REDIRECT 7410R
https://dworakpeck.usc.edu/news/aging-against-all-odds-usc-social-work-professor-investigates-forgotten-hiv-population

“I wasn’t expecting to be alive past 12, then 15, then 35-ish, and now I’m a fluffy 50 and having to deal with a system that’s not ready for me,” said Bobby Wiseman, who has severe hemophilia and is HIV-positive. “We weren’t supposed to get old.”

In the 1980s nearly 90% of people with severe hemophilia, a genetic disorder that prevents blood from clotting properly and typically results in death in young adulthood, contracted HIV from tainted blood products used to treat their disease and half of the people with hemophilia in America died. Today, that story has receded into largely forgotten history, but many of those who did survive have now become the first cohort of people with hemophilia in history to live past 50, thanks to advances in treating both hemophilia and HIV.

“Navigating Time and Space: Experiences of Aging with Hemophilia” is the first research study to address this groundbreaking cohort. Sara Schwartz, clinical associate professor at the USC Suzanne Dworak-Peck School of Social Work and National AIDS Memorial Board Member co-led the study of this little-known chapter of the HIV/AIDS crisis and its implications for today’s aging hemophilia survivors with Tam E. Perry, associate professor at the Wayne State University School of Social Work.

“As someone who has been active in the HIV and AIDS community for many years, it blew my mind and shamed me that I didn’t know this history,” Schwartz said. “This is such a powerful story of resilience. It has completely pivoted my work. They are the first cohort to age and it’s important to document their stories and collect information from them while we can.”

With support from medical sociologist Charles Kaplan, former associate dean of social work at USC, and Dana Francis, a social worker at the University of California San Francisco, the research team evaluated participants in four key gerontological areas: self-care, social networks, the meaning of home/aging in place and productive aging contributions. Their investigation focused on strategies to optimize functioning, shifting the perceptions of time and ways to better address the needs of this underserved population.

“With this study, NHF’s Innovative Investigator Research Award is going to a social worker for the first time ever,” said Len Valentino, president and chief executive officer of the National Hemophilia Foundation. “Social workers are part of the critical foundation, along with research and advocacy, to ensure that people and families impacted by inheritable blood disorders may thrive.”

Uncharted territory for aging

For people with hemophilia, a relatively minor injury can turn into a life-threatening bleed if not appropriately treated, so the things that many of us take for granted as we age — colonoscopies, heart care, long-term residential care — are uncharted territory for this group and their medical professionals. Having survived so far beyond their own and everyone else’s expectations, they are having to advocate for themselves and create a new path forward for the patients with bleeding disorders who will follow them.

“This research definitely highlights the medical needs in my not-so-distant future and beyond,” said Patrick Lynch, a 36-year-old filmmaker and health advocate with severe hemophilia. “I’m going to be the beneficiary of this, but only if I’m paying attention.”

This cohort of persons surviving with hemophilia also faces a host of unforeseen issues associated with aging. Eighty-eight percent of study participants reported being profoundly affected by their unexpected longevity. With the expectation of a short lifespan, most did not plan for the future — the practicalities of careers, 401Ks or savings accounts. Many did not marry or have children, either because their HIV or hemophilia status isolated them socially or because they did not think they would be around long enough.

“It was not on the concept to say invest in this because it was like, ‘to hell with it, I’m going to be dead,'” Wiseman said. “And now it’s this whole thing that I might be here until I’m 85.”

Decades of chronic physical pain, isolation from peers and the disorienting feeling of facing a future they never expected to have, as well as survivor’s guilt, have also created complex psycho-emotional needs. Across the board, study participants called for great mental health support tailored to their population, which often includes intersectionality with HIV status, sexual orientation, age and race.

“It was a medical holocaust,” said Francis, who has focused on the hemophilia community since 1988 and literally seen many of the survivors in the study grow up from children and teenagers, even as many more of their cohort passed. “The younger generation doesn’t know what they don’t know. I want this information to be there when they get to 50.”

The study also explores how the perception of a time horizon often influences our actions, emotions and goals. Using Socioemotional Selectivity Theory to understand what it means when nearness to death expands rather than contracts, many of these findings may have application in use with long-term HIV survivors and, as life expectancy grows longer for typical Americans, broader implications and insights for aging overall.

“It is so important to realize that the stigma and discrimination of marginalized communities has such a corrosive impact on society and that it also directly impacts others,” said John Cunningham, chief executive officer of the National AIDS Memorial. “In the case of AIDS, the hemophilia community was devastated, losing half of all people with hemophilia in a short ten years. It is important to remember injustice upon one is injustice upon all.”

Beyond the fallacy of a “men-only” disease

Schwartz plans to expand on her research to include a focus on women with bleeding disorders. Until recently, it was falsely perceived that men primarily developed hemophilia and women were only the carriers. Now it is being discovered that women can also suffer from the disease, but because the symptoms are often milder or it expresses itself through longer periods of menstrual bleeding, it has often been discounted by doctors. As more women are correctly diagnosed, other serious health complications are being discovered from years of iron deficiency.

“I discovered the hemophilia community and what they’re going through today and I just couldn’t look away,” said Schwartz. “This is a very traumatized and wounded community. They have been overlooked and stigmatized and ostracized. I want to share their story and that’s what I will continue to do.”

