Transcript Clinical mission - Center for Research and Education on Aging

Current and planned strategies to
establish academic programs of aging
and longevity across the US
Greg M. Cole
Assoc. Director, GRECC GLA VA
Assoc. Director, Alzheimer Center UCLA
Professor, Medicine and Neurology, UCLA
Multiple Aging and Related
Programs at UCLA
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Center on Aging
Multi-campus Gerontology Program
Minor in Gerontology - ~130 undergraduates
Claude Pepper Center (OAIC)
Affiliated GRECCs
MacArthur Foundation- Healthy Aging Study
Hilbloom-Diabetes
2 Alzheimer Centers (Federal and State)
2 Parkinson’s Centers ( NIH and VA)
Atherosclerosis Research Unit (~80 investigators)
GRECCs- VA based Geriatic Research
Education and Clinical Centers
• Founded 1975, 16 in 1995, grown to 21-22 GRECCs across the
country, (~$100 million in research/ year)
 The research mission at each site consists of funded, peerreviewed investigations within one or more circumscribed focus
areas in the basic biomedical, applied clinical, and health
services/rehabilitative issues surrounding aging, the aged, and
their health care and functional needs;
 Education mission - training of health providers in the care of
the elderly, at undergraduate and postgraduate levels; among
both VA staff and community providers, and in partnership with
academic affiliates
• Clinical mission - advance the practice of geriatric care through
the development and evaluation of new approaches - which
when demonstrated as effective, are to become integrated into
the fabric of, and supported by, the parent health care system;
and then, ideally, exported elsewhere within the VA and beyond.
GRECCs-2007
Table 1: Geriatric Research, Education and Clinical Centers (August 1, 2005)
VISN
GR ECC n ame
Est’d
GR ECC D irector
1
3
New England (Boston, Bedford)
Bronx/NY Harbor
1975
1999
Neil Kowall, MD, PhD
Albert Siu, MD , MSPH
4
5
6
7
Pittsburgh
Baltimore
Durham
Birmingham/Atlanta
1999
1992
1984
2000
Steven Graham, MD, PhD
Andrew Goldberg, MD
Harvey J. Cohen, MD
Richard Allman, MD
8
8
9
10
11
12
15
16
17
19
20
21
22
Gainesville
Miami
Tennessee Valley (Nashville, Murfreesboro)
Cleveland
Ann Arbor
Madison
St. Louis
Little Rock
San Antonio
Salt Lake City
Puget Sound (Seattle, American Lake)
Palo Alto
Sepulveda
1984
1991
1999
1999
1989
1991
1975
1975
1988
1991
1977
1975
1975
Thomas Mulligan, MD
Bernard Roos, MD
Robert E. Dittus, MD, MPH
Thomas Hornick, MD (acting)
Mark Supiano, MD
Sanjay Asthana, MD, PhD
John Morley, MD
Dennis Sullivan, MD, PhD
Michael S. Katz, M D
Byron Bair, MD (acting)
John C. S. Breitner, MD, PhD
Thomas Rando, MD, PhD
L.Z. Rubenstein, MD , MPH
22
West Los Angeles
1975
Theodore Hahn, MD, PhD
23
Minneapolis
1977
Maurice Dysken, MD
Primary Academic
affiliate(s)
Harvard U,BostonU
Mt. Sinai Sch of
Medicine
U of Pittsburgh
U of Maryland
Duke University
UAB Birmingham,
Emory
U of Florida
University o f Miami
Vanderbilt U
Western Reserve U
U of Michigan
U of Wisconsin
St. Louis University
U of Arkansas
University o f Texas
University o f Utah
U of Washington
Stanford University
U of California, Los
Angeles
Uof California, Los
Angeles
U of Minnesota
GRECC Research Areas
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AlzheimerХs Disease and
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other neurodegenerative
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disorders (behavior,
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mechanism,
pathophysiology,
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management, genetics)
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Andropause (Тmale
menopauseУ)
Arthritis and other joint
disorders
Assessment instruments
(nursing home, home,
palliative care, mental
health)
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Bioethics/bioethical
decision-making
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Blood pressure regulation in 
aging
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Cancer in aging
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Cellular aging (antioxidants,
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cytokines, leptins, nutritional
effects)
Cost effectiveness of new 
care approaches
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Delirium (prevalence,
recognition, prevention,
management)
Depression
Diabetic neuropathy
Dys phagia (prevalence,
mechanism, management)
Ethnicity and aging
Exercise in elderly (effects
on glucose metabolism,
cardiovascularcerebrovascular-peripheral
vascular health, cognition,
obesity, functional status,
immune system, quality of
life)
Falls (predictors, preventive
regimens)
Inf ormatics
Frailty
Gait and balance
Geriatric immuno logy
Geropharmacology
(mechanisms,
polypharmacy, compliance)
Glucose metabolism
Myocardial i nfarction
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Neurogenetics
Neuroimaging
Nursing home infections
Nutrition
Obesity
Oral health
Osteoporosis (cause and
treatment)
Palli ative care/end of life
issues
Patient safety
Prostate disease
Sarcopenia: muscle loss in
aging
Sleep disorders in long term
care
Stroke (prevention;
behavioral, cytologic,
electrical rehab. modalities)
Transitions between c are
systems.
