>>WELCOME TO DAY 3, THE FINAL
DAY OF A VERY LONG SUMMIT. I
THINK THAT IT HAS BEEN PRETTY
GOOD.
I WILL GIVE A LITTLE BRIEF
INTRODUCTION
WHERE WE ARE GOING.
THERE WE ARE. OKAY. WE HAVE
GONE THROUGH THE FIRST SIX
SESSIONS. I WON'T TRY TO
INTERPRET TOO MUCH BUT WILL JUST
LET YOU KNOW WHAT HAS BEEN
HAPPENING AND CATCHING UP FOR
THOSE THAT ARE JOINING. WE
STARTED WITH HEALTH DISPARITIES,
WHICH IS BASED ON A FRAMEWORK
THAT WAS DEVELOPED AT NIA AND
ADAPTED AND MODIFIED AND
EXPANDED AND IS EVOLVING WITH
OTHER NIH INSTITUTES.
IT COVERS PRETTY MUCH.
THIS ONE. RIGHT. IT COVERS
MULTIPLE DOMAINS OF RESEARCH AND
LIFE AND IS GOOD THAT THOSE ARE
RELATED. ONE THING WE ALSO HAVE
TO BE CAUTIOUS ABOUT IS THAT
INPUT DATA IS ALSO IMPACTED BY
HEALTH DISPARITIES AND KNOW
ABOUT THE RELATIVE FREQUENCY OF
MISDIAGNOSIS AND DELAYED
DIAGNOSIS AND DELAYED TREATMENT
DEPEND WRG ARE YOU IN THE US AND
OTHER COUNTRIES AND WE HAVE --
IT WAS POINTED OUT WE ARE
FOCUSING ON SOCIAL DISADVANTAGE.
WE, OF COURSE, DON'T KNOW WHAT
THE LAGS WOULD BE BETWEEN SOCIAL
DISADVANTAGE OVER THE LIFE
COURSE RELATIVE TO CLIMATE
FUNCTION AND WHERE AT ANY POINT
WE COULD HAVE AN IMPACT OF VERY
MAGNITUDE OF HOW MUCH TIME GOES
BY BETWEEN THE IMPACT OF THAT
DISPARITY OR DISCRIMINATION OR
OTHER INFLUENCE. AND WHAT IS
THE LAG BETWEEN THE IMPACT AND
THE OUTCOME. IT WAS ALSO
POINTED OUT WE HAVEN'T THOUGHT
ABOUT SOCIAL ADVANTAGE AS MUCH.
MAYBE THAT IS TRUE WHERE THERE
MAY BE LITTLE TO NO IMPACT. NO
IMPACT OR LITTLE IMPACT OR
SOCIAL ADVANTAGE THAT MIGHT
ACTUALLY TAKE WHAT WOULD BE A
TOXIC STRESS IN ONE SITUATION
AND MAKE IT A HER METTIC STRESS
IN ANOTHER AND IS AN OPTION BUT
NOT A FACT. THEN WE LOOK AT
POPULATIONS AND AMONG MANY KEY
ISSUES IS HETERO JENAETY IN
POPULATIONS AND THE ADVANTAGES
OF OR HOW THE BIOLOGY OF AGING
CERTAINLY PASSES.
ALSO, THE EPIDEMIOLOGICAL
FEATURES OF AGING AND THERE IS
UNIQUE FEATURES FROM SEINE
CONTINUARIANS AND A LOT OF
ALLELIC VARIANTS AND WHAT ARE
COMPLEX TRAITS THAT ARE AGING
AND HAS COMPLEX TRAITS AND
LOOKING AT INDIGENOUS
POPULATIONS THAT SHOULD LEAD US
TO THINK THAT OUR REFERENCE
POINT OF INDUSTRIALIZED
SOCIETIES AND COUNTRIES.
WHILE IT IS IMPORTANT, IT IS NOT
THE ONLY PERSPECTIVE ONE COULD
TAKE AND THERE IS A GREAT DEAL
TO LEARN ABOUT POPULATIONS THAT
ARE CLOSER TO OUR EVOLUTIONARY
HISTORY. THERE ARE QUESTIONS
ABOUT POPULATIONS THAT HAVE
APPEARED TO HAVE ACCELERATED
AGEING THAT ALWAYS GOES BACK TO
WHO IS YOUR REFSHS POPULATION.
IF WE HAVE ENOUGH MONEY TO LOOK
AT EVERYBODY THAT IS THE
REFERENCE POPULATION AND FILTING
INTO THAT GROUP AND QUESTIONS OF
HETERO JENAETY LOOKING IN ANY
POPULATION AND INBRED STRAINS
THAT ARE HOMO-JENAICALLY
POSSIBLE AND DEATH BEGINS IN THE
FIRST QUARTER OF LIFE AND OVER
THE LIFESPAN AND MAXIMUM
LIFESPAN SO IT COULD BE AS BROAD
AS 2/3 TO 3/4 OF THE LIFESPAN
THAT IS LOTS OF HETERO JENAETY
IN TERMS OF TIME OF DEATH.
THEN, YOU KNOW, IN THE SECOND
JERO SCIENCE SUMMIT WE ASKED
QUESTIONS ABOUT RELATIONSHIP
BETWEEN DISEASES AND DRIVERS OF
AGING THAT HAS BEEN EXPANDED,
ESPECIALLY IN THE AREA OF AGING
AND RISK FOR CANCER AND
TREATMENTS THAT MIGHT BE
ACCELERATING AGENT.
WE LOOKED AT MULTI-MORBIDITIES
AND GERIATRIC SYNDROMES AND
ESPECIALLY IN INCIPIENT
MORBIDITIES THAT ARE REALLY OF
CONCERN IN POPULATIONS WHERE
ADDITIONAL MORBIDITY PILES ON
AND HAVING ONE CONDITION SEEMS
TO LEAD TO OTHERS WHETHER THEY
ARE RELATED IN WAYS THAT MAKES
SENSE IF BIOLOGICALLY OR IS
SIMPLY WEARING DOWN THE WHOLE
SYSTEM THAT MAKES SENSE IN AGING
BIOLOGY.
BUT, THE MULTI-MORBIDITIES IN
GERIATRIC SYNDROMES AND EMERGING
PROPERTIES WASN'T STATED AND I'M
PUTTING IN OWN PERSPECTIVE THAT
PROPERTIES RISE FROM COMPLEXITY
OF THE NETWORK.
AGING TRAITS ARE HIGHLY COMPLEX
AND AS LIFE, THEY ARE EMERGING
PROPERTIES AND THERE IS A
DEVELOPMENTAL COURSE TO BUILD AN
ORGANISM AND AFTER THE ORGANISM
IS BUILT, IT HAS TO BE
MAINTAINED AND BIOLOGY OF
DEVELOPMENT AND BIOLOGY OF
MAINTENANCE AS THEY BECOME LESS
ORGANIZED, IF YOU WILL.
THAT CONTRIBUTES TO MANY OF THE
AGING CHANGES.
WE COULD ACTUALLY SEE HOW
BIOLOGICAL NETWORKS CHANGE. IT
IS IMPORTANT TO THINK ABOUT
THOSE IN TERMS OF MULTIPLE TIME
SCALES THAT PART OF THAT IS
ILLUSTRATED IN HOW YOU WOULD
COMPARE STAGES OF LIFE ACROSS
ORGANISMS THAT COMPARE AND
COMPARISONS ARE NOT NECESSARILY
LINEAR. YOU HAVE TO ASK LOOKING
AT ANIMALS OTHER THAN HUMANS
WHAT YOU ARE MODELING ASKING FOR
ONE TO ONE CORRESPONDENCE IN
GENETICS AND GENOTYPES RELATED
TO AGING AND EXPERIMENT AND WHAT
ARE LIMITATIONS FOR EXPERIMENT
AND BOUNDARY CONDITIONS FOR YOUR
CLOCKS AND OTHER QUESTION WOULD
BE IN LABORATORY ANIMALS LOOKING
AT SITUATIONS THAT MIGHT BE
SOMEWHAT UNUSUAL PROTECTED FROM
PATHOGENS THAT EVERYBODY ELSE IS
EXPOSED TO AND NOTHING IS
PERFECT TO PUT IT MILDLY. YOU
CAN MEASURE HEALTH. THAT IS NOT
A QUESTION WE MEAN BY THAT
GENERAL IDEAS OF HEALTH AND
GOING TO PHYSICIAN IN 80S FIRST
THING TO DO WAS THEY WOULD COME
IN AND LOOK AT ME AND WAS
INITIAL ASSESSMENT AND ALLOWED
ME TO LOSE WEIGHT AND LOOK AT
SPECIFIC HEALTH ASSESSMENTS AND
HOW THEY MIGHT APPLY TO
INDIVIDUALS AND SPECIFIC
POPULATIONS AND NOT EVERY
POPULATION IS SAME BURDEN OF
DISEASE OR CONCERNS ABOUT AGING.
OTHER QUESTIONS, OF COURSE, ARE
TO ACCOUNT FOR WHAT FEATURES OF
AGING AS THEY ARE IMPACTED BY
SOCIAL DETERMINANTS OF HEALTH
THAT IS A VERY THORNY PROBLEM
BUT NECESSARY ONE TO APPROACH
AND WORKING ACROSS SPECIES TO
UNDERSTAND MECHANISMS AND
INTERVENTION THAT IS ESSENCE OF
TRANSLATIONAL RESEARCH AND
ESSENCE OF GEROSCIENCE.
