BOSTON — Researchers from Hebrew SeniorLife’s Institute for Aging Research (IFAR), Wageningen University, Tilburg University, University of Reading, and Beth Israel Deaconess Medical Center (BIDMC) have discovered that higher intake of dairy foods, such as milk, yogurt, and cheese, is associated with higher volumetric bone mineral density and vertebral strength at the spine in men. Dairy intake seems to be most beneficial for men over age 50, and continued to have positive associations irrespective of serum vitamin D status.

In women, researchers found no significant results except for a positive association of cream intake in the cross sectional area of the bone.

Study participants included 1,522 men and 1,104 women from the Framingham Study, aged 32-81 years. Researchers examined quantitative computed tomography (QCT) measures of bone to determine associations with dairy intake.

Shivani Sahni, Ph.D., Director Nutrition Program and Associate Scientist at IFAR and senior author of the study said, “This study related dairy intake with QCT- derived bone measures, which are unique because they provide information on bone geometry and compartment-specific bone density that are key determinants of bone strength. The results of this study highlight the beneficial role of a combination of dairy foods upon bone health and these beneficial associations remain irrespective of serum vitamin D status in a person.”

The results of this study were published recently in the Journal of Bone and Mineral Density.

This research was supported by: NIH AR # 053205; FHS N01-HC-25195 R01 AR/AG 41398, unrestricted institutional research grant from Dairy Management Inc., Miss. van Dongen’s internship was supported by funds from the Dutch Dairy Organization and Global Dairy Platform.

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 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, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON — Researchers from Hebrew SeniorLife’s Institute for Aging Research, University of Western Australia, University of Sydney, and Edith Cowan University have discovered that bone density scans, typically used to determine fracture risk, could also be an aid in identifying cardiovascular disease. The study was recently published in the Journal of Bone and Mineral Research.

Researchers analyzed the bone density scans of over 1000 older women from Australia for the presence of calcium deposits in the large artery in the abdomen called the aorta. They graded the severity of these calcium deposits using scans done for osteoporosis screening. They then followed the women for almost 15 years to determine the occurrence of cardiovascular disease within the cohort.

“We found that that the presence of calcifications increased the likelihood of having cardiovascular disease such as heart attacks, and even the likelihood of cardiovascular deaths and mortality in general.” Said Co-author Douglas P. Kiel, M.D., M.P.H., Director, Musculoskeletal Research Center at Hebrew SeniorLife’s Institute for Aging Research. “Our study highlights the fact that having a bone density test not only tells women about their risk of fracture, but also their long term risk for cardiovascular disease. This makes bone density testing even more useful in screening.”

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, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON – In a study published today in JAMA Internal Medicine, researchers reported that training family members in delirium prevention approaches can significantly reduce the incidence of post-operative delirium by up to 16.8 percent within seven days after surgery. This is important because delirium, a sudden change in mental status, or sudden confusion often occurring after major surgery, acute illness, or hospitalization, can have serious complications such as functional and cognitive decline, prolonged hospital stays, institutionalization, and death.

Delirium prevention through multi-component intervention programs has been well-documented to be effective in up to 50 percent of cases, and greatly assists in the recovery of older adults following major surgery. The Hospital Elder Life Program (HELP), an evidence-based multi-component program that prevents delirium and reduces complications for older adult hospital patients, is currently implemented in more than 200 hospitals worldwide. HELP was created by Sharon Inouye, M.D., M.P.H., Director of the Aging Brain Center at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research and Professor of Medicine at Harvard Medical School.

HELP is often implemented by highly trained volunteers who complete targeted interventions such as walking with patients, assisting with mealtime and hydration, performing cognitively stimulating activities, and completing a non-pharmacological sleep protocol. This study is one of the first randomized controlled trials to demonstrate the success of adapting HELP protocols for non-volunteers or family members, as they are often with vulnerable patients regularly following surgery. Adaptations of the HELP protocol are especially important in countries like China, where volunteers are not utilized in hospital settings.

The randomized controlled trial, which examined data on 281 surgical patients at a hospital in China, compared patients in the tailored, or t-HELP, group to patients receiving usual patient care and treatment. Patients in the t-HELP group received daily intervention protocols from family members as instructed by nursing staff. Patients were evaluated daily until post-operative day seven and completed a one-month phone interview follow-up assessment after discharge. Patients who received the t-HELP protocol were significantly less likely to have post-operative delirium within seven days of surgery than patients who did not receive the protocol (2.6 percent vs. 19.4 percent occurrence). The t-HELP intervention was even more effective in preventing severe delirium. Patients who received the t-HELP protocol showed greater functional and cognitive recovery one month after discharge than those patients who received usual care.

