The demographics and biology of Aging

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The demographics and biology of Aging

• Lotta Granholm
• Center on Aging
• MUSC

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1. Demographics
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Demographics in the US

• Older persons, 65 years of age and older,
  represent 13 of U. S. population - 33.9 million
  persons or about 1/8 Americans. By 2030, it is
  expected that there will be 70 million, and that
  the population 85 will increase 5-fold.
• In South Carolina, there are more than 600,000
  individuals in this age group and this number is
  expected to triple by the year 2030. SC is ranked
  8th in growth of senior citizens in the US.

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Health Care to the elderly

• 1 of 5 get prescribed inappropriate meds
• When examining an elderly, assume that medical
  problems are associated with side effects of
  medication
  
• ½ physician time
• ½ prescription meds
• ½ hospital stays

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The sad truth

• Of 700,000 physicians 9,000 board cert.
  Geriatricians (decreasing to 6,000)
  
• Of 100,000 researchers, interest!
  
• Of 144 med schools, 5 have Dept Geriatrics, and
• Summary adequate geriatric training
  
• According to American Federation for Aging
  Research
  

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The 10 Top Reasons why we are so ill prepared

• 10. No sense of urgency
• 9. Little research on basic biology of aging
• 8. Clinical trials not on old/frail
• 7. Lack of coordination in care and research
• 6. Inadequate reimbursement
• 5. Geriatric medicine not valued

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• 4. Scarcity of academic leaders
• 3. Lack of public awareness
• 2. Older people are marginalized

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• and 1
• Western society is engaged in Age-denial
• Peter Pan medicine

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Ageism

• Can be defined as a prejudgement toward the
  elderly based on stereotypes and misconceptions.
  Within this concept, it is assumed that ones
  personality, character, behavior and social
  traits are determined by chronological age. The
  elderly are often seen as being different from
  and inferior to other age groups.
• GRECC, Los Angeles, CA, 2000

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Doing nothing is an Rx for disaster!
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• What are we doing at MUSC?
• Formation of a regional Alzheimer consortium
  (ADRC)
  
• Building a Center for Excellence in Parkinsons
• disease at MUSC
• Designing a resource center on the web for the
  public,researchers and health professionals
  (www.MUSC.edu/aging)
  
• Geriatrics/gerontology
• curriculum for all colleges
• AFAR summer program
• for medical students
• (with UAB and Emory)

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2. The Aged Brain
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The Aged Brain

• A series of subtle but progressive alterations
  that eventually lead to behavioral changes
  
• 1. Dementia risk double every 5 years
• 50 in people over 85 years of age
• 2. Motor function also steadily deteriorates in
  elderly individuals.
  
• Prevalence of extrapyramidal symptoms
• 15 in 65-74 years of age
• 30 in 75-84 years of age
• 50 in 85 year olds

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Common Risk factors

• Oxidative stress (reactive oxygen species, ROS)
• Inability to break down proteins (amyloid,
  a-synuclein, lipofuchsin)
  
• Age
• Heredity
• Lifestyle
• Neuroinflammation
• Gender
• Education, activity, food etc

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The Bad..
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On the top of the list
From Joel Posner
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How bad is it for your brain?
1. 16 mo male rats on 2 cholesterol2
hydrogenated coconut oil for 8 weeks (controls
isocaloric) 2. Rats were subjected to radial ar
m maze, and sacrificed
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No effect on food intake or weight
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Working memory deficits
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One possible mechanism Oxidative stress

• Brain produces a large amount of ROS
• Free radicals are normal products of metabolism
• Predominant cellular free radicals are
• - superoxide (O2 -)
• - hydroxyl (OH-)
• Other molecules, such as hydrogen peroxide, can
  form ROS in the presence of eg. reduced metal
  
• Problem occurs imbalance between production and
  breakdown of ROS

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The Good.
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The brain has a natural defense against ROS

