New York (March 27, 2019)--Insights into molecular changes in the brains of Alzheimer's patients, a new model for predicting the life expectancy of older adults with multiple chronic diseases and age-related vulnerability, and older adults' and healthcare professionals' perspectives on gun retirement are the subjects of top-line presentations at the American Geriatrics Society (AGS) 2021 Virtual Annual Scientific Meeting (#AGS21) (May 13-15, with pre-conference May 12). Research reviewed at the conference's Plenary Paper Session (May 13, 11:15 a.m.-12 p.m. ET) represents geriatrics' most promising scholarship, drawn from a pool of almost 1,000 abstract submissions. This year's marquee research presentations are:
(presented by Caglar Cosarderelioglu, MD)
Alzheimer's disease is the most common cause of dementia, but scientists have yet to understand what causes Alzheimer's. One potential contributor to the development of the irreversible, progressive brain disorder is the renin-angiotensin system (RAS), a hormonal system that plays a critical role in regulating blood pressure. In their study, Dr. Cosarderelioglu and colleagues, led by Peter Abadir, MD, used frontal cortex brain samples from the cadavers of cognitively normal individuals and Alzheimer's patients to examine the differences in their renin-angiotensin systems and determine how these differences might relate to other effects of Alzheimer's disease in the brain. They used two different lab detection methods, quantitative Polymerase Chain Reaction for gene expression and Western blot for proteins, to measure the levels and/or gene expression of six main components of the RAS. Researchers also looked for the relationship between RAS differences and oxidative stress (an imbalance between free radicals and antioxidants that can cause damage to fatty tissue, DNA, and proteins in the body) and inflammation. Among Alzheimer's patients, they identified an increase in the gene and protein expression and activity of only one RAS component, the angiotensin II type 1 receptor (AT1R), which is known for its pro-oxidative and pro-inflammatory effects. Higher levels of AT1R in the brain were associated with higher levels of oxidative stress and beta-amyloid proteins (a marker of Alzheimer's disease) and greater decline in cognitive function. Results of Dr. Cosarderelioglu's study offer insight into how molecular changes in the RAS in the brain relate to Alzheimer's disease.
(presented by Nancy L. Schoenborn, MD, MHS)
Predictions about life expectancy are an important factor in making decisions about the care of older adults. Current prediction models use age and comorbidities (multiple chronic diseases) while neglecting frailty, the medical term for the increasing vulnerability to daily stressors we may experience with advancing age. Dr. Schoenborn and her team set out to correct this oversight by incorporating frailty into a new life expectancy prediction model. The researchers used data from more than 400,000 Medicare beneficiaries ages 66 to 95 enrolled in the fee-for-service program from 1998 to 2014 to estimate the probabilities of their survival rates at five and 10 years, as well as their median life expectancies by age, sex, level of comorbidities, and frailty status. According to researchers' findings, adults with any comorbidities had a higher risk of death than those with none, and adults in the "high frailty" category were more likely to die over the 17-year study period than those in the "low frailty" one. Median life expectancies were less than 10 years in individuals with high comorbidity levels and high frailty, regardless of age. Most strikingly, the median life expectancy for men age 70 with high comorbidity levels and high frailty (5.4 years) was approximately half that for men in the same age group with high comorbidities and low frailty. The study suggests that comorbidities and frailty are significant and independent predictors of life expectancy over 10 years, an important threshold in clinical decision-making for older adults. The table researchers created with their results can help clinicians discuss important decisions with patients, inform simulation models, and drive population health management and research.
(presented by Laura C. Prater, PhD, MPH, MHA)
Cognitive decline and depression are common in older Americans, nearly 40 percent of whom live in a home with a firearm. Access to weapons they can shoot puts them at high risk of unintentional injury and suicide. Working with a team led by Emmy Betz, MD, MPH, Dr. Prater and colleagues conducted a series of focus groups with older firearm owners and interviews with geriatrics healthcare professionals to explore how older firearm owners think about retiring their guns as they age or experience physical or cognitive impairments. Of the 16 older adults, mostly men, who participated in virtual focus groups from October 2020 to January 2021, many said they had considered limiting their firearm access, but the majority had not made concrete plans to do so. Some suggested tools, like gun inventories, that would help facilitate their own planning. In their interviews, geriatrics health professionals compared the process of retiring firearms to giving up one's car keys and writing advance directives. They stressed the importance of planning early and often and acknowledged the value of involving family and friends in ongoing conversations. Future directions for the findings of this qualitative study include developing decision aids and other resources for gun retirement that are modeled on evidence-based tools for driving retirement or advance directives.
About the American Geriatrics Society
Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for more than 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.
About the AGS Annual Scientific Meeting
The AGS Annual Scientific Meeting is the premier educational event in geriatrics, providing the latest information on clinical care, research on aging, and innovative models of care delivery. More than 2,000 nurses, pharmacists, physicians, physician assistants, social workers, long-term care and managed care providers, healthcare administrators, and others will convene virtually May 13-15 2021 (pre-conference program on May 12) to advance geriatrics knowledge and skills through state-of-the-art educational sessions and research presentations. For more information, visit Meeting.AmericanGeriatrics.org.