TAG: "Geriatrics"

Study suggests depression, early death among seniors with disabilities linked

Depressed people less likely to adhere to prescribed medications, diet, exercise.

Carol Mangione, UCLA

People with diabetes have about double the risk of premature death as people of the same age without diabetes. Studies also have shown that they have about twice the odds of suffering from depression, which further increases their mortality risk.

A new UCLA-led study published in the Journal of the American Geriatrics Society found that among adults 65 and older with diabetes, depression is linked with a far greater chance for early death compared with people of the same age who do not have depression.

The researchers suggest that the higher mortality rate among those with depression could stem from the fact that depressed people are less likely than their non-depressed counterparts to adhere to their prescribed medications, diet, exercise and glucose self-monitoring.

The link between depression and mortality among people with diabetes has been the subject of many other studies, but this is the first to specifically compare the phenomenon as it affects those 65 and older with how it affects younger people, said Lindsay Kimbro, project director in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, and the study’s lead author.

Each participant was given a baseline survey and was contacted for a follow-up survey six to seven years after the initial interview.

“We found that depression mainly increases the risk of mortality among older persons with diabetes,” she said. “Although depression is an important clinical problem for people of all ages, when you split the different age groups, depression in the younger group doesn’t lead to increased mortality six to seven years later.”

A significant number of previous reports have linked diabetes and depression with an increased risk for premature death, but Kimbro said it now appears that those results may have been influenced by a focus on elderly patients.

The researchers analyzed information on 3,341 people with diabetes. Their data came from Translating Research Into Action for Diabetes, a study that collected health insurance claims, medical chart review, and phone interviews from 10 health plans in eight states.

The UCLA-led team reviewed information for patients 65 and older (1,402 people) and those who were 18 to 64 (1,939 participants), and measured mortality risk as the number of days until death since the time of the interview. The researchers controlled for age, gender, race and ethnicity, income, and co-morbidities such as heart and kidney disease associated with diabetes.

As in previous studies, the results revealed that the risk for early death among depressed people with diabetes was 49 percent higher than among those without depression. However, the correlation was even more pronounced among older adults: Researchers found a 78 percent higher mortality risk among those 65 and older than they did among non-depressed people with diabetes within that age group. For the younger participants with diabetes, the effect of depression on their risk for early death was not statistically significant.

“Our findings highlight the importance of screening for depression among older adults with diabetes, and of encouraging treatment for those who screen positive,” said Dr. Carol Mangione, a study co-author who holds the Geffen School’s Barbara A. Levey, M.D., and Gerald S. Levey, M.D., endowed chair.

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‘Physician partners’ free doctors to focus on patients, not paperwork

Patient satisfaction increases when doctors have help on administrative tasks.

David Reuben, UCLA

Primary care physicians already have enough administrative duties on their plates, and the implementation of electronic medical records has only added to their burden. As a result, they have less time to spend with their patients.

But a new UCLA study suggests a simple way to lighten their load: a “physician partner” whose role would be to work on those administrative tasks, such as entering information into patient records, that take up so much of doctors’ time. A physician partner allows doctors to focus more of their attention on their patients and leads to greater patient satisfaction with their care, the UCLA researchers say.

The study is published online in the peer-reviewed journal JAMA Internal Medicine.

“Patients want their doctors to spend time with them and give them the attention that makes them feel more confident in their medical care — they don’t want to just sit there while their doctor is on the computer,” said Dr. David Reuben, chief of the division of geriatrics at the David Geffen School of Medicine at UCLA and the study’s primary investigator. “This also saves physicians a huge amount of time after patient sessions end, enabling them to spend more time with their families, keep up with the latest developments in medicine and come back refreshed the next day.”

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UC San Diego launches Center on Healthy Aging and Senior Care

Dilip Jeste named first associate dean and director of center.

Dilip Jeste, UC San Diego

Dilip V. Jeste, M.D., Distinguished Professor of Psychiatry and Neurosciences, has been appointed the first associate dean for healthy aging and senior care at UC San Diego and will direct the newly established Center on Healthy Aging and Senior Care.

The appointment recognizes the broad and growing interest, research and need to improve and promote the long-term health and well-being of older Americans, who comprise an ever-larger percentage of the U.S. population. In 2009, roughly 1 in 8 Americans was 65 years and older. In 2030, that ratio is projected to be 1 in 5.

As the Estelle and Edgar Levi Chair in Aging and director of the Sam and Rose Stein Institute for Research on Aging, both at UC San Diego, Jeste has long been a leading scientist and advocate for greater understanding of how Americans age – and how to help them do so well and healthfully.

“When I first became involved in this type of research two decades ago, aging was viewed as all doom and gloom. Old age was defined by disease, dementia, disability and death. But I’ve found that aging has an important positive side, too. There is, of course, some physical decline and cognitive impairment with aging, but several parts of  psychosocial functioning actually improve. In terms of well-being and emotional regulation, as people get older, even if they are more physically impaired, they tend to be more satisfied with life. It’s the paradox of aging, and it’s something that I think we must address, explore, investigate and understand. We need to stop thinking about how older people are a burden to society and instead focus on how they are a foundation, the personification of resilience, knowledge and wisdom.”

