PROGRESS
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 | Annual Report 2015 2016
A DECADE OF EVOLUTION
Dear Friends and Colleagues, The first decade of the University of Florida Institute on Aging was a decade of growth. Now, as the institute celebrates its 10th anniversary, it is entering a stage of evolution. In recent years, we, the Institute on Aging’s faculty and staff researchers, have built our independence, funding the majority of our research through extramural grants. We currently have 69 active studies, and are constantly looking to expand our research imprint. As our research grows, we are also evolving into an educational institute. We have spent the past two years developing curriculum for two educational programs, an online graduate certificate and an online master’s degree in aging and geriatric practice, which will both launch in 2015. The programs will help develop health care, research and executive careers through education. Because they will be available online, the programs will have the ability to reach health care professionals across the globe. Along with independent research and education, we have expanded health care personnel at UF Health Shands Hospital. Now, we have geriatricians embedded in the acute care surgery service, the medicine service and in the emergency department who can begin to care for older adults as soon as they come through our doors. We continue to provide geriatric services and expertise at the UF Health Senior Care clinic and to older adults in local skilled nursing facilities. We have worked hard to build a robust institute over the past decade, creating a strong foundation of research. Over the next decade, we will continue to expand our research, and through the development of our educational and health care programs, will continue to promote healthy and independent lives for older adults.
Marco Pahor, M.D. Director, UF Institute on Aging
Lauren Solberg, J.D., M.T.S., UF bioethicist
Recently, the institute has developed three new programs to educate students and health care professionals on a local, regional and international level. These include online programs in aging and geriatric practice as well as an ongoing geriatrics boot camp offered to local health care professionals. This interprofessional education plan uses the combined knowledge of basic, translational, social, behavioral, epidemiological and clinical scientists to help trainees become future leaders, researchers or clinicians in geriatrics and aging research and to improve the health and quality of life of older adults.
} Geriatrics boot camp
Led by Lauren Solberg, J.D., M.T.S., a professor of bioethics with appointments in the departments of community health and family medicine, psychiatry, and aging and geriatric research, our faculty conducted two interprofessional geriatric boot camps to educate almost 100 local health care professionals on caring for older adults. Topics included an overview of the geriatric patient, delirium and dementia, palliative care, polypharmacy and ethical case discussions.
} Online programs in aging and geriatric practice
Students gain credentials and further their careers through a graduate certificate or master’s degree in aging and geriatric practice. The courses offered in these programs are designed by our expert faculty and are offered online.
} Geriatrics and rehabilitation clerkship
Expanding from a two- to a four-week mandatory rotation for all fourth-year medical students, the geriatric clerkship’s curriculum focuses on caring for older patients in the UF Health Senior Care clinic and UF Health Shands Hospital as well as in rehabilitation and palliative care settings.
