Lessons in Lifespan Health

From the USC Leonard Davis School of Gerontology, this is Lessons in Lifespan Health, a podcast about the science — and scientists — improving how we live and age.

Conscious aging, redefining yourself and finding fulfillment as you age 09/19/2024

Conscious aging, redefining yourself and finding fulfillment as you age is an author, coach and teacher who leads a yoga class at the USC Leonard Davis School. He joined us to talk about his book, The Art of Conscious Aging and how to redefine yourself and find fulfillment as you age. Transcript I hear all the time, I used to do yoga, but now my body doesn't like it. Well, find a new yoga class. If you remember how it made you feel, then doing it in a new way, maybe a gentler class, maybe a hot yoga class that's in the dark, that's slow, where you hold the poses and no one's looking at you because you may be self-conscious, maybe that's the answer to it. But not doing it is only going to make your life collapse. And I believe that one of the biggest problems with aging is people's worlds get smaller and smaller. Orli Belman (): From the USC Leonard Davis School of Gerontology, this is Lessons in Lifespan Health, a podcast about the science and scientists improving how we live and age. I'm Orli Belman, Chief Communications Officer. On today's episode, how teacher and coach Wayne Lehrer found purpose in aging and is working to help others do the same. Lehrer is the author of The Art of Conscious Aging, the Operating Manual for an Extraordinary Third Act. He also leads a weekly yoga class here at the USC Leonard Davis School. Welcome to our podcast, Wayne, and thank you for being here today. Wayne Lehrer (00:39): Oh, thank you for the opportunity. Orli Belman (00:41): I think it would be helpful to start with some definitions. Let's begin with the terms in your book title. What is conscious aging? Wayne Lehrer (00:48): Well, conscious aging is accepting the fact that it happens for everybody. That's the conscious part of it. You know, most of us live most of our lives under the assumption that we're never going to age, certainly, that we're never going to be old or get older. So conscious aging is how we approach the process and the practice of aging. It's just basically becoming mindful of all of the elements that go into the process of aging, whether it's exercise and diet, sleep, or the subtler things like stress, poor relationships, you know, creating value in the world. So conscious aging is showing up for your life in a way that your life creates value for you and others. Orli Belman (01:32): That's a wonderful idea. And what is the third act? Wayne Lehrer (01:36): So historically, you know, what people normally now refer to as the third act is retirement. Historically, you know, the average lifespan in 1900 was 47 years. So, there wasn't really a third act. You know, people were children, they went to work and then they passed away, basically. And around 1950, with the onset of Social Security and Medicare and all of the other elements that increased life expectancy: the fitness revolution, psychological help, retirement funds, a little bit more disposable income available and a less stressful life, people began to live long enough to have a third act. So basically, life in three acts is the first act of childhood–which I say basically goes from zero to 20–is a time of exploring, discovering who you are, gathering information, finding how you fit into your world and the world. And that's also a period of dependency, could be categorized. Wayne Lehrer (02:42): The second act, starting in your twenties, and for most of, us going to our mid-fifties or 60 years, so about 35 or 40 years, the second act is a time of independence. We develop the ego, the separate self, we explore the world as an individual. We acquire, achieve, build, collect, succeed, compete. And during that time we, you know, sort of begin to build the separate self and what is mine, which could be, you know, my profession, my identity, my family, my place in my community. And then what's historically happened is that 55 or 60 people began to retire. They began to get phased out of their jobs. Empty nest happened and all of a sudden, they're left alone. And historically what happened is people went into a period referred to as retirement, which was really a period of on the highest-level seeking comfort and serenity. Wayne Lehrer (03:41): But on the lower levels what it happened to be was security, being less engaged in life, withdrawing, you know, that just started changing. Now that people have a period of time of 30 or 40 years from the time of retirement–if you retire at 55 or 60 with the average life expectancy rising above 90–there's a good chance you're going to have 30, 40, maybe even 50 more years of life. And so it's as long as the period of the second act. And historically that was seen as a time where you just withdrew and you know, kind of went on this long slow decline towards oblivion, you know. And now for the first time, you know, their health is better, they have some money in the bank, some sense of ways of creating new value and transforming themselves, so it's what I call the new third act. And the new third act is a period of time where you look at how you're going to create value, become an elder, give back, build community and collaboration. Also, if you think about it in the theater or in the film historically, you know, the second act is where all the drama happens. The third act is where the hero rises from the ashes, pulls all the diverse parts of themselves together, finds a new level of who they are, and really makes a difference and redeems themself. At least in the better stories. Orli Belman (05:02): And you've advocated for a different word for retirement. What do you call this new third act instead of retirement and how would you describe it? Wayne Lehrer (05:12): Well, the woman who created AARP called it refirement, but I really think it's a time of reinventing ourselves. You know, where we're looking at all of the gifts we have, all of the professions we've participated in, what we're passionate about and what talks to us in the world, what speaks to us that we feel like we may be the answer to, or we may be able to make a contribution in regard to. And so we have to basically, you know, reimagine, recreate, redesign and reinvent who we are and then reboot as that person. So, you know, I think it's a time of reinvention and reimagining. Orli Belman (05:54): These ideas, are they based on your own personal experience? Wayne Lehrer (05:58): Both my own, those of a lot of my friends. Obviously, I'm in a number of communities right now of people that are, you know, my age or entering into their third act or deep into their third act. And when I look around at the people that are happy and that are actually where they feel that they're in the sweetest point in their life, they're actually in the sweet spot, all of those people are people that have made this transition. And I think the transition is the hardest thing because historically also there's been no role models for a healthy third act. So part of it is observation. A lot of reading. There's a lot of good new research out there. You know, that longtime Harvard study that talks about people that have been, you know, where they followed people for I think 75 years and they found that the people that had long-term relationships, the people that found ways to continue to create value in later life. So yeah, and I also think it's indicative of our time period. So it's really an observation of both our time period and those people that are around me and then my own process of moving through this transition. Orli Belman (07:06): And can you talk a little bit about your own process? I know you've had several careers and maybe you could give some advice to people who finished their first career. Is there anything to take away from your example about restarting, investing yourself and even becoming an entrepreneur? Wayne Lehrer (07:22): It's challenging, especially challenging to do something maybe you've never done before. I put myself in a position or feel called to be in a position where I'm having to use skills I never developed before but based upon all of these other things that I'm very passionate about. So, you know, when I was younger, I studied Oriental medicine, I invented medical machinery, I had a whole life as a designer. I designed theme parks, museums, and world's fairs. I was an IMAX and computer graphics filmmaker, have taught yoga and meditation now for 25 years. So, I've had this full life and, and multiple different experiences and what was in common to all of them. And I believe that this is a case for everybody when they start to approach their third act, is that each of us sort of has a core way we meet the world. Wayne Lehrer (08:12): So, for me, my gift was creating immersive, transformative, spiritually uplifting experiences. So whether it's a yoga class or meditation or it's a ride in a theme park. If you take my ride in the theme park, you're going to be swept away. You know, it's not just going to be a thrill ride; you're going to be pulled into another world. So I think one of the things that a lot of people are maybe terrified or feel really challenged about making a transition out of the career they've had is first assessing and acknowledging the skills that they've actually developed and not seeing a single job as they had, as something that wasn't something that brought them a skillset, brought them a new way to know themselves and have something to offer. And then also, and this I think is particularly indicative of the third act, it's very important at this age to look into the world and see what the things are that you respond to. Wayne Lehrer (09:07): So you know, the most obvious examples would be Mother Teresa said, Oh, somebody needs to take care of the lepers in Calcutta. And Jimmy Carter, who may be one of the better examples of somebody who has a way more profound third act than his first or second act went and started Habitat for Humanity or what Clinton did. And these are skill sets that yes, they had all of the diverse pieces for, you know, they could talk to world leaders, they could get in the door, they'd work with health people and that kind of stuff. But it was also them each being entrepreneurial, you know, actually being the spearhead of those things. And I know for me personally, you know, I've written this book and I feel that it's a message that I've been given to share and that really no one is talking about in the way that I am. As a result of that, I have to learn technology, the most dreaded thing that anybody in their seventies can have to do, you know. And I have to practice social media; you know, I'm a really warm and friendly person. I talk to everybody on the street and at Starbucks, but have me post on Facebook and you know, I shiver. You know, so I'm having to learn all these things and, and the thing that's allowing me to do it is my passion for the thing that I'm doing. Orli Belman (10:21): And you've spent some time around our school over the years, and you know that we are focused on healthy aging and there are a number of scientific studies that show measurable benefits of practices like yoga, meditation, gratitude. We have a course on the mind-body connection, and I'm sure none of these positive findings are a surprise to you. How did you come to these practices and what do you see people getting out of them, particularly as they age? Wayne Lehrer (10:49): That's a great question, and I think it's important to say that even in my book, anybody can start conscious aging at the age of 20. So I started doing yoga and meditation in my twenties. Now that, you know, gave me a bit of a head start, but that was my natural inclination. I was not so drawn to a professional career as I was to the life of a seeker, let's say. So as people age though, they need ways to disengage from their story. You know, if you notice a lot of older people, their stories, you know, the story you tell is the life you're living. And if you're telling a story that's 30 or 40 years old and may not even be true anymore and might not have even been true when you started telling it, may have only been from your trauma point of view, then you need all the help you can get to get free of that, if you want to reinvent yourself in your third act. Wayne Lehrer (11:43): So meditation is one of the ways of doing that. As we get older, if we look metaphorically at aging, part of what happens for people as they age is they become rigid in their thinking emotionally. You know, they limit their emotional life. They don't read new things; they don't go to new places as much. If they go to a new place, it's in the safe confines of a luxury cruise or whatever it is. And same thing happens in the physical body. So any kind of exercise like yoga or tai chi or qigong that's fluid and flowing is going to exercise and lubricate the joints. They actually have, you know, done research and they found out that the synovial fluid, it just needs movement and regular and it'll actually come back. So these are really simple and obvious things, and part of that has to do with the fact that you're only going to notice that if you're paying attention to your experience in the body that you have and in the mind that you have when you're in your sixties or seventies. If you're not paying attention to it, and you still think, oh I can play basketball, I can stay up till one o'clock at night and not pay for it the next day or the next two days. Wayne Lehrer (12:54): You know, so if you're paying attention and you actually have valuing that feedback system, then there's a great chance that you're going to start making the quality of choices that are going to lead you to things like yoga. And you're going to listen to those podcasts and those scientists and the people at the Davis School of Gerontology that are telling you about intermittent fasting. You know, all of these things that are all incredibly valuable that may not have been at all a part of your world while you were striving to earn a living and you know, build your home and your family and your business. Orli Belman (13:29): Can you tell me a little bit more about this feedback system that develops as we age? Wayne Lehrer (13:34): Yeah. When we're younger, we can get away with everything and anything. You know, when you're in your twenties, you want to stay up all night, no problem. You want to stay up two nights and then do a presentation for work? No problem. You want to eat french fries? No problem. Exercise until you drop? No problem. But when you get older, those things are not negotiable anymore; there's a very narrow window. Most people look at that in a negative way. They think, oh I can't do this and I can't do that anymore. But the truth is that you finally have a feedback system that scientists have always had. And the only way that science moves ahead is by having a ground zero or placebo study to go against. All of a sudden you recognize that if I do this, for example, if I say I want to write a book and yet I have an allergy to wheat and I eat wheat and I'm foggy the next day, then I can't write that book. Wayne Lehrer (14:27): And if I'm committed to that thing I'm passionate about, then I'll take a look at what it's going to take for me to accomplish that. Same thing with any dietary thing or exercise element. All of a sudden I have a feedback system because my body will let me know right away and my mind will let me know and I'll know emotionally this person is somebody I'm not comfortable about. I feel toxic after I hang out with them. This is how much time I can do that for. And the value of that is it really makes us more conscious beings, so we have finally have something to measure against that allows us to grow and actually become aware and cognizant of that fine-tuned area called quality of life or wellbeing. Orli Belman (15:12): So you're saying there's a real benefit that we get to be more in tune with ourselves and know what works for us and what doesn't. Wayne Lehrer (15:19): Absolutely. Orli Belman (15:20): And you mentioned earlier this idea of contributing or doing something of value as being important as people enter their third act. And this is also a big concept in the field of gerontology: this idea that there is a benefit to living with purpose. And that's something you're obviously doing. And what do you think about the importance of purpose and the role it plays in your life? Wayne Lehrer (15:45): Well, one of the things that you see really common in people as they age is they begin to feel devalued. If you've been at a job for 20 or 30 years and all of a sudden that job's over and you derived your value from showing up at the job and that's gone, that takes a toll. Now none of these things may individually take you down, but all of a sudden there are five or 200 people every day that you're not seeing either. And so the value that they have for you and that you have for them, that's gone. Your children have moved out and you're not a parent anymore. So the value you got from parenting, from making a contribution to somebody, that's gone. So it's not so much that we need it more in later life, it's that a lot of the sources of value we've had have inadvertently–and not so necessarily obviously–disappeared. Wayne Lehrer (16:38): That said, there's also, I believe, a natural thing that happens in India. They talk about three stages of life and the third stage. And you know, you go from being a householder to somebody who gives back, also sometimes known as a forest dweller. But somebody who becomes a seeker and moves into a more spiritual stage of life where they're making a contribution. So I believe it's a natural thing that actually elevates, if we're getting our value from what we do in the world and all of a sudden we're not doing as much in the world and we need to find a new way to get our value. And it may not be as much from what we do in the world as from actually going inside. Because those jobs that we got in the world, a lot of the jobs that people have for 30 or 40 years weren't jobs that they really chose. Wayne Lehrer (17:25): They were jobs that they were shuttled into by school, by parents, by opportunities that were purely monetary. So all of a sudden, when that's taken away and you become the person that makes the choice over what you want to do with the rest of your life, you have to look inside. And that is where the real value comes. Not just the looking inside, but looking inside and coming up and saying, wait a second, this in the world really matters to me. Like it became obvious to me that I had a contribution to make because those things I started at 20 that had to do with healthy aging, I kept doing them. And so all of a sudden all my friends were saying, oh my God, you're the youngest 73-year-old, we know. You should write a book. And I thought, yeah, that'd be nice. Wayne Lehrer (18:07): And then all of a sudden it, you know, just kept occurring to me. And next thing you know, I felt a calling because I saw a lot of people struggling, making a transition from their second to their third act. So I think a lot of people, it's almost a necessity that they find value because lack of value could result in what most people term depression, isolation, loneliness. These are all the natural things that happen for a lot of people as they age. And a lot of that has to do with that. They haven't found a place to be in the world. And our value comes from multiple places. So our communities have disappeared when we get older because we're not at work, we're not at school, you know, our kids aren't there. So we're not in the family as much. Our communities have disappeared. That's a place we get value. Wayne Lehrer (18:49): A lot of our relationships change. People move away or die. All of a sudden a place that we get value in, intimate relationships is gone. We're not doing our work. So the value we're creating as a... /episode/index/show/lifespanhealth/id/33131137