These findings show that HELP can be adapted successfully and tailored to different hospital settings, including utilizing a non-volunteer model and engaging family members in delirium prevention.

Dr. Jirong Yue, M.D., corresponding author, said, “In China, we do not utilize hospital volunteers; however, family members are typically very involved in the care of older hospitalized patients. Adapting HELP for use with family members is a beneficial way to utilize the family as a resource to improve patient outcomes.”

Dr. Inouye, creator of HELP and senior author on this study, said, “HELP has proven to be effective in preventing delirium for hospitalized patients. This important study shows that HELP protocols can successfully be adapted for use with family members instead of volunteers, creating even more potential for HELP to improve care of older adult patients around the world.”

The study was led by researchers at the Department of Geriatrics at Sichuan University and co-authored by researchers at the Harvard Medical School-affiliated Hebrew SeniorLife Marcus Institute. Co-authors included Dr. Inouye (Twitter: @sharon_inouye or @ElderLifeProg) and Sarah Gartaganis, LICSW, M.P.H., Project Director III, Hebrew Rehabilitation Center at Hebrew SeniorLife.

This research was supported by grants from the National Key Research and Development Program of the Ministry of Science and Technology of China (2018YFC1312300), the Milstein Medical Asian American Partnership Foundation (H1403014), National Natural Science Foundation of China (81800092), National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z2018B03), Sichuan Science and Technology Program (2018SZ0252), Health Research of Cadres in Sichuan province (2019-109, 2017-111), and in part by grants from the U.S. National Institutes of Health (P01AG031720, K07AG041835, R24AG054259, R01AG044518) and the Milton and Shirley F. Levy Family Chair.

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, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Based in Boston, the nonprofit, 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, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook, or read our blog.

BOSTON – Why do some patients recover quickly after surgery, while others don’t? That is an important question when treating older frail patients suffering from aortic stenosis. Lead author Dae Hyun Kim, M.D., M.P.H., Sc.D., and principle investigator Director Lewis A. Lipsitz in the Marcus Institute for Aging Research at Hebrew SeniorLife explore this question in a paper published today in the Journal of the American Medical Association Internal Medicine.

Aortic stenosis is a disease that more often than not develops late in life. It occurs in 2% of people over 65 and affects more men than women. The condition causes the aorta –the main artery that carries blood to the rest of the body – to constrict reducing blood flow from the heart. The disease poses a serious health threat to older adults, impacting function and quality of life at best, and at worse, threatening survival.

With recent advances in surgical techniques, more patients are undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) to treat aortic stenosis. However, this study shows that serious risks of functional decline associated with surgery in older patients may well outweigh the benefits, and in particular, may not meet an individual’s goals for treatment. Although outcomes have improved over time, older patients continue to experience high rates of functional decline, particularly if they are frail before surgery. Many older patients, given the option, would often choose quality of life over longevity when making choices about their care.

Earlier clinical trials and observational studies demonstrated improvement in functional status after TAVR and SAVR. However, these studies’ results may not be applicable to all patients. The studies also assessed functional limitations due to heart failure using disease-specific measures, rather than measures that looked at, for example, how patients were doing with activities of daily living, capturing a broader picture of how patients were fairing after surgery.

As this study shows, the functional status of a patient before surgery impacts post-operative outcomes, including rates of recovery and long-range functional status. After heart valve replacement, five paths were identified that describe how much patients recover. After minimally invasive transcatheter replacement, many patients did not have improvement in functional status. In particular, patients who were very frail before their procedures tended to have the worst outcomes. Patients who are stronger generally get open heart surgery, and after surgical valve replacement, patients generally did better. Discussion of expected recovery can help to inform patient centered decision making.

According to Dr. Kim, “Although older patients with severe aortic valve stenosis undergo these procedures with expectation that their functional status improves, those with severe frailty, have functional decline. We emphasize the various processes of “how” they get to where they are at 12 months, and identified preoperative frailty, postoperative complications and delirium as strong predictors of functional decline, which can be potential targets for intervention.”

