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February 2013

Aging People/Aging Planet

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“Head Above Water” – a mixed media by Orna Makleff

Climate change doesn’t just threaten our planet; it also poses enormous challenges for older adults, say acclaimed artists Mary Lou Dauray and Orna Makleff.

Inspired to take creative action and draw attention to this global problem, the two have created an artistic exhibition, “Aging People/Aging Planet,” which will run from March 2 through June 21 at USC’s Institute for Genetic Medicine Art Gallery at the Keck School of Medicine.

“Our hope is that the show will inspire people to use art as a tool to teach the younger generation to express their concerns for this situation,” Dauray said. “We want them to realize that everyone has the innate potential to creatively help our planet.”

The seed for the show was planted back in 2003, after the most intense heat wave since 1540 swept Europe, leaving thousands of older adults dead. Horrified by the events, Dauray and Makleff began to research the connections between massive climate change and the health of the population most susceptible to it: the elderly.

According to a recent report by the National Institutes on Health: “Elderly adults living in poverty or on limited fixed incomes may lack resources to pay for air conditioning during heat waves, they may live in substandard housing that leaves them more vulnerable to flooding and strong winds, or they may not have easy access to social services or to adequate transportation to evacuate when devastating weather events occur. In additional, functional and physiological limitations associated with aging could impede elderly people’s ability to adapt.”

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“Ice Cave” – a watercolor by Mary Lou Dauray

So what can be done?  One solution to both substandard housing and the unique challenges to the elderly during natural disasters is universal design.  This includes a set of principles that create safe and accessible environments and communities for people of all ages and abilities.  Additionally, increased awareness by all ages of this population’s potential vulnerability can go a long way in preventing unnecessary tragedy and hardship.

Makleff and Dauray hope that their show will open eyes and hearts as well as start important discussions that don’t just concern older adults but also include and empower them. Making all this possible is the transformative power of art: a force as universal as the weather itself.

“Making art always been a way to learn, to see and to teach,” Dauray said. “With this show, our hope is that our art will speak eloquently to a worldwide issue and potentially help effect real change.”

“Aging People/Aging Planet” opens on March 2, 2013 with a celebration from 4-6 pm and runs through June 21, 2013 at USC’s Institute for Genetic Medicine Art Gallery at the Keck School of Medicine (2250 Alcazar Street, CSC 240) in Los Angeles, CA.

Reexamining End-Of-Life Care

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DSC_6914ElderBranch, a resource for people looking for senior careproviders, recently published a series of articles regarding end-of-life care: where we are today, innovative models and interviews with experts.

Below is an excerpt from our interview with Susan Enguídanos, PhD, of the USC Leonard Davis School of Gerontology about a palliative care program that she helped design in partnership with Partners in Care Foundation.

ELDERBRANCH: Generally speaking, what’s broken, missing or lacking when it comes to end-of-life care?

SUSAN ENGUIDANOS: One of the biggest problems is that end of life really starts sooner – in terms of the decline. People get end-of-life care usually in the last three weeks of life, which is in hospice, but you really don’t have any other mechanism in our system to address the decline that starts much earlier.

Our whole health care system is designed to cure and provide care for people who are healthy and can navigate the system, but we don’t have anything that provides the other needs that people have as they start to decline and experience serious health problems.

ELDERBRANCH: Can you describe the Kaiser Permanente program that you helped design?

SUSAN ENGUIDANOS: In terms of the model, it looks a lot like hospice. We have physicians, social workers, nurses, homes health aides, chaplains and it’s all home-based. The frequency of it is predicated on the needs of the patient.

One of the other critical components is that they have access to information – medical personnel, 24 hours a day. So if they had a crisis, they could pick up the phone, call somebody, and reach a nurse who can reach a doctor at any time. What we’re finding in some of the work I’m doing right now is [that among] patients that have been readmitted to the hospital, we’re finding that access in a crisis is a key issue as to why people end up back in the emergency room. It’s not necessarily their first choice, but they didn’t feel like they had an alternative.

ELDERBRANCH: Do palliative care programs actually escalate total costs of care?

SUSAN ENGUIDANOS: For the palliative care team, the right decision isn’t around financing, it’s around what does the patient really want in their last years of life. What type of trajectory and care treatment are well-suited, and providing them information about what their trade-offs are. What [are] your options if you decide not to do aggressive care, or what the odds of survival are if you have a heart condition and cancer.