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REDIRECT https://stemcell.keck.usc.edu/stopping-arthritis/

In Americans undergo knee and hip replacements each year. It’s a last resort treatment for pain and mobility issues associated with osteoarthritis, a progressive disease caused by degeneration of the protective layer of cartilage that stops our bones grinding together when we sit, stand, write, or move around.

But what if doctors could intervene and repair damaged cartilage before surgery is needed?

For the first time, researchers at the Keck School of Medicine of USC have used a stem cell-based bio-implant to repair cartilage and delay joint degeneration in a large animal model. The work will now advance into humans with support from a $6 million grant from the California Institute of Regenerative Medicine (CIRM).

The research, recently published in npj Regenerative Medicine, was led by two researchers at the Keck School of Medicine of USC: Denis Evseenko, MD, PhD, associate professor of orthopaedic surgery, and stem cell biology and regenerative medicine, director of the skeletal regeneration program, and vice chair for research of orthopaedic surgery; and Frank Petrigliano, MD, associate professor of clinical orthopaedic surgery and chief of the USC Epstein Family Center for Sports Medicine.

Osteoarthritis occurs when the protective cartilage that coats the ends of the bones breaks down over time, resulting in bone-on-bone friction. The disorder, which is often painful, can affect any joint, but most commonly affects those in our knees, hips, hands and spine.

To prevent the development of arthritis and alleviate the need for invasive joint replacement surgeries, the USC researchers are intervening earlier in the disease.

“In some patients joint degeneration starts with posttraumatic focal lesions, which are lesions in the articular (joint) cartilage ranging from 1 to 8 cm2 in diameter,” Evseenko said. “Since these can be detected by imaging techniques such as MRI, this opens up the possibility of early intervention therapies that limit the progression of these lesions so we can avoid the need for total joint replacement.”

That joint preservation technology developed at USC is a therapeutic bio-implant, called Plurocart, composed of a scaffold membrane seeded with stem cell-derived chondrocytes–the cells responsible for producing and maintaining healthy articular cartilage tissue. Building on previous research to develop and characterize the implant, the current study involved implantation of the Plurocart membrane into a pig model of osteoarthritis. The study resulted in the long-term repair of articular cartilage defects.

“This is the first time an orthopaedic implant composed of a living cell type was able to fully integrate in the damaged articular cartilage tissue and survive in vivo for up to six months,” Evseenko said. “Previous studies have not been able to show survival of an implant for such a long time.”

Evseenko said molecular characterization studies showed the bio-implant mimicked natural articular cartilage, with more than 95 percent of implanted cells being identified as articular chondrocytes. The cartilage tissue generated was also biomechanically functional–both strong enough to withstand compression and elastic enough to accommodate movement without breaking.

With support from the $6 million translational grant from CIRM, the researchers are using this technology to manufacture the first 64 Plurocart implants to be tested in humans.

“Many of the current options for cartilage injury are expensive, involve complex logistical planning, and often result in incomplete regeneration,” said Petrigliano. “Plurocart represents a practical, inexpensive, one-stage therapy that may be more effective in restoring damaged cartilage and improve the outcome of such procedures.”

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REDIRECT https://keck.usc.edu/medicaid-expansion-linked-to-reductions-in-mortality-according-to-usc-research/

In 2010, the newly passed Affordable Care Act — also known as Obamacare — mandated that states expand Medicaid eligibility to cover millions of uninsured Americans. But when the Supreme Court made Medicaid expansion optional for states, close to half opted out. Today, close to a quarter of states still have not increased access to Medicaid, and Medicaid expansion is now at the center of a national debate about President Biden’s Build Back Better legislation.

Just published research from the Keck School of Medicine of USC sheds new light on that debate. According to a study in The Lancet Public Health, making Medicaid available to more people reduces fatalities. The study shows that expanding Medicaid may result in an overall drop of approximately 3.8 percent in adult deaths each year.

“Using national data to look for results on a population level, we analyzed five federally-maintained registries covering states that have increased Medicaid access as well as those that have not,” said lead researcher Brian P. Lee, MD, MAS, an assistant professor of clinical medicine at the Keck School. “We found that Medicaid expansion exerts an influence on mortality rates – and the magnitude of benefit is correlated with the magnitude of expansion.”

The study found that, among 32 expansion states and 17 non-expansion states, Medicaid expansion was associated with nearly 12 fewer deaths per 100,000 adults annually. The findings could have important public policy implications for improving health outcomes and optimizing quality of care.

Clear benefits, mixed results

Implementation of the optional Medicaid expansion began in 2014 and provided health coverage for an additional 12 million Americans. Lee’s study tracked data during the first four years of expansion eligibility, from 2014-2018.

One of the study’s most important findings is that the reduction in all-cause mortality was associated with the state-level reduction in the uninsured population, even in states that did not expand Medicaid. The findings suggest that increasing the number of people with health insurance is the mechanism driving the improvements in mortality associated with Medicaid expansion.

Although the study showed clear benefits from Medicaid expansion, they varied by state and by disease.

