BOSTON — Researchers from Hebrew SeniorLife’s Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Brown University, and Yale School of Nursing have reported that patients who develop delirium (an acute decline of cognitive functioning) during or after a hospital stay report more distress than those who do not. The same goes for family members of patients who have experienced delirium – they also report more distress than family members of patients who have not experienced delirium.

To uncover these results, scientists administered the Delirium Burden (DEL-B) questionnaire to measure and study the distress caused by delirium in both patients and their families. They then weighed these results against questionnaires from patients and families who did not experience an episode of delirium. Researchers also found that caregivers experienced more distress when their loved one developed delirium than the patient themselves. Beyond this, they discovered that the severity of the delirium episode may also play a role in the amount of distress caused. The results of this study were published today in The Gerontologist.

Annie Racine, PhD, Postdoctoral Research Fellow at the Institute for Aging Research and first author of the study said, “We’ve known for some time that delirium is often a distressing experience for patients and their caregivers, but we haven’t previously had a reliable and validated way to measure or quantify that experience”. Sharon Inouye, MD, MPH, Director of the Aging Brain Center at the Institute for Aging Research and senior author of the paper added, “These DEL-B questionnaires are an important step for the field, enabling measurement of the lived experience of delirium. We hope these instruments will help clinicians and researchers identify ways to make delirium less distressing both for patients and their families.”

In response to this study, the authors suggest that an important goal going forward would be to understand which parts of the delirium experience make it so distressing, and find ways to improve the experience for patients and family members alike. The DEL-B questionnaire could be an important tool in subsequent clinical trials to help find solutions to the distress caused by delirium.

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Numbers R01AG044518, R24AG054259, K07AG041835, P01AG031730, R01AG030618, K24AG035075, and T32AG023480. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About Institute for Aging Research

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Musculoskeletal Center within IFAR studies conditions affecting bone, muscle, and joint health with aging.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the non-profit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visithttp://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON — Evidence suggests that experiencing delirium after surgery can lead to long-term cognitive decline in older adults. However, not everyone who experiences delirium will suffer this fate. After a recent study, researchers at Hebrew SeniorLife’s Institute for Aging Research and Brigham and Women’s Channing Division of Network Medicine (both Harvard Medical School affiliates) have discovered that we can predict cognitive decline after postoperative delirium using pre-surgery information from patients, particularly information on pre-surgery cognitive function.

The study, which was published today in the Journal of Gerontology: Medical Sciences, was only an initial look at this issue, however scientists say this is the first step in identifying causes for cognitive decline after delirium. Delirium, an acute state of confusion, is a common condition affecting up to 50% of hospitalized older adults, which not only leads to cognitive impairment, but can also lead to institutionalization and even death. Those study participants who scored higher on cognitive function tests prior to developing delirium were less likely to experience cognitive decline after delirium than those who scored lower.

“Predicting who is likely to develop long-term cognitive decline following delirium is highly important clinically and this study reinforces the need for strategies to prevent delirium following surgery in vulnerable older adults” said Dr. Sharon Inouye, Senior author for the study and Director of Hebrew SeniorLife’s Aging Brain Center at the Institute for Aging Research. Dr. Elizabeth Devore from the Channing Division of Network Medicine, Brigham and Women’s Hospital and Dr. Richard Jones from Brown University were the first and senior authors on the study.

This work was supported by the National Institute on Aging (P01AG031720 and K07Ag041835 to S.K.I.; R01AG044518 to S.K.I./R.N.J.; and R01AG030618, K24AG035075, and R01AG051658 to E.R.M.). S.K.I. holds the Milton and Shirley F. Levy Family Chair.

About the Institute for Aging Research

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Aging Brain Center within IFAR studies cognitive aging and conditions affecting brain health.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Founded in Boston in 1903, the nonprofit, non-sectarian organization today provides communities and health care for seniors, research into aging, and education for geriatric care providers. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON – A new study published in The Journal of Gerontology: Medical Sciences found a link between depression, diet, and the development of frailty. Frailty, defined as a recognizable state of increased vulnerability resulting from a decline in function across multiple physiological systems, affects 10-15% older adults and often co-occurs with other health conditions, like depression. Diet is thought to be a major contributor to frailty development. While previous studies established a link between an inflammatory diet – including artificial trans fats (like partially hydrogenated oil), refined carbohydrates, and saturated fats – and the risk of development frailty, this is one of the first studies to try to understand the impact of depression on dietary inflammation and frailty.

