BOSTON  – There is growing evidence that a relative abundance of certain gut microbes may be related to skeletal health, according to a new study published in Frontiers in Endocrinology. If confirmed by additional research, the findings could provide the opportunity to alter gut microbiomes to achieve better bone health, as scientists learn more about “osteomicrobiology,” a new term recently used to characterize this relationship.

Due to the lack of large-scale human studies of the gut microbiome and skeletal health, researchers led by Paul C. Okoro, data scientist II at Hebrew SeniorLife and the Hinda and Arthur Marcus Institute for Aging Research, and principal investigator Douglas P. Kiel, M.D., MPH, senior scientist at the Marcus Institute, conducted an observational study based on the Framingham Third Generation Study of men and women, and the Osteoporotic fractures in Men (MrOS) study of older men to determine whether they could find a potentially modifiable factor contributing to skeletal health. The study used high-resolution imaging of the arm and leg.

This is significant because low bone density increases the risk of developing osteoporosis, affecting more than 10 million Americans over the age of 50, and can increase the risk of fractures.

Entitled “A Two-Cohort Study on the Association between the Gut Microbiota and Bone Density, Microarchitecture, and Strength,” the study found that bacteria called Akkermansia, which has been associated with obesity, and Clostridiales bacterium DTU089, had negative associations with bone health for older adults. DTU089, a bacterium from the class Clostridia, has been described to be more abundant in people with lower physical activity, and lower protein intake, and could be significant because prior studies have found protein intake and physical activity have a definite connection to skeletal health. 

“We found patterns in which greater abundance of microbiota were associated with worse measures of bone density and microarchitecture. In fact, some bacteria were associated with differences in the bone cross sectional area, suggesting the possibility that certain microbes could influence how the bone changes size with aging,” said Dr. Kiel. “It is premature to know if the bacterial organisms themselves may have effects on skeletal health. With additional studies we might be able to gain insights regarding associations between specific bacterial species in the intestine and skeletal integrity. We also hope to identify specific functional pathways influenced by the bacteria that could influence the skeleton. For example, some bacteria can lead to low levels of inflammation that may affect bone health. Ultimately, if findings like this are confirmed, we may be able to target the gut microbiome to influence skeletal health.”

Harvard T.H. Chan School of Public Health, Oregon Health and Sciences University, BIDMC, Minneapolis and Palo Alto VA Health Care System, University of Minnesota, University of Pittsburgh, Stanford University, Emory University collaborated in this retrospective cohort study.

Co-authors of the study include Eric S. Orwoll, M.D., professor of medicine, Department of Medicine, Oregon Health & Sciences University; Curtis Huttenhower, PhD, professor of computational biology and bioinformatics, Department of Biostatistics, Harvard T.H. Chan School of Public Health; Xochitl Morgan, PhD, senior research scientist and director of microbiome analysis core, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Thomas M. Kuntz, PhD, research associate, Department of Biostatistics, Harvard T.H. Chan School of Public Health; Lauren J. McIver, associate director of engineering, Department of Biostatistics, Harvard T.H. Chan School of Public Health; Alyssa B. Dufour, PhD, assistant scientist iI, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife; Mary L. Bouxsein, PhD, professor, orthopedic surgery, Endocrine Unit, Massachusetts General Hospital, Harvard Medical School; Lisa Langsetmo, PhD, MSc, associate professor, Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; Samaneh Farsijani, PhD, R.D., assistant professor of epidemiology, Department of Epidemiology and Center for Aging and Population Health University of Pittsburgh; Deborah M. Kado, M.D., M.S., professor of medicine, Department of Medicine, Stanford University, and director of the Geriatric Research Education and Clinical Center (GRECC), VA Health System Palo Alto, CA; Roberto Pacifici, M.D., director, Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine; Shivani Sahni, PhD, associate scientist, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife; Douglas P. Kiel, M.D., MPH, senior scientist, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife.

Funding came from grants from NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases – NIAMS).

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 4,500 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 $85 million, making it one of the largest gerontological research facilities 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.

A groundbreaking study published in the journal Research in Aging sheds light on the financial challenges of housing-with-health-services models for low-income older adults.  The report explores strategies for ensuring the sustainability of these beneficial efforts. 