“The reduction in all-cause mortality was most associated with the number of women and non-Hispanic Black residents in each state. States that have chosen not to expand Medicare have higher proportions of poor and Black residents, so they may have the most to gain from adopting Medicaid expansion,” Lee said.

Different illnesses also yielded different results.

“We showed that Medicaid expansion led to fewer cardiovascular and respiratory deaths, which makes sense: More access to specialty care and prescription drugs likely means fewer deaths related to chronic diseases,” Lee said. “At the same time, the data reveal that expanding Medicaid did not impact cancer-, infection- or opioid-related deaths, which may not be as influenced by preventative care.”

Bridging the gaps

Data on fatalities resulting from complications of opioid use was preliminary, but Lee pointed to it as one of the study’s most interesting findings.

“Certain states – like Delaware, New Hampshire and New Jersey – have actually seen an increase in opioid-related mortality associated with Medicaid expansion. Some people have hypothesized that gaining access to prescription pain medication may result in more opioid-related deaths. Our study shows that hypothesis is something that needs to be explored more definitively,” he said.

However, Lee says there may also be other influences at play.

“We know from experience that, even if they have access to services, patients with substance use disorders may not have access to the right services, or to services in a timely manner,” Lee said. “So, even after we bridge the insurance gap – i.e., covering more people with Medicaid or other health plans – there are probably services gaps that need to be addressed in order to maximize the mortality-related benefits.”

A controlled approach

Lee’s study was designed to take multiple factors into consideration. Earlier data had indicated that both the uninsured rate and the mortality rate were already going down prior to Medicaid expansion in 2014. To account for this, Lee and his colleagues conducted a difference-in-differences analysis, controlling for previous trends as a way to establish the accuracy of their findings.

“This allowed us to assess the absolute difference in all-cause and cause-specific mortality after Medicaid expansion,” he said.

Ultimately, the results may inform the work of policymakers nationally and in countries considering changes in access to public health services.

“Continued Medicaid expansion may be a tool for policymakers to address ongoing wealth- and race-disparities, providing a ladder to improved health outcomes and social mobility for these underserved populations,” Lee said.

About the study

In addition to Lee, other authors of the study include Jennifer Dodge, MPH, and Norah Terrault, MD, also from USC.

This study was funded in part by the USC Research Center for Liver Disease (P30DK048522).

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A new study at the @KECKSchool_USC shows that expanding Medicaid access is associated with nearly a 4% reduction in adult deaths per year.

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USC Research Professor Skip Rizzo thought his mother might like a trip to Rome.

She put on a virtual reality headset, and soon her face was aglow: “Oh! Carl and I used to love this little bar that was right over here.” The visuals brought back memories from 35 years ago when she visited Italy with her husband; this time, Rizzo was right there with her, in a postage stamp-sized video off to one side.

It’s an elegantly simple thing — a VR headset preloaded with spherical video of the world’s great cities. The killer feature is the ability to email a Zoom-like link from the headset itself — and voila, the VR user has a companion for her travels, and the companion can share the view on their own device.

“When I did it the first time, I felt like I was having a conversation with someone in that location, walking around and doing stuff,” said Rizzo, director for medical virtual reality at the USC Institute for Creative Technologies. He consulted with the medical device company Penumbra on the project. “Now, imagine someone in a care facility across the country. Instead of a phone call where you’re trying to figure out what to say when somebody isn’t engaging, it’s ‘Do you want to go to Rome?’ ‘Do you want to go to London today?'”

Skip Rizzo’s mother takes a virtual tour of Rome. (Video/Skip Rizzo)

There are few Americans who do not have an aging family member, friend, neighbor or colleague living with health and mobility challenges that come with advancing years. Millions of those individuals are facing another blow: Alzheimer’s disease or another form of dementia. It’s unclear when disease-altering treatments will arrive, so researchers are starting to look at ways that technology can enhance life and relieve some of the difficulties of caregiving.

Rizzo is best-known for his research using virtual reality to treat PTSD in veterans. He’s also developed “virtual humans” to interact, via computer, with service members who may need mental health services but don’t want to talk to anyone about it. Now, with his 89-year-old mother living with him, he’s returning to an earlier interest in gerontology.

Years ago, Rizzo visited nursing homes where he would find residents gathered at a table, sitting in silence. He had a stack of large cards featuring images of old household appliances or a silent movie marquee. When he pulled out a picture of a wringer washer, the room lit up. “Oh, I had one of those!” “I remember those!”

In research-speak, he was “providing relevant stimuli for stimulating remote memory, aka Reminiscence Therapy.” Even if they couldn’t remember what they had for breakfast, Rizzo said, they could access well burnt-in memories from earlier in their lives, which activated them in a positive way.

Possibilities of VR and aging populations

If low-tech flash cards can bring joy and encourage engagement with the world, imagine the possibilities with virtual reality and Siri-like assistants. Rizzo said some companies are producing content that is relevant for older populations, and early research is showing that users are calmer, happier and looking forward to their daily experiences.

Such moments of pleasure are a needed boost in quality of life for both caregiver and care recipient. Research shows that most family caregivers of people with dementia report a high or very high level of emotional stress; finding ways to reduce that stress is increasingly important to comprehensive dementia care.