The other research that just came out found that people actually live longer because they make different decisions. They have fewer episodes of chemo and radiation but they live longer. We found that if we gave them more care in the home, they either didn’t need or decided not to pursue aggressive care.

ELDERBRANCH: While there is a Medicare hospice benefit, there isn’t something similar for palliative care. How are palliative care programs being paid for and is that a factor when thinking about broader adoption of these kinds of models?

SUSAN ENGUIDANOS: That has been the primary barrier in disseminating the model and promoting replication. [Given] the Kaiser structure is completely a closed system, they can move funds around to cover whatever they want. In systems that aren’t like the VA or Kaiser, there’s always going to be a winner and a loser, and the loser is the person paying for the services and the winner is the person saving money.

We have to figure out how to reimburse these services in a way that there’s not a “loser.” That’s exactly why a lot of these models don’t have the social worker or the chaplain; they have the nurse practitioner and the physician because they can charge for home visits. So that’s a huge barrier in terms of why we haven’t had better success in getting this replicated.

Elderbranch’s complete interview with Dr. Enguídanos, as well as the complete series on end-of-life care can be found in the following parts: I, II, III, IV.

Low-Protein Diet Slows Alzheimer’s in Mice

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Mice with many of the pathologies of Alzheimer’s Disease showed fewer signs of the disease when given a protein-restricted diet supplemented with specific amino acids every other week for four months.

Mice at advanced stages of the disease were put on the new diet. They showed improved cognitive abilities over their non-dieting peers when their memory was tested using mazes. In addition, fewer of their neurons contained abnormal levels of a damaged protein, called “tau,” which accumulates in the brains of Alzheimer’s patients.

Dietary protein is the major dietary regulator of a growth hormone known as IGF-1, which has been associated with aging and diseases in mice and several diseases in older adults.

Upcoming studies by USC Professor Valter Longo, the study’s corresponding author, will attempt to determine whether humans respond similarly – while simultaneously examining the effects of dietary restrictions on cancer, diabetes and cardiac disease.

“We had previously shown that humans deficient in Growth Hormone receptor and IGF-I displayed reduced incidence of cancer and diabetes. Although the new study is in mice, it raises the possibility that low protein intake and low IGF-I may also protect from age-dependent neurodegeneration,” said Longo, who directs the Longevity Institute of the USC Leonard Davis School of Gerontology and has a joint appointment the USC Dornsife College of Letters, Arts and Sciences.

Longo worked with Pinchas Cohen, dean of the USC Leonard Davis School, as well as USC graduate students Edoardo Parrella, Tom Maxim, Lu Zhang, Junxiang Wan and Min Wei; Francesca Maialetti of the Istituto Superiore di Sanità in Rome; and Luigi Fontana of Washington University in St. Louis.

“Alzheimer’s Disease and other forms of neurodegeneration are a major burden on society, and it is a rising priority for this nation to develop new approaches for preventing and treating these conditions, since the frequencies of these disorders will be rising as the population ages over the next several decades,” said Cohen, who became dean of the School of Gerontology in summer 2012. “New strategies to address this, particularly non-invasive, non-pharmacological approaches such as tested in Dr. Longo’s study are particularly exciting.”

The results of their study were published online by Aging Cell last month.

The team found that a protein-restricted diet reduced levels of IGF-1 circulating through the body by 30 to 70 percent, and caused an eight-fold increase in a protein that blocks IGF-1’s effects by binding to it.

IGF-1 helps the body grow during youth but is also associated with several diseases later in life in both mice and humans. Exploring dietary solutions to those diseases as opposed to generating pharmaceuticals to manipulate IGF-1 directly allows Longo’s team to make strides that could help sufferers today or in the next few years.

“We always try to do things for people who have the problem now,” Longo said. “Developing a drug can take 15 years of trials and a billion dollars.

“Although only clinical trials can determine whether the protein-restricted diet is effective and safe in humans with cognitive impairment, a doctor could read this study today and, if his or her patient did not have any other viable options, could consider introducing the protein restriction cycles in the treatment – understanding that effective interventions in mice may not translate into effective human therapies,” he said.

Many elderly individuals may have already be frail, have lost weight or may not be healthy enough to eat a protein-restricted diet every other week. Longo strongly insisted that any dieting be monitored by a doctor or registered dietitian to make sure that patients do not become amino acid-deficient, lose additional weight or develop other side effects.

This research was funded in part by NIH Grant P01AG034906.

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