The study was conducted in partnership with Hebrew SeniorLife, a Harvard Medical School-affiliated nonprofit organization serving older adults in the Greater Boston area.  It drew on insights from 31 key informational interviews and three focus groups with payers, housing providers, and community partners.

The Right Care, Right Place, Right Time (R3) Program deploys wellness teams in affordable housing sites. These teams include coordinators and nurses who adopt an “eyes-on” approach, training all housing staff to observe and contribute to care coordination for residents. The teams bridge housing and healthcare efforts, supporting residents where they live and aiming for better health outcomes and prolonged independence.

Despite the recognized potential of these programs to enhance the lives of low-income older adults, finding reliable funding sources is a significant hurdle. 

Key findings from the study, “Promoting Sustainability in Housing with Services: Insights from the Right Care, Right Place Right Time Program,” include the following:

• Recognized Value: Participants unanimously recognized the value of housing-with-services programs in improving the well-being of older adults.
• Funding Need: There was little consensus on how to secure ongoing funding for these programs. The responsibility for individuals in housing sites is distributed across health insurers, hospitals, and community service providers, making it challenging to incentivize investment.
• Government’s Role: The study suggests that governmental mechanisms, possibly at the federal level, are needed to channel funding toward supportive services. Without reliable funding sources, replicating these housing models for low-income older people will be difficult.

“The study emphasizes the need for innovative solutions to secure funding for supportive services,” said co-author Marc A. Cohen, co-director, LeadingAge LTSS Center, Department of Gerontology, University of Massachusetts. “Sustaining and financing these models has proven to be a complex issue, given the separate systems of publicly-funded housing and healthcare,” he said.

Housing models that integrate supportive services have proven popular among better-off individuals who can afford private-pay environments. Yet options for older people with fewer resources have remained limited due to scarce public financing. The Section 202 low-income housing program, established by the U.S. Department of Housing and Urban Development, has been one option for affordable housing for people aged 62 and older. Service coordinators were added to the program in 1990; yet it has remained limited in scope and poorly funded over the years, leaving many older adults without access to supportive housing environments.

“We expect these findings to contribute to a broader understanding of how housing-with-services models can be developed and maintained to benefit low-income older adults,” said Kim Brooks, chief operating officer, senior living, Hebrew SeniorLife. 

The study examined the experiences and perspectives of individuals involved in the Boston-area Right Care, Right Place, Right Time Program, which enrolled 400 older adults across seven intervention sites.  Four sites were operated by Hebrew SeniorLife and three were operated by partner providers, including Milton Residences for the Elderly and WinnCompanies.

Lead author of the study was Pamela Nadash, PhD, associate professor, Gerontology Department, University of Massachusetts. Co-authors include Edward Alan Miller, professor and chair, Department of Gerontology, University of Massachusetts; Elizabeth J. Simpson, MPH, Department of Gerontology, University of Massachusetts; Molly Wylie, Department of Gerontology, University of Massachusetts; Natalie Shellito, Department of Gerontology, University of Massachusetts; Yan Lin, Department of Gerontology, University of Massachusetts; Taylor Jansen, PhD, Department of Gerontology, University of Massachusetts; and Marc A. Cohen, co-director, LeadingAge LTSS Center, Department of Gerontology, University of Massachusetts and Center for Consumer Engagement and Health System Transformation, Community Catalyst.

This work was supported by Hebrew SeniorLife, which designed and piloted the R3 program and secured additional funding for the evaluation and intervention. Funders include the Commonwealth of Massachusetts Health Policy Commission Health Care Innovation Investment Program; Beacon Communities LLC; Boston Scientific Foundation; Coverys Community Healthcare Foundation; Enterprise Community Partners; Massachusetts Department of Housing and Community Development; Mass Housing; and The Pioneer Institute.

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 4,500 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 $85 million, making it one of the largest gerontological research facilities 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 LeadingAge LTSS
The LeadingAge LTSS Center @UMass Boston conducts research to help our nation address the challenges and seize the opportunities associated with a growing older population. The LTSS Center is the first organization of its kind to combine the resources of a major research university with the expertise and experience of applied researchers working with providers of long-term services and supports (LTSS).