Urinary i ncontinence
(medical and behavioral
management)
Centers of Excellence in Basic
Biology of Aging
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1991 – In a major report “Extending Life, Enhancing Life, a National Research
Agenda on Aging”, the Institute of Medicine (IOM) calls for the establishment of
at least 10 Centers of Excellence to undertake the multi-disciplinary study of
aging.
• Nathan Shock Centers of Excellence in Basic Biology of Aging- NIA founded
with 3 centers in 1995-$1.2M ( U Michigan-J. Faulkner, Washington- P.
Rabinovitch, UT San Antonio-A. Richardson)
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1996 – Construction of the Buck Institute for Age Research begins. Throughout
the planning period, a prestigious Board of Scientific Advisors advised the
Institute on its initial scientific program
2001-Barshop Institute for Longevity and Aging Studies- U Texas San Antonio
(Masoro> A Richardson)
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NIA Supports 77 Centers
• Alzheimer Centers (28)
• Claude D. Pepper Older Americans
Independence Centers-(~11
OAICs, Harvard, Yale,
Hopkins,Duke, UCLA, Michigan, U
Conn,Kansas, Maryland, UT, Wake
Forest)- Geriatrics
Harvard
• Harvard Medical School-The Paul F. Glenn
Laboratories for the Biological Mechanisms of
Aging (2003)- David Sinclair (part of planned
Institute for Aging Research at HMS) PPGYankner, Sinclair (Nature 2006, Tsai (Nature
2007)
• Harvard Cooperative Program on Aging
(HCPOA), a program of the Hebrew
SeniorLife Institute for Aging Research with
funds from the Harvard Older Americans
Independence Center, HMS Division on Aging
and the Massachusetts Alzheimer's Disease
Research Center
• Reinventing aging-Sch Pub Health/MetLife
Stanford/ SRI
• Stanford VA GRECC and VA / NIA Aging Clinical Research
Center
• CRIA-CENTER FOR RESEARCH on INDEPENDENT AGING
(SRI) “will explore a wide variety of opportunities in innovations
to detect, prevent and mitigate the loss of cognitive and physical
function associated with or resulting from the aging process.
The elderly segment of the population is increasing twice as fast
as the remainder of the population. The results of this shift are
dramatically increasing healthcare costs, ranging from
medications for chronic illness to high-end services such as
nursing home care. New technologies can play an important
role in helping elders maintain their independence and reducing
healthcare costs, which are shouldered not only by individuals
but family members and the population at large. In addition to
improving quality of life, the market demand and financial
incentives for research and products in this arena are
significant. The current market for assistive devices through
Medicare alone is $31B. “
epidemiology, genetics,
modeling, medical/clinical, drug
discovery (bench through
clinical manufacture),
biopathways, proteomics,
imaging, materials, sensors,
software, policy,
education/training
- monitoring and sensor devices –
education and adaptive technologies – drug
delivery methods to increase patient
compliance – diagnosis and treatment of
sleep disorders – improved stents –
diagnosis and treatment of sleep disorders –
drugs to slow dementia -
The objectives for CRIA programs are defined as:
•1) Characterize and predict deficits and conditions that impede
independent aging.
•2) Prevent or treat conditions that impede independent aging.
•3) For deficits that cannot be prevented or treated, provide adaptive assistance
to maintain independence.
• Draws on Policy, Biosciences, Engineering, Advanced Materials, and
Computing and Information Sciences.
Mandate for more geriatric training
• Florida State University College of Medicine
was created by legislative act in June 2000
with a mandate to provide a special emphasis
on preparing students to care for elderly
patients
• University of Arizona will develop the Arizona
Reynolds Program of Applied Geriatrics
• UCSF and many other medical schools are
launching new Geriatrics Efforts
Where we are going IF NOTHING IS DONEExpect 14 Million US Cases, ~$300 billion/yr
High
25
Millions
20
Median
15
Low
10
5
0
1950
1960
1970
1980
1990
2000
2010
Year
2020
2030
2040
2050
Why build up aging research?
• Current alternative program is for very expensive
drugs, devices and procedures for multiple
diseases of aging. Corporations and government
are already struggling to pay now. Wait till the
future.
• Avoid bank-breaking medical care costs by
preventing/ delaying/mitigating chronic diseases
of aging
• Gerontology is no longer a backwater. Recent
animal research shows breakthrough promise.
Examples of Programs and
Institutes with Aging Focus
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Andrus Gerontology
Institute on Aging - U Penn
IBAD - UC Irvine
Stein Institute for Research on Aging (SIRA)
celebrates 20 yrs with 83 investigators.
Sun Health Research - Arizona (Alzheimer’s,
Parkinson’s, Prostate cancer)
Stanford
Gladstone - (almost aging-Cardiovascular,
Alzheimer’s, Stroke)
Buck Institute - Nationally, Internationally
recognized researchers