Funding: The FRAILTY-AVR Functional Outcomes Study was conducted with the support of a KL2/Catalyst Medical Research Investigator Training award (an appointed KL2 award) and an additional support from Harvard Catalyst / The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award KL2 TR001100-01 and UL1 TR001102), National Institutes of Health.

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, 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, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON - A study published today in JAMA Internal Medicine reveals the best assessment tools available to establish the severity of diagnosed delirium in hospitalized patients. Delirium is a common, serious, and often preventable complication among older adult patients. This is an important step in the management of delirium in older adults because the ability to quantify severity of the condition beyond merely rating delirium as present or not will help clinicians develop and monitor more effective treatments. The quality of the tools available to measure delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care both during and after hospitalization.

A research team including 21 scientists from Harvard Medical School, the Marcus Institute for Aging Research (Marcus Institute) at Hebrew SeniorLife, and 10 other academic organizations in the U.S. and China, searched databases including 9,409 articles that addressed measurement of delirium severity. They reviewed the full text of 228 and identified 42 different instruments to explore further. Applying pre-specified criteria related to frequency of use, methodologic quality, construct or predictive validity, and broad domain coverage, 6 final high-quality instruments were identified. They included, the Confusion Assessment Method, Confusional State Examination, Delirium-O-Meter, Delirium Observation Scale, Delirium Rating Scale, and Memorial Delirium Assessment Scale. These measures will enable accurate measurement of delirium severity to improve clinical care for this common and devastating condition. The researchers hope this work will stimulate increased usage, and head-to-head comparison of these instruments.

According to senior author of the study, Sharon K. Inouye, M.D., M.P.H., Director, Aging Brain Center, Marcus Institute and Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, “The time is right to advance measurement of delirium severity: Measurement is important, impactful, and efforts to stratify risk, target treatment, and monitor for outcomes are already possible and feasible with existing approaches.” First author, Richard N. Jones, ScD, of Brown University adds, “Measurements of delirium severity should play an important role in the advancement of clinical care and research for persons with delirium.”

An estimated 12 million older Americans experience delirium each year, at a cost of over $164 billion (2011) in annual healthcare expenditures. Delirium is distressing to patients and families, prolongs hospital stays, delays rehabilitation, and increases risks for dementia and death. Despite its importance for patient safety and public health, delirium is often unrecognized by clinicians, and effective treatments remain elusive. Moreover, presentation of delirium is heterogeneous and multifaceted, and measurement of delirium and its severity pose unique challenges.

Funding Sources: This work was supported by grants from the National Institutes of Health [R01AG044518 (SKI/RNJ), R24AG054259 (SKI), K07AG041835 (SKI), P01AG031720 (SKI), and K24AG035075 (ERM)].

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 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, 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, visit https://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON – A study published today in JAMA Network Open/Emergency Medicine supports evidence that older persons admitted to emergency departments (ED), and subsequently diagnosed positive for COVID-19, often present with delirium when they show no other typical COVID-19 symptoms, such as fever and cough. Sharon K. Inouye, M.D., M.P.H., Director of the Aging Brain Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Professor of Medicine at Harvard Medical School, is senior author on the study. Co-first authors include Maura Kennedy, M.D., Assistant Professor of Emergency Medicine, Massachusetts General Hospital and Benjamin K. Helfand, M.D., Ph.D. (Cand.), University of Massachusetts Medical School and Warren Alpert Medical School, Brown University.

Although COVID-19 poses a risk at all ages, adults aged 65 years and older are at greatest risk of severe disease, hospitalization, intensive care use, and death. Persons older than 65 years comprise 16 percent of the United States population yet have accounted for more than 80 percent of deaths in the U.S. Delirium is an acute state of confusion, characterized by an altered level of consciousness, disorientation, inattention, and other cognitive disturbances. Beyond COVID-19, delirium is known to be a common symptom in older adults with severe disease in the ED and is associated with extended hospitalization, and increased morbidity and mortality. Despite the threat delirium poses to older ED patients, it is undetected in two-thirds of cases. 

Researchers involved in the study examined 817 patients 65 or older admitted to the ED and who were diagnosed with COVID-19. They found almost a third had delirium at the time they were seen in the ED. A delirium diagnosis was the main presenting symptom for 16 percent of those patients, and 37 percent had no typical COVID-19 symptoms; delirium was the sixth most common presenting symptoms in all patients. These findings suggest the clinical importance of including delirium on checklists of presenting signs and symptoms of COVID-19 that guide screening, testing, and evaluation.