MODEL AND AGING, WE KNOW PRETTY
MUCH WHAT WE ARE LOOKING FOR IN
TERMS OF INTERACTIONS LANDSCAPE
AND MULTIPLE PHENOTYPES CONVERGE
IN SPECIES SPEAKING AND
ENVIRONMENTAL IMPACTS AND AGE
AND AGING AND METRICS, WHEN YOU
ARE LOOKING AS I THINK WAS
ILLUSTRATED WITH EPI GENETIC
CLOCKS, MOTIVATION WAS LOOKING
AT EPIGENETICS IN RELATION TO
SPECIFIC DISEASE AND LOOKING AT
AGING, AGE BECOMES A PREDOMINANT
PARAMETER AND WE HAVE ITERATIVE
REFINEMENT THAT IS IN PRESENCE
OF INTERVENTIONS AND
INTERVENTIONS EXTENDING LIFESPAN
WITH ASSUMPTION THAT LIFESPAN IF
INCREASED HEALTH MIGHT INCREASE
THAT IS NOT UNIVERSALLY ACCEPTED
AND EVIDENCE FALLS ON BOTH
SIDES, ACTUALLY. HEALTH MIGHT
BE IMPROVED BY INTDVENTION
EXTENDING POPULATION LIFESPAN
AND MIGHT BE IT PROLONGS THE
PERIOD OF MORBIDITY.
THERE ARE ALSO THINGS TO
CONSIDER WHEN MODELING AGING
HAVING TO DO WITH GENETIC DRIFT
AND INBRED POPULATION THAT DOES
OCCUR. IN HUMAN POPULATIONS
WHERE THERE IS, OF COURSE,
COHORT DIFFERENCES. WE ARE
ALWAYS ASKING QUESTIONS ABOUT
ENVIRONMENT AND AGING.
IN MODEL AND AGING AND WOULD
LIKE TO THINK OF SOME ASPECTS OF
AGING AS BEING SIMPLE AND
PHYSIOLOGICAL CHANGES OPPOSED TO
PATHOLOGICAL CHANGES AND SOME
ARE DELETERIOUS AND PANEL
LOGICAL AND SOME WILL BE
ADAPTIVE AND SOME WILL CORRELATE
AND BE NEUTRAL WITH AGE AND IS
IMPORTANT TO DISTINGUISH WHAT
THOSE ARE AND IS POINTED OUT
THAT COMPENSATION CAN HIDE SOME
OF THE DEFICITS.
I TOOK THE SLIDE FROM CHILLING
-- MISSED THE SPOT THANK YOU
BRIAN CHENG AND [INDISCERNIBLE]
FROM COMMENTS YESTERDAY. WE
HAVE AFFECTION FOR LINEAR
DISPLAYS WHETHER DATA WARRANTS
OR NOT AND DIFFERENT SHAPED
CURVE IS APPROPRIATE -- IN A
RESPONSE TO ENVIRONMENTS AND
ENVIRONMENTAL CHANGES THAT HAS
TO DO WITH EVOLUTIONARY WHY NOT
TO DESIGN PURPOSE IN BIOLOGY BUT
WAY OF FRAMING A QUESTION AND
WHAT EVOLUTIONARY PRESSURES ARE
THAT BROUGHT US TO THAT
PARTICULAR POINT. WITH
BIOMARKERS WE ARE TRYING TO FIND
BIOMARKERS THAT WOULD BE ALL OF
THE -- MULTIPLE BIOMARKERS THAT
STEVE LAID OUT YESTERDAY IN
RELATIONSHIP TO WHAT THE FDA
WANTS AND WE ARE LOOKING AT TIME
BETWEEN MEASURING BIOMARKER AND
TIME THAT PHENOTYPE APPEARS
AGAINST BACKGROUND OF
HETEROGENEITY AND LOOKING AT
CROSS-STUDY AND LONGITUDINAL
STUDIES WHERE YOU GET DATA IS
IMPORTANT AND BIRTH COHORTS DO
SHIFT. IT LEADS ME TO WONDER IF
AGE SHOULD BE THE ONLY
INDEPENDENT VARIABLE USED IN
UNDERSTANDING AGING.
I DON'T HAVE A GOOD ALTERNATIVE.
I WISH I DID.
I TOOK THIS SLIDE FROM JAMIE
JUSTICES PRESENTATION. IT WAS
UPLOADED BUT DIDN'T MAKE IT INTO
THE DISPLAY YESTERDAY AND TOOK
THE LIBERTY OF PULLING OUT HER
CREATION SPECIFICALLY FOR THIS
SUMMIT TO LOOK AT WHAT IS GOING
ON IN THIS ITERATIVE PROCESS TO
TRY TO UNDERSTAND AGING WHERE
BIOLOGY, OF COURSE, AS IT
CHANGES, PRODUCES AGING
PHENOTYPES THAT COULD BE SCORED.
THOSE COULD LEAD TO DEVELOPMENT
OF ADDITIONAL CLOCKS WHETHER
MONOOMIC OR MULTI OMIC TO REMAIN
DETERMINED BY THE FIELD AND
THERE IS CERTAINLY LOTS OF WORK
DONE BEING COMPUTER DRIVEN AND
AT CORE OF BIOLOGICAL AGING, IT
HAS BEEN VERY POPULAR AND VERY
WELL TROD AND VERY INVESTIGATION
THAT DAMAGE ACCUMULATION AND
INEFFECTIVE REPAIR AND
COUNTERBALANCE EACH OTHER AND IF
INEFFECTIVE REPAIR IS DOMINANT,
AGING IS EVIDENCE.
ANOTHER WAY OF LOOKING AT IT,
THERE ARE EVOLVED FUNCTIONS THAT
THOSE ARE -- THERE IS A BROAD
RANGE OF TOLERANCE BECAUSE OF
ROBUSTNESS OF THE BIOLOGICAL
SYSTEM AND THINKING OF
DEVELOPMENT OF BIOLOGY, YOU CAN
PRODUCE PEOPLE THAT IS IN THE
PROCESS OF REPRODUCTION.
PEOPLE CAN ARISE WITH WIDE RANGE
OF CHARACTERISTICS AND SHORTEST
PERSON WAS 22 INCHES AND TALLEST
PERSON 9 FEET AND STILL IS
PEOPLE AND THERE IS A WIDE RANGE
OF LATITUDE IN TELEMETRY THAT IS
THE DETERMINATION OF ORGANS
RELATIVE TO EACH OTHER.
PROCESSES THAT KEEP US ALIVE
WITH AN EMPHASIS ON METABOLISM.
THOSE ARE COMMON ACROSS ALL
LIVING ORGANISMS.
IN MANY RESPECTS AND ALTHOUGH
EACH ORGANISM WILL HAVE UNIQUE
FEATURES.
THERE IS TOLERANCES.
THE SYSTEMS UNDER EVOLUTIONARY
CONSTRAINTS HAVE DEVELOPED
BUFFERING AGAINST VARIOUS
INPUTS.
SO, SOME ASPECTS OF EVOLUTION
RESULT IN PRESERVED PLASTICITY
ACROSS THE LIFETIME.
SO, THAT IS ADVANTAGEOUS IN THE
IMMUNE SYSTEM IN COUNTERING
MOLECULES THAT WILL TRIGGER AN
IMMUNE RESPONSE THAT HAD NOT
BEEN ENCOUNTERED PREVIOUSLY AND
ALSO APPLIES IN NEURONAL
CONNECTIONS WHERE THERE IS A LOT
OF SYNAPTIC PLASTICITY THAT IS
ADVANTAGEOUS ACROSS THE LIFE
COURSE IF MAINTAINED AND IS
ADVANTAGEOUS IF LOST IN THE
LIVER PLASTICITY IS CRITICAL IN
DETOXIFICATION OF COMPOUNDS THAT
MIGHT BE IN THE FOOD.
PLASTICITY IS IMPORTANT ACROSS
LIFE COURSE AND PART OF
PLASTICITY IS BUFFERING AGAINST
TOO MUCH OF IT.
SO, TOO MANY SYNAPTIC
CONNECTIONS WITHOUT PRUNING
WOULD BE AN UNBUFFERED SITUATION
THAT CAN RESULT IN ALSO
COGNITIVE.
SO, THAT IS WHERE WE HAVE BEEN
IN A NUTSHELL. WHERE WE ARE
GOING TODAY WILL BE PRACTICE OF
GEROSCIENCE AND GEROSCIENCE
TRIALS.
WHAT CAN WE THINK ABOUT IN TERMS
OF BRINGING GEROSCIENCE TO A
WIDE RANGE OF COMMUNITIES, WHICH
AS POINTED OUT EARLY ON,
REQUIRES INTERACTIONS BETWEEN
PEOPLE THAT WOULD BRING
GEROSCIENCE TO THE COMMUNITY AND
COMMUNITIES AND THAT IS THAT OF
BUILDING TRUST AND ABSOLUTELY
AGREE WITH THAT PERSPECTIVE.
HOW WE DO THAT IS A RELIEF TO
OTHERS.
BUT, THE QUESTIONS HERE ABOUT
WHAT WOULD A GEROSCIENCE TRIAL
LOOK LIKE IS IMPORTANT. AT THIS
POINT, IT REMAINS AN OPEN
QUESTION.