Christy Carter, Ph.D., assistant professor in the department of aging and geriatric research
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S P O T L I G H T O N N E W LY F U N D E D S T U D I E S
Stephen Anton, Ph.D. | NIH R01AT007564
} REVIVE: Resveratrol to Enhance Vitality and Vigor in Elders
- Studying whether a daily 1,000 milligram resveratrol supplement will improve mitochondrial function and physical performance in generally healthy but moderately functioning older men and women in a clinical trial. Thomas Buford, Ph.D. | NIH R21AR065039
} KAATSU Training to Enhance Physical Function of Older Adults with Osteoarthritis - Developing interventions that optimize beneficial effects of exercise training among older adults with osteoarthritis. Ronald Cohen, Ph.D. | NIH R01DK099334
} Obesity and Type 2 Diabetes: Bariatric Surgery Effects on Brain Function
- Examining whether cerebral metabolic and vascular dysfunction underlie obesity-associated cognitive dysfunction and whether significant weight loss and diabetes remission following bariatric surgery reduces these disturbances. Christiaan Leeuwenburgh, Ph.D. (Jae-Sung Kim, Ph.D.*) | NIH 2R01DK079879
} Autophagy in Liver Injury
- Developing novel therapeutic strategies to improve liver function after ischemia/reperfusion injury during liver resection and transplantation surgery. Christiaan Leeuwenburgh, Ph.D. (Mary McDermott, M.D., Northwestern University*) | NIH R21AG047510
} Resveratrol to Improve Outcomes in Older People with Peripheral Artery Disease - Evaluating whether resveratrol improves lower-extremity function in older people with peripheral artery disease. Todd Manini, Ph.D. | NIH R01HL121023-01
} MTDNA Variant Modifiers of Cardiopulmonary Responsiveness to Physical Activity
- Identifying mtDNA variants that predispose older individuals to high or low cardiopulmonary response to chronic exercise. Todd Manini, Ph.D. | NIH R01AG042525
} Metabolic Cost of Daily Activities in Older Adults - Establishing the true metabolic intensity of performing daily tasks in older adults. Frederick Moore, M.D. | NIH 1P50GM111152
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} PICS: A New Horizon for Surgical Critical Care
- Defining the natural history and causes of chronic critical illness that intensive care patients who have had sepsis face. * Principal Investigators
Shinichi Someya, Ph.D., department of aging and geriatric research A study by Shinichi Someya, Ph.D., is examining whether caloric restriction delays the progression of age-related hearing loss, which affects more than 40 percent of people over 65 in the United States. Evidence suggests that reactive molecules containing oxygen, called reactive oxygen species, play a central role in age-related hearing loss. Two major antioxidant defense systems protect cells from these reactive molecules. Someya and fellow researchers are studying whether that defense system declines as we age, and whether restricting calories increases the function of that antioxidant system, protecting inner ear cells from oxidative stress and slowing the development of hearing loss in aging mammals.
Shinichi Someya, Ph.D., assistant professor in the department of aging and geriatric research
As men age, testosterone production gradually decreases. At the same time, they lose muscle mass, but gain fat mass. Their mobility and cognitive function decreases, and they experience declines in sexual function, energy level and bone mineral density. Men’s incidence of bone fracture rises and their tolerance to glucose becomes impaired. In an attempt to improve these symptoms, older men are sometimes given testosterone treatments. In 2003, a panel of the Institute of Medicine of the National Academy of Sciences recommended a coordinated set of clinical trials to determine if testosterone treatment actually does benefit men. Researchers from many institutions including UF Institute on Aging director Marco Pahor, M.D., designed a set of clinical trials to measure whether testosterone treatments improve mobility, sexual function, fatigue, cognitive function, anemia, bone mineral density and coronary artery plaque. In all, 780 participants have been recruited to take part in the trials, including 71 from the state of Florida. The results of this study will be published in spring 2015.
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THE LIFE STUDY
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More than 10 years ago, we asked whether moderate exercise for older adults could help them maintain their mobility and walk better for longer. We knew this research needed to cast a wide net, so we set up eight different field centers across the country as part of a study called the Lifestyle Interventions and Independence for Elders, or LIFE, study. Over the course of the study, more than 1,600 men and women ages 70-89 were assessed. The study included a control group who attended health education classes but did no physical activity beyond light stretching. The physical activity group was able to walk a quarter of a mile, the equivalent of a trip around a neighborhood block. The purpose of our study was to provide definitive evidence that physical activity can improve the independence of older adults, and its results were conclusive. The physical activity group was able to prevent the loss of mobility at a rate 18 percent higher than its non-exercising counterpart. The study proves that moderate exercise is key to keeping older adults mobile and independent. We published our results in the Journal of the American Medical Association. Since then, 90 papers and 41 ancillary research studies have been completed or are in progress. The LIFE study has since provided help in building the framework for a similar study taking place in 11 European countries. The Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies, or SPRINTT, Project aims to use physical exercise, proper nutrition and technological tools to help frail older adults fight the challenges of aging.