Titled, “Association of pro-inflammatory diet with frailty onset among adults with and without depressive symptoms: results from the Framingham Offspring Study,” the study attempted to determine if individuals with depressive symptoms are more vulnerable to frailty development in response to dietary inflammation. The study utilized data from the Framingham Heart Study Offspring cohort. The 1,701 non-frail participants reported their diet and depressive symptoms at baseline and were followed for ~11 years when frailty status was reassessed. The study found an association between inflammatory diet and increased odds of frailty appeared somewhat stronger among those with depressive symptoms. The researchers hypothesize that since individuals with depressive symptoms typically have higher levels of inflammation, adding dietary inflammation on top of that accelerates the development of frailty.

Courtney L Millar, Ph.D., Post-Doctoral Fellow, Marcus Institute of Aging Research, Hebrew SeniorLife, and Harvard Medical School, is the lead author. “This study found that depressive symptoms may exacerbate the development of frailty in response to consuming an inflammatory diet. This suggests that consuming a diet rich in anti-inflammatory compounds (e.g., fiber and plant-based compounds called flavonoids) may help prevent the development of frailty,” Dr. Millar said. 

“Our exploratory data also suggests that when middle-aged and older adults consume a pro-inflammatory diet, they are more likely to newly develop depressive symptoms and frailty at the same time rather than develop either condition alone,” she added. 

This research follows two prior studies conducted by Dr. Millar, one published in May in the American Journal of Clinical Nutrition that showed that consuming a Mediterranean-style diet may prevent the development of frailty, and one published in February in the American Journal of Clinical Nutrition that showed a pro-inflammatory diet increased the risk of frailty development. 

“This study contributes to the understanding of the relationship between dietary inflammation, depression, and frailty,” Dr. Millar said. “For those with depression, it may be even more important to increase their intake of fruits and vegetables that are rich in fiber, flavonoids as well as other dietary antioxidants.”

The Framingham Heart Study, Massachusetts General Hospital, and the University of South Carolina collaborated on this observational study. This study was primarily funded by the National Institute of Aging (NIA) (grant no. T32-AG023480), the Beth and Richard Applebaum Research Fund, as well as the Boston Claude D. Pepper Center OAIC (OAIC; 1P30AG031679).

Other authors included: Alyssa B. Dufour, Ph.D., Assistant Scientist II, Hinda and Arthur Marcus Institute for Aging Research; James R. Hebert, D.Sc. Health Sciences Distinguished Professor and Director, South Carolina Statewide Cancer Prevention and Control Program, the Department of Epidemiology and Biostatistics and the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC and Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC;  Nitin Shivappa, M.B.B.S., M.P.H., Ph.D., Adjunct Assistant Professor, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; Olivia I. Okereke, M.D., M.S., Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School and Department of Epidemiology, Harvard TH Chan School of Public Health; Douglas P. Kiel, M.D., M.P.H., Director, Musculoskeletal Research Center and Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research; Marian T. Hannan, D.Sc., M.P.H., Co-Director, Musculoskeletal Research Center and Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research; and Shivani Sahni, Ph.D., Director, Nutrition Program and Associate Scientist, Hinda and Arthur Marcus Institute for Aging Research.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $63 million, making it the largest gerontological research facility in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.

BOSTON -- Research published today in JAMA Internal Medicine finds that developing postoperative delirium is associated with a 40% faster rate of cognitive decline over those who do not develop delirium.

“Delirium is associated with faster cognitive decline,” said Zachary J. Kunicki, Ph.D., M.S., M.P.H., assistant professor at the Warren Alpert Medical School of Brown University, and the first author.  “Whether delirium causes this faster rate of decline, or is simply a marker of those who are at risk of experiencing faster rates of decline, is still to be determined.”

“This study has the longest follow-up period of any study examining persons with delirium following surgery,” said Sharon K. Inouye, M.D., M.P.H., director of the Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, and senior author and principal investigator on the work.  “While future studies are needed, this study raises the possibility that delirium may predispose to permanent cognitive decline and potentially dementia.  This highlights the importance of delirium prevention to preserve brain health in older adults who undergo surgery,” she said.

Delirium is the most common post-operative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia.

Richard N. Jones, Sc.D., Warren Alpert Medical School of Brown University, is co-senior author of the article, “Six-year cognitive trajectory in older adults following major surgery and delirium.” Inouye is the overall principal investigator of the SAGES Study (NIH grant No. P01AG031720) that funded this long-term observational study.