David Brenner, M.D., vice chancellor for health sciences and dean of the School of Medicine, said the new center will help make UC San Diego a local, national and global leader “in not just clinical care, research and training, but also in innovation and health policy for seniors. And Dr. Jeste is, with his unsurpassed scientific expertise, vision and tireless advocacy in these areas, ideally suited to lead this collaborative effort across the campus.”

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Experts question routine mammograms in elderly

UCSF-Harvard study finds tests offer limited benefit to oldest female patients.

Louise Walter, UC San Francisco

Doctors should focus on life expectancy when deciding whether to order mammograms for their oldest female patients, since the harms of screening likely outweigh the benefits unless women are expected to live at least another decade, according to a review of the scientific literature by experts at UC San Francisco and Harvard medical schools.

National guidelines recommend that doctors make individualized screening decisions for women 75 and older. But the analysis, published online in JAMA (March 31), concluded that since this age group was not included in mammography trials, there is no evidence that screening helps them live longer, healthier lives.

The authors said that many women in this age group receive regular mammograms anyway, with no discussion about the uncertain benefit or potential harms of continued testing, which include unnecessary treatment for slow-growing cancers or pre-cancerous lesions that pose no real threat to the women’s lives.

They concluded that women who are expected to live a decade or more should talk with their doctors and weigh the potential benefits of diagnosing a dangerous but treatable cancer through mammography against the possibility of being misdiagnosed or treated aggressively for a cancer that posed no real harm.

“People should be informed that everything we do in medicine can have good and bad effects, and that goes for mammography,” said Louise Walter, M.D., UCSF professor of medicine and chief of the Division of Geriatrics.

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Building muscle may help older adults live longer

UCLA study adds fuel to evidence that muscle mass a better predictor of mortality than BMI.

Preethi Srikanthan, UCLA

New UCLA research suggests that the more muscle mass older Americans have, the less likely they are to die prematurely. The findings add to the growing evidence that overall body composition — and not the widely used body mass index, or BMI — is a better predictor of all-cause mortality.

The study, published in the American Journal of Medicine, is the culmination of previous UCLA research led by Dr. Preethi Srikanthan, an assistant clinical professor in the endocrinology division at the David Geffen School of Medicine at UCLA, that found that building muscle mass is important in decreasing metabolic risk.

“As there is no gold-standard measure of body composition, several studies have addressed this question using different measurement techniques and have obtained different results,” Srikanthan said. “So many studies on the mortality impact of obesity focus on BMI. Our study indicates that clinicians need to be focusing on ways to improve body composition, rather than on BMI alone, when counseling older adults on preventative health behaviors.”

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Genome editing goes hi-fi

Innovative technique in stem cells could boost scientists’ ability to study genetic disease.

Bruce Conklin

Sometimes biology is cruel. Sometimes simply a one-letter change in the human genetic code is the difference between health and a deadly disease. But even though doctors and scientists have long studied the often devastating disorders caused by these tiny changes, replicating these changes in the lab in order to study them in human stem cells has proven challenging. But now, scientists at the UC San Francisco-affiliated Gladstone Institutes have found a way to efficiently edit the human genome one letter at a time—not only boosting researchers’ ability to model human disease, but also paving the way for therapies that cure disease—by fixing these so-called ‘bugs’ in a patient’s genetic code.

Led by Gladstone investigator and professor in the UCSF School of Medicine, Bruce Conklin, M.D., the research team describes in an issue of Nature Methods how they have solved one of science and medicine’s most pressing problems: how to efficiently and accurately capture rare genetic mutations that cause disease—as well as how to fix them. This pioneering technique highlights the type of out-of-the-box thinking that is often critical for scientific success.

“Advances in human genetics have led to the discovery of hundreds of genetic changes linked to disease, but until now we’ve lacked an efficient means of studying them,” explained Conklin. “To meet this challenge, we must have the capability to engineer the human genome, one letter at a time, with tools that are efficient, robust and accurate. And the method that we outline in our study does just that.”

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Grant will help program continue training for safe senior driving

TREDS works to assist older drivers with health issues that may put them, other drivers at risk.

Linda Hill, UC San Diego

Linda Hill, UC San Diego

For the seventh consecutive year, the Training, Research and Education for Driving Safety (TREDS) program at the UC San Diego School of Medicine has been awarded a grant from the California Office of Traffic Safety (OTS) that will help keep our roadways and senior drivers safe through professional training.