SO, WE WILL TALK ABOUT THE
CLINIC AND THE COMMUNITY AND HOW
WE CAN POSITIVELY IMPACT CARE OF
OLDER ADULTS AND PREVENTION. WE
HAVE TO DEAL WITH BOTH
COMMUNITIES, THOSE WHO ARE
ALREADY OLDER AND THOSE WHO HOPE
TO BE OLDER.
AND THE GEROSCIENCE CLINICAL
TRIALS IS NOT CRITICAL THAT
GEROSCIENCE HYPOTHESIS BE
SUPPORTED BUT WOULD BE NICE TO
KNOW IF SLOWING THE RATE OF
AGING REALLY DOES HAVE BROAD
IMPACTS AND IF THERE IS SINGLE
WAYS OR MULTIPLE WAYS AND WE
DON'T WANT TO CREATE
POLYPHARMACY BY ANY STRETCH OF
THE IMAGINATION BUT WOULD LIKE
TO KNOW HOW TO STRUCTURE
CLINICAL TRIALS AND WITH ASKING
WHO WOULD BE OF BENEFIT AND WHO
MIGHT NOT BENEFIT AND WHO MIGHT
BE HARMED. WE NEED TO GO RIGHT
BACK TO WHERE WE STARTED. WE
HAVE TO BE INCLUSIVE AND FORMED
ABOUT TRIALS ABOUT SOCIAL
DERNLNANTS OF HEALTH. WE WILL
END WITH A SESSION ABOUT LOOKING
FORWARD THAT WILL BE KEY
TAKEAWAYS THAT WILL BE THE FINAL
SESSION OF THE DAY.
SO, THANK YOU FOR YOUR
ATTENTION.
IS DEBRA WHITMAN HERE?
PLEASE.
>>GOOD MORNING, EVERYBODY. I'M
BREATHLESS. 45 MINUTE TO GET
ANY SPRINTED HERE TO BE ON TIME.
YOU ARE IN LUCK. WE HAVE AN
INCREDIBLE LINEUP OF SPEAKERS
HIGHLIGHTING FOUR AREAS -- WITH
GOALS TO FACILITATE
COMMUNICATION AMONG RESEARCHERS,
PROVIDERS AND THEIR PATIENTS AND
TO IMPROVE THE UNDERSTANDING AND
INTEGRATION OF GEROSCIENCE IN
CLINICAL PRACTICE AND IN PATIENT
CARE. QUICKLY, OVER TO THE
SPEAKERS WHO WILL COME UP IN A
LITTLE BIT.
VERNON KENNEDY NATIONAL
INSTITUTE OF AGING IS SESSION
FACILITATOR AND DR. HEATHER
WHITSON, PROFESSOR OF MEDICINE
AT DUKE UNIVERSITY WILL TALK
ABOUT GEROSCIENCE AND PREDICTION
AND DR. ROBERT PIGNOLO PROFESSOR
OF MEDICINE AT MYOCLINIC WILL
TALK ABOUT GEROSCIENCE AND
TREATMENT AND DR. FORMAN, CHAIR
OF SECTION OF JERAT TRICK
CARDIOLOGY AT UNIVERSITY OF
PITTSBURGH MEDICAL SCHOOL WILL
TALK ABOUT GEROSCIENCE AND
MANAGEMENT AND GEORGE CURBEL
PROFESSOR OF MEDICINE AND WILL
TALK ABOUT TRAINING AND
TRANSLATIONAL GEROSCIENTISTS AND
SAVVY CLINICIANS AND WE HAVE
SEVERAL ESTEEMED PANELISTS
INCLUDING DR. IMAN WHO IS
ASSISTANT PROFESSOR OF
UNIVERSITY OF CONNECTICUT AND
DR. DANIEL PARKER WHO IS AT
CENTER FOR STUDY OF AGING AND
HUMAN DEVELOPMENT AT DUKE
UNIVERSITY AND MY ESTEEMED
COLLEAGUE AND ADVISOR IRWIN TAN
WHO IS DIRECTOR OF LEADERSHIP
AND HEALTH THERAPY.
[INDISCERNIBLE] OF IT THIS LONG
LIST OF SCIENTISTS WILL BE
PRESENTING A WHOLE RANGE OF
ISSUES. I THOUGHT IT MIGHT BE
QUESTIONABLE WHY ARP AN
ECONOMIST IS SPEAKING TO ALL OF
YOU TODAY.
THAT IS BECAUSE AARP REPRESENTS
OVER 30 MILLION PEOPLE WHO ARE
REALLY EXCITED AND IN NEED OF
THE TYPE OF SCIENCE YOU ARE ALL
DEVELOPING. AARP VIEWS
GEROSCIENCE AS GROWING AND
EXCITING FIELD WITH POTENTIAL TO
DELAY, PREVENT ALLEVIATE OR
REVERSE A WIDE RANGE OF DISEASES
AND CONDITIONS ASSOCIATED WITH
AGING AND WE BELIEVE THERE
SHOULD BE GREAT INVESTMENT IN
RESEARCH ON THE AGING PROCESS
AND PARTICULARLY FOR DISEASES
ASSOCIATED WITH AGING AND
DISEASES THAT DISPROPORTIONATELY
EFFECT OLDER PEOPLE. WE
STRONGLY SUPPORT EFFORTS TO
PROMOTE HEALTH AND LONGEVITY
ACROSS ALL LIFE STAGES AND I
WANT TO REALLY THANK NIA AND
DIVISION OF AGING BIOLOGY IN
PARTICULAR FOR COORDINATING
GROUNTD BREAKING NIH-WIDE
GEROSCIENCE INTEREST GROUP
SPONSORING TODAY'S SUMMIT AND
APPRECIATE THE PARTICULAR FOCUS
ON DISPARITIES IN TODAY'S
CONFERENCE TO ENSURE THAT
RESEARCH IS BASED ON THE ENTIRE
POPULATION AND BENEFITS GO TO
EVERYONE.
SUCCESSFUL ADVANCES IN
GEROSCIENCE HAVE POTENTIAL TO
DELAY, PREVENT ALLEVIATE OR
REVERSE A WIDE RANGE OF COMMON
CHRONIC CONDITIONS AND DISEASES
AS PEOPLE AGE AND IS NO SURPRISE
THAT PEOPLE ARE INTERESTED AND
AARP RESEARCH SECOND HALF OF
LIFE SURVEY ASKS RESPONDENTS IF
THEY PREFER TO TAKE A PILL TO
SLOW DOWN AGING OR EXTEND THEIR
LIFE BY 10 YEARS.
THEY FOUND THAT PEOPLE PUT MUCH
GREATER VALUE ON QUALITY OF
HEALTH RATHER THAN QUANTITY OF
YEARS.
IN FACT, 72% OF PEOPLE IN THEIR
60S WOULD BE VERY OR EXTREMELY
LIKELY TO TAKE A PILL TO SLOW
AGING AND ONLY 50% WOULD TAKE A
PILL TO EXTEND THEIR LIFE BY 10
YEARS.
GE
GEROSCIENCE HAS ENORMOUS
ECONOMIC POTENTIAL IMPROVEMENTS
IN HEALTH AND TREATMENTS THAT
TARGET AGING AND ESTIMATED A
COMPRESSION OF MORBIDITY
PROMOTING HEALTHY LONGEVITY IS
EVEN MORE VALUABLE THAN
INCREASES IN LIFE EXPECTANCY AND
TARGETING AGING OFFERS
POTENTIALLY LARGE ECONOMIC GAINS
AND LARGER ECONOMIC GAINS THAN
ERADICATING INDIVIDUAL DISEASES
AND ANALYSIS CONCLUDE INCREASING
LIFE EXPECTANCY BY ONE YEAR
WOULD BE WORTH 38 TRILLION
DOLLARS.
NOW, MOST PEOPLE HAVE NEVER
HEARD OF GEROSCIENCE. WE MUST
BE CAREFUL IN HOW WE DESCRIBE
THE WORK AND DON'T CREATE NEW
BIASES AGAINST OLDER ADULTS AND
WE START AGING FROM THE MOMENT
THAT WE ARE BORN THAPD IS WHY
AARP AGREES WITH THE NATIONAL
INSTITUTE OF AGING VIEW THAT
AGING IS NOT A DISEASE BUT
RATHER A PROCESS.
IT IS REALLY IMPORTANT THAT WE
DON'T STIGMATIZE THAT PROCESS.
CHARACTERIZATION OF AGING
DISEASES IS CONTROVERSIAL ACROSS
HEALTH CARE ECOSYSTEMS THAT IS A
NORMAL PROCESS EXPERIENCED BY
EVERYONE OPPOSED TO A DISEASE
THAT IS EXPERIENCED BY SOME AND
WE ALSO KNOW THAT CHRONOLOGICAL
AGING IS HETEROGENOUS AND AGE
ALONE IS A POOR MARKER FOR
DISEASE RISK AND FINALLY
CHARACTERIZED AGING AS A DISEASE
RISKS EXACERBATING COMMON AGE
AND AGE RELATED DISCRIMINATION.