That’s why Rizzo and his colleague Elizabeth Zelinski, a professor of gerontology and psychology at the USC Leonard Davis School of Gerontology, are exploring ways to create a personalized “virtual caregiver support agent.”

The idea is to have a virtual helper responsive to the spoken word — like iPhone’s Siri, but embodied as a character that pops up on a phone or smart TV. The primary caregiver inputs biographical details about the care recipient so that the virtual helper can engage with the user.

VR and aging populations: From reminders to walks down memory lane

The No. 1 function would be programming in reminders for medication or doctor appointments, Rizzo said. The No. 2 function would be to fill in for memory lapses. For example, the user could say, “I can’t remember my niece’s name but I don’t want to bug my husband.” If that information isn’t in the system, a pop-up reminder prompts the caregiver to fill it in later.

The result is a support agent or companion that’s not only a stimulus for the user, but also a source of respite for the caregiver. The knowledge base is enriched over time, incorporating old or personal photos to prompt memories. The virtual agent can offer simple games like checkers.

Which is much like the way Rizzo spends time with his mother: “We always walk down memory lane and play games and stuff. So I would like to build out a virtual version of me.”

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REDIRECT https://gero.usc.edu/2021/09/30/immigration-boosts-u-s-life-expectancy-according-to-usc-princeton-study/

If immigrants to the United States formed their own country, their pre-COVID-19 life expectancies would exceed or match those of the world’s leaders in longevity — Swiss men and Japanese women. A new study by USC and Princeton researchers estimates that immigration adds 1.4 to 1.5 years to U.S. life expectancy at birth. In 2017, foreign-born life expectancy reached 81.4 and 85.7 years for men and women, respectively. That’s about 7 and 6.2 years longer than the average lifespan of their U.S.-born counterparts.

“Demographers knew that immigrants lived longer. The main question that we set out to answer was, ‘How much is this really contributing to national life expectancy trends?'” said Arun Hendi, the lead author of the study and an assistant professor of sociology and public affairs at the Princeton School of Public and International Affairs. “Our results show that they’re making an outsized contribution to national life expectancy.”

The study was published in the September 2021 issue of SSM Population Health, by Hendi and Jessica Ho, an assistant professor of gerontology and sociology at the USC Leonard Davis School of Gerontology. Their work provides new insights on how immigrants contributed to national life expectancy trends over nearly three decades, from 1990 to 2017.

The research suggests that immigrants are responsible for approximately half of the recent U.S. gains in life expectancy. Moreover, the gap in life expectancy between foreign-born and native-born residents is widening.

In fact, the researchers say, Americans’ life expectancy would steeply decline if it weren’t for immigrants and their children. Under that scenario, U.S. life expectancy in 2017 would have reverted to levels last seen in 2003 — 74.4 years for men and 79.5 years for women — more closely resembling the average lifespans of Tunisia and Ecuador.

Study shows diverging trends during the last decade

Prior research has shown that between 2010 and 2017, overall U.S. life expectancies saw an unprecedented stagnation. The plateau has been largely attributed to drug overdose deaths among adults in their prime working ages and slowdowns in the rate of improvement in cardiovascular disease mortality. But this new study shows that immigrants experienced life expectancy gains during this period, while the U.S.-born population experienced declines.

“If it weren’t for immigrants, our national life expectancy stagnation that we experienced since 2010 would instead be a national decline in life expectancy,” Ho said. “For them to have that large an impact is unexpected because they represent a relatively small proportion of the U.S. population.”

In addition, while the immigrant advantage was already present in 1990, the research shows that the difference between immigrants and the U.S.-born has widened substantially over time, with the ratio of American-born to foreign-born mortality rates nearly doubling by 2017.

“When compared to immigrants’ life expectancy, the U.S.-born are doing poorly. Much of this is related to their very high mortality at the prime adult ages,” said Ho, an expert in the social determinants of health and mortality. “Low mortality among prime-aged immigrants doesn’t just help the foreign-born — it helps the U.S.-born too. Prime-aged adults are likely to be in the labor force and raising children. This means that they contribute to higher tax revenues and slower population aging.”

Hendi says this is particularly relevant today because those prime adult ages are where the country is losing years of life due to drug overdose mortality and other preventable causes of death.

“The fact that immigrants are doing well suggests that there is a capacity to thrive in the U.S., but the U.S.-born aren’t fulfilling that potential,” he said.

Immigrants are a small but influential share of the U.S. population

Immigrants make up under 15% of the U.S. population, up from around 8% in 1990 but still a small percentage of the total. Hendi and Ho cite healthy behaviors and the changing selectivity of the immigrant population as factors that may contribute to their influence on total life expectancy.

“Immigrants tend to be healthier in part due to the selective migration of those who have the health, resources and stamina to migrate to the U.S., and this selectivity may have grown stronger,” Ho said.

The researchers highlight the role of increases in high-skilled immigration, which is partly reflected in changes in countries of origin as immigrant streams shift from Mexico to places like India and China. They also note that there may be pro-longevity characteristics of immigrant populations, regardless of country of origin, including a lower propensity to drink, smoke and use drugs than U.S.-born residents.