Studying how the brain’s blood vessels affect cognitive health 08/13/2024

Studying how the brain’s blood vessels affect cognitive health Dan Nation is a professor of gerontology and medicine at USC. His research focuses on vascular factors in the brain and how they affect memory decline and dementia in older adults. He joined us to talk about studying blood vessels in the brain to identify early signs of dementia and potential therapies to treat it. Transcript Speaker 1 (): The variability in your blood pressure day to day, month to month, year to year, and sometimes even beat to beat–the variability in your blood pressure is predictive of dementia risk. So higher levels of blood pressure variability are bad, even if you have very well controlled blood pressure levels. And this is important because currently we only treat average blood pressure. There is no treatment for variability in blood pressure. So it's a new area that we should try to look into controlling to see if we can prevent dementia in people who have high variation, even if they're already treated for hypertension. Speaker 2 (): From the USC Leonard Davis School of Gerontology, this is Lessons in Lifespan Health, a podcast about the science and scientists improving how we live and age. I'm Orli Belman, Chief Communications Officer. On today's episode: how Professor Dan Nation is studying blood vessels in the brain to identify early signs of dementia and potential therapies to treat it. Dan Nation is a professor of gerontology and medicine at USC. His research focuses on vascular factors in the brain and how they affect memory decline and dementia in older adults. Welcome to our podcast Dan, and thank you for being here today. Speaker 1 (): Thanks for having me. Speaker 2 (): I wanna start by asking you about blood vessels in our brain. Is there anything unique about the brain's vasculature system, and how did it become the focus of your research? Speaker 1 (): Yeah, it's a great question. So there's actually several things that are unique about the brain vasculature. For one thing, just the number of blood vessels. So you might think about the larger vessels that you can see with the naked eye, but most of the vessels are microscopic. And we have so many blood vessels in the brain that there's actually one blood vessel for every neuron. So every brain cell basically has its own microscopic blood vessel. So it's billions and billions of blood vessels, and this is likely the case because the brain has an incredible need for blood flow to support its very high metabolic rate. And the brain cannot store energy unlike other tissues in the body, and so any energy that the neurons need, they have to get on the fly from blood. So there's a torrential amount of blood flow that's disproportionate to the size of the brain. Speaker 1 (): In addition to that, blood is actually toxic to brain tissue. And so the neurons need a special environment to operate, and so that milieu has to be well controlled. So the blood contains proteins, cells, infectious agents, metals, ions–all of which, if it were to get into the actual brain compartment, would be very toxic and would cause degeneration of the brain cells, cell death. And so their brain has a special structure that divides the blood off from the brain. This doesn't exist in other parts of our body; it's called the blood brain barrier. So that has to have integrity in order for the brain to survive and function properly. In addition, because of that, the way waste products of regular cellular metabolism and so forth, any other toxins that are in the brain, the way that gets moved out of the brain is different than other parts of the body because the lymphatic system in the brain is really different because we have to have this blood-brain barrier. So for a number of different reasons, the vessels are special. A lot of it has to do with the blood-brain barrier because the separation of the blood from the brain means that all of the nutrients have to be pumped actively into the brain. And all of these, again, waste products have to be pumped actively out somehow. And so any dysfunction there could lead to the buildup of toxins in the brain, which would cause degeneration. Speaker 2 (): So your PhD is in psychology, correct? Speaker 1 (): Yeah, neuropsychology. Speaker 2 (): Neuropsychology. So how did you get interested in the vascular system? Speaker 1 (): Yeah, I actually have always studied the vascular system because I was in a neuroscience lab that was focused on relationship between behavior and cardiovascular disease and basically neurovascular function and in particular as a clinical neuropsychologist we're involved in treating patients with neurocognitive disorders of aging, like dementia of Alzheimer's disease. And so I became interested in how these neurovascular factors may contribute to those diseases and to cognitive decline from those experiences. Speaker 2 (): This sounds like a very complex system. What happens to it as we age? Speaker 1 (): So as we get older, most people will develop a number of different vascular changes or will be at risk for different age-related vascular diseases. The most common is hypertension or high blood pressure. As we get older, the odds of developing high blood pressure just go up and up, and ultimately if you live long enough, most people will develop hypertension at some point. The majority of people over the age 65 have high blood pressure. And so that has to do with changes in your overall vascular system that can lead to a hardening or stiffening of the arteries and development of specific changes in the way the blood vessels of the brain work, which can damage the blood-brain barrier, lead to leakage of blood into the brain, decreased blood flow to the brain. And also what we've found is that older adults, their micro blood vessels don't dilate as well, and so they need to be able to dilate in order to provide more blood flow as needed to support brain health. Speaker 2 (): It sounds like you know a lot about what's happening and the inner workings of our brain. Have updated imaging technologies improved our understanding of the role of these small blood vessels, and what can you tell us about your research in this area? Speaker 1 (): Yes, so brain MRI has been very useful because it's usually relatively non-invasive, and we can use MRI to actually study the functioning of these microscopic blood vessels that would be otherwise very difficult to study. And we can actually visualize some microscopic changes such as small bleeds in the brain because they have this blooming artifact on brain MR. So we can see things that are microscopic, and we can study how the blood vessels can dilate or constrict using brain MRI. And we can study whether anything is leaking from the blood into the brain using brain MRI. So there's a lot more that is happening in MRI science that we're constantly monitoring and trying to incorporate into our studies. So I think there will be further advances, and we'll be able to study brain blood vessels even better in the future. Speaker 2 (): And when you look at brain blood vessels, are you looking , particularly, at these microscopic ones? Speaker 1 (): Yeah, we study the blood flow through these microscopic vessels and also whether or not they're leaking the leakiness of these vessels. Speaker 2 (): I listened to a talk you gave, and you mentioned something called a neurovascular unit. What role does that play in brain health or brain dysfunction? Speaker 1 (): It's a relatively newer concept that sort of springs off of the fact that again, there's a blood vessel for every neuron in your brain. It becomes clear when you understand how dense the micro vasculature is in the brain, that really it can't be totally separated from the functioning of the neurons themselves. When an area of your brain becomes active and neurons increase their activity, they need more blood flow, more nutrients, more clearance of waste, more oxygenation. And so they actually send a signal to other cells that control how much blood flow is happening, how much blood flow is coming to the vessels. So the blood vessels and the neurons are connected and communicating with each other. And so it's become clear that there's really this micro organ that we call the neurovascular unit, which is comprised of the blood vessel cells themselves, the neurons and other support cells, astrocytes, pericytes. And so all these different cells work together as a unit to make sure that blood flow meets the neurons’ metabolic demand. Speaker 2 (): And when this isn't working correctly, why is early detection of dysfunction in this area so important? Speaker 1 (): Yeah, it's extremely important because if you think about it, when you have a problem with the blood vessel that could predate the actual injury to the brain, you can have dysfunctional blood vessels, but that doesn't mean you have any brain damage yet. You just have vascular disease. The blood vessels have a disease happening within them, but that can ultimately lead to death of the brain tissue. And in the brain, once tissue is dead, those neurons died. They're not replaced, and the brain can kind of rewire itself, but it can't really regrow that brain tissue. So the idea is if you cannot detect the blood vessel problem before the brain injury has happened, then you could intervene and prevent irreversible brain damage. Speaker 2 (): That sounds important. How would somebody know? How do you test for blood vessel function? Speaker 1 (): So, as I mentioned, we're using brain MRI technology. We're also working on blood tests. There's different markers people are interested in. It's still, you know, at the research phase, but we have the ability to quantify how well your blood vessels are responding to stimuli, how much blood flow you have into sensitive areas of your brain that are very important for memory and other mental functions and whether those vessels are leaking, which could lead to, again, irreversible brain damage. Speaker 2 (): What can we do to improve our vascular health? Speaker 1 (): So the number one thing is, well first of all to monitor your vascular health through going to see your physician so that you can catch cardiovascular risk factors early. If your blood pressure is elevated, if you have a problem with your cholesterol levels, if you're pre-diabetic or diabetic, it's extremely important that those cardiovascular risk factors are caught early and are well controlled and treated right away. If they are, they're not likely to lead to brain damage, but if they're left untreated, then you have a very high risk of this ultimately damaging your brain. The other thing is basic stuff that you would do for heart health is also good for brain health. So things like a good healthy diet, exercise. Physical activity doesn't have to be running marathons. Moderate levels of physical activity are helpful for the blood vessels in your brain. Speaker 2 (): That's certainly a message we've heard on this podcast before: what's good for the heart is good for the brain. I think most people are familiar with the idea of high or low blood pressure, but you're looking at something called blood pressure variability. What is that, and what do we know about its connection to dementia risk? Speaker 1 (): Yeah, so as I mentioned, many people over the age of 65 are going to have high blood pressure, and those rates just go up and up. But the research has shown that once you're over 65, if you have high blood pressure, develop high blood pressure, and as long as it's being treated, your actual blood pressure level doesn't really correlate with dementia risk very much. I mean, it needs to be treated; that's important. We know that. But beyond that, where you're at with your blood pressure as an older adult hasn't been very predictive of things like brain degeneration, dementia. But what we've observed is that, even if you are treated and even if you are treated pretty aggressively, have have very low blood pressure with treatment, the variability in your blood pressure day to day, month to month, year to year, and sometimes even beat to beat the variability in your blood pressure is predictive of dementia risk. So higher levels of blood pressure variability are bad, even if you have very well controlled blood pressure levels. And this is important because currently we only treat average blood pressure. There is no treatment for variability in blood pressure. So it's a new area that we should try to look into controlling to see if we can prevent dementia in people who have high variation, even if they're already treated for hypertension. Speaker 2 (): And are the traditional treatments effective? Has your research revealed anything about blood pressure medications and whether they can affect variability? Speaker 1 (): Yeah, we're just now starting to do this work. It's complicated because there's many different things that affect blood pressure variability, and we need to do a lot more research. But it's already known that medications that are longer lasting, drugs that have a longer half-life or have longer term effects, for example, those tend to be better at keeping variability low in addition to keeping your blood pressure levels low. And that makes sense, right? If the drug is wearing off, you know, after a short period of time or by the end of the day, then you would expect to have more variation between doses. And so we plan to do more research on the different types of blood pressure medicines, the classes, specific agents, and we'll call their pharmacokinetic properties, how long they last in your blood, the half-life and so forth. But also adherence to blood pressure medication if people skip a dose or they're taking it at the wrong time of day–that kind of thing can also affect blood pressure variability. Speaker 2 (): And is this research that's still in the lab stage, or is this informing clinical practice yet? Speaker 1 (): Well it's clinical research, so we're studying human beings, older adults from the community who are taking blood pressure medications and that kind of thing. So it should, you know, our findings will be of value to clinicians, I think. And they're very interested in anything as it relates to blood pressure medicines because they're dispensing these drugs all the time in such a common condition. Speaker 2 (): We have talked to Mara Mather about heart rate variability in this podcast, and I know that's a big area of research for her. Is there a connection between heart rate variability and blood pressure variability? Speaker 1 (): Yeah, they're different things, but they are connected in the sense that your body tries to maintain steady blood pressure. It's not necessarily a good thing to have your blood pressure fluctuating all the time. And one of the ways that that happens, just homeostatically with normal functioning of your physiology, is changes in heart rate can help to modulate blood pressure. So they are related in terms of your cardiovascular system, but they're distinct. High heart rate variability is probably a good thing in relation to better health, whereas high blood pressure variability is a bad thing. Speaker 2 (): This is a little bit of a subject change, but can damage blood vessels repair or regenerate themselves? And what might this mean for cognitive decline? Speaker 1 (): Yeah, so anytime you receive any kind of injury, including a brain injury, the blood vessels and the tissue goes through a regeneration, healing restoration process. And in this case, usually it's the branching of additional vessels off of the existing vasculature. This is a process called angiogenesis, generating new branch points off of the blood vessel. So, if somebody has a stroke for example, you're gonna have a large piece of brain tissue that has been destroyed by not getting any blood flow. There's going to be a healing process that's gonna happen there, and there's gonna be some regrowth of branches of neurons as the brain kind of rewires itself and people healing from a stroke. And that has to be supported by branching off of blood vessels. So I said the neurons are very dependent on blood flow. So they work together during wound healing. And so yes, we certainly have an interest in this process since it's likely ongoing if you have some kind of microvascular damage happening, and we wanna understand more about whether it could be of benefit or it could go wrong and potentially cause harm and so forth. So we're studying this angiogenesis process in people with cognitive impairment. Speaker 2 (): And can you tell me a little bit about how you're studying it? Speaker 1 (): Yes. So we have lots of different projects happening. We are studying these cells that are in your blood circulation and come from different parts of your body, and they're very important in this angiogenesis process. They can actually form new blood vessels to replace damaged or dysfunctional ones. And so we can take blood from, again, older adults in the community who may or may not have different levels of vascular damage in their brains. And we can grow these cells in a dish and try to better understand whether they're functioning well, whether they're able to form blood vessels the way they're supposed to or if there's something wrong with that process. Speaker 2 (): Is this what you're talking about when you say growing a brain in the lab? Speaker 1 (): Yeah, so I've partnered with a bioengineering team that grows these micro brains, little brains in a dish. And what we can do now, and this is our new initiative we just started, is we can take blood from our participants and actually grow their brain vasculature in a dish. So these brain micro vessels that we're studying with brain MRI, we can actually grow them in the dish from these blood samples because we can grow these specialized cells that I'm referring to. They'll grow blood vessels in a dish, and we can see how they function. Are they forming blood vessels that are leaking? Are they forming blood vessels that are not branching properly or have other kinds of dysfunctional properties that don't support blood flow and so forth? And then we can tie that back to what's happening with that person's brain MRI. Do they have leaky blood vessels in their brains? Do they have proper blood flow on brain MRI or not? And so by doing this process, we can actually, the goal is to develop this sort of personalized medicine approach to try and better diagnose and treat brain blood vessel problems. Speaker 2 (): So everybody's brain grows differently in a dish depending on what you're putting in? Speaker 1 (): Yeah, this is what we're testing. So just let me give you a concrete example. If somebody has cognitive impairment and we do a brain MRI and we see that, sure enough, they have leaky blood vessels, might it be the case that this regeneration process isn't working in that person? So we could take their blood and grow a little mini brain that has their brain blood vessels in it and see whether they're leaking or not. If they are leaking, then it suggests that perhaps there's something wrong with this regeneration process, and we can actually try out different drugs in the dish and treat that person's micro brain with different potential therapies and see if any of them work. And then that might give us a clue as to how to fix the problem. Speaker 2 (): Wow, that's really exciting. Is there anything you wanna add or any of your other research studies that you wanna give us an overview of? Speaker 1 (): Yeah, I think the only other thing I would wanna highlight, something that I'm really excited about that we've made a number of discoveries on and are continuing to, and we actually have some papers just now coming out, is this connection between memory decline and dementia and the functioning of these tiny blood vessels, these micro vessels. We've continued to find that the memory centers in the brain,... /episode/index/show/lifespanhealth/id/32562087