FINALLY, THERE IS CLEAR EVIDENCE
THAT PERCEPTIONS IN AGING COULD
EVEN INFLUENCE YOUR OWN HEALTH
TRAJECTORY. I NOTE THE WORK OF
DR. BECKY LEVY WHO SHOWED THAT
POSITIVE ATTITUDES ON AGING AND
ONE'S OWN AGING IS ASSOCIATED
WITH LONGER LIFE AND THOSE WITH
LESS POSITIVE SELF-PERCEPTIONS
ON AGING.
MORE RECENT WORK BY REBECCA LEVY
AND FARUCHI SHOWED POSITIVE
PERCEPTIONS ON AGING WERE
ASSOCIATED WITH LOWER RISK OF
DEMENTIA. WHILE WE AGREE THAT
AGING PROCESS IS A MAJOR RISK
FACTOR FOR DISEASE AND
CONDITIONS WE ARE ALSO HOPEFUL
THAT ONE DAY INTERVENTIONS WILL
BE WIDELY AVAILABLE AND
CONFERENCE ORGANIZERS NOTED
THERE IS NO UNIVERSAL MEANING OF
CONCEPT OF GEROSCIENCE BY
CLINICIANS THAT LIKELY ADDS TO
UNDERUSE AND MISREPRESENTATION
OF THE TERM.
ANOTHER IMPORTANT CHALLENGE IS
IT IS STILL UNCLEAR HOW FDA WILL
APPROACH A RELATIVELY NEW FIELD
AND RESULTING INTERVENTIONS AND
IS REALLY CRITICAL THEY BEGIN
THOSE DISCUSSIONS AND HEARTENED
THIS MORNING TO GET AN E-MAIL
THAT FDA COMMISSIONER ROBERT
WILL BE SPEAKING ON THESE ISSUES
ON MAY 3RD.
WE WERE ANXIOUSLY LOOKING
FORWARD TO HEARING WHAT HE HAS
TO SAY.
APPRECIATING A DEFINING SUCCESS
THAT REMAINS A CHALLENGE
CREATING PERFECT BIOMARKERS TO
MEASURE TREATMENT WILL BE
DIFFICULT AND AGING IS
INFLUENCED BY UNIQUE AND
BEHAVIORAL AND SOCIAL FACTORS
MESH YOURING OUTCOMES USING
TRADITIONAL ENDPOINTS SUCH AS
DISEASE OR DIAGNOSIS OR DEATH
MAY NOT BE PRACTICAL AND
IDENTIFYING PROXY AND OUTCOME
MEASURES IS INSTRUMENTAL TO
TRANSLATING RESEARCH TO IMPROVED
AND HEALTHY LONGEVITY AND NEED
TO WORK TOWARDS THAT GOAL
TOGETHER.
WHILE WE DO HAVE A GEROSCIENCE
AND WHEN WE DO HAVE A
GEROSCIENCE INTERVENTION
APPROVED BY FDA THAT I BELIEVE
IS WHEN AND NOT IF. WE NEED TO
ENSURE APPROPRIATE ACCESS FOR
CONSUMERS.
COST OF TREATMENT MATTERS.
IF NEW GEROSCIENCE INTERVENTIONS
IS SUCCESSFUL FOR PEOPLE WITH
SIGNIFICANT RESOURCES AND PEOPLE
WHO HAVE A HIGHER LIFE
EXPECTANCY AND CAN WORSEN
EXISTING ECONOMIC AND
RACIAL/ETHNIC DISPARITIES AND
SAFE AND EFFECTIVE GEROSCIENCE
INTERVENTIONS MUST BE WIDELY
AVAILABLE AND ACCESSIBLE FOR ALL
PEOPLE. THIS IS PARTICULARLY
TRUE IN CASE OF DRUG DEVELOPMENT
THAT BENEFITTED FROM TAXPAYER
FUNDED RESEARCH.
WE ALSO NEED TO BE CLEAR ABOUT
WHO MIGHT BE -- WE NEED TO BE
CLEAR ABOUT WHO MIGHT OR MIGHT
NOT BENEFIT FROM TREATMENTS AND
WHO MIGHT BE HARMED.
TREATMENTS ARE IMPACTING MANY
CORE PROCESSES OF AGING AND MAY
HAVE SIDE-EFFECTS AND WE NEED TO
BE TRANSPARENT ABOUT BENEFITS
AND RISKS.
SO, FDA SHOULD BE GRANTED
APPROPRIATE RESOURCES TO CONDUCT
ADEQUATE POST MARKET
SURVEILLANCE ACTIVITIES
IMPORTANT TO MEASURE SIDE
EFFECTS AND ADVERSE EFFECTS
AGAINST REAL WORLD CONDITIONS
AND IN CLOSING APPLAUDING NIA
INCLUDING CONSUMER VOICE IS
CRITICAL WE GATHER AS THOUGHT
LEADERS FROM FEDERAL AGENCIES
SCIENTIFIC SOCIETIES BY
PHARMACEUTICAL INDUSTRY AND
EXPERTS IN EMERGING --
IDENTIFYING GAPS AND RESEARCH IN
THIS FIELD AND THAT CONFERENCE
IS FOCUSED ON IT EQUALLY
IMPORTANT IS THAT WE INCLUDE
CONSUMERS AND PATIENTS AND
CAREGIVERS AND AT AARP WE
REPRESENT NOT ONLY 30 MILLION
MEMBERS BUT PEOPLE ACROSS ALL
LIFE STAGES SO THAT WE ALL MAY
EXPERIENCE HEALTHY LONGEVITY
ACROSS WHAT WE HOPE WILL BE A
LONGER LIFESPAN.
I THEREFORE ASK SPEAKERS AND
PANELISTS TO MAKE SURE VOICES OF
CONSUMERS CAREGIVERS AND
PATIENTS ARE PART OF EVERY
FUTURE CONVERSATION ON PROMISE
OF GEROSCIENCE AND WITH THAT I
WANT TO INVITE PANELISTS UP
STARTING WITH DR. WHITSON.
THANK YOU.
>>[APPLAUSE].
>>GOOD MORNING I WILL START OFF
TALKING ABOUT GEROSCIENCE IN
PREDICTION MEDICINE AND WANT TO
THANK THE NIA THAT FUNDS MUCH OF
THE WORK IN THIS AREA AND
SPEAKING TO YOU AS DIRECTOR OF
DUKE AGING CENTER AND REACH
EQUITY CENTER AND DUKE UNC WORK
I'M TALKING ABOUT TODAY
REPRESENTS MANY PEOPLE ON THE
TEAMS THAT ADVANCE THESE LINES.
SO, I WILL START OUT BY TALKING
ABOUT IMPORTANCE OF RESILIENCE
TO STRESSORS IN HUMAN HEALTH AND
GEROSCIENCE AND TERMS
GEROSCIENCE AND REDILLIENCE SAID
IN THE SAME BREATH ALREADY
DURING THIS CONFERENCE TALKING
ABOUT APPLYING GEROSCIENCE TO
DISPARATE OUTCOMES WE SEE IN
OLDER ADULTS TO WHAT APPEARS TO
BE A VERY UNIFORM STRESSOR AND
TALKING ABOUT TWO TYPES OF
BIOMARKERS WE ARE PARTICULARLY
INTERESTED IN DYNAMIC BIOMARKERS
AND PROVOCATIVE TESTS TO PREDICT
OUTCOMES AND STRESSORS AND
PERTURBATIONS AND STARTING OUT
TALKING ABOUT TWO PATIENTS I'M A
CLINICIAN AND WE ARE DOG A LARGE
STUDY AT THIS POINT LOOKING AT
TOTAL KNEE REPLACEMENT AS AN
EXPERIMENTAL REAL WORLD STRESS
OR IMAGINE TWO PATIENTS SIMILAR
IN CHRONOLOGICAL AGE FACING A
SIMILAR ELECTIVE PLANNED
UPCOMING STRESSOR OF A KNEE
REPLACEMENT SURGERY THAT ARE
DIFFERENT WITH DIFFERENT LIFE
TRAJECTORIES AND PRESENT FOR
SURGERY DIFFERENTLY AND 76 YEAR
OLD WOMAN -- DOES NOT EXERCISE
AND IS QUITE SEDENTARY HAS A
HISTORY OF NUMBER OF
COMORBIDITIES COMPARE TO
GENTLEMAN GOING INTO OR SAME
SURGEON AND SAME DAY AND IS 75
AND HAS A FEW COMORBIDITIES
WELL-CONTROLLED BLOOD PRESSURE
AND GLAUCOMA BUT MAIN REASON FOR
HAVING THE SURGERY IS HE WANTS
TO GET BACK TO PLAYING GOLF AND
TENNIS AS REGULARLY AS HE HAS
BEEN DOG AND HAS A STRONG
CAREGIVER NETWORK ONE PATIENT
AFTER THE SURGERY FOLLOWS
TRAJECTORY B THAT WE WANT AND
THEY HAVE EXPECTED DECLINE IN
MEASURES OF FUNCTION AND
MEASURES OF MOBILITY ANDIN
DEPENDENCE. THEY BOUNCE BACK
AND HOPEFULLY EVEN BOUNCE BACK
TO A LEVEL BETTER THAN WHERE
THEY START AND ONE PATIENT WILL
FOLLOW TRAJECTORY C WHERE
SURGERY HAPPENS AND THEY DEVELOP
A SERIES OF COMPLICATIONS AND