“Many of America’s immigrants come from lower-income, less-developed nations, leading some to worry that these immigrants bring their home countries’ high-mortality conditions with them and thus drag down America’s national average longevity,” Hendi said. “But the results say just the opposite. Far from dragging down the national average, immigrants are bolstering American life expectancy. A big part of the story appears to be that immigrants take fewer risks when it comes to their health.”

The study additionally found that the children of foreign-born residents retain some life expectancy advantage but do not fare as well as their parents.

Hendi and Ho used data from the National Vital Statistics System and the U.S. Census Bureau to estimate life expectancy levels among foreign-born, U.S.-born and total populations between 1990 and 2017.

The team plans to examine COVID-19’s impact on immigrant life expectancies. A January 2021 study by USC and Princeton researchers found the COVID-19 pandemic had significantly affected life expectancy, with stark declines in life expectancy among Black and Latino populations. A separate USC study last July of a large diverse group of Medicaid enrollees found Latino patients had starkly higher odds than whites of testing positive for COVID-19 as well as higher odds of hospitalization and death.

More about the study:

This work was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grants R00 HD083519 and P2C HD047879) and the National Institute on Aging (grant R01 AG060115) at the National Institutes of Health.

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REDIRECT https://gero.usc.edu/2021/09/07/master-of-science-in-gerontology-brett-anderson/

Turning 28 is a mixed blessing for a musician. So many music legends died at age 27, there’s a club named for them, the 27 Club. When Brett Anderson turned 28, she was grateful to make that milestone but realized she wasn’t exactly a legend. “I realized I didn’t want to burn hot and flare out early,” she says.

Legend or not, Brett Anderson and her band, The Donnas, were rock stars. They made eight records and travelled the world. At the height of their popularity in the early 2000s, they performed on Saturday Night Live, The Late Show with David Letterman and the main stage at Lollapalooza.

Now, as a master’s student at USC Leonard Davis, Anderson is surprised she found herself pulled in this direction. “I spent basically the first 20 years of my career trying to rebel and go against the grain.”

But after the 2008 recession, the band slowed down, and Anderson found herself with some time on her hands. She took classes at Los Angeles City College and eventually enrolled in the psychology program at Stanford University. There, she took a class in longevity which completely changed her perspective.

“Aging suggests decline and loss,” Anderson says. “Longevity focuses on what it takes to overcome disease and maintain a positive attitude as you get older.” The distinction inspired her to pursue not one, but two graduate degrees. She’s currently working on a Master of Science in Gerontology at USC and a Master of Social Work at UCLA.

Helping students create personalized career paths

Having struggled with substance use, Anderson has a specific interest in aging and addiction. She says, “In late onset addiction, people have made it through a whole career and life. And then something happens — pain medication or an adverse event — and they find themselves dealing with a substance use disorder.”

USC Leonard Davis gives Anderson the opportunity to pursue her interests to create a unique career path. It starts with faculty who know how to engage students and provide a sound foundation in gerontology.

One of those faculty is Associate Professor Paul Nash, who impressed Anderson with his ability to connect with the students. “He assesses our level of knowledge, comes down to meet us at that level, then brings us up to the next level. You really get the feeling that you’re being taught by the best,” Anderson says.

Associate Professor Susan Enguidanos, who teaches about end-of-life care, also inspired Anderson. Enguidanos gives her class several assignments that explore death and dying in very personal ways. “These exercises seemed light and easy at first but became very deep as we discussed them as a class,” Anderson says. “It’s amazing when you have a group where everyone is interested in talking about what it means to have a good death.”

Training the next generation of aging scholars

Set in the largest private university in California, USC Leonard Davis is a small school. Anderson says, “It’s warm, accepting and accessible. You can pretty much know everybody if you want to.”

Anderson felt included even before she was admitted. “When I asked if I could bring my mom to an admission event they said, ‘Sure, bring her along!’ They were so nice to her. She had the best time.”

Anderson loves being surrounded by people who feel an urgency about serving the booming aging population. She says, “When I’m out in the world, I feel like people aren’t giving it enough attention. But when I come to school, I see the people who are going to make a difference.”

Anderson knows her classmates will be her colleagues someday. They will be the next generation of aging scholars and will work together to change the future of aging.

Drawing a line between music and gerontology

Looking back on her music career, Anderson sees parallels with her future career path. For example, as a female group in a male dominated industry, The Donnas fought against gender stereotypes. In her future work, Anderson will need to address stereotypes in aging and addiction.

Anderson and The Donnas also pushed boundaries. By writing, producing and performing their own work, the band made a statement that anyone could do rock and roll. With her two master’s degrees, Anderson is poised to rock the status quo in the gerontology world as well.

Music is never far away from Anderson, though. Currently, she has a field placement at the Motion Picture Television Fund. They offer varying levels of care to people who were in the entertainment industry. Anderson says, “Recently, the activities department was considering starting a band and asked if I wanted to be involved. Of course, I said yes to that.”

The post Former rock star seeks master’s to address addiction in older adults appeared first on USC News.

Associate Professor Julie Zissimopoulos: the impact and economics of Alzheimer’s

On the need for policy changes:

“I think one important policy change is solutions to support family caregivers in the workplace, compensation programs. But this isn’t going to be enough. Demographic trends suggest that family caregiving as the main source of care is likely not sustainable. People are having fewer children, and there are more Americans with dementia. So we really need an insurance system to cover long-term care. The current system does not function well. [Those] who take it up tend to only be those at high risk with very high healthcare costs. So we need to be a little innovative here, maybe consider a voluntary auto-enrollment in long-term care insurance with an opt-out much like what has worked well in the retirement savings market.”