According to Dr. Inouye, “This study demonstrates that delirium is not only a common symptom of COVID-19, but also may be the leading and possibly sole symptom in older persons. Thus, delirium should be considered an important presenting symptom of COVID-19.”

Additional collaborating institutions on the study include:

• St. Mary Mercy Livonia Hospital
• Beth Israel Deaconess Medical Center
• Maine Medical Center
• Brigham and Women’s Hospital 
• Yale School of Medicine
• University of North Carolina Chapel Hill School of Medicine. 

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, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Based in Boston, the nonprofit 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, visit https://hebrewseniorlife.org, or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.

BOSTON – Results of a study published today in JAMA Surgery reveal the impact post-operative delirium has on health care costs in the U.S. Data from the study shows that if delirium were prevented or made less severe for patients, it could reduce health care costs by $33 billion per year, that is, $44,300 per patient per year. Severe delirium resulted in an additional $56,500 per patient per year, as compared to routine health care costs for older post-operative patients.

Tammy Hshieh, M.D., M.P.H., Adjunct Scientist, and Ray Yun Gou, M.A., Data Scientist II, both with the Aging Brain Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, are co-first authors. Sharon K. Inouye, M.D., M.P.H., Director of the Aging Brain Center in the Marcus Institute, is principal investigator and senior author on the study. Douglas L. Leslie, Ph.D., a Health Economist at Penn State University, is co-senior author on the paper. 

Delirium is a common, serious clinical problem for older adults, often complicating major surgery. It has been associated with poor hospital outcomes, including prolonged hospital stay, functional and cognitive decline, institutionalization, and death.

Prior to this study, existing data did not accurately indicate current costs of delirium to the health care system. This information is essential to helping guide policymakers and health care leaders in decision-making and prioritization surrounding delirium care. According to the study’s authors, the aim of the study was to update cost estimates to help funders and health systems develop incentives and strategies that improve processes and quality of care for older adults, and to track improvements over time.

The study included 497 patients from the Successful Aging after Elective Surgery (SAGES) study, an ongoing cohort study of older adults undergoing major elective surgery. Eligible patients were age 70 or older and scheduled to undergo major surgery at one of two Harvard-affiliated hospitals with an anticipated length of stay of at least three days. Eligible surgical procedures included total hip or knee replacement; lumbar, cervical, or sacral laminectomy; lower extremity arterial bypass surgery; open abdominal; aortic aneurysm repair; and open or laparoscopic colectomy. Cumulative and period-specific costs were examined using Medicare claims and extensive clinical data for one year following surgery. Data showed that adjusted cumulative health care costs per patient were significantly higher for those who developed delirium compared with those who did not.

“The economic impacts of delirium and severe delirium after elective surgery are substantial,” said Dr. Hshieh.

“Our study highlights the need for policy imperatives to address delirium as a large-scale public health issue that warrants renewed efforts to bolster prevention, early detection, and management,” said Dr. Inouye.

Collaborating institutions on the study included Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, Brown University, and Penn State University.

This study was supported in part by grants from the National Institute on Aging; grants no. P01AG031720 (SKI), R24AG054259 13 (SKI), R01AG044518 (SKI/RNJ). 

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, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Based in Boston, the nonprofit 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, visit https://hebrewseniorlife.org and our blog, or follow us on Facebook, Instagram, Twitter, and LinkedIn.

BOSTON - A new study shows that genetic pre-screening could reduce the number of screening tests needed to identify individuals at risk for osteoporotic fractures. Douglas P. Kiel, M.D.,M.P.H., director of the Musculoskeletal Research Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, is an author on the report published this month in PLOS (Public Library of Science) Medicine.

Osteoporosis is a common and costly condition that increases the risk for bone fractures in those with the disease. Fractures, which lead to significant morbidity, mortality and expense, are a large public health concern. Annual costs associated with fractures exceed $19 billion in the United States.

Dual-energy X-ray absorptiometry (DXA), which measures bone mineral density (BMD), has been considered the clinical standard for determining fracture risk, along with the Fracture Risk Assessment Tool (FRAX). A FRAX assessment considers factors such as age, gender, weight, alcohol use, smoking history, and fracture history. Screening programs are generally designed to identify those whose risk is great enough to require intervention. However, assessment takes time and DXA accessibility has declined. Usually only a small proportion of individuals who undergo screening is found to be at high risk, indicating that much of the screening expenditure is spent on individuals who will not qualify for treatment.