DELIRIUM AND WHAT HAVE YOU AND
FUNCTION AND MOBILITY NEVER
RECOVER AND REST OF LIVES FAMILY
WILL REFER TO THEM AS MOM OR DAD
WAS NEVER THE SAME AFTER THAT
SURGERY AND WHAT WE WANT NOT TO
HAPPEN AND WHAT WE TRY TO
PREVENT HAPPENING WHICH OF THE
PATIENT WAS MOST LIKELY TO
FOLLOW TRAJECTORY C AND
SOMETIMES WE GET IT WRONG AND
QUESTION IS CAN WE LOOK TO
GEROSCIENCE TO FILL IN WHY WE
GET THIS WRONG JUST BEFORE WE
KNOW ABOUT THE PERSON AND THE
TRESSOR AND OF COURSE GOAL HERE
IS PREDICTING RECOVERY
TRAJECTORIES THAT IS IMPORTANT
TO PATIENTS AND FAMILIES TO GIVE
AS ACCURATE A PROGNOSIS AS WE
CAN AND IS IMPORTANT TO HEALTH
SYSTEM AND TO SOCIETY TO BE ABLE
TO PREDICT WHAT WILL HAPPEN AND
TARGET UNLIMITED RESOURCES
APPROPRIATELY AND AS BEST AS WE
CAN AND HOPE BY PREDICTING
BETTER WE UNDERSTAND MECHANISMS
BETTER THAT WILL HELP US KNOW
WHAT INTERVENTIONS AND WE HAVE
CURRENTLY INTERVENTIONS
AVAILABLE WHERE THERE IS ALREADY
SUPPORT FOR PROMOTING RESILIENCE
AND POSSIBILITY OF GEROSCIENCE
IF POSSIBILITY IF UNDERSTOOD AT
MOLECULAR OR CELLULAR LEVEL
LEVERS THAT MIGHT ALSO PREDICT A
PERSON'S LIKELIHOOD TO COME OUT
OF THESE STRESSORS BIG OR SMALL
OR ACUTE OR CHRONIC TO COME OUT
OF STRESSORS BETTER OFF THAN
THEY WERE BEFORE OR AT LEAST NOT
TERRIBLY DAMAGED. COULD WE
POTENTIALLY FIND DRUGGABLE
TARGETS TO HELP TO ESSENTIALLY
GIVE PEOPLE A BETTER CHANCE AT
RESILIENCE AND A PILL AND NOT
SAYING ANYTHING HERE THIS GROUP
DOESN'T REALIZE THAT WITH AGE
OUR ABILITY TO RESPOND BRISKLY
AND ADAPTIVELY TO ANY KIND OF
PERTUBATION AND DECLINES
STARTING AGING FROM MOMENT WE
ARE BORN AND I WOULD SAY THAT
FROM A BIOLOGICAL STANDPOINT
THAT BIOLOGICAL RESILIENCE IS
DECLINING ACROSS THIS LIFESPAN
AT ALL OF THE STAGES BEFORE WE
REACH THAT FINAL ONE WHERE THE
PERSON IS FRAIL. I THINK OF
EVERY HUMAN AS A COMPLEX AND
DYNAMICAL SYSTEM AND THAT MEANS
THE SYSTEM IS MADE UP OF
SUB-SYSTEMS GOING FROM THE ORGAN
SYSTEMS LEVEL AND TISSUES AND
CELLS AND MOLECULES.
ALL OF THESE SUB-SYSTEMS ARE
ENGAGED IN FEED FORWARD AND FEED
BACK AND WORKING TO REPAIR
DAMAGE IN A WAY THAT IS
EFFICIENTLY COORDINATED ACROSS
SYSTEMS AND EVOLVED AMAZINGLY
THE HUMAN LIVES IN A COMPLEX
DYNAMICAL SYSTEM THAT IS SOCIETY
AND SYSTEMS PLAY OUT CONSTANTLY
IN EVER-CHANGING ENVIRONMENT
WHEN NOT ENCOUNTERING MAJOR
STRESSOR LIKE SURGERY OR
INFECTION WE ARE TRYING TO
CONSTANTLY ADAPT TO AND MAINTAIN
EQUILIBRIUM. TO P ME, THIS IS
THE WHAT THAT MAKES THE IT AND
THAT WE ARE TALKING ABOUT IN
THESE THREE DAYS IS BIOLOGICAL
AGING AND THINK WHAT THAT MAKES
IT IS CHANGES AT MOLECULAR LEVEL
THAT ARE CONSTANTLY EATING AWAY
AT ABILITY TO RESPOND ADAPTIVELY
AND EFFICIENTLY AND REPAIR
DAMAGES THAT MAY OCCUR. THEN TO
BE ABLE TO MOVE ON FROM
STRESSORS TO MY MIND WE ARE
TARGETING WITH A TALK OF
BIOLOGICAL AGING AND OTHER THING
WE TALKED ABOUT A LOT HERE AND
SOMETIMES I THINK THAT DISEASE
OR COMORBIDITY GETS A LITTLE
CONFLATED WITH BIOLOGICAL AGING,
TO ME, IS A VICIOUS CYCLE. I
THINK DISEASES CERTAINLY WHEN
THEY OCCUR DIMINISH BIOLOGICAL
RESILIENCE CHIPPING AWAY AS
FAVORABLE BIOLOGY THAT NEEDS TO
HAPPEN IN EVERY CELL AND TISSUE
AND DISEASES OFTEN EFFECT
CERTAIN TISSUES AND CELLS MORE
THAN OTHERS AND THEN HAVING
DISEASES LOWERS RESILIENCE OF
THE WHOLE COMPLEX DYNAMICAL
SYSTEM MAKING IT MORE VULNERABLE
TO FUTURE DISEASES THAT TO ME IS
A KIND OF VICIOUS CYCLE. THE
PART THAT IS GEROSCIENCE PIECE
OF IT TO ME IS BIOLOGICAL
RESILIENCE HAVING MOLECULAR
BASIS AND, AGAIN, IN EVERY
TISSUE AND CELL IN THEORY, THERE
ARE BIOLOGICAL PILLARS THAT
DECLINE WITH AGE VERY NICELY AS
JAMIE JUSTICE'S FIGURE SHOWED.
YOU KNOW, SORT OF A COMBINATION
OF LOSS OF ABILITY TO RESPOND TO
STRESSORS AND LOSS OF ABILITY TO
REPAIR DAMAGE THAT OCCURS.
SOMETIMES IN THAT VERY ATTEMPT
TO RESPOND TO PRIOR STRESSORS.
WHAT WE KNOW IS THAT THE RATE OF
THIS DECLINE IS NOT THE SAME FOR
EVERYONE.
THESE TWO GENTLEMAN ARE THE SAME
AGE, CHRONOLOGICALLY SPEAKING
AND PRESUMABLY DIFFERENT IN
TERMS OF BIOLOGICAL AGE AND
THING WITH TRYING TO PREDICT
THIS IS SOMETIMES, AGAIN,
PATIENTS REALLY SURPRISE US.
WE ARE TRYING TO GET BETTER AT
SORT OF PREDICTING AND PROMOTING
RESILIENCE THAT IS AROUND HEALTH
STRESSORS. SO, THAT COULD BE AN
INJURY AND INFECTION AND
HOSPITALIZATION AND NEW
MEDICATION.
FIRST, WE HAVE TO SORT OF DECIDE
WHAT WE WILL MEASURE TO KNOW
WHETHER WE ARE PREDICTING IT
ACCURATELY OR NOT AND IS THE
FRAMEWORK WE USE IN THE DUKE
PEPPER CENTER LED BY KEN SHMADER
IN MANY STUDIES AND POPULATIONS
AND TYPES OF HEALTH STRESSORS WE
TRY TO MEASURE WHAT WE CALL
PRESTRESS RESERVE THAT I THINK
IS VERY SIMILAR TO WHAT THE
WORLD HEALTH ORGANIZATION LABELS
INTRINSIC CAPACITY AND THAT
PERSON'S ABILITY BEFORE THE
STRESSOR TO HAVE RESERVE IN
PHYSICAL DOMAIN, YES. ALSO,
COGNITIVE PSYCHOLOGICAL DOMAINS
THAT WE TRY TO MEASURE SOMETHING
ABOUT THE STRESSOR AND MAGNITUDE
OF THE STRESSOR AND TRY TO
MEASURE THIS THING WE CALL
RESILIENCE THAT IS IMMEDIATE
TRAJECTORY RESPONSE THAT HAPPENS
IN THE SYSTEMS THAT WE CAN --
THAT WE ARE FOCUSED ON RIGHT
AFTER THE STRESS OR -- WHICH IS
VERY DYNAMIC RELATES TO
LONG-TERM OUTCOMES THAT PEOPLE
CARE ABOUT SURVIVALIN DEPENDENCE
AND QUALITY OF LIFE.
SO, IN TRYING TO SAY HOW WE WILL
MEASURE GREEN BOX AND GREEN BALL
OF SORT OF WHAT HAPPENS AFTER A
STRESSOR, WE THOUGHT AS
CLINICIANS ABOUT TWO THINGS WE
CARE ABOUT. ONE QUESTION THAT
WE AND PATIENTS OFTEN CARE ABOUT
IS WHAT IS MANY I PATTERN OF
RECOVERY GOING TO LOOK LIKE
AFTER THIS STRESSOR?
WHAT CAN I EXPECT?
