becoming increasingly clear that care of chronic geriatric conditions is better when it’s done in teams,” said the study’s lead author, Dr. David Reuben, chief of the geriatrics division in the department of medicine at the David Geffen School of Medicine at UCLA. “There are some things that nurse practitioners do better than doctors and some things that doctors do better than nurse practitioners.”

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Memory improves for older adults using computerized brain-fitness program


Study is one of first to assess cognitive effects of a computerized memory-training program.

Prabha Siddarth, UCLA

FINDING:
UCLA researchers have found that older adults who regularly used a brain-fitness program on a computer demonstrated significantly improved memory and language skills.

The UCLA team studied 69 dementia-free participants, with an average age of 82, who were recruited from retirement communities in Southern California. The participants played a computerized brain-fitness program called Dakim BrainFitness, which trains individuals through more than 400 exercises in the areas of short- and long-term memory, language, visual-spatial processing, reasoning and problem-solving, and calculation skills.

The researchers found that of the 69 participants, the 52 individuals who over a six-month period completed at least 40 sessions (of 20–25 minutes each) on the program showed improvement in both immediate and delayed memory skills, as well as language skills.

The findings suggest that older adults who participate in computerized brain training can improve their cognitive skills.

IMPACT:
The study’s findings add to a body of research exploring whether brain fitness tools may help improve language and memory and ultimately help protect individuals from the cognitive decline associated with aging and Alzheimer’s disease.

Age-related memory decline affects approximately 40 percent of older adults. And while previous studies have shown that engaging in stimulating mental activities can help older adults improve their memory, little research had been done to determine whether the numerous computerized brain-fitness games and memory training programs on the market are effective in improving memory. This is one of the first studies to assess the cognitive effects of a computerized memory-training program.

AUTHORS:
Authors of the study were Karen Miller, Ph.D., an associate clinical professor at the Semel Institute for Neuroscience and Human Behavior at UCLA, and Prabha Siddarth, Ph.D., a research statistician in psychiatry and biobehavioral sciences at the Semel Institute. Both are available for interviews.

FUNDING:
The study was funded in part by Dakim, manufacturer of Dakim BrainFitness, the computerized program used in the study. Miller and Siddarth have served as consultants on the development of the software included in the program.

JOURNAL:
The study is published in the July issue of the American Journal of Geriatric Psychiatry. A copy of the full study is also available.

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Alzheimer’s and low blood sugar in diabetes may trigger a vicious cycle


UCSF researcher urges caution on use of certain diabetes drugs in dementia patients.

Kristine Yaffe, UC San Francisco

A new UC San Francisco-led study looks at the close link between diabetes and dementia, which can create a vicious cycle.

Diabetes-associated episodes of low blood sugar may increase the risk of developing dementia, while having dementia or even milder forms of cognitive impairment may increase the risk of experiencing low blood sugar, according to the study published online today (June 10)  in JAMA Internal Medicine.

Researchers analyzed data from 783 diabetic participants and found that hospitalization for severe hypoglycemia among the diabetic, elderly participants in the study was associated with a doubled risk of developing dementia later. Similarly, study participants with dementia were twice as likely to experience a severe hypoglycemic event.

The study results suggest some patients risk entering a downward spiral in which hypoglycemia and cognitive impairment fuel one another, leading to worse health, said Kristine Yaffe, M.D., senior author and principal investigator for the study, and a UCSF professor of psychiatry, neurology and epidemiology based at the San Francisco VA Medical Center.

“Older patients with diabetes may be especially vulnerable to a vicious cycle in which poor diabetes management may lead to cognitive decline and then to even worse diabetes management,” she said.

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UC Health ranks among best in nation


U.S. News gives high marks to UC medical schools.

University of California Health ranked among the nation’s best graduate schools in a survey released today (March 12) by U.S. News & World Report.

Five UC medical schools placed in the top 50 nationally for research rankings and four placed in the top 40 nationally for primary care rankings.

In research, UC San Francisco was the top-ranked public school and tied for fourth among all U.S. schools, with UCLA 13th overall, UC San Diego 15th, and UC Davis and UC Irvine tied for 42nd. In primary care, UCSF ranked fourth, UCLA ranked 11th, UC Davis tied for 19th and UC San Diego tied for 39th, with UC Irvine tied for 66th. UCSF has the only medical school ranked in the top five of both categories.

UC medical schools also received high marks in a number of specialty programs. UCSF ranked first for its medical program in AIDS, second in both internal medicine and women’s health, tied for second in drug/alcohol abuse education, fourth in family medicine, sixth in geriatrics, and seventh in pediatrics. UCLA ranked third in geriatrics, seventh in drug/alcohol abuse education, tied for ninth in AIDS and 10th in women’s health. UC San Diego ranked ninth in drug/alcohol abuse education and 11th in AIDS.

U.S. News’ 2014 America’s Best Graduate Schools rankings were released online today (March 12) and can be viewed at www.usnews.com/grad.

The new rankings include previous assessments of a number of other health fields, which U.S. News also surveys but not each year. UCLA ranked first in clinical psychology, UCSF ranked first in pharmacy, UC Davis ranked second in veterinary medicine, UCSF ranked fourth for both its master’s of nursing program (tied) and its nursing-midwifery program, while in public health UC Berkeley tied for eighth and UCLA was 10th. The surveys do not rank dental or optometry schools.

UC Health runs five academic health centers and the nation’s largest health sciences education system with more than 14,000 students and 18 health professional schools and programs in medicine, dentistry, nursing, optometry, pharmacy, public health and veterinary medicine. UC’s sixth medical school, UC Riverside, will enroll its first class this fall.

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