The potential exists to improve the efficiency of osteoporosis screening programs using genetic markers to assess fracture risk. The purpose of this study was to understand if genetic pre-screening could reduce the number of screening tests needed to identify individuals at risk of osteoporotic fractures. It used genetic data from more than 300,000 participants from the UK Biobank to calculate the genetically predicted bone ultrasound measure. This was then compared with the commonly used FRAX score and standard BMD measured by DXA as to its ability to predict the risk for fracture.

By building a polygenic risk score and validating its utility in fracture risk screening in five separate cohorts totaling more than 10,000 individuals, study researchers determined that genomics-enabled fracture risk screening could reduce the proportion of people who require BMD-based testing by 41 percent, while maintaining a high ability to correctly determine appropriate treatment for those at risk. While these findings are not meant to be prescriptive, they indicate the possible utility of polygenic risk scores in screening programs that are dependent on heritable risk factors.

“Someday everyone will know their genetic predispositions to various diseases and traits because genetic typing has become so inexpensive,” said Dr. Kiel. “When available, these genetic markers can be used to predict diseases to help health care providers screen and treat patients tailored to their genetic predisposition to a given disease. Using genetic risk scores to guide screening for osteoporosis may result in disease screening strategies that are more thoughtful and personalized than the one-size-fits-all approach currently in place within medical practice.”

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Hinda and Arthur 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.

Dr. Kiel heads the Geriomics program in the Marcus Institute, which is a scientific collaborative established to understand the contribution of genetics to aging and common human diseases that affect older adults.

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 nonprofit 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, visit http://www.hebrewseniorlife.org and our blog, or follow us on Facebook, Instagram, Twitter, and LinkedIn.

BOSTON – In a paper published in the Journal of the American Medical Association Internal Medicine today, researchers showed how analysis of data from the multigenerational Framingham Osteoporosis Study may in part explain why the incidence of hip fracture in the U.S. has declined during the last two decades. Douglas P. Kiel, M.D., M.P.H., and Marian T. Hannan, D.Sc., M.P.H., are among the authors. Dr. Kiel is Director, and Dr. Hannan is Co-Director, of the Musculoskeletal Research Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife.

Led by Dr. Kiel, the Framingham Osteoporosis Study is an ancillary study of the Framingham Heart Study, which enrolled its first cohort of participants in 1948 and now includes a third generation of participants.  Initially launched to understand the epidemiology of cardiovascular disease, the study has become a treasure trove of data for epidemiologists searching for factors that contribute to many conditions that impact public health, including hip fractures. An estimated 150,000 hip fractures occur each year in the U.S., with estimated costs of care between $10.3 billion and $15.2 billion.

The cause of the decrease in the incidence of hip fracture is unknown, but has been attributed to the treatment of osteoporosis – a disease that causes bones to become weak and brittle. However, in this study, researchers looked at factors beyond osteoporosis treatment that could better explain the dramatic decline in hip fracture in recent decades. For example, Framingham Osteoporosis Study data showed that in persons aged 85 to 89 years, the incidence of hip fracture was 759 per 100,000 person-years in the offspring group compared with 2,018 per 100,000 person-years in the original cohort. The decrease in fracture was too significant to be explained by osteoporosis treatment alone, especially since the decreases were occurring before the availability of effective treatments for osteoporosis.

Study researchers carefully looked at decades of hip fracture data, which allowed statistical differentiation of changes in the incidence of hip fractures arising from the year of birth, aging, and the time period in which the data was collected. They found that a reduction in smoking and excessive alcohol consumption explained some of the declines in rates, emphasizing that ongoing public health considerations help to prevent fractures.

As a result of this study, Dr. Kiel cautioned, “While there is still a need to treat patients with osteoporosis, health care providers should continue to encourage public health interventions, specifically smoking cessation and preventing heavy drinking of alcohol.”

Dr. Hannan added, “There is a need to continue public health approaches along with treating osteoporosis to decrease fracture risk.”

This study was funded by the National Institute of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Hinda and Arthur 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. For further information on the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, please visit https://www.marcusinstituteforaging.org/.