OTHER THING WE OFTEN CARE ABOUT
IS THAT THING OF HOW MUCH BETTER
OR WORSE IS THIS PERSON GOING TO
DO THAT I MIGHT GUESS THAT THEY
WILL DO BASED ON AGE AND
PRESTRESSOR STATUS. WE HAVE
COME UP WITH TWO DIFFERENT WAYS
THAT EACH MEASURE THESE.
I WILL RUN THROUGH THEM QUICKLY.
ONE IS A RECOVERY PHENOTYPE
APPROACH WHERE WE DO BASICALLY
REPEATED MEASURES OF SOME ASPECT
OF THE RECOVERY WE CARE ABOUT.
THAT MIGHT BE A MEASURE OF
MOBILITY AND MIGHT BE A MEASURE
OF SPEED OR OF OVERALL
SELF-RATED QUALITY OF LIFE OR
HEALTH.
WE MEASURE IT REPEAT WILLED I
AND DESCRIBE THE TRAJECTORY THAT
IS HIGHLY DESCRIPTIVE. YOU CAN
QUANTIFY MULTIPLE PARAMETERS
LOOKING AT SLOPE AND DEGREE OF
RECOVERY PROPORTION TO BASELINE
OR BEYOND IT SUMMARIZING
MULTIPLE OUTCOMES USING FANCY
STATISTICAL TECHNIQUES WE WANT
TO FOLLOW COGNITION AND MOBILITY
AND PAIN AND SUMMARIZE ALL THOSE
INTO A SINGLE MEASURE.
THIS IS HIGHLY DRIVEN BY THEIR
AGE, COMORBIDITIES AND
PRESTRESSOR FUNCTIONS AND
BASICALLY THE PHENOTYPES ARE
HIGHLY ELATED TO HOW THEY WERE
BEFORE THEY WERE STRESSED.
THIS IS DATA THAT IS WITH JAY
MAGAZINER AND HIS GROUP WITH
BALTIMORE HIP STUDY TATE AH AND
LOOKING AT WHAT PREDICTED THAT
PHENOTYPIC RECOVERY IN HIP
FRACTURE IN OLDER ADULTS AND
PREDICTIVE AREAS IN CURVE
EXPLAINING VARIABILITY OF
PHENOTYPES PROOEND STRESSOR
FUNCTION EXPLAINED A LOT OF
ABOUT IT. THE THING ABOUT THE
PHENOTYPE, IT IS VERY
UNDERSTANDABLE TO CLINICIANS AND
PATIENTS AND IF WE SEARCH FOR
WHAT GEROSCIENCE AND WHAT CAN
UNDERSTANDING CHANGES AT
MOLECULAR OR BIOLOGICAL LEVEL
POTENTIALLY GIVES A LITTLE MORE
PREDICTABILITY OR DRUGGABLE
TARGET, THEN MODELING RESILIENCE
IN THIS WAY DOESN'T HELP US VERY
MUCH. WE EXPLAIN SO MUCH
VARIABILITY IN THAT PRESTRESSOR
FUNCTIONAL STATUS.
WAY THAT WE HAVE GOTTEN BEYOND
THAT IS LOOKING AT EXPECTED
RECOVERY DIFFERENTIAL LARGE
GROUP OF PEOPLE FACED A SIMILAR
STRESSOR AND USE PRESTRESSOR
VARIABLES TO PREDICT
POPULATION'S TRAJECTORY AND
EVERY PERSON IN THE POPULATION,
WE CAN DETERMINE WHAT THEY ARE
PREDICTED OR EXPECTED OUTCOME
WOULD BE AT MONTH 6 OR MONTH 12.
WE LOOK AT THE DIFFERENCE
BETWEEN ACTUAL OUTCOME AT THAT
TIMEPOINT AND ARE PREDICTED
CALLING IT EXPECTED RECOVERY
DIFFERENTIAL THAT GIVES A
MEASURE HOW BETTER OR WORSE THEY
DID THAN WE WOULD HAVE EXPECTED
AND WITHOUT STEALING TOO MUCH
THUNDER FROM DANA WHO WILL BE
OUT IN A MOMENT THIS IS WORK
SHOWING A PROOF OF CONCEPT
AROUND THAT AGAIN USING DATA
FROM BALTIMORE HIP STUDY AND
PICKING OUT A FEW STATIC
BIOMARKERS OF A FEW PILLARS OF
AGING AND BIOLOGICAL PROCESSES
THAT WE KNOW DECLINE WITH AGE
AND ARE RELATED TO GEROSCIENCE
AND HE HYPOTHESIZED WOULD BE
PARTICULARLY IMPORTANT FROM A
PERSON RECOVERING FROM A HIP
FRACTURE. IN GENERAL, THE
TAKE-HOME MESSAGE OF THIS WAS
THAT HIS HYPOTHESIS BORN OUT
VERY BEAUTIFULLY AND PANEL OF
BIOMARKERS EXPLAINED 38% OF
OBSERVED ABILITY WHEN USING
EXPECTED RECOVERY DIFFERENTIAL
AS OUR OUTCOME AND, AGAIN, TO
PEOPLE THINKING ABOUT BIMARKERS
AS A PREDICTOR IS VARIABILITY
AND GENERATES HYPOTHESES WHAT IT
IS THAT CAUSES PEOPLE TO HAVE
BETTER OUTCOMES OR WORSE THAN
EXPECTED OUTCOMES AND THINGS
LINE UP PERFECTLY WITH WHAT
HYPOTHESIS WOULD BE MARKERS OF
LOWER CELLULAR SENESCENCE AND
LESS CHRONIC -- AND BETTER
SKELETAL MUSCLE METABOLISM WERE
ASSOCIATED WITHOUT PERFORMING
WHAT AGE, COMORBIDITY STATUS AND
PRESTRESS FUNCTIONAL LEVEL WOULD
HAVE SUGGESTED. ARE THERE OTHER
FEASIBLE SAFE TESTS THAT CAN
PREDICT RECOVERY AFTER
REAL-WORLD STRESSORS?
FOR THIS IS MIKOPI AND I AND
MASCOT THAT IS A MICROSCOPIC AND
HIGHLY RESILIENT ORGANISM THAT
IS OUR MASCOT FOR THE PRIMEY
STUDY ENROLLING 200 PATIENTS
SCHEDULED FOR ELECTIVE KNEE
REPLACEMENT.
WE FOCUS ON GETTING DATA BEFORE
KNEE REPLACEMENT THAT WILL
PREDICT OUTCOMES AND I WILL
SPEAK SPECIFICALLY ABOUT WE ARE
TRYING TO GET AT DYNAMIC
MARKERS.
SO, THE WAY THAT WE ARE DOING
THAT IS PROVOCATIVE TESTS AND
ESSENTIALLY A STRESS TEST
PARADIGM. YOU HEARD SOME OF
THIS FROM JEREMY WALSTON
YESTERDAY AND HOPKINS GROUP AND
COLLABORATORS AS WELL. FOR
EXAMPLE, THESE ARE SOME
PROVOCATIVE TESTS WE ARE
CAPTURING ON PEOPLE DOING A DUAL
TASK TEST YOU ARE MADE TO WALK
AND TALK AT SAME TIME NOT
SURPRISINGLY PEOPLE DON'T WALK
OR TALK AS WELL WHEN THEY DO
BOTH AT THE SAME TIME AND THOSE
THAT PERFORMANCE REALLY DROPS
OUT OFF IN THE DUAL TASK
CONDITION IS CONSIDERED AN
INDICATOR OF NOT HOLDING UP WELL
TO THE STRESS OF NEEDING TO
COORDINATE BOTH COGNITIVE AND
MOBILITY FUNCTIONS
SIMULTANEOUSLY AND WE ARE
COLLECTING NEAR RED SPECTROSCOPY
ON THE LOBE DURING TINY STRESS
TESTS COGNITIVE TESTS AND MANL
PROBLEMS AND LOOKING AT HOW
BRISKLY TISSUE OXYGEN CHANGES IN
RESPONSE TO STRESSORS AND
STRESSING BLOOD OF PARTICIPANTS
IN WAYS THAT WE DON'T WANT TO
STRESS PARTICIPANTS THEMSELVES
BECAUSE IT WOULDN'T BE SAFE. WE
ARE TAKING BLOOD AND EXPOSING
BLOOD TO INFLUENZA VACCINE AND
TOXINS AND LOOKING AT SUPER
NEEDS OF -- TO LOOK AT THE
RESPONSE OF PBMCS TO STRESSORS
AND ARE EXAMPLES OF PARADIGMS OF
TESTS THAT WE WILL GET AT BETTER
THAT ARE PREDICTING RESILIENCE
THROUGH GEROSCIENCE. ONE OTHER
TYPE I WILL TALK ABOUT IS
LOOKING AT COMPLEXITY OF TIME
VARYING DATA AND LOU LIPSETTS
WHO IS HERE IS ONE OF OUR
COLLABORATORS IN ADDITION TO
THIS GROUP AT DUKE AND THEY ARE
LOOKING PARTICULARLY AT
COMPLEXITY OF EEG SIGNALS BEFORE
OR COMPARING IN SOME CASES
BEFORE AND DURING ANESTHESIA.