“Medicare could also help; we had a new benefit of Part D that covers drug expenditures and protects against very high out-of-pocket spending for those beneficiaries with high drug expenditures. This was very successful. Medicare could do something similar for long-term care, but it will be very costly. So we will need to figure out who will pay, how we will finance this and, and who is going to bear the costs of this. Will it be the younger generation through taxes on, say, health insurance premiums? If so, how are we going to make sure that they don’t bear the full burden?”

Assistant Professor Marc Vermulst: the role of genetic mutations in human aging and disease

On the origins of Alzheimer’s and Parkinson’s disease:

“One of the things I’m really interested in is the occurrence of age-related diseases, for example Alzheimer’s and Parkinson’s disease. And one of the major questions is ‘why do people get these diseases?’ There are families that have a mutation that makes them more predisposed to getting these diseases, but that really only explains five to maybe 15% of all of the cases. The remaining 85 to 95%, we really have no clue why these people get these diseases. So what I’m trying to do is I’m trying to explain these remaining 85%.”

‘Because all of these diseases are caused by misfolded proteins, and transcription errors cause these misfolded proteins, I think that we have found a new mechanism that can cause these diseases. And if the mechanism is indeed correct, that means we can now do something about it. So it’s really about finding the origin of the disease itself in order to be able to design medicine for it.’

Associate Professor Hussein Yassine: Uncovering links between nutrition, genes, and risk for Alzheimer’s disease

On what can people do to reduce Alzheimer’s disease risk:

“I think timing is key. I think if you know that you are at increased risk based on family history or APOE4 genotype, nutritional and lifestyle interventions during middle age will provide you likely the most benefit. Our research and others suggest that between the ages of 45 and 65, those at risk individuals should be on certain lifestyle modifications, whether it is at least one serving of fatty fish per week, or some good exercise regimen. We’re not talking about marathon running; maybe three times a week, 15 minutes per day is good enough. Lifestyle modifications, no smoking, reduced consumption of simple sugars to avoid complications of diabetes and obesity, increased intake of green leafy vegetables, which are enriched in polyphenols and antioxidants, good sleep, listening to music, certain forms of meditation, or, in some individuals, praying. And all of these factors have a positive effect on mitigating or decreasing the chances of getting Alzheimer’s.”

Professor John Tower: the roles of sex differences and mitochondria on aging

On sex-specific interventions:

“I think what I would expect is we’re going to see sex-specific interventions in aging and aging-related diseases, even diseases common to the male and the female, like Parkinson’s and Alzheimer’s, that having an intervention that’s tailored to the male or the female will be more efficacious.”

Research Associate Professor Donna Benton: Family Caregiving Challenges During COVID-19

On how to better support dementia caregivers:

“The policies need to be there so that we get better diagnoses, that we have more physicians who are trained to recognize and help family members, that social services and physicians also know where to refer people to once they have a diagnosis of dementia and how to help the family because … the physician isn’t going to be there to help with support groups. They’re not going to become the support group person. They’re not going to help them navigate other social services. But if they make the right referral to, say, the Alzheimer’s Association or AARP or a California Caregiver Resource Center system, that actually helps start the process so that the caregiver will have somebody who they can call whenever they need to. … Over the course of many years, as the disease progresses, you’re going to need different training [and] different information.”

Professor Mara Mather: Slowing down the progression of Alzheimer’s disease

On the potential benefits of meditation:

“One study, which looked at a large sample of people who have practiced meditation for many years versus people who have not practiced meditation, found that when they just used a machine learning technique to guess at how old the brains were of each person, this algorithm guessed that on average, the meditators’ brains were 7.5 years younger than their actual age, compared to the control brains, which were non-meditators and didn’t show that effect. So it seems that meditation is associated with benefits for actual brain health, which is really interesting.”

Professor Christian Pike: Sex differences in Alzheimer’s disease

On the differences between men and women regarding Alzheimer’s disease:

“There are so many differences between men and women in Alzheimer’s disease. I mean, at the core of it, the disease is very much the same across all people. But then when you begin to break it down into the effects of different risk factors, you begin to see significant differences. … And in recent years there’s been a greater emphasis on sex differences in the more we look, the more differences between the male brain and the female brain that we find.”

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REDIRECT https://keck.usc.edu/keck-school-awarded-2-million-to-help-identify-if-financial-vulnerability-is-a-risk-factor-for-alzheimers-disease/

The Han Research Lab at the Keck School of Medicine has been awarded a $2 million grant from the National Institute of Health (NIH) to study the link between financial decision making and Alzheimer’s Disease. The collaboration between primary investigator Duke Han, PhD, and co–investigators Laura Mosqueda, MD, Hussein Yassine, MD, Annie Nguyen, PhD, and Xinhui Wang, PhD seeks to find out if vulnerability to financial exploitation can help identify older adults at risk for cognitive decline.

