Welcome to the Barshop
Institute
A world leader in aging research
Why do research on aging?
10,000 baby boomers turning 65
every day
85+ population will triple by 2050
100+ population will grow more
than 7-fold by 2050
How important is aging?
Risk Factors for Cancer
Percent Increase
40
30
20
10
0
Smoking Alcohol
Diet
Infection
Aging overwhelms all other risk factors
6000
for Cancer
Percent Increase
5000
4000
3000
2000
1000
0
Smoking Alcohol
Diet Infection Aging
Risk Factors for Alzheimer’s Disease
500
400
300
200
100
g
in
ok
t
ac
In
Ap
oE
Sm
Ph
be
ia
D
ys
te
s
x
0
Se
Percent Increase
600
Aging overwhelms all other risk factors for
80000
60000
40000
20000
g
in
Ag
Sm
ok
in
g
oE
Ap
t
ys
In
te
Ph
be
ia
D
ac
s
x
0
Se
Percent Increase
100000
Alzheimer’s Disease
Aging as a therapeutic target
Neurodegenerative diseases
Cancer
(Alzheimer’s, Parkinson’s, ALS)
Sarcopenia
AGING
Stroke
Type II
Diabetes
Arthritis
Osteoporosis
Heart
Disease
Adapted from: Biochim. Biophys. Acta (2009) 1790: 1067-1074.
Research Models
Target Discovery
Nathan Shock
Center of Excellence
in the Biology
Preclinical Testing
Aging Interventions
Testing Center
Clinical Testing
Older Americans
Independence
Center
Translation of Research into Practice
The South Texas Aging Registry
and Repository (STARR)
Donna Lehman, Ph.D.
Associate Professor of Medicine
Primary Goals for STARR
Recruit a diverse group of community-dwelling adults
who are potentially interested in participating in
translational research
• Multi-ethnic
• Range of ages
• Healthy adults as well as those with chronic illnesses
Community Outreach to Date
• Outreach to VA physicians & VA telehealth
• City of San Antonio Senior Centers & city programs
• Local health fairs within the VA and San Antonio community
• Toolkit for VA implementation created
Community Implementation
– Senior Centers
• City of San Antonio and WellMed
• Salvation Army
– Adult independent living facilities (ex: Air Force Villages)
– Partnerships with outpatient clinics in the community
• Toolkit dissemination
• Recruitment of patients to other sites once established
– Community events (ex: Silver Solutions)
– Partnerships with organizations (ex: Age Well Live Well)
San Antonio Longitudinal Study of Aging (SALSA)
Baseline Characteristics by Ethnic Group
San Antonio Longitudinal Study of Aging (SALSA)
Age, years (range: 65-80)
Female
Education, years (range: 0-23)
Income, category (range: 1-15)
Comorbidity, excluding diabetes
Diabetes
Frailty status
Non-frail
Frail
Mexican
Americans
n=394
n(%) or
mean(SD)*
69.3 (3.2)
227 (57.6)
8.9 (4.6)
10.4 (3.2)
137 (34.8)
122 (33.5)
European
Americans
n=355
n(%) or
mean(SD)*
70.2 (3.6)
205 (57.7)
13.4 (2.6)
12.8 (2.3)
149 (42.0)
35 (11.9)
Total
n=749
n(%) or
mean(SD)*
69.8 (3.4)
432 (57.7)
11 (4.4)
11.6 (3)
286 (38.2)
157 (23.9)
329 (88.7)
42 (11.3)
320 (93)
24 (7)
649 (90.8)
66 (9.2)
P-value
<0.001
0.97
<0.001
<0.001
0.043
<0.001
0.04
SALSA Mortality Findings
• Prior to covariate adjustment, mortality was
higher in MAs compared to EAs
• After adjustment there was no ethnic
difference
• Frailty, diabetes, and low income were
significant independent predictors of
mortality in SALSA
PROMOTING PHYSICAL ACTIVITY IN
OLDER ADULTS
Sara E. Espinoza, MD, MSc
Associate Professor, Department of Medicine & Barshop Institute
Associate Director/Clinical, San Antonio VA GRECC
Physical Activity in Older Adults
• Inactivity can have negative effects on physical health, lead to disability
• Increased physical activity beneficial at any age, even “frail” older adults
• Walking has few risks and can improve overall health
• Walking Clinic at the San Antonio VA, focus on increasing activity level
• Target population older (age ≥60 years) veterans enrolled in primary care
Baseline Face-to-Face Visit
• Safety screening and baseline assessments
• Patient education regarding diet (diabetic) and exercise
• Patient sets personal goals for the program
• Pedometer provided to patient and spouse/caregiver
Telephone Follow-up (1 -2 calls per week)
• Weekly telephone contact
• Number of steps per day are recorded in patient log and
reported
• Average number of steps per week calculated by Walking Clinic
staff
Follow-up Face-to-Face Visit (6 -8 weeks after Baseline Visit)
• Repeat assessments
• Encouragement to continue the program & follow-up resources
provided
Improved Physical Activity and Gait Speed
PATIENT CHARACTERISTICS
N = 133
Age
69.2 ± 7.9 years
Male
85.8%
Overweight or Obese
97.3%
Ethnicity, Hispanic
41.0%
Ethnicity, Caucasian
41.8%
Diabetes
52.2%
Coronary artery disease
18.7%
RESULTS (N = 106)
Baseline
End of Program
P-Value
4474 ± 2394
6046 ± 3476
<.0001
Timed Up and Go (sec)
10.2 ± 2.3
9.2 ± 2.0
<.0001
Timed 10-foot gait speed (sec)
2.72 ± 0.5
2.49 ± 0.5
<.0001
Number of steps per day
In an analysis of 50 patients who had Hemoglobin A1c within 6 months prior and subsequent
to participation in the Walking Clinic, we found Hemoglobin A1c decreased on average by
0.26 (p = .058).
Higher Gait Speed Predicts Survival
Studenski et al., JAMA, 201
Can we slow the aging process?
Effect of Caloric Restriction
on Lifespan
100
Percent Alive
Lifespan (mos)
90
n
80
Ad Libitum 77
30.9
33
70
Caloric Restriction 79
38.3
49
Median
Maximum
60
50
40
30
Increase in
Maximum Life Span
20
10
0
0
5
10
15
20
25
30
35
Age in Months
40
45
50
Extending lifespan/ slowing aging retards/prevents
many
age-related diseases
Neurodegeneration
Sarcopenia
Cancer
Stroke
Dietary
Restriction
Diabetes
Arthritis
Osteoporosis
?
Heart
Disease
Rapamycin & Longevity
History
2009:
Nature publication showing that rapamycin
increased lifespan of mice.
Harrison, Strong, Sharp et al., Nature, 460, 392-396, 2009
December 2009
Science selected the rapamycin study as one of
the 10 scientific breakthroughs of 2009.
Effects of rapamycin
(in mice)
•
•
•
•
•
•
•
•
Extends longevity
Delays Alzheimer’s disease
Delays normal cognitive aging
Prevents or delays several cancer types
Delays development of atherosclerosis
Rejuvenates stem cells (some kinds)
Preserves balance and coordination
Improves sleep, reduces depression/anxiety
Increasing brain blood flow reduces
amyloid accumulation
Control
Rapamycin
Clinical trial at the VA
Normalized score
(SLUMS and TAPS)
Before
After
15
10
5
0
Placebo
Dr. Dean Kellogg, personal communication
Rapamycin
1 mg/day