BOSTON  – A new study, “Timing of Orthostatic Hypotension and its Relationship with Falls in Older Adults,” has brought critical insights to the assessment of orthostatic hypotension, a drop in blood pressure commonly found among older adults when transitioning from a sitting or lying position to a standing position that can lead to dizziness and falls.

Published in the Journal of the American Geriatrics Society and based on a secondary analysis of the “Study to Understand Fall Reduction and Vitamin D in You,” This study examined the prevalence of orthostatic hypotension at different time points after standing in a population of older adults, and it also explored the association between orthostatic hypotension and fall risk.

Key findings from the study, which involved community-dwelling adults aged 70 and older, revealed that orthostatic hypotension was most prevalent and symptomatic within 1-2 minutes after standing. However, the study also demonstrated that orthostatic hypotension assessments conducted after 4 to 6 minutes of standing were more informative for predicting fall risk.

According to Lewis A. Lipsitz, M.D., director of Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research and Hebrew SeniorLife’s chief academic officer, “The findings have important implications because falls represent a major cause of serious, life-threatening injury in older adults, and understanding the timing of orthostatic hypotension assessments can help clinicians identify those at highest risk and institute appropriate interventions to reduce falls and related injuries.”

The lead author was Aldis H. Petriceks, B.A., Harvard Medical School. Co-authors include:

• Lawrence J. Appel, M.D., MPH, director of the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health
• Edgar R. Miller 3rd, M.D., PhD, deputy director, Johns Hopkins Institute for Clinical and Translational Science
• Christine M. Mitchell, ScM, senior research associate, Johns Hopkins Bloomberg School of Public Health
• Jennifer A. Schrack, PhD, M.S., professor, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Center on Aging and Health
• Kenneth J. Mukamal, M.D., MPH, M.A., department associate, Beth Israel Deaconess Medical Center
• Lewis A. Lipsitz, M.D., Irving and Edyth S. Usen and Family Chair in Medical Research, Hebrew SeniorLife, professor of medicine, Harvard Medical School and chief, Division of Gerontology, Beth Israel Deaconess Medical Center
• Amal A. Wanigatunga, PhD, MPH, assistant professor, Johns Hopkins Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health
• Timothy B. Plante, M.D., associate director of preventive cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, assistant professor, University of Vermont Medical Center
• Erin D. Michos, M.D., MHS, associate director of preventive cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, the Johns Hopkins University School of Medicine
• Stephen P. Juraschek, M.D., PhD, Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center

This work was supported by the Johns Hopkins Institute for Clinical and Translation Research, grant/award; number: UL1TR003098; Mid-Atlantic Nutrition Obesity Research Center, grant/award number: P30DK072488; National Heart, Lung, and Blood Institute, grant/award number: 7K23HL135273; National Institute on Aging, grant/award numbers: 5K24AG065525, U01AG047837.

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 4,500 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 $85 million, making it one of the largest gerontological research facilities 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.

BOSTON – A new study published in Frontiers in Aging Neuroscience is the first to identify an optimal Repetitive Transcranial Magnetic Stimulation (rTMS) treatment regimen for older adults with treatment-resistant depression, according to researchers at Hinda and Arthur Marcus Institute for Aging Research and the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife. A noninvasive procedure, TMS uses magnetic fields to stimulate nerve cells in a specific part of the brain to successfully treat depression, but the study found the treatment response can be slower and take a larger number of rTMS treatment sessions in older adults than with younger individuals. This has implications for best practices as well as healthcare policy.

Major Depressive Disorder (MDD) is a leading cause of disability worldwide, and is common in older adults, affecting up to one third of the population. In order adults, MDD is often resistant to treatment, and treatment is frequently complicated by medical comorbidities and polypharmacy, according to a study conducted by Marcus Institute and Wolk Center researchers published earlier in the year in Ageing Research Reviews. Brain stimulation strategies, and specifically rTMS, have been considered an effective antidepressant treatment for those who do not respond or tolerate other treatment strategies but other studies suggested that rTMS was less effective in older adults. The publication in Ageing Research Reviews showcased a set of novel approaches for the optimization of the TMS protocol for depression and discussed the possibility for a standardized TMS protocol tailored for the treatment of geriatric depression. 