Deprescribing and medication management for older adults 06/20/2024

Deprescribing and medication management for older adults Michelle Keller is an assistant professor of gerontology and the Leonard and Sophie Davis Early Career Chair in Minority Aging at the USC Leonard Davis School. She spoke to us about her research focused on improving patient-clinician communication, medication management, and the identification of dementia in minority older adults. Here are highlights from our conversation. On polypharmacy “When it comes to older adults and medications, it's important to understand that while medications can be incredibly beneficial for treating various conditions, they can also present really unique risks in this population. Older adults often take multiple medications at the same time. This is what we call polypharmacy.” “Older adults can be more sensitive to certain medications, they might experience side effects more intensely or even at lower doses than younger individuals. … This is particularly true for medications that affect our central nervous system, our brain, right? So, thinking about medications that are sedating or that have some sort of psychoactive effect. These medications, especially when they're combined together, can lead to things like confusion, dizziness and an increased risk of falls.” On her study of interventions to address polypharmacy “What we found in this study was that interventions to address polypharmacy can do a great job of reducing medications which are potentially harmful, identifying which medications people should be taking, improving the appropriateness of the medications people are taking, and reducing the total number of medications. So thinking about outcomes related to medications, what we have found is that it is really hard to change more downstream clinical outcomes, things like mortality, falls, hospitalizations, and emergency department visits. We did find that interventions that had multiple components; in other words, where a clinician is meeting face to face with a patient, reviewing their medications, reviewing all the chronic diseases that they have, along with their full patient history of what has happened to them in the past, those interventions tend to have a greater effect on mortality. So in other words, those types of interventions are reducing the risk of that someone actually dies.” “We also found that falls decrease when patients fully stop potentially harmful medications. These may be medications where somebody is feeling very dizzy or that make people feel very dizzy or drowsy, medications that may control somebody's blood sugar a little bit too much… So, their blood pressure's a little too low and they may actually fall as a result of these medications. But what we found was that stopping medications such as benzodiazepines, which are often taken for sleep or anxiety, can take months. These types of medications can have withdrawal effects. And so it's really, really important for somebody to work very closely with a healthcare provider to slowly taper these medications down to try to reduce those withdrawal effects.” “What we have found in working with other researchers and clinicians is that when patients team up with a healthcare provider, such as their primary care physician or clinical pharmacist who's embedded in the healthcare system, they really are able to stop taking some of these medications, and they feel a lot better. They feel much more energy, they're able to do the things that they really enjoy. They have a greater quality of life. But it's something that just takes time.” On the Empower Intervention for benzodiazepines “The typical recommendation for benzodiazepines is that they really should be taken short-term. These are medications that physicians typically recommend somebody take for a maximum of four weeks. What we have found in some of our research is that people are actually taking these for years, if not decades. And so stopping these medications can be quite challenging, and sometimes patients aren't fully convinced about why they should be stopping these medications. So, we took an intervention that started in Canada. It was developed by researchers in Quebec, and this is called the Empower Intervention. And what we did is we tailored it to a health system here in the US. The Empower Intervention is a really great brochure that contains some pretty striking facts about benzodiazepines.” “To give you some examples of benzodiazepine, these are like your Xanax, your Ativan, your Klonopin; these are the medications that we're talking about here. These brochures highlighted some really interesting facts, such as the fact that they can be harmful or linked to hip fractures and car accidents, and they can make people feel very tired and weak. What we did for this intervention is we sent these brochures to about 300 people along with a letter from their primary care physician, emphasizing that these medications can be harmful if taken for too long and especially among older adults. So what we did for this study is we compared patients who had received these brochures to patients who did not receive them. So they're going on usual care. Their physicians may have mentioned something to them, this was our control group, right? We didn't send anything to this particular group.” “We reviewed the medical records for both groups, and we looked at what kinds of medications they had been prescribed. And what we found is that patients who received the brochures were really activated. You know, when they received this messaging they would send messages in the patient portal to their physicians saying, ‘I didn't know that there were these risks of these medications. I would really like to come in and talk to you about them.’ They made appointments to start tapering down these medications. What we found was for every 10 brochures that we sent, one person completely stopped taking these medications, which is a really good return on investment. This is a simple intervention. It has now been done in some other health systems in the US, particularly the Veterans Affairs health system.” On challenges in de-prescribing “I think some of the challenges that physicians face in de-prescribing is that de-prescribing takes a lot of time. As we all know, our primary care visits are very short; physicians, particularly in the primary care setting, are really rushed through their visits. And so I think having some of these conversations can just be something that's challenging. I also think they're quite complex conversations to have. They may not have received the training, for example, on how to taper a medication in a safe way so that a patient does not feel withdrawal effects. And I do think that there is something about getting physician buy-in … they are concerned [that] if they bring it up, the patient may be angry with them; they may be upset. And so I think really showing physicians ways in which this can be brought up that are really framed around ‘how do we center the patient's health and quality of life’ – I think those are still questions that we as researchers are working on.” On the role of caregivers “It's really important for caregivers to be aware of the medications their loved ones are taking for many reasons. I think they can be amazing advocates in helping bring up potential side effects during doctor's visits. So, for example, if a caregiver is noticing that someone is feeling drowsy or doesn't have that much energy or is feeling dizzy, any sort of cognitive impairments such as those that may be seen in dementia, [they] may actually be a result of medication side effects. So, I think really becoming an advocate for somebody when seeing the doctor is one really important thing that caregivers can do.” “Another area where caregivers can play a really important role is among people with dementia. People with dementia can have really some challenges in managing their medications. They may miss doses, they may take several medications twice, so they may have an overdose, or they may take the wrong medication altogether. So, caregivers can play really pivotal roles in helping somebody manage medication changes. There have been some early interventions looking at how to engage caregivers and persons with dementia. And some of the challenges that those researchers have seen is that there [is] often more than one person actually caring for somebody with dementia. And so, engaging that whole group of people who may be working with that person has been a real challenge.” On challenges facing patients with language barriers “There is research showing that patients with language barriers have a greater risk of being hospitalized or re-hospitalized because of some of the communication challenges that come with medication management. So, you can imagine that, for example, older adults and their caregivers with language barriers may have a difficult time understanding medication instructions, which can lead to improper use. So when and how to take medications, recognizing potential side effects, understanding the purpose of each medication. And on top of that, you can layer on things, like if somebody doesn't have a great understanding of the condition. We call that disease literacy, or they may have health literacy issues.” “Right now, a mentee and I are working on this review of interventions that have been done specifically for patients with language barriers focused on improving medication management. And what we found was that interventions that really engaged people from communities with language barriers have been some of the most effective ways to really help people learn about which medications are working really well for them, how to improve medication adherence and other important outcomes. So, for example, an intervention that we found was researchers engaged folks in the community, co-created videos about medications in the community and why it was important to take them. And then when they actually distributed these interventions, they made sure that both in terms of the videos and some of the other educational materials that were handed out to folks that these really were very tailored both language-wise, literacy-wise, and culturally tailored to the communities that they were serving.” On new dementia medications and disparities in the diagnosis of dementia “We are learning that older Black and Latino adults tend to get diagnosed with dementia once the disease has progressed more. And what that means is that they may not have received some of the kind of services that may help them or their families. So, for example, they may not have received enough support to be able to plan for the rest of their lives, or their families may not necessarily have received caregiving support early on in disease progress.” “I think in regard to these particular dementia medications, for example, if older adults are diagnosed with dementia at a place where they're no longer eligible to receive these medications, I think that'll be a really pretty serious health equity issue. So, I am really interested in how we make sure that people are getting diagnosed in time to make them eligible for really potentially beneficial treatments that may help them down the road.” On effective strategies for de-prescribing “The most effective strategies that we see de-prescribing these medications is offering something else. So, for example, some of the most evidence for insomnia really exists around the use of using cognitive behavioral therapy. There's also been well-done systematic reviews that have found evidence that music or acupuncture may help people with insomnia. … I think one thing that's very important to think about when we de-prescribe medications is what else can we offer people? We're not just leaving people in the lurch and saying, ‘We're taking this away and we're leaving you with nothing.’ We're actually able to offer them some non-pharmacological options as well.” Transcript Speaker 1 (): One thing that's very important to think about when we de-prescribe medications is: what else can we offer people? We're not just leaving people in the lurch and saying, we're taking this away and we're leaving you with nothing. We're actually able to offer them some non-pharmacological options as well Speaker 2 (): From the USC Leonard Davis School of Gerontology, this is Lessons in Lifespan Health, a podcast about the science and scientists improving how we live and age. I'm Orli Belman, Chief Communications Officer. On today's episode: how Professor Michelle Keller is working with older adults, caregivers and clinicians to manage the use and potential overuse of high risk medications. Michelle Keller is an Assistant Professor of Gerontology and the Leonard and Sophie Davis Early Career Chair in Minority Aging at the USC Leonard Davis School. Her research is focused on improving patient-clinician communication, medication management, and the identification of dementia in minority older adults. Hi, Michelle. Welcome and thank you for joining us today. Speaker 1 (): Thank you so much for having me. Speaker 2 (): I wanna start by asking you to talk about older adults and medications. We can all understand why medications are beneficial, but when it comes to older adults, what are some of the ways they can be problematic? Speaker 1 (): Absolutely. So when it comes to older adults and medications, it's important to understand that while medications can be incredibly beneficial for treating various conditions, they can also present really unique risks in this population. So older adults often take multiple medications at the same time. This is what we call polypharmacy. Polypharmacy can increase the risk of drug interactions, right? So I like to think of the example of a suitcase, right? So imagine that you are packing up, getting ready to go to a trip. You start putting one thing into the suitcase, gets a little heavy, but you can manage it, right? You're suddenly adding more and more things and the suitcase is getting heavier and heavier to the point where you actually throw out your back at the airport, right? This is really what I think of when our bodies are kind of processing multiple medications at once with the additional challenge that some of these drugs may actually interact with one another. Speaker 1 (): This is why it's so important for patients to talk to their doctors about the medications they're taking and the potential risks of each medication as people get older. I think one thing that people don't often think about is that when clinical trials are being done, often many clinical trials have excluded older adults. So we don't always have a great sense of how these medications work in older adult populations. And on top of that, they may exclude people with chronic conditions who are already taking a variety of other medications. And so as a result, what is happening now is that we have many people who are taking these medications, and it hasn't been well tested in these populations. It hasn't really been, you know, we don't have a clear sense of what is happening when all of these medications are being taken together. So polypharmacy can really increase the risk of drug interactions. Speaker 1 (): As I was saying, when one medication affects another, and this can lead to a variety of adverse effects. So for example, if someone is taking multiple medications that make you feel drowsy or sleepy when you stack them on top of each other–thinking again about that suitcase, that can lead someone to have an increased risk of falls, potentially a fracture resulting from those falls, car accidents if they're feeling very drowsy or dizzy and other medications can increase our risk of internal bleeding. Another thing that's really important to think about for older adults is that as we get older, our bodies undergo various changes that can alter how our medications are absorbed, distributed, and actually excreted from the body. So for example, kidney and liver function can really decline with age. And so that can actually affect how well we process the drugs through our body. Speaker 1 (): What that means is that drugs may stay in our bodies for longer periods of time leading to more side effects or adverse effects. The last thing I really wanted to bring up is this idea of how things change as we get older. So we maybe have been taking a medication for many years, but as we get older because of the changes that are happening within our body, some medications, which were fine for us when we were younger, are now gonna lead to more serious adverse effects now that we're older. So older adults can be more sensitive to certain medications, so they might experience side effects more intensely or even at lower doses than younger individuals. They might feel the effects. So this is particularly true for medications that affect our central nervous system, our brain, right? So thinking about medications that are sedating or that have some sort of psychoactive effect. Speaker 1 (): These medications, especially when they're combined together, can lead to things like confusion, dizziness, and an increased risk of falls. One medication which people often take to help them sleep is Benadryl or Tylenol PM. This medication is actually a drug that's really recommended to avoid in older adults because it can be very sedating, making people feel very drowsy throughout the day. And it actually also has the effects on the brain and has been associated with a higher increased risk of dementia. So these are medications that again, we don't think of as generally harmful, but again, in an older person might really be an issue. Speaker 2 (): That's a really helpful example 'cause that's just an over the counter medication that anyone can get, even without a doctor. You recently published two papers looking at interventions for addressing polypharmacy. The first one was a review of several studies. What did you learn in that review about the effectiveness or not of programs that are designed to reduce harmful polypharmacy? Speaker 1 (): So we reviewed several systematic reviews. These are collections, as you mentioned, of numerous studies to understand how well interventions to address polypharmacy are working. Many of these interventions include a process called de-prescribing, which is the process of systematically reducing or stopping medications that may no longer be beneficial or might be causing harm, particularly in older adults. The goal of deprescribing is to optimize an individual's medication regimen to improve their overall health and quality of life. What we found in this study was that interventions to address polypharmacy can do a great job of reducing medications which are potentially harmful, identifying which medications people should be taking, improving the appropriateness of the medications people are taking, and reducing the total number of medications. So thinking about outcomes related to medications, what we have found is that it is really hard to change more downstream clinical outcomes. Speaker 1 (): Things like mortality falls, hospitalizations, and emergency department visits. We did find that interventions that had multiple components, in other words where a clinician is meeting face-to-face with a patient, reviewing their medications, reviewing all the chronic diseases that they have along with their full patient history of what has happened to them in the past, those interventions tend to have a greater effect on mortality. So in other words, those types of interventions are reducing the risk that someone actually dies. We also found that falls decrease when patients fully stop potentially harmful medications. So these may be medications that make people feel very dizzy or drowsy medications that may control somebody's blood sugar a little bit too much and so... /episode/index/show/lifespanhealth/id/31829782