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 nonprofit 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, visit http://www.hebrewseniorlife.org and our blog, or follow us on Facebook, Instagram, Twitter, and LinkedIn. 

BOSTON - A paper just published in the Journal of the American Geriatrics Society found that adherence to infection control processes, especially proper wearing of personal protective equipment (PPE) and cohorting strategies, such as grouping residents based on their risk of infection or whether they tested positive for COVID-19, was significantly associated with declines in weekly infection and mortality rates. 

Lewis A. Lipsitz, M.D., Director of the Hinda and Arthur Marcus Institute for Aging Research and Chief Academic Officer at Hebrew SeniorLife, was the lead author on the report, which analyzed the process and outcome of Massachusetts’ novel state-wide COVID-19 infection control program developed to stem the rate of infection among vulnerable nursing home populations. 

In April 2020, Massachusetts nursing homes became a hotspot for COVID-19 infections and associated deaths. In response, Governor Charles Baker allocated $130 million in additional nursing home funding for two months. Funding was contingent on compliance with a new set of care criteria, which included mandatory testing of all residents and staff, and a 28-point infection control check-list. The 28 items included:

• six core (must-pass) competencies related to cohorting of COVID-19 cases; 
• closing of congregate spaces;
• training and demonstrated proficiency in the donning and removal of PPE; 
• proper wearing of PPE;
• the presence of appropriate infection control policies; and 
• the ability of staff to recognize and respond to the signs and symptoms of COVID-19 infection. 

Within two days of the Governor’s announcement, Hebrew SeniorLife and the Massachusetts Senior Care Association collaborated to rapidly organize a Central Command Committee and five teams responsible for: 

• infection control consultation and training;
• PPE procurement; and
• staffing, testing, and data management. 

Eighty nursing homes with previous infection control deficiencies, and 43 additional facilities that failed an initial State Executive Office of Health and Human Services audit, were deemed “special focus” for on-site and virtual consultations, and all Massachusetts facilities were offered weekly webinars and answers to questions regarding infection control procedures. The facilities were also informed by the Massachusetts Senior Care Association of available resources for the acquisition of PPE and back-up staff, and the Massachusetts National Guard was mobilized to provide universal testing.

Review and analysis of data collected from the program showed both resident and staff infection rates in special focus facilities rapidly declined to the same low level in both groups after facilities put recommended infection control interventions in place. For example, special focus resident infection rates declined from 10 percent (May 17) to approximately 0 percent (July 5). 

“Massachusetts’ innovative program was unprecedented in this country,” said Dr. Lipsitz. “It helped long-term care providers increase their knowledge of, and access to, best infection control practices and reduce the risk of COVID-19 spread for both residents and staff.”

Lou Woolf, President and CEO of Hebrew SeniorLife said, “We hope to see this intervention replicated in other states, appropriately funded, and sustained in all nursing homes, so that future waves of COVID-19, and other pandemics, can be prevented or mitigated.”

"This study shows the importance of prioritizing surveillance testing, funding for wages, and PPE for nursing homes so that we can protect both our staff and our residents," said Tara Gregorio, President of the Massachusetts Senior Care Association. "Until a vaccine is approved and available widely, these remain our best defenses against COVID-19."

Co-authors on the study include Alyssa Dufour, Ph.D., and Laurie Herndon, G.N.P., from the Hinda and Arthur Marcus Institute for Aging Research, Alida M. Lujan, M.B.A., M.P.A., from Massachusetts Institute of Technology Sloan School, Gary Abrahams and Helen Magliozzi from the Massachusetts Senior Care Association, and Mohammad Dar, M.D., from Massachusetts Medicaid (MassHealth).

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, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Based in Boston, the nonprofit 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, visit http://www.hebrewseniorlife.org and our blog, or follow us on Facebook, Instagram, Twitter, and LinkedIn.

About MSCA
The Massachusetts Senior Care Association represents a diverse set of organizations that deliver a broad spectrum of services to meet the needs of older adults and people with disabilities. Its members include more than 400 nursing and rehabilitation facilities, assisted living residences, residential care facilities, and continuing care retirement communities. Forming a crucial link in the continuum of care, Mass. Senior Care facilities provide housing, health care, and support services to more than 100,000 people a year; employ more than 50,000 staff members; and contribute more than $3.5 billion annually to the Massachusetts economy.