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Formation of the department of aging and geriatric research Formation of current Institute on Aging
Added fourthyear clerkship for medical students Started Locomotor Experience Applied Post-Stroke trial
UF IOA awarded a Claude D. Pepper Older Americans Independence Center five-year grant
Submission of LIFE grants Submission of Clinical and Translational Science Institute grants Autophagy and basic science research funding
2009
2008
2007
2006
2005
TEN YEAR REVIEW
Clinical Translational Science Award is granted, funding clinical and translational research and training Formation of Cognitive Aging and Memory Clinical Translational Research Program, supported by endowed fund of McKnight Brain Research Foundation and UF LIFE grant funded
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Health Promotion Center of the Institute on Aging opens
Research extends to Lake Nona with 4,200-squarefoot clinical research unit within the Research and Academic Center at Lake Nona
Ronald Cohen, Ph.D., named director of UF CAM-CTRP Pepper Center award renewed for another 5 years LIFE enrollment complete; preliminary publication begun
Clinical Translational Research Building funded by NIH grant C06RR029852 and UF UF Health Senior Care clinic moves into Clinical and Translational Science Building Lawrence Solberg, M.D., new head of geriatric medicine appointed
2014
2013
2012
2011
2010 IOA receives award for new building, including the Claude D. Pepper Older Americans Independence Center, the Clinical and Translational Science Institute and the CAM-CTRP
LIFE study complete Testosterone trial complete UF Sepsis and Critical Illness Research Center funded Embedded geriatricians in UF Health Shands Hospital Launching two new educational programs
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K E Y R E S E A R C H F I N D I N G S A N D S TAT I S T I C S
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2014: YEAR IN REVIEW
15 Basic Science
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54 Clinical Translational Science
69 Research projects
UF Claude D. Pepper Older Americans Independence Center | Research areas and key findings
The biomarkers of physical function
The effect of a year of exercise
A protein called “agrin” helps develop the neuromuscular junction — the connection of the nervous system with the muscular system. When it cleaves, it produces a material called C-terminal agrin fragment, or CAF, which could be used as a biomarker for predicting changes in the physical function of older adults. While we did not find a higher level of this biomarker in older adults with limited mobility, we need to further study how CAF can be used as a biomarker of physical function.
Exercise is the only intervention to date proven to prevent physical disability. However, individual responses to exercise are variable and previous studies have suggested that genetic factors may play a role in this variability. This study showed that a common genetic variant that regulates angiotensin-converting enzyme, or ACE — an important factor in the regulation of blood pressure — was associated with changes in physical function among older adults after a one-year exercise intervention.
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Bondoc I, Cochrane SK, Church TS, Dahinden P, Hettwer S, Hsu FC, Stafford RS, Pahor M, Buford TW, for the Life Study Investigators. J Nutr Health Aging. (in press)
· circle in front of name indicates
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UF Institute on Aging researcher
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Buford TW, Hsu FC, Brinkley TE, Carter CS, Church TS, Dodson JA, Goodpaster BH, McDermott MM, Nicklas BJ, Yank V, Johnson JA, Pahor M
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Physiol Genomics. 2014 Mar 1;46(5):149-58. doi: 10.1152/ physiolgenomics.00169.2013. Epub 2014 Jan 14.
60+37+3q 3 International
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57 National
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92 University of Florida
749 Research study participants 1,091 Visits conducted
152 Scientists
Resveratrol supplements safe to test in older adults
Textured insoles may improve automatic walking
Resveratrol has been found to have potent antioxidant, antiinflammatory and anticarcinogenic effects. But no one has yet studied the safety and efficacy of giving resveratrol to older adults as a supplement. We found that a moderate daily dose of 300 milligrams and a high daily dose of 1,000 milligrams were welltolerated in our subjects. This supports the study of resveratrol for improving cardiometabolic health in older adults in larger clinical trials.