Improving the health and well-being of family caregivers 03/05/2024

Improving the health and well-being of family caregivers Francesca Falzarano is an assistant professor of gerontology at the USC Leonard Davis School. Her research is inspired by her personal experience as a caregiver to her parents and explores how to improve the mental health and well-being of family caregivers, including through the use of technology. On young caregivers “I think right now it's estimated that five and a half million individuals are under the age of 18 are caring for a parent or some family member with chronic illness, mental health issues, dementia-related illnesses, and other age-related impairments. So, this is something that's becoming more and more pervasive, and the needs of adolescents are going to vary extremely, and they're going to be extremely different compared to what my needs were as a caregiver versus what a spouse's needs are going to be.” “I talked to a ton of first-generation Gen Z caregivers who have really been at the forefront of their loved one's healthcare interactions since they were young teens, just translating and digesting information that a doctor is saying and communicating it to the rest of the family. So there's a lot of burden that we're placing on these individuals without simultaneously understanding what their unique needs are.” On dementia caregiving “If you think about dementia itself, it's got a very unpredictable disease course where most of that time is spent in dependency, and you have a variable lifespan anywhere from four to 20 years. So what we are learning is that there are so many things beyond just the caregiver's direct care tasks beyond what they're just doing in the care environment, like bathing or dressing or feeding that go into the caregiving role that individuals are not getting support for, whether that's managing finances, making end of life decisions, navigating the labyrinth that is Medicaid and Medicare, talking to healthcare professionals. It's essentially all of these roles and responsibilities that unfold over time is what we would dedicate one expert to take care of in our, in our school or department. And we're expecting caregivers to have learn on the fly and typically they're getting support and help in crisis.” “We learned that caregivers are expecting or anticipating the information, about what to expect about what the disease will look like and about how their responsibilities are going to unfold from the primary care physicians. But as our, my caregiver participants have said, it's a situation of diagnose and adios. So there's very little follow up, there's very little ongoing support that's provided.” On long-distance caregivers “Long-distance caregivers... their biggest challenges that they face is that intersection with the formal care system, being able to get adequate communication and information about their loved one's care. And really just feeling involved and being able to adequately manage all of the responsibilities involved in keeping someone safe, but also in terms of their doctor's appointments and their medications and the people that are physically providing care.” “I think we need to do a better job at educating the clinicians and the care providers that just because an individual is not in person does not mean they're not a caregiver and they're not really involved in all of the work that goes into that.” “The prevalence of dementia is just going to continue to increase and the likelihood that we'll have to provide care for somebody we love is very high. The likelihood that we'll have to do it more than once is also very high. And so really kind of my goal is to normalize caregiving the way we normalize parenting the way we provide all the resources and follow up for somebody who's going on maternity leave and about to give birth to a child. And that we need to start looking and viewing caregiving in a similar way and normalizing it and reducing the stigma as much as possible so we're not embarrassed or ashamed of our circumstances, but we can use it to empower ourselves to get the support we need.” On technology “Technology has really opened a lot of doors, particularly in research and behavioral interventions to kind of alleviate stress and poor psychosocial outcomes. We've finally kind of looked at technology as a way to broaden opportunities for these individuals who might not be able to leave the house otherwise.” “I think technology can come in because a lot of the issues with the healthcare system and connecting caregivers to formal supports is we don't have enough human bodies in a room to take the time to assess each caregiver to give them the personalized support. We don't have the staffing, the time, just the capacity and technology can really help us improve and personalize that support beyond human capability. And so if I go on Netflix and Netflix can recommend what I want to watch next, Amazon can tell me what I want to buy next. I can go online and use AI to pick out an insurance plan, to pick out what my skincare routine is or my birth control. Why are we not using technology to give more tailored, targeted and precise support to caregivers?” “I think technology can help bring their desire for personalized caregiving navigation to fruition. And I also think it could bring the possibility of a one-stop shop where caregivers can get educated, find resources, connect with other caregivers, and not struggle to find the information and help they need. I think that becomes a lot more feasible when we bring in technology.” “I’m working on two tech-focused research projects right now. One of them is kind of, alluding to what I was just talking about, is the development of a self-assessment and referral platform where caregivers can get a sense of what areas they need the most support in. And using AI and machine learning to generate targeted referrals to kind of make the pipeline between identification, assessment and referral more seamless.” “I think this is another great thing that we can leverage technology for, is how do we engage people with dementia as well? And so a second research project I'm conducting with my colleagues at Weill Cornell, is a reminiscence therapy web-based platform where, and reminiscence therapy is pretty widely used in clinical settings. There's not as much empirical research done on reminiscence therapy, but we know that it helps the person with dementia recall memories. We know that music and all of these different interactive, prompts and activities done within reminiscence therapy could be really therapeutic for care recipients. And so, and typically in institutional settings they're kind of very general and it's facilitated by a clinician or a therapist in a nursing home. And we are creating right now a reminiscence therapy web app where caregivers are facilitating these activities and documenting meaningful memories with the person with dementia. It's something that they, they can do together. It's something that they can engage in that can promote relationship quality, help with feelings of grief that are so pervasive in both caregivers and patients.” /episode/index/show/lifespanhealth/id/30244258

Aging among Black Americans 10/19/2023

Aging among Black Americans Lauren Brown is an assistant professor at the USC Leonard Davis School. Her research uses publicly available data to uncover the unique difficulties Black Americans face in maintaining physical and psychological well-being as they age. Her lab both challenges the methods used to study older Black adults and strives to increase diversity in data science research with the goal of increasing the visibility of Black and Brown people via data and storytelling. Quotes from the episode On the role of racism in biomedical and statistical sciences and disease prediction If you think about the history of statistics and where it starts from, the earliest statisticians were actually also eugenicists. And a lot of it stemmed from the fact that Black people at the time that the census had started were property. And it was a way to count and keep up with property until we get to a point in the early 1900s when we start recording actual race in the census and colored being one of the options that you could check. And that being a way we kept track of Black populations, unfree, Black populations in particular, but also freed as well. And that transition of having Black people in the census started what was eventually used as studies that were confirming or trying to confirm biological and genetic inferiority among Black people. So once Black people were started to be included in the census and started included in medical research, clinical research, that research was usually often to compare Black people to white people with the innate goal to say Black people had more muscle mass biologically and genetically or smaller brain circumferences and justify it would a way to justify slavery by suggesting that the biological and genetic inferiority was a part of how Black people became slaves and would justify their continuation as slaves. So you fast forward to today that legacy of, of genetic and biological inferiority in medical, and statistical analyses has now manifested in things like race norming, where we're actually saying like, there are adjustments we use for Black patients in the clinic to justify whether they do or do not qualify for care strictly based on race. And a lot of it is based on false statistics that eugenicists had originally been pushing in the early 1900s. How injustice through data and storytelling affects the health and wellbeing of Black Americans When you think about like an individual, how this may affect one individual Black person, like for example, if we think about George Floyd's killing in 2020, his death originally was considered in the autopsy report performed by the medical examiners due to prior health conditions. They originally blamed his underlying health conditions and drug use as the cause of death. It was only after the family got an independent autopsy that they were able to show that the death was a homicide that then implicated Derek Chauvin and the Minneapolis Police Department, as responsible for the death and the knee on the neck. So this idea of blaming Black biology, is something that persists, I think, in larger society and that the biological inferiority is the cause and the precipice for Black death, and that it's not at all the function of society when actually now we know, you know, based on a lot of great research that the social environment is much more responsible for the fact that Black and Brown people often live shorter lives than white people or any other race and ethnic group in the US. We often live with more disease and disability at the end of life. And a lot of that we know is now it’s social conditions, it's discrimination, it's racism, those are at the forefront. But the research doesn't always follow that line of thinking because of the history and the legacy that still exists that we're still combating. And this new level of science is trying to push up against this idea. On diversity in population studies It’s been really obvious that a lot of the measurement and the things that people use to measure the wellbeing of Black life is really centered in white populations. And it's not innate or particular to the lived experiences of Black and Brown people. And so I think oftentimes we miss the real story that's happening up underneath a lot of Black health and aging specifically because those studies weren't designed just for Black people. They were designed for all aging populations and to monitor the aging of populations over time. The ethical considerations if you're leaving a whole group of people out or if you're not intentional about measuring their aging, is that you're not able to predict their clinical progression or able to assist their aging process in a way that's meaningful for them. We're doing everything much better for white populations than we are for minoritized populations. And so that the injustice is embedded in the structure of how these studies often come about. And the intention around what I want to do in this work is to help magnify the voices of Black people in these studies so that they more accurately represent the aging experience so that we can get better at predicting disease, preventing disease, and ensuring better aging process. On the Linked Fate Data Collective Linked Fate Data collective is a group of activists, of scholars, of students, of people who are interested in expanding their data science tools in order to promote the accurate depiction of the aging and the living process or the lived experiences of Black and Brown people. The idea being that, you know, most of the data science spaces are very white and male and often then reflect the values of people who are white and male. And I am very passionate about creating a space that looks and feels different for the people that I would love to bring into the data science realm. And you know, how we do that, I think, you know, there's a lot of argument about the pipeline issues of how we get people into data science or how we get people the skills to be able to do this on how we get Black and Brown people interested in data work. The inception of the name Linked Fate comes from a term that was originally used in African American studies. And the term was referring to block voting in Black populations where African Americans vote primarily Democratic with this idea that, you know, their fate is connected to the fate of the larger group. And so, there’s an interest in finding a collective voice in order to impact change and power. And that's really what I named this space after is that we have collective voice in data and it's the power of an individual magnified by many that gets people something that's powerful with the data work. And so that's really what this Linked Fate Data Collective is trying to do, is bring underrepresented groups and people and their ideas into a space that will honor the data science that we want to see in the world. And that is not perpetuating scientific racism, that's not perpetuating a lot of the genetic determinism and the things that some of the current science and medical and clinical spaces are perpetuating. On the Black mental health paradox One of the things I like to do in my work is move away from these disadvantaged narratives that really plague the aging story of Black Americans. Most people are very interested in the weathering and accelerated aging of Black Americans, when really there's a lot of trends that suggest that's not the only way that Black Americans are aging. That it's not just weathering stress aging faster, that there are also a lot of other processes that don't act so linearly. One of them is that mental health paradox, which is this data artifact that has been found in like five nationally representative samples now that despite having higher stress burdens, despite facing discrimination, despite having lower socioeconomic status, so lower education, income and wealth and despite having worse physical health, Black Americans have lower rates of depression relative to white Americans. So this could exist for many of reasons. It could really be a data artifact and it just could be that we are not measuring either mental health and depression in Black people in the way that it manifests so that we can measure it. Or it may be that we're not measuring the stress that's most impactful for Black Americans. And so we're not really capturing the stress burden. And so, we don't understand how that translates to mental health. And a lot of the work that I'm doing on the paradox is in that exact realm, which is that the stress experience is not being fully captured for Black Americans. And it’s not acknowledging the coping response that Black Americans can use in order to fight the adversity that they're facing. So, my idea here is to restore agency to Black people. That you're not just the sum of your stress exposures, you're also able to react and respond to those. And we have a lot of agency in responding to that and a lot of historical agency and a lot of lessons generationally passed down. And that's a really important way to acknowledge both the incredible hardship that Black Americans face in this country in growing old, both psychologically and physically. But it's also acknowledging our ability to fight back at the same time. And it's already happening. You know, it's not like we need an intervention for it or something else to do for it. Black people are already doing this and you can measure that. So yeah, it's a cool project. On the Fatal Encounters research project So motivated by the George Floyd murder in 2020 me and a colleague, Dr. Terrence Keel at UCLA recently got a RSF, Russell Sage Foundation grant. We're basically going to this data source called Fatal Encounters. It is a data source that crowd sources all of the police involved deaths that have happened in the United States. So, we are going to this data source and we are looking in LA County and we are finding the names of people who've been involved in police related deaths that have not involved firearms. That's because firearm deaths are very straightforward, can typically labeled the death as a homicide because you know, the act of shooting. But for non-firearm deaths like George Floyd, those are more arbitrary and harder to prove homicide and the autopsy reports can be very misleading, especially by the medical examiner and the coroners. And those autopsies are public in LA County. We're taking the names going to get all of the autopsies from the medical examiner/coroner. So, we have like 320 autopsies from 2000 to 2020, and we're trying to create a data set that represents how people are being classified in terms of cause of death and if there's any other indication of, you know, markings on the body some type of conflict that happened during the process. So, it's any interaction with the police out on the street or in LA County Jail. So, we have both of those data sources and we're able to try to say something about what's happening to a lot of these people, especially Black men whose moms are also very interested in understanding what happened to their kid. And so, the project is really motivated from that space. On the lack of diversity in genomic data In genetic sciences, you know I think 80% of our genetic and genomic data is from European ancestry populations, even though only 16% of the world is European ancestry. So, there's this huge imbalance in what we know about genetics because we only know what's happening among European populations. It's not, they're even telling people right now to not do genetic work in Black and Brown populations because we're not sure what we're finding is accurate because we don't have good training data. And the way genetic sciences work is that training data, everything is based on a reference population and a training population. It's not dissimilar from early eugenics where everything is compared to whites. You're constantly comparing Black and Brown people to white people. And if that's the way you're starting, it's going be a story that's rooted in inferiority and rooted in comparison and not necessarily rooted in the true story that should be unfolding that you can unfold when you're not trying to make those comparisons. So that's happening really horribly in the genetic sciences where you have dominant European frameworks and genetic data. You're trying to say something about other types of people and it's really not working, and scientists know that, but they're continuing to just do work on European populations. /episode/index/show/lifespanhealth/id/28371176

