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RESEARCHERS INTENT ON BRINGING BETTER LIVING TO LONGER LIVES

 "" PHOTO — Physician-scientist Wei Yao reviews an image showing bone density in her research to better understand how bones change with age. At far right, additional images depict varying levels of bone mass.
 
Physician-scientist Wei Yao reviews an image showing bone density in her research to better understand how bones change with age. At far right, additional images depict varying levels of bone mass.
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Thanks to modern medicine, people are living longer than ever before. Therein lies a paradox: Greater longevity means more people suffering from wear and tear on the body.

Now, health-care professionals are increasingly focused on how to manage and slow degenerative conditions – afflictions that don't necessarily kill patients but can make their golden years difficult.

It's a game of catch-up, as the world's proportion of elderly people is expected to grow from one in 10 today to one in five by 2050.

Response to the specific health needs of this substantial patient group requires a detailed understanding of the aging body, as well as studies designed to find the most effective interventions for seniors. Toward that end, researchers at UC Davis are focusing their attention on everything from finding better treatments for osteoporosis to learning more about how eye disease develops and evaluating how seniors access mental health care.

"Americans are living into their late 80s and 90s now, and due to low-grade inflammation, they are degenerating," explains Nancy Lane, director of UC Davis' Center for Healthy Aging and an expert on osteoarthritis and osteoporosis.

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"When people are in pain and can't move, that creates other medical problems, such as obesity, depression and disability. The need to understand the musculoskeletal system is likely the most critical to the health of our nation," says Lane, who holds a UC Davis endowed chair for healthy aging and geriatrics, one of only six such endowments in the state.

Healthy Bones

Lane conducts basic research to learn more about how the bones change with age. Women tend to start losing bone mass around age 55 – when estrogen levels drop – while men don't experience this change until their 80s.

Researcher Wei Yao and Lane have identified a signaling pathway called Wnt (short for wingless from yeast) that appears to be involved in this gender difference. The signaling pathway appears to be influenced by sex hormones, and controls the formation of bones.

PHOTO — Nancy Lane, right, director of the UC Davis Center for Healthy Aging and holder of an endowed chair for aging, collaborates with assistant professor of medicine Wei Yao in finding ways to use stem cells to help repair fractures and build bone mass.  ""

Nancy Lane, right, director of the UC Davis Center for Healthy Aging and holder of an endowed chair for aging, collaborates with assistant professor of medicine Wei Yao in finding ways to use stem cells to help repair fractures and build bone mass.
 
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"We think testosterone may protect men's bones longer," says Yao, assistant professor of medicine.

Women whose bones become thin and weak as a result of osteoporosis are treated with two kinds of bone activators that stimulate new bone growth and increase bone strength. Lane is studying the effects of osteoporosis on bone physiology in a small animal model of osteoporosis. She is trying to determine if sequential treatment of osteoporosis – first with a bone-forming agent, parathyroid hormone fragment hPTH (1-34), followed by an inhibitor of bone loss, a bisphosphonate – is the best longterm treatment for osteoporosis. She recently reported that parathyroid hormone, usually given by daily subcutaneous injection, is delivered more effectively through a new skin patch that can be applied 30 minutes per day.

Perhaps one of the most exciting research projects currently under way in the Aging Center laboratory is exploring the use of stem cells. In collaboration with UC Davis stem cell researchers Kit Lam and Jan Nolta, Yao and Lane are aiming to develop a method to coax to the bone surface a patient's own mesenchymal stems cells that reside deep in the bone marrow. Once at the bone surface, the stem cells could help repair fractures and build bone mass.

Says Lane, "We believe this could be a new way to treat osteoporosis and bone fractures in all age groups."

Maintaining a healthy skeleton also requires tackling osteoarthritis, the number one cause of disability in elderly people. The Wnt signaling pathway also is important in osteoarthritis. Lane's research suggests that the version of the Wnt gene that a person inherits appears to affect the shape of the hip and a person's risk of developing osteoarthritis in that joint.

Lane says that if her research continues to reinforce that finding, physicians might one day perform a genetic test to identify high-risk patients. They could then intervene early to reduce the strain on a patient's hip – with special shoes, for example – to slow deterioration of the joint.

Healthy Eyes

"" PHOTO — Ophthalmologist John Werner conducts research at UC Davis' Vision Science and Advanced Retinal Imaging Laboratory on how to maintain the health of the eye to accommodate a longer life span.
 
Ophthalmologist John Werner conducts research at UC Davis' Vision Science and Advanced Retinal Imaging Laboratory on how to maintain the health of the eye to accommodate a longer life span.
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Like the skeleton, the eyes suffer from wear and tear. Retinal cells have the highest metabolic rate of all cells in the body, so they are vulnerable to any disruption in the delivery of their metabolites via the blood supply, says John S. Werner, a researcher at UC Davis' Vision Science and Advanced Retinal Imaging Laboratory. That's why the risk factors for age-related macular degeneration, a deterioration of the retina, overlap with those for cardiovascular disease. Seniors also have increased susceptibility to cataracts, a condition characterized by clouding of the lens.