The study titled, “Finance, Cognition, and Default Network in Aging (FCDNA)” will follow 180 older adults for three years measuring cognition, behavioral economic preferences, neuroimaging and genetics. By leveraging both quantitative data and qualitative interviews, the team hopes to better understand financial vulnerability in older age and how this relates to risk factors for Alzheimer’s disease. This knowledge may help inform intervention and preventive care for those who may be at risk for dementia.

“We care immensely about the health and financial wellbeing of older adults,” shares Han. “In addition to the quantitative measurements such as neuroimaging and genetic testing, we are interviewing people to hear their stories. We hope our work leads to the development of new ways that might benefit older adults.”

In the United States, it is estimated that older adults are exploited for an estimated $3 billion to $36 billion annually. Additionally, financial abuse of older adults is the most common type of elder abuse and is associated with significant health issues. In identifying these markers early, health care professionals can learn how to detect and intervene to help older adults with their cognitive health and overall wellbeing as they age.

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A team of international researchers has found that the Tsimane indigenous people of the Bolivian Amazon experience less brain atrophy than their American and European peers. The decrease in their brain volumes with age is 70% slower than in Western populations. Accelerated brain volume loss can be a sign of dementia.

The study was published Wednesday in The Journal of Gerontology, Series A: Biological Sciences and Medical Sciences.

Although people in industrialized nations have access to modern medical care, they are more sedentary and eat a diet high in saturated fats. In contrast, the Tsimane have little or no access to health care but are extremely physically active and consume a high-fiber diet that includes vegetables, fish and lean meat.

“The Tsimane have provided us with an amazing natural experiment on the potentially detrimental effects of modern lifestyles on our health,” said study author Andrei Irimia, an assistant professor of gerontology, neuroscience and biomedical engineering at the USC Leonard Davis School of Gerontology and the USC Viterbi School of Engineering. “These findings suggest that brain atrophy may be slowed substantially by the same lifestyle factors associated with very low risk of heart disease.”

The researchers enrolled 746 Tsimane adults, ages 40 to 94, in their study. To acquire brain scans, they provided transportation for the participants from their remote villages to Trinidad, Bolivia, the closest town with CT scanning equipment. That journey could last as long as two full days with travel by river and road.

The team used the scans to calculate brain volumes and then examined their association with age for Tsimane. Next, they compared these results to those in three industrialized populations in the U.S. and Europe.

The scientists found that the difference in brain volumes between middle age and old age is 70% smaller in Tsimane than in Western populations. This suggests that the Tsimane’s brains likely experience far less brain atrophy than Westerners as they age; atrophy is correlated with risk of cognitive impairment, functional decline and dementia.

The researchers note that the Tsimane have high levels of inflammation, which is typically associated with brain atrophy in Westerners. But their study suggests that high inflammation does not have a pronounced effect upon Tsimane brains.

The Tsimane: healthy hearts and — new research shows — healthy brain aging

According to the study authors, the Tsimane’s low cardiovascular risks may outweigh their infection-driven inflammatory risk, raising new questions about the causes of dementia. One possible reason is that, in Westerners, inflammation is associated with obesity and metabolic causes. In the Tsimane, however, it is driven by respiratory, gastrointestinal and parasitic infections. Infectious diseases are the most prominent cause of death among the Tsimane.

The Tsimane can serve as a baseline for healthy brain aging.

Hillard Kaplan

“Our sedentary lifestyle and diet rich in sugars and fats may be accelerating the loss of brain tissue with age and making us more vulnerable to diseases such as Alzheimer’s,” said study author Hillard Kaplan, a professor of health economics and anthropology at Chapman University who has studied the Tsimane for nearly two decades. “The Tsimane can serve as a baseline for healthy brain aging.”

The indigenous Tsimane people captured scientists’ — and the world’s — attention when an earlier study found them to have extraordinarily healthy hearts in older age. That prior study, published by The Lancet in 2017, showed that Tsimane have the lowest prevalence of coronary atherosclerosis of any population known to science and that they have few cardiovascular disease risk factors. The very low rate of heart disease among the roughly 16,000 Tsimane is very likely related to their pre-industrial subsistence lifestyle of hunting, gathering, fishing and farming.

“This study demonstrates that the Tsimane stand out not only in terms of heart health but brain health as well,” Kaplan said. “The findings suggest ample opportunities for interventions to improve brain health, even in populations with high levels of inflammation.”

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In addition to Irimia and Kaplan, study authors include Nikhil N. Chaudhari, David J. Robles, Kenneth A. Rostowsky, Alexander S. Maher, Nahian F. Chowdhury, Maria Calvillo, Van Ngo, Margaret Gatz, Wendy J. Mack and Caleb E. Finch (USC), E. Meng Law (Monash University), M. Linda Sutherland, James D. Sutherland and Gregory S. Thomas (MemorialCare, Fountain Valley, Calif.), Christopher J. Rowan (Renown Regional Medical Center), L. Samuel Wann (Ascension Healthcare), Adel H. Allam (Al-Alzhar University, Egypt), Randall C. Thompson (St. Luke’s Mid America Heart Institute), David E. Michalik (University of California, Irvine), Daniel K. Cummings and Edmond Seabright and Paul L. Hooper (University of New Mexico), Sarah Alami and Michael D. Gurven (University of California, Santa Barbara), Angela R. Garcia and Benjamin C. Trumble (Arizona State University, Tempe) and Jonathan Stieglitz (Institute for Advanced Study, Toulouse, France).

