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Aging & Geriatrics Study ExamplesStudy Examples | Key Publications | Intro These are among the current Group Health Center for Health Studies (CHS) studies on aging and geriatrics:
Alzheimer’s Disease Patient Registry (ADPR)/Adult Changes in Thought (ACT) Study
A five-year, $5.7 million grant from the National Institute on Aging (NIA) is continuing a broad-range research project on Alzheimer's disease (AD) and the changes in thinking that happen with aging. The ultimate goal is to develop and test strategies to delay or lower the risk of AD. For now, the project is analyzing links between AD and dementia and many common drugs, including ones for high blood pressure, hormone replacement, and high cholesterol levels. It also evaluates other potential risk factors for AD, such as high blood pressure and cholesterol levels, lack of exercise, obesity, diabetes, and tobacco use. This project maintains both the Group Health/UW AD Patient Registry and the Adult Changes in Thought (ACT) Study, which provide other investigators with long-term, comprehensive data and well-characterized research subjects. The Registry, started in 1987, enrolled people with newly detected dementia until 1998 and followed them until about 2000. Adult Changes in Thought, a prospective cohort study started in 1994, includes a random sample of Group Health members over age 65 who were determined to be free of AD and other forms of cognitive impairment. They are being evaluated every one to two years to monitor cognition and other aspects of how they are aging. The major focus of the work for the next five years is the ACT study population, which is now positioned as a "living laboratory" to study aging. It continues to follow people still alive from the original enrollment and replaces those who die with new volunteers; so there are always 2,000 people over age 65 in the study. Most aging cohort studies become smaller over time, but the ACT will remain a constant size—and a place where scientists can perform additional studies, a few of which are listed below: Problem Solving and Physical Intervention in Aging (Principal Investigator: Linda Teri, PhD, UW School of Nursing’s de Tornyay Center for Healthy Aging; Lead Group Health Investigator: Eric B. Larson, MD, MPH): This randomized controlled trial has tested how two training programs affect emotional well-being, physical health, and independent living among Group Health outpatients aged 75 and older. One program has provided skills training in problem solving and encouraged mood-enhancing activities and health-promoting behaviors. The other was designed to increase strength, balance, and flexibility. The patients have been followed for two years to evaluate how these two interventions—together and separately—affect their degree of independent living, disability, and health care utilization and costs. The goal is to prevent the physical decline that too often accompanies AD. The NIA is funding this study with $150,000 to CHS over five years. Surrogate Markers of Cancer Susceptibility in Older Patients (Co-Principal Investigator: Derek L. Stirewalt, MD, Fred Hutchinson Cancer Research Center): These experiments are investigating whether susceptibility to DNA damage and programmed cell death varies by age, history of cancer, and presence of cytogenetic translocations (broken and reattached chromosomes). The goal is to evaluate these translocations as markers for cancer susceptibility in seniors. In Vivo Mapping of Gray Matter Loss in Pre-clinical Dementia (Co-Principal Investigator: Satoshi Minoshima, MD, University of Michigan Department of Internal Medicine): This study uses positron emission tomography (PET) to create pictures of people’s brains noninvasively. It aims to identify patterns of gray-matter loss that may be used to predict AD. Biomedical Risk Factors for Presbycusis (Co-Principal Investigator: George A. Gates, MD, UW Department of Otolaryngology–Head and Neck Surgery): This research examines whether problems with processing sounds (central auditory dysfunction), involved in age-related hearing loss (presbycusis), could help identify people at risk for developing AD. Behavioral Treatment of Nocturnal Disturbances in Alzheimer's Disease (Co-Principal Investigator: Susan M. McCurry, PhD, UW): This research will test a method to reduce sleep disturbances in older people. Midlife Cognitive Change and Risk of Cognitive Decline (Co-Principal Investigators: Sherry L. Willis, PhD, and K. Warner Schaie, Seattle Longitudinal Study, Pennsylvania State University): With ACT investigators, these researchers will identify factors leading to "mild cognitive impairment" in older people. Effects of Rosiglitazone in Patients with MCI (Co-Principal Investigator: Suzanne Craft, PhD, Seattle Veterans Affairs Medical Center): This new study will explore the relationships among insulin resistance, metabolic syndrome, mild cognitive impairment, and Alzheimer's disease. Pharmaconeuropathology of Brain Aging and Dementia (Co-Principal Investigator: Thomas Montine, MD, PhD, UW): This study will focus on the role of so-called oxidative damage on brain aging. Delivering Effective Primary Care to Older Adults
Typical primary care settings don't take a comprehensive, planned, and geriatrically oriented approach toward older outpatients. By contrast, this randomized controlled trial uses an interdisciplinary Senior Resource Team—a gerontologic nurse practitioner, a pharmacist, and a fellowship-trained geriatrician-to help with functionally oriented assessments and individualized treatment planning. The team is integrated into primary care practices of Group Health's group and network model clinics, assessing patients aged 75 and older for disability risk factors, geriatric syndromes, and chronic diseases, and ensuring that they get the treatments they need. UW and MacColl Institute researchers will then compare health outcomes of patients who receive care in this model with a control group receiving usual primary care. They will test whether the new model results in a less functional decline and less health care use. The John A. Hartford Foundation is funding this project for $1.5 million over four years. Improving Depression Care for Seniors (IMPACT)
This study, called Improving Mood—Promoting Access to Collaborative Treatment (IMPACT), assesses the ability of a "collaborative-care" model to improve the treatment of depressed patients aged 60 and older in primary care settings at multiple sites. The John A. Hartford Foundation funds this $830,000 four-year demonstration project, which compares the effects of an enhanced depression treatment model to usual care. Those in the enhanced model get care from a primary care physician and a depression nurse specialist supervised by a psychiatrist. Treatment adherence is a crucial outcome, because it lets patients get sufficient antidepressant medications and/or guideline-proven psychotherapy for periods long enough to help them. The researchers are also looking for differences in symptoms, outcomes, satisfaction, quality of life, and direct and indirect costs of care between the two groups. Improving Primary Care of Older Adults
Like the study called Delivering Effective Primary Care to Older Adults, described above, this study is based on the use of Senior Resource Teams at Group Health primary care practices. But this study focuses on the model's effects on primary care providers, rather than on patients. This is the first study of interdisciplinary teams to try to influence and measure changes in how providers care for their elderly patients. Its goals are to improve appropriate prescribing; optimize management of chronic diseases; and increase primary care's performance of routine assessments of physical and cognitive function, geriatric syndromes, and other risk factors for functional decline in elderly patients. The Paul Beeson Physician Faculty Scholars in Aging Research Program Award—which recognizes full-time junior faculty members committed to pursuing an academic career in geriatric teaching, research, and practice—supports this study with $450,000 over three years.
Study Examples | Key Publications | Intro |
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