Using dance to ease Parkinson’s symptoms 06/21/2023

Using dance to ease Parkinson’s symptoms Patrick Corbin is an associate professor of practice at the USC Gloria Kaufman School and an internationally renowned dance artist whose career has spanned over 30 years and bridged the worlds of classical ballet, modern and contemporary dance. He recently spoke to us about his work, exploring the positive effects that dance can have on neurology. On movement and movement therapy Well, on a neurological level movement is cognition. Movement stimulates cognition. So that's sort of the sciencey part. The other part is that dance is a multifaceted, multilingual way of movement, and we're actually in a duet from the time your mother becomes aware of you in the womb, you're already in a duet with her. So you're dancing before you're born. We come into this world dancing and we dance through life. So, it is intrinsic to our development. So why shouldn't it be also important to therapies and things? Movement therapy can range from anything from occupational therapy and living with different disorders to dance class or performative sort of therapies. Also, movement therapy can be sports anything obviously involving movements. Exercise can look like so many different things, and that's why we are getting in touch with each other and starting to work together. Because the more fun the exercise, the more people are going to do it. Dance is fun; therefore, people are going to do it and keep it going. On the benefits of dance in general There are a whole host of different areas where dance brings people together. We dance at parties; we dance at weddings we dance, and we don't even know that we're dancing. So, anybody who says, “ugh, you know, I'm not a dancer, I can't dance.” You know you don't even need two legs because that's even ableist going on. Do you move through space and do you like music? Then you dance and it's doing something good for your brain. Because of course, we focus on people maybe with disabilities or syndromes or some kind of situation that way, but actually dance is just really good for everybody, you know? It's all about community. You don't have to do dance in a group setting, but often we do. So, it's always keeping that active, curious, creative form of connection going with others. And also, it makes you feel a little sexy, right? So why shouldn't somebody who's 80 years old who has Parkinson's feel a little sexy? I think that's one of the best things that dance does, it puts us in touch with that sexier self, that sassy self, where you can express so many things through it. And I think that's one of the great gifts it can bring to anybody. On the benefits of dance for people with Parkinson’s disease and other conditions The anecdotal evidence is just massive, right? Everybody has stories about their family member who just started going to dance class and their quality of life changed. So, the scientific evidence is quite strong. Also, especially when you're talking motor skills, gait, and speed. When you're talking about the, the experiential evidence we want to talk about dance as, once again, this multifaceted art or form of exercise that brings together other domains other than just the motor. So, you have the sensory, you have the motor, you have cognitive, you have social, emotional, spiritual, rhythmic, and of course your creative process. So, what does that do to the whole person, right? What does that do for somebody who may be, have become isolated for whatever reasons? And, and I'm going to go across the board here with many different kinds of disabilities that this is, these are often invisibilized populations when you're talking about elders or when you're talking about, especially in the past, children with autism, or for instance. Now, one thing I did witness at one time is sometimes what happens the slowing happens so much, or the automaticity is so in decline that an actual freeze will happen. And so there are different ways that you can cue people out of a freeze. And this is specifically in Parkinson's. So, the person who was teaching our class said that when one of her students froze at the door, she just said, no, just do your waltz. Do your waltz and waltz into the room. And they were able to cue themselves in waltz into the room where they were completely frozen and couldn't take a step. So those are the kind of things, immediate things that we actually see in real-time. On USC’s Dance and Ability course focused on people with Parkinson's The goals for the course in a broad sense as far as the University and USC Kaufman goes, is that have been wanting to do something that was truly interdisciplinary since I landed here on campus eight, almost nine years ago. And it's been that gentle pressure and getting to know different people. And then that finally culminated this year in getting funded by Arts and Action, which is a great funding organization on campus here at USC that I was able to bring together Giselle Petzinger and Michael Jakowec from Keck Medicine and Neurology. We brought the OT school; we brought the PT school into it. We brought John Walsh from Gerontology. We worked with a community group in Pasadena called Lineage Performing Arts Center where we designed this course together. So, I want to give our students a chance to use their fierce intellects and their fiercely intelligent bodies to start changing things in the world and to start understanding that your research in the studio is real research and it has real effects on people's lives. And the best thing about it, and this was my greatest hope, and was sort of the greatest payoff, was the intergenerational connection that came with our students getting off this campus and going to work with an elder population in Pasadena. And we were just dancing together and the love that filled that room, that number one, are students valuing these amazing people, right, that are, that are dancing through this these elements of trauma in their lives. And those folks up there, you know, maybe viewing young people in a different light than they possibly have been lately…It's all about connection. So, we can sort of complain about the lack of connection because of social media, but what are we doing about it? So that's, that's the other thing I want to do is create a community. And that's what happened. It was really kind of magical up there. On the benefits for caregivers In Parkinson's the caregivers if joining into class are getting every bit of spiritual physical, feedback reward that anybody involved in the classes…The caregivers when we went to Lineage, I noticed that they were taking time to sit and read a book and maybe do a little self-care on their own if they weren't joining in, some were joining in. And so, I know that it offers a respite, and it also offers a moment where they can view the person who's in their care as a dancer, right? As they're doing something, that maybe they're too afraid or don't feel able to do. So that's sort of a power dynamic shift that's kind of a beautiful thing too. When I was working with the children with autism, one of the services that we were providing was a respite for these parents who I mean, these were, these were working-class people in Carlstadt, New Jersey that could not leave their child unattended ever, right? Incredibly intelligent, these kids, one was a computer whiz, and he would go in and just wreck all of the computers. So, I realized that they could go and have a cup of coffee and maybe be just a couple for 45 minutes. So, I know that that's also something that any kind of service you're providing that, that is community and group-oriented, you're taking care of the whole family. And that's another thing that I wanted to impress upon the students. And they got it. The students really, really stepped up. On cross-campus collaboration So, the structure of the class is it's all in the studio, but we have lectures. So, we will have two lectures in a row and then a creative session, then two lectures in a row, creative session. And then we also peppered three times throughout the through that were field trips, field work that will be again in Pasadena in the spring, and of course in the fall will be in Culver City. So, we have whoever might be available to do the lectures. What we tried to do is we tried to give some kind of background in whatever we're studying. So, we had a few lectures with the neurologists about Parkinson's, just what it is. Then we had a creative session with the practitioner from Lineage Performing Arts Center and myself, who was training in dance for Parkinson's at the time. and then we rinse and repeat that cycle over with somebody from occupational therapy, in gerontology, in physical therapy. And then we would wrap it up again with the neurologist coming back into it. And throughout that we're then putting it into action or putting it into practice when we, when we visit on the field trips. It's just a dream come true. And because I've been, you know, researching on my own just as a curious person in the world and doing so much reading and watching films and sort of diving in on a pretty deep level to some of these things that then when I'm sitting in a lecture with Gisele Petzinger and Mike Jakowec or Dr. Walsh or Lisa Fukuzato from Occupational Therapy or Marisa Hentis, that as a dancer coming into this academic space that I know something and I know something that is valuable, and I've been able to bring these things together because I knew that there was a there there, and it just needed a spark to come together. So that was the most gratifying and invigorating, edifying takeaway from this whole experience is so that dancers in general, artists, I should say in general, can walk into these spaces and have a conversation with a neurologist, and we can have a real conversation about science because I've done the work. So, I want that to be apparent that we're, we're all doing our research, whether it's in the studio or whether it's in the laboratory. Yeah. On dance and aging And of course, there are issues in the field. It's getting better. Also, our perceptions as ourselves as aging bodies is different. You know I, as a 58-year-old going on, 59-year-old person don't feel old in this body at all. Whereas, my mom, God rest her soul, my mom at even at 40, she felt she perceived her aging body differently. So culturally that is changing in a broader sense. And so that is of course, filtering into dance in general. There are very few opportunities for aging dancers, but they are specialized and they, some of them are very high level but when you're talking about performing, it's the same sort of ageism and ableism that you have in any other sort of aesthetic process like acting, dancing, anything like that. But it's getting better. I'm working on it on a daily basis with my students. I'm like, you should be able to keep up with me, <laugh>, look at me. I'm strong. You know? And also, what I want to impart to my students in general is that if we take care and accept our bodies where they are and honor our bodies at each stage or season in life, then we can express through them instead of shutting down and becoming isolated. Share your aging body as a thing of beauty. /episode/index/show/lifespanhealth/id/27227997

The effects of exercise on the brain 04/13/2023

The effects of exercise on the brain Connie Cortes is an assistant professor of gerontology at the USC Leonard Davis School. Her work straddles the fields of neuroscience and exercise medicine, and she recently spoke to us about her research seeking to understand what is behind the beneficial effects of exercise on the brain with the goal of developing what she calls “exercise in a pill” therapies for cognitive decline associated with aging and neurodegenerative diseases. On brain plasticity and brain aging Brain plasticity we define as the ability of the brain to adapt to new conditions. And this can be mean something like a disease, it can mean something like stress, it can mean something like learning, and it can also mean something like aging. Our brain is actually quite plastic and can respond to a lot of these stimuli. Now, brain aging is a slightly different component to that where we think about what happens during the brain as we get older, the normal wear and tear. What are the differences and the similarities as well between a 75-year-old brain versus a two-year-old brain? What we've come to understand is like most other aging tissues, an aging brain begins to suffer from wear and tear just like a car would and that's where regular maintenance and regular checkups come in. … But essentially things at the biological level begin to slow down and as they slow down, that can affect the way our neurons fire and therefore we get age-associated decline in cognition and memory. On why exercise is good for the brain health That’s one of the questions that my lab is trying to answer, but in the field of exercise medicine, we've come to appreciate that exercise is very good for the brain, and it appears to do so in multiple ways. It can affect your cardiovascular health, which has a direct impact on the brain as far as blood flow and essentially clearing the brain out of things it doesn't need. The other way is delivering, metabolites and essential nutrients to the brain during exercise we make a lot of these things that get into our blood and eventually transfer through the blood-brain barrier into the brain. And so as far as the biological mechanisms of how exercise is good for the brain, we really, truly don't know yet. But that is why this field is so exciting and I think we're poised to answer these questions in the next five to 10 years. On whether exercise can prevent or slow cognitive decline or diseases like Alzheimer's that are associated with aging For actually many decades now, we have had anecdotal evidence from the clinics that aging populations that are active, physically active, and or exercise have significantly lower levels of age-associated neurodegeneration, as well as just age-associated cognitive decline. And it's only been in the past, I would say 10 years that we've come to appreciate that it is truly the exercise activity. And so what we find is that consistently, no matter what markers of brain health we look at, those aging populations that are sedentary tend to do worse than those that are physically active. And so the field now is extremely interested in trying to understand why this is happening and can we kind of use these mechanisms and these targets as new therapies down the road. On efforts to develop “exercise in a pill” therapies We all know a hope that exercise is good for us. However, the most at-risk populations that we are trying to help, especially here in the school of gerontology, are populations that usually cannot engage in the level of exercise required. Now in the field, we're still trying to define what an exercise prescription is, but you may have heard you know, three times a week, 90 minutes a day, uh, some sort of cardio. And something that raises your heartbeat, uh, that is, has come from exercise studies in young people. However, elderly populations are sometimes suffering from additional medical conditions or sometimes there's a financial constraint or even an accessibility constraint, and they just cannot engage in that level of exercise. And so what we are trying to figure out is can we design exercise in a pill to perhaps allow them to receive the benefit without having to get on a treadmill three times a week? On when to begin exercising So that's the good news. It doesn't matter when you start, you will always get benefits. So for those of us that are a little bit more on the sedentary side, that's the good news. Now the better news is, is that yes, the earlier you start, the better. But this goes back to this concept of brain plasticity. The brain will respond to these interventions that promote neurotrophic signaling no matter how old you are, which is great for us from a therapeutic standpoint. And so the recommendation of remaining physically active is, start as soon as you can. And today is a good day to start. On the muscle-brain axis and how our muscles and brains communicate One of the challenges that we face in the field of exercise medicine is that exercise changes everything. And so we are always stumbling around this roadblock of, are the changes that we're seeing in our studies, the chicken or the egg, is it a cause or a consequence? Are they driving the benefits that we see or they just a response of the system? And so by narrowing down how different tissues communicate with each other during and after exercise, we're trying to answer this question of who is responsible for driving the benefits. And we focused on skeletal muscle because as you can imagine, it's one of the biggest responders to exercise. You need it to get on the treadmill, you use it to start lifting weights. And so where, first of all, trying to figure out how skeletal muscle responds to exercise and also how this changes with age. And what we have come to understand is that during exercise skeletal muscle secretes messages into the blood circulation that we believe are essentially talking to the brain and telling it to do better. And if we can identify these messages, then we can probably deliver them in the form of medication and therapy. And so this muscle-to-brain axis we believe is essential for the brain benefits of exercise, and we're hoping to use it to start, uh, prioritizing some of these targets for therapy. On exerkines The field of skeletal muscle physiology has known for a very long time that it's an endocrine organ, that it secretes things as it communicates with the rest of the body but the fields of exercise, medicine, skeletal muscle physiology and neurobiology have only started talking to each other in the past five years. And so there's an entire field of research now, um, called the field of exerkines, exercise-associated cytokines, things that come out of skeletal muscle and other tissues during exercise that may be some of these responses that were going after. On rethinking Alzheimer's as not only a disease of the brain Since Alzheimer's disease, was first identified over a hundred years ago now, we've thought about it as a disease of the brain, but recently we've come to appreciate that it may be a disease of the body and the brain is just the most sensitive organ to it. So in Alzheimer's disease patients if you examine some of their blood markers, some of their heart markers, some of their muscle markers, they're actually very different compared to healthy control populations. And so we are coming to appreciate the fact that despite the fact that the brain resides behind the blood-brain barrier and we thought it was isolated from the rest of the body, it's actually in direct communication and conversations with the rest of the body and the periphery. And so in our lab, we truly believe that skeletal muscle can influence the rate at which the brain ages and or develops things like Alzheimer's disease. On differences in how males and females respond to exercise It is only recently that the field is realizing that we don't know what the female brain does in response to exercise. However, from the clinical perspective, we do have some indications that women might be in a position to receive the most benefits from exercise interventions. And this comes from the current understanding that, for example, uh, women are the most at risk for developing Alzheimer's, and exercise is such a potent intervention against it. And so in our lab, we're currently beginning to tease out the sex differences associated with brand responses to exercise and trying to see what might be different. And we have some really interesting findings where, um, after exercise, the hippocampus particularly, which is the area that degenerates during aging and during Alzheimer's disease, it's where we store memory and cognition and it's also the, the brain region that responds the most to exercise. We have tremendous differences in the way the hippocampus is remodeled after exercise. So the biological responses might be unique to one sex or another, which again, provides us unique areas for intervention for either men or women or perhaps combinatorial approaches across sexes. On future work looking at circadian rhythm and exercise Yeah. So, I mentioned we're very interested in sex differences to exercise interventions. Genetics is another huge one. In the lab, we are constrained by our genetic homogeneity of some of our animal studies. And so integrating some of the human studies to bring in this genetic diversity is going be fascinating and then circadian rhythms is another one. Some of the listeners may actually notice by themselves that they prefer to exercise in the morning or at night, and that has to do with your own circadian rhythm as well. And so perhaps we could also identify not just the best type of exercise for you, but also the best time to do it to maximize the benefits that you may receive. So in the lab, the way we are approaching this is we're using this integrated approach of neuroscience, exercise physiology and gerontology, but also using across platforms. So we go all the way from basic cellular biology to animal modeling to human studies, and then all the way back to cells in a dish. In particular, I'm very excited about a new animal model we've created that despite never running on a treadmill throughout its entire life, the brain is responding as if it's exercising. And so by using this animal model that doesn't need to exercise, but displays the benefits of exercise in the brain, we hope we can start to prioritize this chicken and the egg question that I mentioned - what is important and what is driving the benefits? And we're going to use these animals as a platform to prioritize drug targets to start testing in the near future. On small changes to promote brain health It's never too late to start. It's never too late to change some of your behaviors and your habits. And the power of very small things to have a huge effect is something that I don't think we quite appreciate. So something as simple as going on a walk around the block once a day, just getting some sunshine, especially now that the rain is finally breaking, that is incredibly helpful, changing your diet a little bit. You know, drinking one less soda a week can have a huge impact on different outcomes in your body. And so thinking about small changes rather than radical, big changes that are very difficult to maintain can help a lot. On the importance of mentorship, access and diversity This is an essential component of who I am as a lab leader and as a scientist, I'm a strong believer in, um, opening doors for those coming up behind me, uh, simply because one of the reasons I'm here is because mentors open doors for me. And so I'm returning the favor. I'm particularly passionate about historically excluded minorities in STEM. I myself am a Latina scientist, and there are not enough of us out there and I truly believe that all of us belong here, and it's through diversity of ideas that we're going figure out these big questions with major impact to human health. And so ever since I was a grad student, I've worked tirelessly to, like I said, uh, bring in junior investigators, mentor junior investigators, and make sure that my lab is a welcoming place for anybody that's interested in the research that we do. I've mentored, undergraduate students, graduate students, postdocs, and now other junior faculty. I've spoken at multiple of my professional societies. I've given career mentoring workshops. Sometimes I've come to realize a lot, a very small thing, like I mentioned earlier, can make a huge difference. Students that look like me, that see me up there on the podium realize that they can do it too. And so that's commitment to science. Accessibility and diversity in science is a huge thing for me as well. On her video series I started the very video series a couple of years ago because I kept seeing all of these misconceptions around science and especially about the brain. It's something I've been interested in since I was an undergraduate student, and I love the brain and so I realized that sometimes, especially as scientists, we tend to use language that's very difficult to follow. We love our acronyms, so many acronyms all the time. And even in talking to my parents and talking to my husband, they will give me a very confused look. And I've realized I've defaulted to using very complicated language, and I came to appreciate that it doesn't need to be that complicated. We are not an ivory tower anymore. We need to share our science with the public. Our research is funded by federal tax dollars, so the federal taxpayer should know what we're doing and they should be able to communicate with us and learn about what we do. And so that was the purpose of my minute science video series that I hope to continue sometime soon, um, once my schedule clears up a little bit. And so we talk about things like, you know, is it true that you, you only use, you know, you don't, you never use your entire brain at the same time. Or is it really true that you can be right brain and left brain, but not both? But does it mean when people, people say the lizard brain, um, is it true that your olfactory system is the first one to respond to memory and why? Things like that. /episode/index/show/lifespanhealth/id/26538396