The SAGES cohort has followed 560 older adults (age 70 and older), measuring their cognition every 6 months for 36 months, then annually afterwards for up to 6 years. Using a detailed cognitive testing battery, comprised of 11 different tests, we found that cognitive changes  after surgery are complex and that delirium influences every timepoint. The average cognitive changes seen after surgery include an abrupt drop at one month after surgery, an increase at two months after surgery, a stable period from 6-30 months after surgery, and then steady decline from 3-6 years after surgery. Delirium is associated with a sharper drop at 1 month, greater recovery at 2 months, and faster decline in all time periods from 6 months to 6 years, respectively. The results suggest that either delirium itself may contribute to cognitive decline after surgery, or that delirium may serve to identify those at risk for future more rapid cognitive decline. Future research will be needed to examine whether either or both of these hypotheses best explain the relationship between delirium and cognitive decline.

Collaborating institutions are Warren Alpert Medical School of Brown University; Beth Israel Deaconess Medical Center; Harvard Medical School; and the University of Maryland.

The study was supported by grants no. P01AG031720 (S.K.I.), R33AG071744 (S.K.I./R.N.J.), R01AG044518 (S.K.I./R.N.J.) from the National Institute on Aging.

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, was founded in 1903 and today is a national leader dedicated to empowering seniors to live their best lives. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline; and Jack Satter House, Revere. Hebrew SeniorLife also trains more than 1,000 future health care professionals each year, and conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a robust research portfolio whose NIH funding in 2021 places it in the top 10% of NIH-funded institutions. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.

About the Warren Alpert Medical School 
The Warren Alpert Medical School is the medical school of Brown University, located in Providence, Rhode Island, United States. Established in 1811, the school was among the first in the nation to offer academic medical education. Today, Alpert Medical School is a component of Brown’s Division of Biology and Medicine, which also includes the Program in Biology. (A third component of the Division, the Program in Public Health, became the Brown University School of Public Health on July 1, 2013.) Together with the Medical School’s seven affiliated teaching hospitals, the Division attracts over $240 million in external research funding per year. The fourth most selective medical school in the United States, Alpert Medical School earned rankings of twenty-fourth for primary care education and thirty-first for research in the 2014 U.S. News & World Report rankings. Graduates of Alpert Medical School are accepted into competitive residency programs and leading medical centers.

BOSTON — Researchers from Hebrew Senior Life’s Institute for Aging Research and University of Massachusetts Lowell have discovered that adults with higher intakes of dietary protein from both animals and vegetables see greater benefits in muscle mass and strength. Results from this study were published today in The American Journal of Clinical Nutrition.

Using data from the Framingham Osteoporosis study, researchers found that greater dietary protein intakes are related to better muscle health in both men and women. Moreover, the observed higher muscle strength and muscle mass occurred regardless of the major food sources which provided protein - suggesting that higher protein intake from any protein dense food source (animal or vegetable) can improve muscle health. These findings are particularly important as age-related musculoskeletal losses are a major health burden which can lead to physical disability and increased mortality.

Lead author Dr. Kelsey M. Mangano said of the study, “We know that dietary protein can improve muscle mass and strength. However, until now, we did not know if one protein food source was better than another in accomplishing optimal results. This study is significant as it suggest that higher protein intake form any food source will benefit muscle mass and strength in adults.”

Mangano is an assistant professor of nutritional sciences at UMass Lowell and an adjunct faculty member at Hebrew SeniorLife’s Institute for Aging Research, a Harvard Medical School affiliate.

This work was funded by: NIH’s National Institute of Aging (T32-AG023480), NHLBI Framingham Heart Study (N01-HC-25195), Framingham Osteoporosis Study (NIH R01 AR041398), and Academy of Nutrition and Dietetics Healthy Aging Dietetics Practice Group Research Award.

About the Institute for Aging Research

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Aging Brain Center within IFAR studies cognitive aging and conditions affecting brain health.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Founded in Boston in 1903, the nonprofit, non-sectarian organization today provides communities and health care for seniors, research into aging, and education for geriatric care providers. For more information about Hebrew SeniorLife, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

About UMass Lowell

UMass Lowell is a national research university located on a high-energy campus in the heart of a global community. The university offers its more than 17,750 students bachelor’s, master’s and doctoral degrees in business, education, engineering, fine arts, health, humanities, sciences and social sciences. UMass Lowell delivers high-quality educational programs, vigorous hands-on learning and personal attention from leading faculty and staff, all of which prepare graduates to be ready for work, for life and for all the world offers. www.uml.edu