Geriatrics and Palliative Medicine Research

The Geriatrics and Palliative Medicine section collaborates with the basic science laboratories of the Huffington Center on Aging in studies aimed to further our understanding of the molecular and cellular mechanisms of aging. Huffington investigators are studying the biochemical and genetic basis of age-related dysfunction or age-associated diseases that occur in various cell types and organ systems, including the aging brain and endocrine and cardiovascular systems. Geriatrics fellows and faculty collaborate to bring a human piece to the puzzle. The overall goal is to understand the changes that occur during aging, with the hope that they will be able to intervene in specific age-related diseases and disorders to improve the quality of life of the elderly. One recent example involved geriatrics fellow, Cynthia Robinson, M.D., who collaborated with Huffington researcher Wei Wei Dang, Ph.D., to evaluate start site dysregulation in older people, a manifestation of aging in yeast.

Our physicians are collaborating in clinical research protocols to study the effect of glutathione replacement. This study tests the effects of replacement in elderly men and women. Potential benefits of replacing this critical intracellular antioxidant include an improved sense of well-being and an increase in muscle mass, perhaps leading to improvement in daily functional activities and in immune function.

Dr. George E. Taffet conducts studies of aging and aging-related diseases of the cardiovascular system. His approach combines basic science and clinical investigation approaches and focuses on factors leading to diminished work capacity in healthy older people and investigation into the prevention and treatment of disability arising from heart failure. Normal aging is accompanied by diastolic dysfunction, an impaired ability of the heart to relax and refill. This diastolic dysfunction is one of the limits of exercise tolerance in older people and predisposes them to heart failure. Dr. Taffet showed that a pump protein important in cardiac relaxation is decreased in the old rat heart and that inflammation increases the amount of fibrosis in the old heart, both contributing to the inability to fill. Working with Dr. Charlotte Tate, he demonstrated that exercise would improve this aspect of heart function in part by increasing the content of this pump. Subsequently, they have found that caloric restriction also prevented age-related diastolic function in rodents. The group's present endeavors include exploring other ways to improve cardiac relaxation and evaluating cardiovascular function in old and transgenic mice.

Dr. Kathryn Agarwal and Dr. Angela Catic are studying how cognitive dysfunction modifies the ability of older individuals to manage their medical illnesses. Using simple, bedside tests like the Mini-Cog, they have shown that inability to draw a clock leads to readmissions for older heart failure patients and medication errors for older veterans. The role of delirium and its detection and depression also are a critical part of this effort.

The Huffington Center on Aging Ethics Research team includes Dr. Aanand Naik and Nancy Wilson, LMSW. This team is a founding component of a larger multi-departmental collaborative effort at Baylor addressing healthcare utilization and ethical issues. Areas of investigation addressed by the team involve ethical dilemmas, personal values, and decision making; issues surrounding life-sustaining technology; and healthcare utilization and quality of care. Specific efforts initiated by the team include projects designed to implement and test the:

• Effectiveness of increased expression of values in long-term care decision making
• Measurement of potential enhancement to well-being with increased patient autonomy
• Mechanisms to increase the frequency of advanced directive discussions

Collaborating with investigators at the Michael E. DeBakey Veterans Affairs Medical Center, Geriatrics and Palliative Medicine faculty have long supported descriptive and analytic research concerning patient outcomes. Beyond survival and functional status, investigators in this area are also concerned with characteristics associated with acceptance or rejection of interventions by older persons, proxies and practitioners. In addition, a national multi-site clinical trial regarding the efficacy and cost-effectiveness of personal response systems is being coordinated at the Huffington Center on Aging.

Huffington Center on Aging faculty and faculty associates are involved in affiliated research activities with other departments such as the Alzheimer's Disease and Memory Disorders Center, where new and ongoing patient-centered and basic science research on Alzheimer's disease is conducted.

Other departments conducting affiliated research include the departments of Psychiatry and Otolaryngology, and the Section of Endocrinology, Diabetes and Metabolism, also in the Department of Medicine.