TREDS works with health care providers and law enforcement to identify and assist older drivers with health issues that may put them and other drivers at risk. Driving abilities decrease with age due to physical impairments such as vision, cognition, frailty and the use of medications. Prescription and over-the-counter medications can significantly impair necessary driving skills, including eye sight, reaction time, judgment, hearing, simultaneous task processing and motor skills. Additionally, when drugs are mixed with alcohol, the results can be devastating. According to studies, a 10 mg of Valium has been found to be equivalent to a blood alcohol content (BAC) of 0.10 in its ability to impair driving.

“Physicians have a responsibility to their patients and to the public to help minimize driving risks through appropriate prescribing practices and patient counseling,” said Linda Hill, M.D., M.P.H., professor of family and preventive medicine, UC San Diego School of Medicine and TREDS program director. “It is estimated that 78 percent of drivers 55 years old and older are using at least one prescription medication with the potential to impair driving, yet only 28 percent of senior drivers are aware that their medications have this potential effect. Patients over 65-years-old make up 12 percent of the population, yet they consume 31 percent of prescribed drugs.”

Antidepressants are an example where both the medication and the disease being treated can affect driving safety. Depression increases the crash risk two to three times, and equally worrisome is that antidepressant medications have been associated with more than double the crash risk in the elderly.  Muscle relaxers, anti-anxiety and anti-insomnia medications also adversely affect the safety of senior drivers.

Diabetes drugs, chemotherapy and narcotics can also result in impaired judgment, confusion, drowsiness, nausea and dehydration, all likely to impair driving safety.

“The frailness associated with cancer and chemotherapy alone reduces driving skills and increases crash risks,” said Hill. “Individuals should understand the medications they are taking and how they can impair their driving abilities.”

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Aging Baby Boomers, higher health care costs to impact long-term care

UC Berkeley study finds that costs could nearly double over next decade.

William Dow, UC Berkeley

William Dow, UC Berkeley

UC Berkeley School of Public Health researchers state in a new study that an unprecedented increase in seniors over the next decade could nearly double Medi-Cal long-term care costs, from $6.6 billion to $12.4 billion annually by 2023.

“This long-anticipated increase in seniors will impact Medi-Cal long-term care costs,” said lead researcher William Dow, professor of health economics and head of the School’s Health Policy and Management division, which released the socioeconomic analysis. “The huge baby boomer generation is now retiring. Over the next 10 years, California will experience a 44 percent increase in seniors, jumping from 4.8 million today to 6.9 million by 2023.”

An 88 percent increase in public expenditures for institutional long-term care is projected over the next decade. Since nearly 90 percent of long-term care is provided by family and friends, the growing demands not only impact state coffers, but family caregivers as well. Family caregivers, the study says, report higher levels of mental and physical health problems and are generally uncompensated for their services. For their employers, the demands of caregiving also hurt productivity and increase absenteeism.

“The burdens on family caregivers are enormous,” explained Brenda Bufford, chief of the state of California’s Partnership for Long-Term Care, which funded the study. “This research highlights those challenges, which are especially pressing when you realize that 70 percent of seniors will need long-term care.”

The study concluded that Californians should strongly consider planning ahead to ensure they live their later years with quality and dignity. At some point, they may require in-home or nursing home assistance with basic, daily functions that are often taken for granted. Without proper planning, paying for long-term care can be a devastating financial burden.

California Partnership for Long-Term Care is a consumer education program of the California Department of Health Care Services. Californians can log onto the Partnership for Long-Term Care website, which offers a free planning tools and access to long-term care insurance policies.

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UCSF to establish Health Workforce Research Center

Center to examine capacity of health care workforce to meet growing long-term care needs.

Joanne Spetz, UC San Francisco

Joanne Spetz, UC San Francisco

UC San Francisco has been awarded one of three Cooperative Agreements from the U.S. Bureau of the Health Professions to establish the UCSF Health Workforce Research Center (HWRC).

According to director Joanne Spetz, Ph.D., the task of the center will be to examine the supply, demand, distribution and capacity of the health care workforce to meet the needs of older adults and persons with disabilities, many of whom will be likely to prefer receiving long-term care at home or in community-based settings.

“The aging of the U.S. and global populations – the so-called ‘Silver Tsunami’ – means that an increasing number of us will require long-term care when we can no longer care for ourselves,” said Spetz, a professor of economics at the UCSF Philip R. Lee Institute for Health Policy Studies in the Department of Family and Community Medicine and associate director of research strategy at the UCSF Center for the Health Professions.

“Simply managing the activities of daily living often requires ongoing care from a combination of licensed and unlicensed health workers,” she observed. “We believe that the demand for these workers will increase significantly in the coming years. Health policy decision-makers need tools and strategies to ensure that the U.S. has an adequate workforce to meet our long-term care needs.”

Spetz will lead the UCSF HWRC with Deputy Director Susan Chapman, Ph.D., R.N., associate professor in the Department of Social and Behavioral Sciences at the UCSF School of Nursing. The center represents a collaboration among the Institute for Health Policy Studies, the UCSF Center for the Health Professions and the UCSF School of Nursing. Spetz and Chapman also are affiliated faculty at the Center for the Health Professions.

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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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