The new study, titled “In Older Adults the Antidepressant Effect of Repetitive Transcranial Magnetic Stimulation is Similar but Occurs Later Than in Younger Adults,” evaluated the rTMS treatment outcomes in a large international multicenter cohort of more than 500 patients, and specifically compared the response to rTMS in adults younger than 65 compared to those older than 65. Researchers found there is an initial slower response to treatment for older adults than younger adults but that after six weeks, the degree of improvement in older and younger adults is the same. Therefore, the new study provides experimental evidence that while more sessions may be needed in older adult patients to improve depression severity, the efficacy of rTMS is clear and it offers a valuable therapeutic option to an otherwise extremely disabling disease. 

Alvaro Pascual-Leone, M.D., Ph.D., Medical Director of the Deanna and Sidney Wolk Center for Memory Health and Senior Scientist at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew Senior Life, is the lead author. “The findings are significant from a healthcare policy perspective because many major insurance providers in the U.S. have coverage policies that hinge on a clinical response within four weeks. They need to expand coverage to at least beyond six weeks of treatment to ensure maximal benefit for older adults who are in particular need of effective treatment option for major depression. It brings new hope to patients and their families that TMS can relieve treatment- resistant depression.”

Berenson-Allen Center for Noninvasive Brain Stimulation in Boston, University of Iowa Center for Noninvasive Brain Stimulation in Iowa City, and Champalimaud Foundation Neuropsychiatry Unit in Lisbon, Portugal, collaborated in this study.

This study was funded by Fundação para a Ciência e Tecnologia (FCT; Portugal) through a PhD Scholarship (SFRH/BD/130210/2017); the National Institutes of Health (NIH) (NS114405-02, MH120441-01); FCT (Portugal) through a Junior Research and Career Development Award from the Harvard Medical School – Portugal Program (HMSP-ICJ/0020/2011); PTDC/MED-NEU/31331/2017 and PTDC/MED-NEU/30302/2017. The study also received national funds from FCT/MCTES and co-funded by FEDER, under the Partnership Agreement Lisboa 2020 - Programa Operacional Regional de Lisboa, and from a Starting Grant from the European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 950357). 

Other authors included: Gonçalo Cotovio, M.D., Ph.D.-candidate, Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal, NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, and Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon; Aaron D. Boes, M.D., Ph.D., assistant professor, Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, and associate professor of Pediatrics-General Neurology, the University of Iowa Carver College of Medicine; Daniel Z. Press, M.D., Chief, Division of Cognitive Neurology, and 
associate professor of Neurology at the Harvard Medical School and the Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center; and Albino J. Oliveira-Maia, M.D., M.P.H., Ph.D., Director of Neuropsychiatry, Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon.

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, MA – The Successful Aging after Elective Surgery (SAGES) II study has been launched as a 5-year prospective observational study of 400-420 community dwelling persons, age 65 years and older, prior to scheduled surgery. The study participants are followed during hospitalization through 18 months post-operatively, to examine the pathophysiology and inter-relationship between delirium and dementia using novel biomarkers and cutting edge approaches.  

“We examine novel biomarkers potentially associated with delirium – including inflammation, Alzheimer’s disease (AD) pathology and neurodegeneration, neuroimaging markers, and neurophysiologic markers – and other clinical outcomes,” reports Tammy Hshieh, M.D., M.P.H., one of the first authors.

The SAGES II study lays the groundwork for important future studies based on this comprehensive cohort. According to the researchers, “our overarching hypothesis is that delirium may be a significant initiating and/or predisposing factor for long-term cognitive decline and that patient and hospitalization-specific factors are important additional contributors to delirium and cognitive impairment.” 

The study launch and methods are reported in the paper, “Successful Aging after Elective Surgery II – Study Design and Methods,” published in the Journal of the American Geriatrics Society (October 10, 2022).  The lead authors are Tammy Hshieh, MD, MPH, Assistant Scientist I, Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Assistant Professor of Medicine, Brigham and Women's Hospital, Assistant Professor of Medicine, Harvard Medical School and Eva Schmitt, Ph.D., Assistant Scientist I, Associate Director, Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research; with Sharon K. Inouye, M.D., M.P.H., Director, Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Milton and Shirley F. Levy Family Chair Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, senior author and overall principal investigator of SAGES I and II. The goal of this paper is to describe the complex study design and methods for the SAGES II study which integrates MRI, TMS/EEG, PET modalities and high-quality longitudinal data.