Tips for healthy aging 02/02/2023

Tips for healthy aging and instructional associate professor of gerontology at the USC Leonard Davis School, and a specialist in geriatric medicine, joins us for a conversation about healthy aging, including tips on how to keep the body and mind functioning for as long as possible. Quotes from this episode On the importance of setting small goals "People may have all the good intentions, but they might set up goals that are too ambitious and then when they don't reach that goal, they feel frustrated, and they quit… We have to let them understand that goals must be small…So, an apple a day. We have to eat the apple a day and be happy and recognize when we reach three or four days in a row that we are eating the apple, right? So celebrate the success even of small, very small goals." On keeping your diet simple "Diets cannot be too restrictive for a long period of time. The majority of people will give up. It is important that diet needs to be easy to follow, but at the same time needs to be healthy. When we talk about a simple diet, we are now referring on something that needs to be easy to follow, but also simple in terms of the way we make food. So we have to eat in a very simple way. So, avoiding ingredients that are maybe tasty, but not that healthy. And sometimes they also cover the, the real flavor of, of food. We have this tendency to add always sauces and creams and other things on food that actually cover the real flavor of food and also contain a lot of saturated fatty acids, heat and sodium, sometimes sugar. So, we increase these calories by adding something that we don't really need. Diet must be simple in terms of the type of diet that we have, but also in the way we cook and prepare dishes." On the benefits of the Mediterranean diet "So, the results that, that we have referred to the traditional Mediterranean diet, which is characterized by high consumptions of fruits and vegetables, cereals, legumes, extra virgin olive oil, nuts, and a moderate intake of fish, and a low intake of dairy products and meat products. So, we do have robust evidence suggesting that high adherence to these dietary patterns is linked to positive health outcomes, in particular for cardiovascular diseases, dyslipidemia and diabetes. But another important result was that the adherence to Mediterranean diet was inversely associated with a number of medications. So, patient who were more adherent to Mediterranean diet, they also used less medication. Another interesting observation that we found was related to depressive symptoms and comorbidity. When we analyze our data, we found out that the relationship between comorbidity and depressive symptom was high in older adults…In patients with higher adherence with Mediterranean diet, this correlation was weaker. When Mediterranean diet adherence declines, this relationship was stronger. So Mediterranean diet played seems to play a crucial role in mediating the relationship between the presence of comorbidity and depressive symptoms." On the importance of physical activity "Although we don't have big clinical trials on physical activity, we have small, randomized control trials showing that certain level of physical activity, may have some benefits in terms of improving the cardiovascular health and, utilization of glucose in the muscle in modulating inflammation, improved cognitive function and physical performance. Some of the benefits that we have from being active and also exercise regularly include an improvement in the cardiac output improving the health of the heart by improving cardiac contractility, oxygen uptake. And we know that we don't have to do long sessions of exercise or being extreme physically active. Already, if we walk between 45 to 75, 85 minutes a week, we can already see some benefits. Of course, the more we exercise, the more benefits we see, but at some point we reach a plateau." On sarcopenia "With the aging process, there is a decline in our muscle mass, strength and also performance. And this phenomenon is called sarcopenia. The level of physical activity, the changes in the hormones that occurs in older adults the amount of proteins that we eat when we are old all of these factors may contribute to the onset of sarcopenia, and also the progression of some sarcopenia. In terms of dietary intervention for sarcopenia, it is important in older adults to maintain an adequate protein intake. Recent studies suggest that older adults need to ingest between one to 1.2, 1.3 gram per kilogram a day of protein to sustain their muscle mass and functionality. And this amount can also be adjusted based on the body composition." On weight management "Weight management is a complex problems and obesity is a complex condition that can lead to health problems, including cardiovascular disease, diabetes ... but weight is not the only parameter that we should take into consideration when we talk about weight loss in particularly in older adults. So, it's not only important to monitor the fat content and the weight, but also evaluate the composition of the weight. There is some studies and meta-analysis conducted in older adults showing that even if the BMI is likely higher in older adults, this is not really associated with overall risk of mortality. So, on the other hand, if the BMI is low, below 22 or 23, the risk for mortality increased. Why that happened and why this has been observed, because of course, malnutrition may have some serious consequences in older adults. Weight fluctuations is another risk factor. So not only being underweight, but also this fluctuation of weight in older adults may have a negative effect. So, it's good to have a stable weight, preserve our muscle mass, do not rely only on the weight on the scale, and have an evaluation of the body composition. " On stress "Stress is an adaptive mechanism that allows the body to perform better in certain circumstances and situations, and to cope with temporary threats. However, when process become chronic these adaptive mechanisms of the body become destructive. Chronic activation of stress can alter our metabolism, can disrupt our endocrine system, including the reproduction, the reproductive system, glucose metabolism, but it can also affect our immune system and other many cell function. And all of these can accelerate the aging process. Now we also known that chronic stress may affect also our chromosomes. A large body of evidence has linked stress with shorter telomeres, and shorter telomeres are associated with cellular, aging, inflammation and chronic diseases." On healthy aging "Aging is a dynamic and complex process where biological, psychological, environmental, and behavioral factors are involved. And the complex interactions of these factors explain, at least in part why there is significant inter-individual variability in the way we age. But it also suggests that modification of some of these factors, when possible, can also slow down the aging process. I think that we cannot feel satisfied by considering healthy aging only when there is absence of disease. I think we should be a little bit more ambitious and consider aging as a physiological process that despite all the biological changes that occurred during this process, allow us to maintain an adequate physical, mental, and social wellbeing by preserving not only our basic functions, but also our functional reserve and functional capacity as long as possible. This will have a tremendous impact not only in terms of quality of life, but also or our loved ones and the community will live." /episode/index/show/lifespanhealth/id/25814619

Cellular balance across the lifespan 08/30/2022

Cellular balance across the lifespan Dion Dickman, associate professor of neuroscience and gerontology, joins George Shannon to discuss how the nervous system processes and stabilizes the transfer of information in healthy brains, aging brains and after injury or disease. Quotes from the episode: On synaptic plasticity: “Synapses are essential, fundamental units of nervous system function and plasticity is this remarkable ability to change. And throughout early development into maturation and even into old age, synapses just have this amazing resilience to change and adapt to different situations and injury disease, things like that. So synaptic plasticity is really the essence of what it means to grow and mature and change throughout life. Things like learning and memory all depend on changes in synaptic function and structure and it's really a key area of research for many of us.” On challenges to maintaining nervous system stability: “You can imagine in the incredibly complex environment of your brain, where neurons are making synapses with thousands of other neurons, that itself is a big challenge to maintain stability. Sometimes I'm kind of amazed that we don't walk around like raving lunatics half the time and our brains remain stable. When you think of disorders of excitability or stability, things like seizures and various forms of defects in cognition ultimately come down to not being able to stabilize or maintain your neural circuit function. And this really just comes down to normal development that all of your nervous system has to stay stable and your synapses are the key substrates to maintain stability.” On the aging brain: “.. a lot of studies are showing is that this cognitive decline that happens in aging really is ultimately due some sort of a maladaptive reduction in plasticity. And it's kind of amazing, but, young humans, our brains are remarkably plastic and resilient, and that resiliency and plasticity seems to degrade over time and into old age… We think as old age happens .. people's memories start to lapse, even in the absence of any disease, they're not quite as sharp. We think this all ultimately comes down to some limitations imposed on neuroplasticity and that's a major area of the research. On studying diseases like schizophrenia, which cannot be seen in brain imaging: “There are no good biomarkers for neuropsychiatric diseases like schizophrenia and bipolar and things like that. So, there are basically two ways to study these kinds of diseases. One is through behavior where you try to get animals to model behaviors that mimic neuropsychiatric diseases. There's some good work happening rodent systems. Although I find it to be honest, very difficult to know whether a mouse is showing the defect in social interaction, for example, that are characteristic of autism or schizophrenia for that matter. So the alternative instead is not to actually model the disease in drosophila or mice, but to take humans in which we can mine their genetics to find genes highly associated with the disease in humans and find out what the fundamental function of these genes are. And that's kind of the strategy that we take. So we found about 30 genes now that when mutated in drosophila give rise to defects in this process of homeostatic plasticity at synapses, and the vast majority of these genes have links to human diseases that give rise to neuropsychiatric diseases like autism spectrum disorder, schizophrenia, seizure disorders and, bipolar disorder as well. And so I think by understanding the fundamental functions of individual genes, we can extrapolate what might be happening in humans when those genes aren't functioning properly.” On the importance of sleep: “…one of the most fascinating questions in neuroscience, or really science more generally is what is the function of sleep? What is the essential function of sleep and what role does synaptic homeostasis and disease play a role in sleep behavior? So, it's quite interesting that almost every neuropsychiatric disease has a sleep disorder associated with it. That's already very interesting. If you look at schizophrenics, their sleep patterns tend to be very fragmented. Whereas people with depression, chronic depression seem to sleep too much, much more than is needed and many neurodegenerative diseases of old age like Parkinson's, and Alzheimer's one of the earliest predictors of these are sleep dysfunction at earlier stages and there's also many studies that have shown that if you treat the sleep dysfunction, you can improve the symptoms of neuropsychiatric disorders. A schizophrenic, for example, might get if you improve their sleep, their symptoms, cognitive symptoms seem to improve children with autism spectrum disorder have, big defects in sleep behavior during development. And it's thought that if you treat the sleep defect, you can improve the phenotypes of autism. So a lot of research seems to be showing that synaptic homeostasis and plasticity and sleep behavior and disease all share really important and synergistic links between them. And I think that really is the major challenge for the future is to understand what happens to synapses during sleep. What happens to synapses during various neuropsychiatric diseases and can this intimate relationship between sleep and, and synaptic plasticity be targeted as a way to improve and treat psychiatric and neurodegenerative diseases.” On bringing a multidisciplinary approach to research: This is a big advantage, I think of especially working at USC, in, you know, straddling different schools like Dornsife and gerontology and really being able to throw everything we can in our toolkit at a question or a problem. So, our lab is a drosophila genetics lab. We do neurogenetics. But we do electrophysiology to understand how synapses function we do basic imaging to see synaptic structures and how they work. But we also do a lot of super resolution imaging. Now we've got a super resolution microscope that we've recently purchased that allows us to look at the nano architecture of synapses and how they might change during defects and plasticity and disease. And finally, we're doing things like calcium and voltage imaging to really see the dynamics of how, you know, visualize plasticity happening in real time or dysfunction happening as they go on. So I think having a large toolkit to throw everything we can at a question really lets you see the same problem from many different perspectives. On the value of basic scientific research: “Science is for me a curiosity driven process. It's great that there are ramifications to disease and health and humans, but what initially inspired me was just to understand how does nature work and how does the nervous system work. And so I want to just say supporting basic research, basic science, even if it doesn't have any direct implications on disease right away, I think is really important as part of scholarship, as part of what we at the mission of our university, but also just as our world. I think to study basic processes and just understand how nature works and then the applications of them with all evolve. You know CRISPR CAS9, as many of you have probably heard about, all came from basic research and now it is going to revolutionize health and disease.” /episode/index/show/lifespanhealth/id/24218949