The ability to walk safely is important as adults age, and that ability is relatively automatic in healthy people. Somatosensation, the sense of touch, is important to help the nervous system control walking and make it automatic. Impaired somatosensation in older adults may reduce the automatic control of walking and require older adults to think about how to move their legs while walking, which then may hamper their ability to walk. By measuring brain activity, we found that enhancing somatosensation using textured insoles helps older adults think about their walking less — possibly helping them walk better.
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Anton SD, Embry C, Marsiske M, Lu X, Doss H, Leeuwenburgh C, Manini T
Experimental Gerontology 57(2014):181-187. 24 May 2014.
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Clark DJ, Christou EA, Ring SA, Willamson JB, Doty L.
J Gerontol A Biol Sci Med Sci, 69(11): 1422-8, 2014.
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Agricultural and Life Sciences n Dentistry n Education n Engineering n Health and Human Performance n Liberal Arts and Sciences n Medicine n Nursing n Pharmacy n Public Health and Health Professions n Veterinary Medicine n
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325 Clinical Translational Science
391 Peer-reviewed publications
11 UF colleges
Plantar tactile perception and mobility function
The relationship between sitting and Type 2 diabetes
Impaired somatosensation, or the sense of touch, is common in older adults and contributes to age-related loss of mobility function. We tested mobility function at four sites on the sole of each foot: the big toe, the first metatarsal head, the heel and the fifth metatarsal head. We found tactile perception at the first metatarsal head was more closely linked to mobility function than the other three places tested. The findings warrant further research to examine whether interventions such as textured insoles and assessments that focus on this site may more effectively optimize clinical care.
Sitting all day can be unhealthy. As jobs become more sedentary, we wondered about the association between sitting and Type 2 diabetes. Examining surveys collected from the national Women’s Health Initiative study, we found that the risk for developing diabetes increased sharply for women who sat between 12 and 15 hours per day. Women who sat more than 16 hours during their waking day had the highest risk of developing diabetes, even if they otherwise exercised five days per week, 30 minutes per day. At highest risk were obese women.
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Cruz-Almeida Y, Black ML, Christou EA, Clark DJ
Front Aging Neurosci. 2014 Apr 11;6:68. doi: 10.3389/ fnagi.2014.00068.
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Manini TM, LaMonte MJ, Seguin RA, Manson JE, Hingle M, Garcia L, Stefanick ML, Rodriguez B, Sims S, Song Y, Limacher M Obesity (2014) 22, 1133–1141. doi:10.1002/oby.20620.
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41+34+11741q 49+28+167q 5 postdoctoral associates 3 visiting scholars 2 fellows
18 volunteers 48 graduate students
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31 Undergraduates
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155 Skilled nursing
352 Oak Hammock outpatients
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1,080
611
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142 Medical/Graduate Education students
170 Clerkships
611 In-patient consults
Age and race effects on pain sensitivity and modulation among middle-aged and older adults This study tested the effects of aging and race on response to painful stimulus using a wide range of stimuli. We found that as adults age, they experience a decline in pain sensitivity in their lower extremities. We also observed that differences in pain sensitivity based on race were found in younger adults were also found in older adults.
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Riley JL, Cruz-Almeida Y, Glover TL, King CD, Goodin BR, Sibille KT, Bartley EJ, Herbert MS, Sotolongo A, Fessler BJ, Redden DT, Staud R, Bradley LA, Fillingim RB
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J Pain. 2014 Mar;15(3):272-82. doi: 10.1016/j. jpain.2013.10.015. Epub 2013 Nov 14.
1,080 Senior Care
2,198 Patients seen
419 Trainees
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Racial and ethnic differences in older adults with knee osteoarthritis Knee osteoarthritis contributes significantly to disability in older adults, and racial and ethnic minorities are disproportionately affected. For the first time, this study established that there are racial and ethnic differences in clinical and experimental pain, including pain inhibition, among older African American and non-Hispanic white subjects with knee osteoarthritis. Our findings warrant further study of the common and group-specific pathophysiologic mechanisms contributing to clinical pain in osteoarthritis.