Research funding was provided by the National Institute on Aging at the National Institutes of Health (grant RF1 AG 054442) and the Institute for Advanced Study in Toulouse and the French National Research Agency under the Investments for the Future (Investissements d’Avenir) program (grant ANR-17-EURE-0010).

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If you’re looking for Jake Pham and Eloise Martinez, you might find them together on FaceTime. The physical therapy student and senior are separated by 50 miles and almost 50 years. Their connection should be in person, but fate had other plans when the pandemic hit.

“With Eloise, I’ve been very fortunate that she and I had a great connection,” Pham said. “There’s good chemistry and we bonded very easily, so we talked for a minimum of one hour. Sometimes we go up to three hours a week.”

Pham, a 25-year-old physical therapy student at USC and Martinez, a 72-year-old retiree from Fontana, Calif., were brought together in part by the pandemic.

Pham is one of 91 students who took part in the USC Interprofessional Geriatrics Curriculum during the past academic year.

The curriculum, housed at the Keck School of Medicine of USC, unites students from seven disciplines: medicine, occupational therapy, physical therapy, physician assistant, psychology, pharmacy and social work. A team is formed along the professional model where health experts from various disciplines support an older partner.

We consider our older adult partners to be our teachers.

Cheryl Resnik

“We consider our older adult partners to be our teachers,” said faculty adviser Cheryl Resnik, associate professor of clinical physical therapy at the USC Division of Biokinesiology and Physical Therapy. “When COVID struck, we had an older population at high risk. People were isolated and they needed a human connection, but we couldn’t put seven students and the faculty member in somebody’s home so we had to rework it.”

Bonnie Olsen, professor of clinical family medicine at the Keck School of Medicine, leveraged a grant to help get devices into the hands of seniors who needed them. Olsen, who heads the larger Geriatric Workforce Enhancement Program, drove the quick turn from in-person to online support.

Wanted: a little help with FaceTime

Pham, an inherently patient man who finds energy in human connection, managed to bridge gaps between operating systems and generations.

“It’s kind of along the same lines as working with my parents or working with patients in a clinic — I’ve learned to be a little bit more understanding,” he said. “With Eloise, I’d put my phone on speaker and I’d be very descriptive. I’d say ‘look for this icon’ or ‘look for the green arrow.’ Eloise is sharp. After I walked her through it, she called me on FaceTime. That’s how we started.”

“My problem was I had a device and I had no idea what I could do with it,” said Martinez, whose husband Alex also takes part in the Interprofessional Geriatrics Curriculum. “Jake’s got me to where I can FaceTime with my daughter and see my grandson in New Mexico.”

Many hours and conversations later, Pham and Martinez stay in touch. Now that both are vaccinated, they hope to someday meet in person.

USC’s Interprofessional Geriatrics Curriculum helps to break down siloes

Conducted in at least five languages, including Russian, Korean and Chinese, the curriculum is guided by veteran faculty advisers like Seyed Parham Khalili, clinical assistant professor of family medicine at the Keck School of Medicine.

“We’re stronger together, and better informed, when we combine our strengths,” he said. “That’s one of the other major benefits of the program. It’s a confluence of ideas. It’s teaching them to learn on their own how to work interprofessionally and how to break down these unfortunate silos between health professionals.”

Throughout the past academic year, teams met online with faculty advisers to talk about patient care. Several brought up concerns about their older adult partners who were homebound and had limited mobility. Physical therapy students offered recommendations for safe exercises while students from the USC Suzanne Dworak-Peck School of Social Work contributed ideas about how to screen for mood disorders.

We’re stronger together, and better informed, when we combine our strengths.

Seyed Parham Khalili

Others helped provide reassurance and information as pandemic rumors ran rampant.

Physical therapy student Kristen Ishii connected with an older adult who was fearful about the disease and vaccinations.

“Some of her friends had warned her she could die from the vaccine because of underlying conditions,” Ishii said. “I tried to compare it to another common vaccine, the flu shot. Based on her expression, the light bulb was starting to turn on. I think the reassurance of having someone she trusts, outside her friend circle, was helpful.”

For USC students, educating older adults goes both ways

Henry Steyer, a medical student at the Keck School of Medicine, plans to practice primary care, often the first point of contact for a patient. Over the past year, he’s checked in with 72-year-old Silvia Padilla at least once a month.

“People have been dealing with really hard things during this pandemic,” Steyer said. “Silvia has a big family, but she hasn’t been able to see them. She’s used to cooking for others and helping others, so she misses that, but she’s always able to find the silver lining.”

Padilla has little trouble with tech. She and Henry go over her grocery lists and daily routines on Zoom. They talk about exercise, stress, nutrition and the latest COVID news. They sometimes text between video chats.

“I felt like I had known him for a long time,” Padilla said. “We’d talk a lot about how I felt throughout that week, and he would coach me through.”

The benefits go both ways.

“Just talking is helpful to education as well,” Steyer said, “because that’s part of what I’m going to do for the rest of my life.”

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