A balancing act: homestasis under stress 07/27/2022

A balancing act: homestasis under stress is a Distinguished Professor of gerontology, molecular and computational biology, and biochemistry and molecular medicine at USC. Over the course of his career, he has played a central role in defining the pathways and mechanisms by which the body is able to maintain balance under stress and in uncovering the role aging plays in disrupting this balancing act. He recently joined Professor George Shannon to discuss his research on how the body is able to maintain balance under stress and the implications it could have for preventing age-related disease and decline. Quotes from this episode On the concept of adaptive homeostasis “So every organism that we've looked at is able to adapt to stress. And I'm talking not about psychological adaptation, but adaptation at a cellular or molecular level. And we've been working on what are the pathways which that adaptation occurs. And what we came up with over a series of a number of years is the concept of adaptive homeostasis. “What we found with adaptation is that successful adaptation actually involves the turn-on of a number of genes, a key one being something called NRF2. And NRF is a sort of a master regulator that turns on about another 200 genes. When I say ‘turn on,’ what I mean is that those genes start making their protein products. So the code in that gene starts being read, turned into a protein product. Thousands of proteins are then made. Many of them at least are enzymes that have a job to do. And all of those enzymes have a role in enabling you to adapt.” On adaptive homeostasis and aging “As organisms age, the capacity for adaptive homeostasis declines. That's been true in everything we've looked at all the way from bacteria to yeast, to worms, to flies, to mice. “NRF2 activity is modified in aging. And so it doesn't work as well … And the reason we think that happens is that there's another gene that's turned on in aging that inhibits NRF2 responsiveness. It turns out that that gene might actually be helping to protect you against cancer. So one of the things that cancer cells are very good at is avoiding stress and adapting to stress. And in fact, NRF2 works really, really well in most cancer cells, better than in normal cells. So it looks as if the body is adapting to age by inhibiting its own NRF2 thus decreasing adaptive homeostasis in order to diminish the increase in cancer. We all know that cancer increases with age. Maybe it would increase twice as much if you didn't have this offset by inhibiting NRF2 in the cancer cells. And the price you pay is that you're also inhibiting NRF2 in your normal cells at the same time.” On understanding the role of enzymes and backup systems “What we've learned over the years is that the body treats important enzymes much more like the way that NASA treats important components in a space shuttle. In other words, if something is important, let's have a backup to it. And if it's really important, let's have a backup to the backup. And if it's life-threatening, let's have a backup to the backup to the backup. And the problem is when you knock out one enzyme if you don't know if there's a backup enzyme to that one, then, and that takes over, then you'll completely mask the effects you're seeing. “We had a great example of that in my lab several years ago where we found an enzyme that was induced during chemical stresses that stopped DNA being read. So basically protein RNA synthesis and protein synthesis were stopped by this particular enzyme that got turned on during stress situations. If you inhibited that enzyme, it didn't make any difference because there was a backup to that enzyme. And if you inhibited the backup, it didn't make any difference either because there was a backup to the backup. So it turned out what was really important in cells is that if you're being stressed to the point where it could be lethal for that cell, all of these things will get turned on simultaneously and any one of them can do the job. You're willing to spend the extra chemical energy, so to speak, to turn all of them on to make sure that you don't die from the stress. So that, that's why I think just looking at one enzyme or another is not the way to go. And I think most people would follow that ethos today.” On the role of sex in the adaptive response “What we found is that the females adapt better than males. Females generally lose less of their adaptive homeotic capacity with age than do males. So sorry, men we’re losing out there. And also curiously, and this we don't understand, female flies responded to certain oxidants very well and others less well and males responded differently to different oxidants than did females. So there were some oxidants to which males responded relatively well [and] females didn't respond well and vice versa. This is sort of the power of molecular biology. “These days, we are able to do experiments with flies, where you can switch the sex of a fly from male to female or female to male. We wanted to do that basically to see whether or not we were right about the maleness or femaleness of the adaptive response. And it turns out when you switch a male fly to a pseudo female or a female to a pseudo male, genetically, they exactly switch their adaptive homeostatic capacities to the new sex.” On future research directions “So everything basically in physiology is explained by homeostasis, but the homeostatic range is flexible and you can change it by training and by doing various other things. I think what we're seeing is the beginning of understanding how that process kicks off, or those kinds of processes kick-off, how they begin that involves NRF2 and similar enzymes and similar genes. But then after the initial response, if you're looking at a long-term adaptive response, that's a whole different set of genes and set of proteins that are involved that we're only at the very, very beginning of understanding I would say.” On the importance of being a mentor “If you're going to be an educator or a professor, it should be a major part of what you do. I've been fortunate enough to receive several mentoring awards, and I'm very proud of them. And I think they're some of the most important work that I've done. “Over 30 postdocs have gone through my lab over the years and a similar number of PhD students have done their PhDs in my lab. Many of them have gone through and done their work very well. And, and we've said goodbye, and I see them occasionally and others of them are family members … They are literally a part of Joanna, my wife and I, my family; we see them all the time. We are very close to many of them and follow their careers and have had relationships with some for over 30 years. It's a really a joy in terms of some of the best aspects of being a university professor. I think it's one of the things I've enjoyed most, I must say. And hopefully I've been able to be of some help some of those people over the years and to occasionally steer them in the right direction.” /episode/index/show/lifespanhealth/id/23868243

Improving health outcomes and quality of life 06/07/2022

Improving health outcomes and quality of life is the Mary Pickford Chair in Gerontology and director of the at the USC Leonard Davis School. She's also the co-director of the National Center on Elder Abuse, which is housed at the Keck School of Medicine of USC. She recently spoke to George Shannon about her research, including her work exploring ways to provide long-term care services and supports that allow older adults to be as independent as possible and the challenges and opportunities that technology provides in this area. Quotes from this episode On building on lessons learned during the pandemic “I think a lot of what we saw were challenges that we already knew were there - how fragmented services are, how older adults can be at risk of isolation, how important the home community-based services and programs and opportunities to interact are for everybody. And I think showing the importance of community, which we didn't have during the pandemic, except a bit on social media and phone calls and maybe people getting together outside. So the key question is, how do we take the learning and the recognition of what we already knew into the future to build on these important lessons, to do better with our aging service delivery? I was going to say our aging service delivery system, but that's a huge problem. There isn't a system; there's just a lot of different components of a system.” On innovations in long-term care and supports “We have to prepare for an aging population. And until recently I felt like we didn't do that great a job preparing, but I see a lot of exciting innovations, which to some extent may have been jump-started a little bit because of the challenges of the pandemic. We have a variety of models of senior living and I think we're going to see more innovation there or the innovations that have been developed take off because they did better in the pandemic too. So if we look at what kind of care was best for older adults who maybe were isolated or need long term services and supports during the pandemic, how do we build on that? And how do we make sure that we translate what we know into reasonable programs and policies.” On barriers to implementing technology solutions “People not only need to have some kind of device. They need to have broadband, it needs to work. And we've seen that in some parts of the country, especially in rural areas, broadband it's not available. All the things we take for granted, electricity, water, et cetera, how much is this an essential service that we’ll do a better job providing across the nation in areas where it doesn't exist very effectively now. And then as I said, how do we help people learn? And what are the particular cultural competencies required for trainers? What are the different uses that people want? This gets back to being person-centered and engaging the people that will be the end-user users and understanding what's most effective for them. There are still a fairly large proportion of older adults who don't have access to any sort of computer; some have smartphones. And there is this notion, I guess, if we build it, they will come. Or if we give it to them, they'll use it, it would be the way of talking about that. But there's a variety of barriers. And if you hand somebody a box with a computer in it and say, ‘There you go, you're now going to go on the other side, the right side of the digital divide.’ They're not. So what can we learn about how to help people use technology in a way that is useful for them effective, meaningful?” On telehealth “So this will be a time saver. I think that's pretty clear, but the nursing facilities have to invest in it. The staff have to invest in it. They have to learn how to do it. And one of the things we're seeing is they thought the residents would be the most resistant and they're not. They're like, ’Okay, if I can see my doctor this way, fine.’ But I think the question is, how is it used, where is it most effective and where is it not a good replacement for a physician coming to the facility? So, there's a fair amount of literature developing on this, but I think there's so many exciting innovations that are rolling out and we need to build on what we're learning and make them better and be more effective in the next generation of telehealth and facilities and helping people on the digital divide connect. So all these things are really exciting opportunities to learn how to connect.” On person-centered care “So the idea behind person-centered care is that people have different needs. Of course, they also have different preferences, different preferences for care and for services and for supports and for contributing and giving back and primarily and mostly as with all of us, for controlling their lives and the decisions that are made. So person-centered care recognizes that the power should live with the individual in terms of the ability to make decisions about care informed decisions. But I think sometimes, we, as professionals can see, oh, this would be best for this person. And professionals are extremely busy also. And so it kind of overlooks sometimes the person's needs and preferences and working in areas like elder mistreatment and elder self-neglect. A lot of times people have legitimate reasons for wanting things that we don't necessarily think would be the best choice, but person-centered care asks us to really get in touch with what's behind those preferences. And to what extent can we ethically honor them and this is something I see the field doing a much better job thinking about and working on and great things have been written. And the American Geriatric Society a few years ago had an expert panel come together and develop a definition and sort of protocols for this. And I think that's really moving the field. One more thing I'll say is that ageism contributes here. So we make assumptions about older people that they can't express their preferences adequately. And providers talk to the caregiver, not the older person. Or they say this is what needs to be done. So I think there's also a culture change of recognizing that it's about the older person. And we start with the older person, and that's not to say that there aren't age-related increased likelihoods, but not inevitabilities of memory issues and things of that kind. And so we need to be clear that the person has the capacity to express their preferences, but we start with person-centered. The elder is the person who whatever is happening is happening on behalf of, or for, or with. And that's where we start.” On students “That's our future. … Our legacy is you see the students that go through our program and they're very excited about learning and they bring innovation and enthusiasm, and then they go out and do wonderful things and they become the leaders of the field. And you could see that across the board in so many areas.” /episode/index/show/lifespanhealth/id/23358134

Stem cell biology and aging 04/30/2022

Stem cell biology and aging Rong Lu is an associate professor of stem cell biology and regenerative medicine, biomedical engineering, medicine, and gerontology at USC. She joins George Shannon to discuss her research into the complex and surprising behavior of individual blood stem cells and what it could mean for treating diseases associated with aging. Quotes from this episode On stem cells and what makes them so promising for medical research Stem cells are the special cells in the body that can produce other type of cells. So in particular there are two type of stem cells, one called embryonic stem cells that only exist in the embryonic stages. And the other type of stem cells are called somatic stem cells that are also exist in adulthood. And these somatic stem cells can produce only a specific subset of the cell types in the body. For example, skin stem cells can only produce skin cells and blood stem cells can only produce blood and immune cells. But all the stem cells share the general special property called self-renewal and differentiation. So differentiation describes their ability to produce a different type of cells and self-renewal refers to their ability of making more of themselves over time and sustain the long-term differentiation and tissue regeneration. On the ability of stem cells to regenerate as we age …that's what makes stem cells super special because they are the only long-lasting cells in the body that continuously regenerate and sustain the tissue. But over time, stem cells capacity in terms of self-renewal are reducing and therefore the tissue as homeostasis decline when the body ages. On whether stem cells might offer protection against age-related immune decline Sure. So over aging stem cells become less and less competent in producing immune cells. And, the hope is if we can maintain the stem cells capacity over time then we could make the stem cells offer the protection. Again, this is very much a research in progress and many research labs are working on this important question, including my own lab. On the focus of research in her lab In our lab, we're interested in understanding how are individual stem cells different from each other and how different stem cells work together to maintain an overall balanced blood pool. And in particular, over aging, we want to understand how individual blood stem cells change during aging and how their change lead to the aging phenotype of the animal. And what we found is that there are a specific subset of blood stem cells that age, particularly faster than the others. And there's also another group of stem cells that actually can change in the opposite way during aging and provide more immune cells and their presence really correlate with the delayed aging phenotype of the animal. So we're very excited about this finding and we're following up on this study using our bar coding tool to track these anti-aging stem cells and study what make them so special. On the development and use of a tool to label individual cells with unique “barcodes” The barcoding tool was developed a couple of decades ago by several labs simultaneously. At that time they used the viral insertion site as a marker to track individual cells. So about 10 to 20 years ago, high throughput sequencing technology started to emerge. And at that time, I started to combine the new capacity of this high throughput sequencing to quantify the cellular behavior at a single cell level. So instead of using viral insertion site, I provide a particular DNA barcode sequence into the virus and use that as a marker to track individual cells. And what this allow us is a high precise quantification of the cellular behavior and also the high throughput that is needed to track hundreds and thousands of stem cells in the body. We can use this tool to study cancer cells and understand the heterogeneity among individual cancer cells. For example, a recent study from my group used it to track the primary acute lymphoblastic leukemia cells in xenograph mouse model. And what we found is that individual leukemia cells have different ability to grow to metastasize and to respond to the drug treatment. And we found that some cancer stem cells that are particularly resistant to drugs to drug treatment In particular, some leukemia cells that are particular resistant to chemotherapy treatment, exhibit distinct gene expression signature compared to others. On gene expression signatures The gene expression signature means these particular subset of cells express a distinct subset of genes that make them different and potentially may cause their specific drug response behavior. So these particular gene expression signature can allow us first to identify these cells and to detect whether these cells exists and whether the patient has the potential of resist chemotherapy. And secondly, these gene expression signature can also be potential drug treatment targets to allow us to particularly target these cancer or leukemia cells in the therapeutic treatment. On future directions in aging research So in the context of aging, we are very excited about our recent discovery of these anti-aging, uh, stem cells. And we would like to further understand how to activate these anti-aging behavior and how to expand their function in the animal. And we are also very excited about our discovery on the cellular heterogeneity in disease, in particular, in their response to chemo drug treatment. And we would like to further identify the potential functions of the gene expression signature that we discovered. In addition, we also want to understand whether the microenvironment of the stem cell play a role in terms of instructing their heterogeneous behavior. /episode/index/show/lifespanhealth/id/22961987

The intersection between stress and aging 03/23/2022

The intersection between stress and aging Assistant Professor of Gerontology joins Professor George Shannon to discuss their research seeking to understand why stress response pathways break down as we grow older and whether there may be ways to delay that breakdown and potentially promote healthier lifespans. Quotes from this episode On the definition of stress: Stress can come in so many different forms and flavors. It can come in the form of something external, something like heat stress. For example, being out in the desert heat, it can be something as similar to cold stress of a winter storm, or even something like a bacterial or viral infection… Stress can also be internal though. It's not only external. When we think of humans, we can think of big things like mental stress, emotional stress, social and societal stressors. So really the definition of stress is pretty large. And just to say anything that causes some kind of adverse reaction to the body is a stress. And so we study all of these various types of stresses and how it impacts our bodies, our health, and of course aging. On how our cells respond to stress: The response to stress within the cell is simply to activate mechanisms that prevent damage. And the main way that this happens is to turn on genes. So genes encode specific types of proteins and processes and mechanisms that are important to mitigate the stress. So it's like essentially activating or turning on a switch that has some kind of functional output, similar to how you will just flip a switch to turn on a fan or an air conditioner. So you can cool down the house. Exactly in the same way, the cells will switch on jeans that can activate pathways that prevent or mitigate that is associated with exposure to stress. So for example, when we are under heat stress, our cells will turn on the mechanisms and pathways that will essentially alleviate damage associated with heat stress, such as damaging proteins or things like that, that happen under heat stress. So the cell is essentially trying to repair or discard damaged proteins that happen with exposure to heat. On efforts to give older person to have a younger person’s ability to deal with stress We know that the capacity to deal with stress declines during the aging process. So the question is if we give an older person, a younger person's capacity to deal with stress, would that actually combat aging? So if we go back to example again, before, if I give the grandmother her grandchild's capacity to deal with desert heat, we know that she'll be more resilient to the heat. She'll likely survive the desert, but generally, would she actually be healthier overall as well? Would she be in a sense younger? And the answer in most model organisms that we study is yes. When we give an old organism, a young organism's capacity to deal with stress, not only can they handle that specific stress better, but overall they're healthier and live longer. So when we think about model organisms, what we're doing is activating those genes that I talked about. So essentially turning on those switches that will then activate a specific pathway, like in the example I gave earlier where heat stress causes damaged proteins, you can turn on the switches that will essentially activate pathways that will remove or repair the damaged proteins. So what happens during the aging process is that the capacity to turn on these genes switch on these genes are impaired. So what do we do with this? We really try to increase the capacity of that gene to turn on. So it would be like increasing the electrical circuit's capacity to pump energy into your AC so we can increase the gene's output and in model organisms, this is easy. We can simply overexpress your gene. So what does that mean? If we think about the number of copies a gene has, usually one gene will have one copy, but if we give an organism 50 copies of the same gene, even if we decrease the output by half during aging, you're still having 25 times the gene expression, which will improve the overall outcome. But of course, in humans, you can't just go in and increase the number of copies of a gene. We're not yet there for gene therapy. So what can we do in humans? Well, if we know what specific mechanisms are activated by the gene, we can try to target them with drugs. So use drugs that increase the function of one specific mechanism. So we know many of the genes and mechanisms that get activated when we're exposed to for example, heat stress. So we can try to develop drugs that activate these pathways to essentially hyper-activate the stress response and try to use this to combat aging. On the concept of hormesis and the benefits of exercise: Hormesis - what it means is that exposure to low levels of stress can activate a beneficial stress response that makes you more resilient to exposure to future stressors. Exercise is exactly this. When you exercise you're stressing out the body, you can get micro-tears and the muscles when you do strength training, and that's what lets the muscles grow and become stronger. Any kind of cardio or any type of fitness will make your body temperature elevate, which will cause a mild heat, stress and exposure to all of these mini stressors during exercise activates all of these stress response pathways that I talked about before. And so when your body faces stress, you essentially become more resilient to it. So athletes tend to be healthier mostly because they have a higher tolerance for stress. Their bodies are better able to mitigate damage associated with stress because their bodies can activate stronger stress responses. So the concept of hormesis is that what doesn't kill you makes you stronger. Every hardship you face makes you more resilient and stronger to face the next one. So truly there's a connection to exercise and fitness as a model of essentially adapting to stress, to essentially combat aging. On the benefits of stress Yeah, I know we covered a lot today. I went into so many diverse topics, so I just want to summarize everything by, uh, saying Kelly Clarkson sings it right. For sure. She says what doesn't kill you makes you stronger. Definitely true. So while people will always tell you avoid stress, it isn't good for you. I want to just say, well, some stress isn't so bad living a completely stress-free life might actually not be so beneficial. So let yourself experience some good stress, work out, go to the gym, fight off a bully, maybe, immerse yourself in a challenging job. Everything you face in life will make you that much stronger. And who knows. It might even positively impact your lifespan. /episode/index/show/lifespanhealth/id/22547921