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Cruz-Almeida Y, Sibille KT, Goodin BR, Petrov ME, Bartley EJ, Riley JL, King CD, Glover TL, Sotolongo A, Herbert MS, Schmidt JK, Fessler BJ, Staud R, Redden D, Bradley LA, Fillingim RB Arthritis Rheumatol. 2014 Jul;66(7):1800-10. doi: 10.1002/art.38620.
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NEW FRONTIERS
SEPSIS CENTER Occasionally, critically ill patients are on the verge of recovery when they develop sepsis, a systemic inflammatory response the body sometimes has in response to bacteria or other germs. It can be one of the most devastating issues patients face — particularly aging patients. In 2012, UF researchers identified a condition they call persistent inflammation, immunosuppression and catabolism syndrome, known as PICS. They say the condition afflicts thousands of people each year, most often older adults who are successfully treated for sepsis. To study sepsis and PICS, UF Health was awarded a $12 million, five-year grant from the National Institutes of Health to create a oneof-a-kind sepsis treatment center. The grant, NIH P50GM111152, will help establish the UF Sepsis and Critical Illness Research Center. The first of its kind in the nation, the center will study long-term outcomes in patients treated for sepsis in the trauma intensive care units at UF Health Shands Hospital, with the goal of developing clinical solutions for sepsis, PICS and other illnesses that stem from sepsis.
Christiaan Leeuwenburgh, Ph.D., professor and chief of the division of biology of aging in the department of aging and geriatric research
The center reflects a partnership between the grant’s principal investigator Frederick A. Moore, M.D., chief of acute care surgery at UF Health and Lyle (“Linc”) Moldawer, Ph.D., professor and vice chair of research in the department of surgery, along with several other UF Health colleagues. Christiaan Leeuwenburgh, Ph.D., a professor and chief of the division of biology of aging in the department of aging and geriatric research; Anna-Maria Joseph, Ph.D., assistant scientist with the division of biology of aging; and Stephen Anton, Ph.D., chief of the division of clinical research, will be involved in one of the center’s projects. They will explore the possible role of immature immune system cells called myeloid-derived suppressor cells in the onset of PICS. Leeuwenburgh will also be addressing muscle wasting within patients recovering from sepsis and PICS.
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PAIN CENTER A developing line of research in the department aging and geriatric research studies a pervasive issue in older adults: pain. Some studies indicate that 50 to 70 percent of community-dwelling older adults suffer from chronic pain, according to Yenisel Cruz-Almeida, Ph.D., MSPH, and Kimberly Sibille, M.A., Ph.D., both assistant professors in the department of aging and geriatric research as well as the Cognitive Aging and Memory Clinical Translational Research Program. Sibille and Cruz-Almeida are also both affiliated faculty in the University of Florida Pain Research and Intervention Center of Excellence, or PRICE.
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Yenisel Cruz-Almeida, Ph.D., MSPH, assistant professor in the department of aging and geriatric research
PRICE was formed in 2013 and is directed by IOA executive board member Roger Fillingim, Ph.D., who is also an executive committee member of Florida’s first Claude D. Pepper Independence Center. PRICE, a multi-college center funded by the UF Clinical and Translational Science Institute and supported by the IOA and the UF Health Cancer Center, serves as a professional home for UF scientists, clinicians and trainees dedicated to the improved understanding and treatment of pain.