According to the organization Research to Prevent Blindness, the number of blind people in the world is expected to double between 1999 and 2030, and many more will have vision impairment.

Healthy Eye, Detahced Retina, Macular Degeneratgion"Some say the lifespan of the eye can't keep up with the lifespan of the body," says Werner. "I think that's too pessimistic. However, we do need to focus on how to maintain the health of the eye to accommodate a longer life span."

Indeed, Werner's optimism helped him garner a $5 million research grant awarded by the National Eye Institute in December. He and colleagues at three collaborating universities will continue their studies using high-tech imaging tools, including adaptive optics developed by astronomers, to investigate how vision changes with age and how eye disease develops.

Werner said they have found that visual sensitivity declines about 25 percent per decade, beginning in adolescence. However, this process appears to be slowed by protection from sunlight and a diet rich in vegetables containing carotenoid pigments.

"What you would do for cardiovascular health is also advisable to do for your eyes," Werner notes.

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His studies also have revealed signs of macular degeneration across the retina that normally can't be detected in the eye doctor's office.

The next step will be to find ways to diagnose the disease earlier.

Healthy Mind

Cognitive function does not necessarily decline with age, but the elderly do have special needs for maintaining mental health. Suicide rates rise sharply for men after age 65.

PHOTO — Ladson Hinton, director of the education core for the UC Davis Alzheimer's Center, is exploring ways to reduce disparities in depression care for older men.  ""

Ladson Hinton, director of the education core for the UC Davis Alzheimer's Disease Center, is exploring ways to reduce disparities in depression care for older men.
 
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"It's really a public health crisis, and unrecognized or under-treated depression is the underlying factor," explains Ladson Hinton, an associate professor in the Department of Psychiatry and investigator at UC Davis' Alzheimer's Disease Center.

Hinton recently conducted a study exploring why older men are undertreated for depression. The results, reflecting the perspectives of primary care physicians, suggested that older men feel uncomfortable asking for help and do not express depression in ways that are easily recognizable to physicians

Depression also may degrade the cognitive health of a spouse.

Hinton analyzed longitudinal data on more than 300 spousal pairs from a five-year study called the Sacramento Area Latino Study on Aging (SALSA). The results, to be published this year, confirmed the hypothesis that living with a depressed spouse affects one's brain health. Living with a partner with higher depressive symptoms was associated with poorer cognitive function over time.

"The finding speaks to the influences of social relationships on cognitive functioning and health," Hinton notes.

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Now, Hinton is working on a four-year project aimed at identifying ways to reduce disparities in depression care for older men. An interdisciplinary team will interview 100 older men who have been depressed, as well as 50 primary-care physicians, in the San Joaquin Valley.

"We want to learn more about how to tailor treatment to better meet the needs and preferences of older men, and to understand if there are cross-cultural differences," says Hinton, who has a background in health-services research and medical anthropology.

Healthy Setting

 "" PHOTO — Tara Sharpp, a post-doctoral fellow at the proposed Betty Irene School of Nursing at UC Davis, is conducting research into the medical needs of residents living at assisted living facilities and whether having a nurse on-site contributes to unnecessary trips to the ER.
 
Tara Sharpp, a post-doctoral fellow at the proposed Betty Irene School of Nursing at UC Davis, is conducting research into the medical needs of residents living at assisted living facilities and whether having a nurse on-site contributes to unnecessary trips to the ER.
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As the senior population grows, so does the number of people living in residential care facilities for the elderly. These places offer assisted living, following a hospitality model similar to a hotel, but they don't offer skilled-nursing care. The senior residents, however, have many medical needs. Studies have found that between 33 and 67 percent of residents had dementia.

Tara Sharpp, a post-doctoral fellow specializing in gerontological nursing at the proposed Betty Irene Moore School of Nursing at UC Davis, is concerned about how well the health needs of residents at these facilities are being met.

Sharpp conducted interviews and made observations at one facility over six months. All of the residents had dementia. And employees – required to have just eight hours of training in dementia care – often expressed that they felt unprepared for the job of caring for seniors. Both assisted-living employees and health-care providers believed that they lacked sufficient understanding of their roles, says Sharpp.

"There were major misunderstandings on both sides."

Sharpp also is concerned that seniors living in these residential facilities are more prone to preventable health problems, such as falls, pneumonia, diarrhea and medication errors. She also suspects that residents' health care is unnecessarily costly, a contention she developed after observing that about 40 percent of the residents in her pilot study were sent to a hospital emergency room in six months.

"If a nurse were there," she says, "he or she could assess for injuries at the facility, possibly eliminating unnecessary trips to the ER."

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To test her hypothesis, Sharpp will collect data in facilities that are owned by nationwide chains. She will investigate how often residents leave to go to the doctor or hospital and what medications they take. She also hopes to compare data between facilities that do and don't have nurses.

Sharpp might also learn more about the training needs of facility employees. She found that many did not recognize just how many residents had dementia and required special care.

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"It's important that the caregivers get the right education from the right people," she notes.

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  "As the senior
population grows, so does the number of people living in residential care facilities for the elderly, many with medical needs.  
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