THEY FOUND THAT THE COMPLEXITY
OF EEG SIGNALS CHANGES WHEN WE
MOVE FROM BEFORE TO DURING
ANESTHESIA AND PATTERN OF CHANGE
NOT SO MUCH QUANTITY OF HOW MUCH
COMPLEXITY OF DATA CHANGES AND
PATTERN OF THE CHANGE SEEMS TO
BE PREDICTIVE. I WILL SAY
PREDICTIVE WITH A FRUSTRATING P
VALUE OF .054. FOR PRELIMINARY
STUDY CERTAINLY COMPELLING
FUTURE WORK AND OTHER THING THEY
ARE LOOKING AT WHILE I THINK IT
CAN TELL US A LOT ABOUT THE
MECHANISM WHAT ANESTHESIA IS
DOING TO OUR BRAIN AND WHY IT IS
PUTTING US AT RISK FOR DLEERIUM,
I DON'T KNOW THAT WOULD BE A
CLINICAL FEASIBLE TOOL BECAUSE
IT IS A LITTLE HARD TO GET A 32
CHANNEL EEG BEFORE AND DURING
SURGERY AND ARE DEVELOPING WHAT
IS A VERY FEASIBLE CLINICAL TOOL
WHICH IS LOOKING AT EYES OPEN
AND CLOSED BEFORE SURGERY AND
HOW EEG SIGNAL CHANGES WITH THAT
STRESSOR.
THIS IS MY LAST SLIDE.
SO, WE OFTEN USE WHAT WE CALL A
METAPHOR OF A CASTLE UNDER SIEGE
TO THINK ABOUT HOW WE ARE
PREDICTING RESILIENCE AND
CERTAINLY WE KNOW IF THINKING OF
A CASTLE THAT IS UNDER ATTACK
AND CASTLE IS BODY AND STRENGTH
OF ATTACK OR MAGNITUDE OF THE
STRESSOR NEEDS TO BE ONE FACTOR.
WE NEED TO MEASURE SOMETHING
ABOUT THAT AND ADDITION OF
QUALITY OF CONSTRUCTION OF
CASTLE ITSELF AND MAY BE ASPECTS
OF THE CASTLE THAT LOOK CRUMBLY
AND FRAIL AS IF THEY WON'T HOLD
UP SO WELL TO ATTACK.
WE ALSO THINK THAT HOW QUICKLY
THIS CASTLE CAN DEPLOY EFFECTIVE
DEFENSES.
FOR EXAMPLE, DOES IT HAVE A TEAM
OF ARCHERS THAT LIKE A ROBUST
IMMUNE SYSTEM COULD POP UP IN
TIME OF NEED AND HOW QUICKLY TO
REPAIR DAMAGES AND MANAGE AND
STORE. DOES IT HAVE FOOD AND
LAMP OIL INSIDE THAT CAN HELP IT
OUTLAST THE SIEGE AND QUICKLY
REPAIR DAMAGES THAT MIGHT BE A
REALLY EFFECTIVE MITOCHONDRIAL
BIOLOGY.
AND OUR HYPOTHESIS IS THAT VERY
DIFFERENT CELLULAR AND MOLECULAR
MECHANISMS MAY UNDERLIE RESERVE
AND RESILIENCE THAT IS IMPORTANT
TO THINK OF THOSE SEPARATELY AND
PROBE THEM DIFFERENTLY.
I WILL CONCLUDE THERE. JUST TO
SAY, AGAIN, THIS IS A VERY LARGE
TEAM EFFORT AND MANY OF OUR TEAM
P MEMBERS AT MULTIPLE OTHER
UNIVERSITIES ARE HERE OUT IN THE
AUDIENCE TODAY.
THANK YOU.
>>[APPLAUSE].
>> GOOD MORNING, EVERYONE. I
WOULD LIKE TO THANK RON AND LOU
FOR INVITING ME TO
PARTICIPATE IN THIS SUMMIT.
I AM TASKED WITH THE TOPIC OF
GEROSCIENCE IN DISEASE
TREATMENT. AND TO START, I
WOULD LIKE TO PARAPHRASE
SOMETHING THAT LOU EENLI SAID
YESTERDAY.
THAT IS THAT HE SAID THAT JERAT
TRIGSES ARE LOOKING FOR TOOLS
AND INTERVENTIONS THAT CAN BE
INFORMED BY TRANSLATIONAL
GEROSCIENCE.
I WOULD -- I WOULD AGREE WITH
THAT AND EXTEND THAT TO SAY THAT
CLINICIANS TAKING CARE OF ADULTS
IN GENERAL ARE LOOKING FORWARD
TO POSSIBLE INTERVENTIONS.
THESE ARE MY DISCLOSURES
MENTIONING WITH USE OF
MEDICATIONS AND NEWT TRA SUIT
CALS AND KNOW FINANCIAL INTEREST
IN COMPANIES THAT MANUFACTURER
THESE COMPOUNDS AND IS AN
OUTLINE OF MY TALK.
FIRST, I WILL BEGIN WITH
EVIDENCE BASED ON PRECLINICAL
STUDIES FOR WHICH THERE IS ALSO
HUMAN DATA CONDUCTED FOR REASONS
NOT RELATED TO VALIDATION OF THE
GEROSCIENCE HYPOTHESIS.
NEVERTHELESS, DATA THAT WE NEED
TO CONSIDER.
I WILL THEN MOVE ON TO EVIDENCE
BASED ON CLINICAL STUDIES THAT
ARE SPECIFICALLY CONDUCTED ON
GEROSCIENCE INTERVENTIONS.
AND THEN FINALLY, I WILL TRY TO
PUT THIS ALL TOGETHER.
I WILL OFFER CONSIDERATIONS FOR
USE OF GEROSCIENCE-BASED
INTERVENTIONS IN THE CLINIC THAT
ADDRESSES ONE OF THE POINTS THAT
RON MADE ON HIS FIRST SLIDE THIS
MORNING AND BELIEVE HE USED THE
WORD DEPLOY.
HOW DO WE DEPLOY AT LEAST
INITIALLY SOME OF THE
INFORMATION AND LESSONS LEARNED
FROM TRANSLATIONAL GEROSCIENCE.
LET'S START WITH EVIDENCE BASED
ON PRECLINICAL STUDIES.
THIS IS A TABLE THAT LISTS
PRECLINICAL EVIDENCE FOR
GEROSCIENCE-BASED INTERVENTIONS
THAT IS -- THESE INTERVENTIONS
ARE ARBITRARILY DIVIDED INTO
THOSE FOR WHICH WE HAVE
INFORMATION ON -- FOR BENEFICIAL
EFFECTS IN EXTENSION OF LIFE AND
HEALTH SPAN AND EXTENSION OF
HEALTH SPAN AND OF LIFE SPAN AND
OTHER POTENTIAL INTERVENTIONS
ARE ALSO LISTED HERE AND BECAUSE
AN INTERVENTION IS NOT LISTED
UNDER ONE OF THE CATEGORIES
DOESN'T MEAN THAT IT DOESN'T
OFFER THAT BENEFIT. IT JUST
MEANS THAT WE DON'T HAVE THAT
INFORMATION YESTERDAY. IF YOU
PERUSE THIS LIST YOU WILL NOTICE
MANY THINGS LISTED HERE HAVE
BEEN MENTIONED IN DAYS 1 AND 2
OF THE SUMMIT AND OTHER POINT I
WANT TO MAKE IS JUST TO
REITERATE THE ELOQUENT SUMMARY
THAT DR. ZEISS MADE DAY 1 THAT
ALL CLINICAL STUDIES OR SHOULD
SAY MOST OF THE STUDIES WERE
CONDUCTED IN RODENTS ESPECIALLY
MICE AND IS A QUESTION ABOUT THE
ABILITY TO TRANSLATE THIS INTO
SIMILAR FINDINGS IN HUMANS.
SO, ONE WAY TO TRY TO ASSESS THE
LEVEL OF EVIDENCE FOR WHAT WE
KNOW IN PRECLINICAL STUDIES IS
TAKING A SYSTEMATIC APPROACH.
HERE, I'M SHOWING AN APPROACH
THAT WE TOOK THAT IS DOING A
REVIEW OF THE LITERATURE USING
DATA SOURCES AND SEARCHES THAT
ARE PRETTY STANDARD AS WELL AS
HOW WE DID THE STUDY SELECTION.
WHAT IS DIFFERENT HERE IS THAT
WE FOCUSED EXCLUSIVELY ON DATA
WE WERE ABLE TO UNDERSTAND FROM
PRECLINICAL STUDIES AND IN TERMS
OF QUALITY ASSESSMENT USE A
MODIFIED GRADE FRAMEWORK MOSTLY
BECAUSE OF POSITY OF STUDIES FOR
SOME OF OF THE INTERVENTIONS
THAT WE CONSIDERED.
THIS IS A SUMMARY SLIDE OF WHAT
WE CONCLUDED BASED ON THAT
SYSTEMATIC REVIEW.