Kimberly Sibille, M.A., Ph.D., assistant professor in the department of aging and geriatric research
Chronic pain changes the structure and function of the brain, and this can negatively impact a person’s cognition and physical performance. Cruz-Almeida’s research interests are related to understanding the mechanisms involved in age-related changes in the experience of pain and in factors that may increase or decrease pain in humans. She is currently investigating nervous system factors associated with multisite pain in older adults and this pain’s impact on mobility. Sibille’s research involves examining the biological burden of chronic pain in osteoarthritis and other musculoskeletal chronic pain conditions. She is interested in the interactive influences of biological, psychological, cognitive, behavioral and social factors with a focus on aging, resilience and optimizing treatment response. Both Sibille and Cruz-Almeida have studies in development to investigate ways to enhance the brain’s response to chronic pain treatments.
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NEW CONNECTIONS
} Geriatric Consult Service The UF Institute on Aging’s geriatricians are embedded in the acute care surgery service, the medicine service and in the emergency department.
} UF Health Senior Care clinic There were 1,080 visits in 2014.
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The Institute on Aging has helped expand UF Health Shands Hospital’s geriatric care with two new staff members whose expertise is in geriatric care.
Jacobo Hincapie Echeverri, M.D.,
most recently a fellow in geriatric medicine at Harvard Medical School, is the embedded geriatrician in the emergency department. His position brings geriatric care to frail older patients as soon as they enter the hospital.
Jianhong (Crystal) Hua, M.D.,
provides primary care to outpatients within the UF Health Senior Care Clinic and is the embedded geriatrician for inpatient medical services, working closely with the hospital’s medicine and teaching services. Hua recently completed a geriatric medicine fellowship with the department of aging and geriatric research within the Institute on Aging. Her background includes experience as a pediatric surgeon and as a family practitioner.
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THE AGING BRAIN
The Cognitive Aging and Memory Clinical Translational Research Program (CAM-CTRP) continues to tunnel down into new ways of addressing the severe cognitive impairments and memory problems experienced by approximately one in seven adults over the age of 65. New research projects include a study by program director Ronald Cohen, Ph.D., which examines the effects of chronic obesity on brain structure and function following bariatric surgery. “Obesity has a negative impact on thinking and memory function as we get older, but we do not know exactly what changes in the brain lead to these effects,” said Adam J. Woods, Ph.D., assistant director of the Cognitive Aging and Memory Clinical Translational Research Program.
Adam J. Woods, Ph.D., assistant director, CAM-CTRP
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Ronald Cohen, Ph.D., director, CAM-CTRP
“Because people rarely lose weight so rapidly and in such a controlled way, bariatric surgery can provide a unique model of the effect of obesity on the brain.” The program also continues to develop the neurophysiology and neuromodulation core, which Woods leads. This multidisciplinary lab will be expanding its capability to enhance brain function through the acquisition of a state-of-the-art system used to simulate small regions of the brain, providing additional novel methods for exploring the positive benefits of noninvasive brain stimulation for the treatment of agerelated cognitive decline, chronic pain and depression. The neuroimaging core, led by Cohen, also continues to expand the CAM-CTRP’s neuroimaging capabilities in collaboration with the UF Advanced Magnetic Resonance Imaging and Spectroscopy Facility.
GIVING TO THE UF INSTITUTE ON AGING:
Why Every Dollar Counts Unlocking life’s mysteries — particularly the secrets of how long and how well we live — is the distinct focus of the University of Florida Institute on Aging. Our scientists and physicians are dedicated to achieving a better understanding of the biological mechanisms of aging and of how we can maintain or enhance our physical independence and cognitive abilities. Private philanthropy is so essential to our work; your gift, regardless of size, can make the critical difference in funding new scientific endeavors. Imagine discoveries that fuel positive cellular changes or lead to new therapies to help rehabilitate aging bones and joints ... private philanthropy makes all this and much more possible.
To learn more about how you can invest in a healthier and more independent tomorrow for us all, please contact Mary Ann Kiely at 352-273-9620 or mkiely@ufl.edu.
University of Florida Institute on Aging P.O. Box 100107, Gainesville, FL 32610 www.aging.ufl.edu 352-294-5800
Non-Profit Organization U.S. Postage PAID Permit No. 94 Gainesville, FL 32601