• Antioxidant scavengers
• Glutathione
• Ascorbate
• Vitamin E (a-tocopherol inhibits lipid
  peroxidation)
  
• Carotenoids, flavonoids (present in brain??)
• Antioxidant enzymes
• - Cu/Zn superoxide dismutase (SOD-1)
• - Mn superoxide dismutase (SOD-2)

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Flavonoids

• Most widely occurring group of phenolic
  phytochemicals
  
• Flavones, Flavanones, Catechins, and
  Anthocyanines
  
• Flavonoids are oxidized by ROS, providing are
  more stable radical
  
• Exist in large amounts in
• - Wine, green tea, strawberries, blueberries,
  spinach,Ginkgo biloba, muscadine grape

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Blueberries.

• Can block oxidative stress in the
• brain
• Can enhance neurogenesis and block cell
  death and degeneration
  
• Can prevent and/or reduce cancer
• Can affect cardiovascular health

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Oxidative stress-related pathways
Artificial selection for longevity
Caloric restriction
pharmaceuticals
Genetic engineering
Increased activity of stress-resistance genes
Decreased levels of Reactive Oxygen species
Decreased tissue damage and neuro- inflammation
Increased longevity
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What can we do?

• Nutritional antioxidants (food, supplements)
  and/or caloric restriction
  
• Symptomatic treatment (L-DOPA, AChEI etc)
• Anti inflammatory (Minocycline, NSAIDS)
• Cholesterol lowering (Statins)
• Hormone replacement therapy
• Enzyme inhibitors (g-secretase etc)
• Genetic engineering? Gene delivery?

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And the Ugly
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Demographics in South Carolina
South Carolina Nation
 
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Poverty, minorities, and rural communities

• The ethnic elderly population will increase
  dramatically by year 2030.
  
• Older minorities are expected to increase by
  328, and will constitute 1/3 of the total
  elderly population in the U. S. by 2050.
  
• South Carolina has a high poverty and minority
  rate, low level of medical access etc.
  
• Of 46 counties, 44 are considered medically
  underserved.

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Life Styles of the old and healthy
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• All five senses, physical strength, and organ
  capacity tend to somewhat decline with age.
  Incremental declines with normal aging must be
  differentiated from illness through appropriate
  geriatric assessment.
• Other systems that are affected by normal aging
• - Liver function
• - Kidney function
• - Basal metabolism
• - Hormone production/metabolism
• - Higher order functions (brain/cognition/motion
  )

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Preconceptions and ideas about older adults

• Adults do not tend to become more religious as
  they age.
  
• The majority of older adults prefer to live
  independently. Recent figures show that 32 of
  all older persons live alone, while the majority
  live with a spouse. Only 9 live with children,
  siblings, relatives, or non-relatives. Only 5 of
  older adults reside in nursing homes

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Older adults in the work force

• Over half of all older adults work as volunteers
  or for pay and continue in the work force or as
  caregivers.
  
• Older adults engaged in volunteer activities do
  better on behavioral tasks
  
• The older adults are slightly more productive,
  have better absentee records and fewer accidents
  on the job than younger employees.

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What about healthy aging???

• The majority of older Americans are free of
  disabilities, fully functioning, self-sufficient
  and healthy.
  
• Older adults are more diversified and
  heterogeneous than any other age group.
  
• As we age, each individual develops a uniqueness
  as a result of having had more varied experiences
  in life.
  

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What people need

• 1 A caring person to take the time and to listen
  to their problems. It could be a nurse, a P.A.,
  or a minister, but they have to be heard.
  
• 2 They need a person who is well versed in
  pharmacology who knows side effects, interactions
  and how they can be taken correctly. They need to
  know the possibilities for alternative medicines
  in lieu of prescription drugs.
• 3 They need a dietician specialized on
  geriatrics.
  
• 4 They need to be trained in physical therapy
  and exercise to prevent injury and pain and
  incapacitation.