Anti-Aging Research and the Future of SNFs.
The rhesus monkeys, aged 18 to 35 years, are part of a collection of unusually long-lived biological "resources," which the National Institute on Aging (NIA) makes available to researchers studying the causes and processes of aging. Other items in the NIA "zoo" include inbred strains of mice, rats raised for generations on low-calorie diets, skin cultures from victims of premature aging syndromes, and living cells from individuals with a family history of Alzheimer's disease.
This federally sponsored mad scientist's smorgasbord reflects a major shift in the priorities of government and private research on aging. Fifteen years ago, the deterioration of aging was still viewed as something that could be conquered by treating individual diseases. Average life expectancy has nearly doubled during this century, primarily because of the discovery of antibiotics, improved hygiene and reduced threats to the life of mother and child at birth. In 1990, however, University of Chicago demographer S. Jay Olshansky and his colleagues reported that humans are reaching the upward limit of extending life by conquering disease. Specifically, their calculations showed that the total elimination of all cancer, for example, would extend average life expectancy by only two years. According to Olshansky, the basic reason for frailty in old age is that our bodies simply are not designed to operate for a long time. Dealing with this fundamental design issue required a new direction for research on the eld erly.
A single federal employee, Nathan Wetherell Shock, PhD, was largely responsible for that new direction. Dr. Shock began his career in the government in 1941, as chief of the newly formed Unit on Gerontology of the National Institutes of Health (NIH). He remained with NIH until his death in 1989, serving as the first scientific director of NIA and later as scientist emeritus of the NIA Gerontology Research Center in Baltimore. As a researcher, Shock perhaps is best known for launching the Baltimore Longitudinal Study of Aging BLSA) that is tracking age-related changes among 1,200 volunteers, including some recruited for the project in the 1950s. His most important contribution, however, was in steering our country's gerontology research towards two questions: "What are the underlying biological factors that produce what we perceive as aging?" and "What are the mechanisms that produce impaired performance with age?"
Dr. Shock's legacy is reflected in the evolution of the federal government's research agenda on aging during the past 10 years. A quick look at the meetings and publications of the Geronotological Society of America in 1989 reveals that many of the research studies were attempting to define what is "natural" in aging and what is caused by disease. At Massachusetts' Hebrew Rehabilitation Center for the Aged, for example, Neil M. Resnick, MD, was reporting on NIA-supported research of the causes of urinary incontinence. Resnick concluded:
We can no longer ascribe urinary incontinence in frail elderly persons merely to advanced age, dementia, immobility, or institutionalization, although all these factors undoubtedly play a part...[T]he cause of incontinence should be carefully sought in each patient, no matter how frail.
At the same time, researchers from the National Eye Institute were studying whether impaired vision might produce some of the hip fractures observed in the elderly, while Carolyn C. Hoch, PhD, and her colleagues were using a grant from the National Institute of Mental Health to examine whether sleep-disordered breathing could indicate the presence of Alzheimer's disease. In San Diego, Mary and Margaret Quayhagen were using NIA funds to prove that a program to encourage mental activity among home-based Alzheimer's patients produced good clinical results. In effect, all of these studies reflected Dr. Shock's question: Is impairment "normal" to aging or does it have other causes?
This question has more or less been answered today. Scientists have shown that individuals who age relatively slowly tend to have fewer impairments in their 80s and 90s than people who aged more rapidly. Recent research on people who survive into their second century, such as Harvard University's ongoing New England Centenarian Study, suggests that the very old can remain surprisingly healthy and active. According to Edward G. Lakatta, MD, of NIA's Gerontology Research Center, writing in the Journal of the American Gerontological Society:
Further characterization of what constitutes the most optimal lifestyle habits and research into the specific mechanisms of genetic and nongenetic aspects of aging will contribute not only to the development of specific lifestyle and pharmacologic interventions, they will also likely lead to gene therapy to optimize the likelihood that given individuals will age "successfully." Thus, a conceptual breakthrough that will be expanded and further defined in the foreseeable future is the distinction of successful aging from normal or usual aging.
How does this research direction affect the nursing home field? In the short run, it means a reduced role for SNFs in aging research. SNF-based clinical studies now take a back seat to the more costly, laboratory-based research on the molecular, chemical and genetic mechanisms of aging. Typical topics of federally supported aging research today include association of the biochemical interleukin-6 with depression in older people and proof that a mutation in the Tau gene of chromosome 17 produces degenerative dementia among the elderly. Nursing homes are still involved in providing the patients needed for human studies, but the complex, high-technology experiments that advance the research cannot be conducted by most nursing homes.
Over time, however, achievement of the goal of the federal research agenda on aging might significantly change the role of the nursing home in society. If Lakatta's vision is correct, the current lines of research will produce techniques that will help people reduce the impairments that they experience if they survive into very old age. It is not likely that this will produce a generation of Americans who easily reach their 110th or 120th birthday, but it suggests that more very old people will be able to survive without living in a long-term care facility. Today's nursing homes might evolve into geriatric treatment providers, where older patients are admitted to receive gene therapy or other care that will allow them to age "successfully" and return to their preferred living arrangement.
If science eventually changes the goal of nursing homes from helping old people live longer to helping them live better, the vision of Dr. Nathan Shock will have had a greater impact than all the regulatory and reimbursement changes of recent years combined in shaping the future of long-term care.
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|Author:||Stoil, Michael J.|
|Date:||Dec 1, 1999|
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