Genes, environments and aging 02/22/2022

Genes, environments and aging Research Assistant Professor Thalida Em Arpawong joins Professor George Shannon to discuss her research to better understand how our genes and environments influence how we respond to stress and adversity and impact how we age. On the definition of bioinformatics and its use in research “Bioinformatics is a science subfield, but really just refers to a set of tools that we use to collect, analyze, and interpret findings from large volumes of biological data. We use tools like super computers, biostatistical models, computer programming, and specific types of software, while at the same time, integrating biological concepts to guide how we use these tools. So the data we use—we call it “omics” data, for short—includes primarily genomics, transcriptomics, epigenomics, proteomics, metabolomics, that is, all the omics. Here in the school of gerontology, Dean Cohen had a vision of creating a core to help support researchers in their labs that want to use omics data but may not have the background to do so. So, relatedly, with the Genomic Translation Core, we also use bioinformatics to work with human data, to collaborate with biologists. So these biologists work on model organisms for their research, like worms, mice, or yeast, and the biologists who have been granted pilot awards through the Nathan Shock Center because they've made some important discoveries in their model organisms, we work with them to confirm what the relevance is of their findings for human aging processes. It’s an exciting time because through this work together, we have the potential to use the expertise across different disciplines to answer some bigger questions that we haven't been able to previously with regard to cross-species effects of genomics and health.” On her research on how experiences of stress and adversity throughout different developmental stages in life and genetic factors work together to influence emotional and cognitive health as we age “So we used to think that genetics was much more deterministic, but we now know there are much more complex and interrelated processes occurring. We found that social structures in which we can characterize groups, such as gender, race and ethnicity or social status, are very importantly related to how genes get expressed. Similarly, people's behaviors shape levels of gene regulation and expression, then have downstream effects on immune system health, development of chronic diseases—for example, obesity, heart disease, depression—and even lifespan. So it's becoming more critical to include these key social factors in human research when we evaluate the effects of genomic data on health.” On her research looking at how having early childhood adversity and adulthood adversities affect the level of depressive symptoms when older “What we found were two main things. First, that there was essentially a dosage effect, so that with each additional childhood adversity, there was an even greater risk for more later-life depressive symptoms, even after the age of 50. And second, the hypothesis that was supported was called stress proliferation, which is essentially the idea that stress begets stress. So therefore, earlier-life adversities are accompanied by more adulthood adversities, and that's how they work together to impact mental health later on.” On the mind-body connection, or the role of mental health in healthy aging “When we think of psychological factors, such as stress and adversity and socioeconomic hardships, compared to other factors that affect aging, we're finding that there are more influential compared to genetic or biological factors. And in a recent study by Eileen Crimmins, she found that, in particular with mortality and cognitive functioning, these factors explain 25 to 30% of the variance. So that's a significant amount and often much more variance explained than we can detect for something like genetics.” On epigenetics and how our social environment can affect our genetic expression “We used to work under the assumption that the effect of genes was best studied at the level of a genotype or just what's encoded in our DNA sequences. But we're finding that there's so much more and we need to measure how our DNA has structural changes that occur throughout life that are not in the code itself but actually in our epigenome. So similar to using genetic risk scores, we can actually now calculate these epigenetic risk scores, and those tend to encapsulate things we've been exposed to or behaviors. … There is research on how we react to stressful experiences, how that it gets embedded into our epigenome. And we can quantify some of that using these epigenetic scores.” On the role of education in health outcomes as we age “Education is important for aging because it's one of the most consistent measures to relate to almost all of the health outcomes that we look at, including cognitive, emotional, physical outcomes, financial outcomes, and mortality. So it's an important aspect, and what we found is that the heritability of educational attainment has been estimated to be around 40%, which then leaves 60% attributable to social influences, or the environment, but unpacking how those genetic factors and environmental factors sort of work together is important if we're looking from the perspective of how to promote more education, especially for those at high risk for some of the negative health outcomes.” On her research looking at psychological resilience in aging “I appreciate that the aging field is really the only one that embraces the resilience concept in a way that there isn't a sole focus on disease or deficits, but an interest on healthier aging or successful aging from the perspective that there are different processes involved than when avoiding or preventing disease and morbidity. A lot of my work has focused on psychological resilience in different developmental stages of life, which means evaluating what contributes to people doing better than expected in the face of adversity or challenge. So not just having greater wellbeing or greater health, but having those states despite having been exposed to having to adapt to life insults and significant stress. So what I'm focusing on now is evaluating lifelong effects from adolescents through older adulthood for psychological resilience and how that affects biological aging.” On her research looking at the importance of physical activity across the lifespan “One of my projects uses the Project Talent Twin and Sibling study to answer the question of ‘Does it matter when somebody is more physically active in earlier life or later life, or do you need both to result in better cognitive and emotional health later on?’ and how much of the determination of those behaviors is nature versus nurture. For instance, how much is physical activity dictated by socioeconomic adversity when growing up or [by] later-life financial constraints? And then with regard to nature, one key finding is that there seems to be very little overlap between earlier and later life physical activities that's due to genetic factors. So I didn't expect to find this, but it's interesting because from a public health perspective, I'm interested in how physical activity is a protective factor against adversity [and] results in better health and how the implications for findings from this work can inform how we design interventions to support how individuals adapt to stress throughout life.” On the concepts of generativity and post-traumatic growth “There has been a lot of research on generativity and how that relates to a resilience concept called post-traumatic growth. So people who've been through really intense, kind of acute stressful experiences have to reflect and rethink what their life means, what their purpose is, what their direction is in life, how they orient to people and relationships. And one of the things that is very related to gaining more post-traumatic growth is, for older individuals, having this perception of greater generativity because I think there's that relationship to purpose and meaning. And at the same time when you're talking about looking forward, there's that whole concept of future orientation that also is related to higher levels of post-traumatic growth and adaptation post-acute stress and adversity. So I think these are all very intertwined and interesting.” On efforts to study the effects of mindfulness and meditation “There's that whole field of psychoneuroimmunology that also bears some similar concepts [to transcendence] where there's a lot of researchers who were looking at things like mindfulness, or flow. But the concept of mindfulness, I think, relates to transcendence and there is a whole group of researchers that formed these collaborations with the Dalai Lama, and they were trying to conceptualize how to operationalize these aspects of meditation and other things that we find are beneficial, but we can't really study that clearly. And so there is a whole area that has emerged about the mind and the psyche and how we can use the mind and psyche to manipulate the effects on our immune systems and other aspects of our biology.” On expressing gratitude to research study participants “I'd really like to thank all the people who participate in surveys. Some who've taken part since high school, in the case of the Project Talent Studies, and allowed us to follow them up over 50 years later, and others who've answered question every two years for almost 30 years, some have given DNA and biological samples. But this method of tracking people's experiences, their natural histories, their biology, and how well these all come together has been absolutely invaluable to research across so many fields. And what we know about life course risk and protective factors for health as we age would not be where it is today without these folks, especially the diverse range of folks involved, so we can make research more relevant to addressing health needs for everyone. So if any of them are listening, a hearty, very grateful, ‘Thank you.’” /episode/index/show/lifespanhealth/id/22220261

Health policies and well being 12/09/2021

Understanding lifespan influences on cognitive ability 10/14/2021

Traumatic brain injuries and Alzheimer's disease 09/02/2021

Intersectionality, LGBTQ+ issues and the impacts of ageism 06/25/2021

How air pollution, location and education impact aging 06/18/2021

The impact and economics of Alzheimer’s 04/26/2021

The role of genetic mutations in human aging and disease 03/30/2021

Uncovering links between nutrition, genes, and risk for Alzheimer's 02/25/2021

Sex differences and mitochondria 12/17/2020

Leveraging technology to help older adults 11/23/2020

The challenges and opportunities of teaching online 09/30/2020

How racism is a threat to public health 08/20/2020

Family caregiving challenges during COVID-19 07/14/2020

COVID-19 risk factors and research directions 06/01/2020

COVID-19 and global health 05/12/2020

Covid-19 tips for grocery shopping and healthy eating 03/24/2020

Covid-19 tips for grocery shopping and healthy eating Cary Kreutzer, associate professor of gerontology and pediatrics and the director of the USC Leonard Davis School’s master of science degree program in Nutrition Healthspan and Longevity, joins Chief Communications Officer Orli Belman in a conversation about how to eat healthy, shop smart, reduce stress and stay connected through food as we practice social isolation due to the Covid-19 virus. Cary Kreutzer quotes from this episode: On staying connected through food “I think as we all are sequestered to our homes and may or may not be with extended family, using whatever sources of media to make those connections with family members and reaching out to them to either have them on the line as you're preparing an old family recipe or having them on the line as you're enjoying a meal and feeling as if they're there with you at that meal are all great ideas of how you can bring family in.” On what food items to have on hand “I think as we try to eat more at home, or are in a position where we need to be eating more at home, and are less able to make quick trips to the grocery store, which probably isn't a smart idea, [we should be] looking for foods that have a longer shelf life: those that need to be refrigerated, those that we can store in our freezer, or even looking to canned goods that we can have as a backup plan should we need to grab for those items.” On canned fruits and vegetables “A vegetable is a vegetable, and they all are going to provide vitamins and minerals. [In terms of] the processing of frozen and the processing of canned vegetables or fruits, we lose minimal amounts of nutrients in that processing. Many items are either quick-canned or quick-frozen and we're losing very little nutritional value. … For those that worry about their salt intake, my only caution I would say for canned foods would be to rinse the foods that are canned, that can be rinsed. Many foods like soups or even sauces, you can now buy low salt versions of those just as a way of decreasing and salt intake.” On choosing prepacked fresh produce “I would choose bagged or fresh fruits and vegetables that are in containers, whether it's a bag or whether it's plastic containers. I've toured those food preparation sites where lettuce and other foods are put together, and they're very sanitary with their practices. In a grocery store, we don't know whether people are carrying this virus while they're shopping. If you're going to buy loose carrots and your plan is to cook those carrots, I think you would be fine. But I would not buy something like a raw head of lettuce that I was going to rinse and then chop and put in a salad. I would probably stick to bagged lettuce just to be safe.” On safe supermarket shopping strategies “I would suggest trying to limit the number of times you're going to a store right now. ... It is probably is prudent to try to get what you need once a week, or longer if you can do that. And definitely have a shopping list. Sometimes if it's the store I always go to, I'll try to write things on my list in the order of where I pretty much know they are in the store: all the dairy together, all the canned foods together, all the breads together, meats together so that I can quickly get through that list. … [If you can’t find an item], find someone who you can ask where to find that item so that you can get in and get out quickly.” On take-out food “With picking up food or even having food delivered, try to stay focused on warm foods that you can reheat in the oven or heat up to 180 degrees, which is a warming temperature in the oven. I would only use raw ingredients that you're preparing at home to add to those foods. And I definitely would throw out any packaging that comes with those foods. I'd use my own dishes. I would also throw out bags or plastic or things that they come in and make sure I wash my hands well because we do know that the virus can live on some surfaces longer than others.” On staying hydrated “Avoid foods that cause you to be dehydrated; coffee, as a natural diuretic, as well as alcohol can be dehydrating. Try to focus more on water. Herbal teas are good. You can add squeezed fruit or frozen fruit to a juice if you need to add some flavor for those. With diabetes, you need to watch the amount of sugar-sweetened beverages you're consuming. So limit the juices; while those are good in terms of nutritional value, they're usually pretty high in sugar, and a little bit every day is really all we should be consuming.” On ways to avoid stress eating “I think, for all of us, being aware and recognizing that this can be stressful and coming up with plans for activities … to think of ‘What are all the things that I've been putting off that I can do around the house?’ [such as] weeding, or planting my garden a little bit earlier. Thankfully, we're not restricted with our ability to go out. That could be riding bikes, that could be going for a walk. It doesn't have to be intense exercise. … In my neighborhood, there were some neighbors that were going to have a meet and greet. Many of us have seen the video of Italy and people on their balconies singing together. In my neighborhood, that there were people that were going to go out on their porch and just wave to one another across the street. … You can use all types of social media, whether it's calling friends or family on phones now we can do video chats, we can do Skype through our computer. So lots of ways to connect with other people. I would also say, I know for my religious affiliation, they have sent lots of ideas of how I can stay connected to my religious beliefs and not feel alone. So, reach out to those resources that are provided for whatever your religion may be and work on trying to destress your environment.” /episode/index/show/lifespanhealth/id/13684805

Lessons in Lifespan Health

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