According to the paper, “delirium may serve as a marker of pre-existing factors that put patients at increased risk of long-term cognitive decline and dementia. We anticipate that timely interventions and recognition of risk factors for delirium can prevent long-term cognitive decline and dementia, and will ultimately, allow us to improve clinical care for older adults.”

Background 
Delirium is a clinical syndrome characterized by inattention and disturbance in cognition that develops acutely with a fluctuating course. Delirium is a common, serious, and often fatal disorder, associated with increased risk of functional decline, nursing home admission, prolonged length of hospital stay, and cognitive decline. It affects up to 60% of hospitalized seniors, with costs exceeding $204 billion per year (2021 U.S. dollars). The adjusted healthcare costs due to severe delirium in post-operative patients in the U.S. are estimated at $56,474 (95% CI $40,927-$77,440) per patient over one year.  As a preventable condition in 30-50% of cases, delirium holds substantial public health relevance as a target for interventions to prevent its associated burden of downstream complications and costs.

SAGES II represents a comprehensive and advanced study with pre-operative, post-operative and long-term follow-up on a longitudinal cohort of older patients undergoing major surgery. Few studies offer the multi-faceted breadth of assessments of SAGES II, with in-depth clinical characterization, cognitive measures over time, and biomarkers. SAGES II also examines patient-centered outcomes, such as depression, self-rated health, quality of life, and caregiver assessments longitudinally. SAGES II represents a concerted effort to enhance understanding of delirium pathophysiology, an area that remains poorly understood. Moreover, the focus on understanding delirium that leads to long-term cognitive impairment (i.e., complicated delirium) is a major advance, that will allow clinicians and researchers to target interventions for identified risk factors to the most vulnerable patients. Lastly, SAGES I and II will provide a valuable database and biorepository for future research.

According to the authors, the SAGES II study is an important prospective cohort study, and this paper will be the basis for all future work from this innovative gerontological research. Researchers previously studied a cohort of >560 older surgical patients in the Successful Aging after Elective Surgery (SAGES I) Program Project Grant (P01AG031720), and found that delirium was followed by an accelerated trajectory of long-term cognitive decline.  Important risk markers for delirium were elucidated, related to inflammation (Interleukin-6, C-Reactive Protein and Chitinase 3 Like Protein 1), structural dysconnectivity on MRI, and impairment in global cognitive performance. In an effort to validate knowledge of the inter-relationship of delirium and dementia, including the pathophysiology of delirium and its potential linkage to dementia, we proposed the SAGES II study.

Enrollment for SAGES II began on April 1, 2019 and follow-up is ongoing.  Funding is provided by NIA: P01AG031720, R33AG071744, R01AG044518, K24AG035075, R01AG030618, R01AG051658.

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.

Featuring: Sharon K. Inouye, M.D., M.P.H., Director, Aging Brain Center, Institute for Aging Research
Presented by The Alzheimer's Drug Discovery Foundation and the Brain Dysfunction Discussion Group

Tens of millions of surgeries are conducted in the U.S. every year on people over the age of 65. With surgical procedures becoming increasingly safer and capable of promoting continued mobility and functionality into old age, the frequency of surgeries in the elderly will probably continue to rise. And yet, these procedures can have a dark side: for a significant percentage of elderly patients, anesthesia and surgery can lead to postoperative delirium and possibly long-term cognitive decline.

The risk of experiencing these postoperative complications depends on the type of surgery and the condition of any given patient. Despite the high incidence of these conditions, they are often overlooked in the clinic, and their underlying mechanism and long-term effects are poorly understood. On June 21, 2016, the Alzheimer's Drug Discovery Foundation partnered with the Brain Dysfunction Discussion Group at the Academy to convene Surgery and Cognition: Delirium, Cognitive Decline, and Opportunities to Protect the Brain. At this meeting, leading scientists and physicians discussed the challenges and opportunities to creating biomarkers and therapeutics for patients who are vulnerable to delirium, cognitive decline, and dementia following surgery.