THERE WAS HIGH QUALITY EVIDENCE
FOR MODERATE PHYSICAL ACTIVITY
FOR IMPROVEMENTS IN ALL-CAUSE
MORTALITY AND AGE-RELATED
MORBIDITIES AND CIRCUIT MARKERS
FOR AGING SEVERAL DIETARY
INTERVENTIONS INCLUDING
PLANT-BASED DIETS INTERMITTENT
FASTING AND MODERATE CALORIC
RESTRICTION THAT IS ALSO HIGH
QUALITY EVIDENCE FOR METFORMIN
TO CONSIDER FOR USE COMPARED TO
THOSE GLUCOSE TOLERANCE AND AGE
SET MORBIDITY AND HIGH LEVEL
EVIDENCE FOR ACE INHIBITORS TO
BE CONSIDERED PATIENTS WITH
HYPERTENSION AND PEOPLE WITH
PHYSICAL PERFORMANCE AND
GLYCEMIC CONTROL AND
ANTIINFLAMMATORY EFFECTS AND
HIGH QUALITY TO BE CONSIDERED IN
PATIENTS WITH OSTEOPOROSIS AND
HISTORY OF FRACTURES FOR
FRACTURE PREVENTION AND
MORTALITY BENEFITS FOR RISK
CANCER AND CARDIOVASCULAR
DISEASE AND FOUND THERE WAS
INSUFFICIENT EVIDENCE TO MAKE
ANY RECOMMENDATIONS FOR USE OF
RAPAMYECIN AD BOOSTERS AND SIN
ALYTIC AGENTS AND MOVING ON TO
EVIDENCE BASED ON CLINICAL
STUDIES SPECIFICALLY FOR
GEROSCIENCE INTERVENTIONS AND
HERE I'M FOCUSING ON CLINICAL
STUDIES AND SEEN IN THERAPEUTICS
WHAT DO WE KNOW THERAPEUTIC
BENEFIT IN ITD YOPATHIC FIBROSIS
AND STUDY PROOF OF CONCEPT IN
TARGETING AGENT IN PATIENTS WITH
-- AND HAVE STUDY SHOWING
ANTIDIABETES EFFECTS OF
[INDISCERNIBLE] AND WE HAVE
EVIDENCE FOR ZOLEDRONATE FOR BMD
FRACTURE PREVENTION AND
MORTALITY BENEFIT.
SO, THIS IS THE SHORT PROTOCOL
THAT WAS USED IN THE STUDY ON A
DISSAT NIF [INDISCERNIBLE] IN
PULMONARY FIBROSIS AND STUDY IS
BY JAMIE JUSTICE AND OTHERS THAT
YOU CAN SEE IT WAS A SHORT STUDY
DOSING D + Q ON 1ST THREE DAYS
OF EACH WEEK. AFTER THE LAST
WEEK WERE COLLECTION OF
FOLLOW-UP MEASURES.
SO, IN SUMMARY, ALTHOUGH THERE
WAS NO IMPROVEMENT IN PULMONARY
FLUNKS IS POTENTIAL EFFICACY
SIGNAL IN TERMS OF IMPROVEMENTS
IN PHYSICAL FUNCTION AND WANT TO
POINT OUT THEY ARE SECONDARY
ENDPOINTS IN THE STUDY AND IT
WAS A SMALL STUDY WITH ONLY 14
PATIENTS AND DON'T HAVE ANY
INFORMATION ABOUT CHANGES IN
LUNG PATHOLOGY AND DON'T HAVE
INFORMATION ABOUT TARGET
ENGAGE
ENGAGEMENT.
HOWEVER, IN THE STUDY CONDUCTED
IN SMALL NUMBER OF PATIENTS WITH
DIABETIC KIDNEY DISEASE THERE
WAS EVIDENCE FOR TARGET
ENGAGEMENT AND THIS SLIDE SHOWS
THAT SENESCENCE CELLS WERE
DECREASED IN ADIPOSE TISSUE THAT
WAS BASED ON A GROUPED ANALYSIS
USING 3 SINOLYTIC MARKERS.
IN THE SAME STUDY COMPOSITE
BLOOD FACTORS WERE REDUCED AFTER
D PLUS Q TREATMENTS AND ON LEFT
UNDER TARGETS YOU SEE LIST OF
S-SAAS FACTORS ANALYZED AND FULL
CHANGE WITH REDUCTION SHOWN IN
SHADES OF BLUE.
SO, THE NEXT STUDY I'M GOING TO
DESCRIBE WAS TO LOOK AT THE
ANTIDIABETIC EFFECTS OF
SINOLYTIC AGENT OF DASATINIB AND
[INDISCERNIBLE] COLLABORATED
WITH US ON THIS AND THIS WAS A
RETROSPECTIVE STUDY LOOKING AT
DIABETIC PATIENTS GIVEN
DASATINIB A STRONG SALITYIC OR
EMATINIB SAME DRUG CLASS BUT
WEAK SENOLYTIC AND PEOPLE WERE
CONCERNED IF ON EITHER
MEDICATION FOR AT LEAST A YEAR
AND WERE GIVEN DRUGS FOR CANS
ERR DIAGNOSIS AND HAD TO HAVE
HAD MEASURES OF GLYCEMIC CONTROL
PRIOR TO ADMINISTRATION OF
EITHER DRUG AND HAD MEASURES OF
GLYCEMIC CONTROL 12 MONTHS LATER
THIS SLIDE IS HIGHLIGHTING FACT
THERE WAS SIGNIFICANT DECREASE
IN SERUM GLUCOSE IN DASATINIB
ABOUT YOU NOT EMATINIB GROUP AND
A1C HEMOGLOBIN THERE WAS AN
IMPROVEMENT -- TO PUT THIS IN
CONTEXT THIS CHANGES IN A1C
ISCOMPARABLE TO MANY CURRENT
ANTI-GLYCEMIC AGENTS THAT WE
CURRENTLY USE NOW, ZALENTRENATE,
IT IS A DIFFERENT STORY. DATA
WE HAVE FOR IT WAS INITIALLY IN
LARGE CLINICAL STUDIES TO LOOK
AT BONE MARROW DENSITY AND
FRACTURE PREVENTION AND DATA
SUGGEST
SUGGESTING XENOTHERAPEUTIC
EFFECTS CAME LATER AND IS VERY
GOOD LARGE CLINICAL STUDIES THAT
ARE, AGAIN, SHOWING MAINTENANCE
OR IMPROVEMENT OF BONE MINERAL
DENSITY AND PREVENTION OF
FRACTURES.
THERE WAS A MORTALITY BENEFIT
INDEPENDENT OF PREVENTION OF
FRACTURES AND IS EVIDENCE FOR
ZOLEDRONATE IMPROVING DISABILITY
AND CANCER AND RISK OF CANCER
AND RISK FOR CARDIOVASCULAR
DISEASE. I MENTIONED THAT THIS
WAS FOLLOWED BY PRECLINICAL
EVIDENCE BUILDING A CASE FOR
ZOLEDRONATE AS A SENOLYTIC AGENT
AND RECENT PAPER PUBLISHED BY
JOSH BARR AND OTHERS FOR YOU TO
LOOK AT THAT.
SO, HOW DO WE PUT ALL THIS
CURRENT INFORMATION TOGETHER TO
MAKE SOME SORT OF SUGGESTIONS
TOWARDS USING THIS INFORMATION
IN THE CLINIC?
SO, THIS IS ONE PARADIGM. SO,
WE HAVE LOTS OF EVIDENCE FOR
EXERCISE AND DIET INCLUDING
CALORIC RESTRICTION.
AND THESE INTERVENTIONS COULD BE
USED AND ARE USED FOR A SINGLE
DISEASE STATES AND
MULTI-MORBIDITY AND TWO CAVEATS
HERE, OF COURSE, IS BOTH OF
THESE INTERVENTIONS ARE
BEHAVIORAL INTERVENTIONS THAT
MEANS THEY ARE EASY TO
PREDESCRIBE BUT DIFFICULT TO
OVERSEE ADHERENCE AND OTHER
CAVEAT IS THAT AT EXTREMES, BOTH
INTERVENTIONS CAN HAVE HARMFUL
EFFECTS.
THE OTHER PART OF THE PARADIGM
IS TO TAKE DRUGS THAT WE USE FOR
SINGLE DISEASE STATES AND PUT
THEM IN THE CONTEXT OF
INFORMATION THAT WE HAVE ABOUT
GEROSCIENCE AND IF WE ARE
CONSIDERING A DRUG CLASS FOR
SINGLE DISEASE STATE, WHY NOT
CONSIDER THOSE DRUGS FOR THOSE
SINGLE DISEASE STATES THAT HAVE
ALSO ADDED BENEFIT.
I HAD MENTIONED METFORMIN ACE
INHIBITOR AND ZOLEDRONATE AND
FOR AGING INTERVENTIONS IN
CONTEXT OF TREATING A DISEASE
STILL HAS THE -- THE RISK
BENEFIT EQUATION THAT NEEDS TO
BE ADDRESSED.
AFTER 5 TO 6 YEARS OF USE OF ACE
INHIBITORS INCREASED RISK OF
LUNG CANCER GIVING ZOLEDRONATE
GIVES INSIGNIFICANTLY LIKELIHOOD
OF ACUTE PHASE REACTIONS AND FOR
ALL DRUGS ARE LIMITATIONS BASED
ON CHRONIC KIDNEY DISEASE.
AND SO THIS SLIDE IS A LITTLE
MORE CONTROVERSIAL. IN OTHER
CLINICAL SCENARIOS WHERE MIGHT
WE CONSIDER USING
XENOTHERAPEUTIC INTERVENTIONS?
WE CERTAINLY WANT THOSE
CONDITIONS TO HAVE INFORMATION
THAT IS MEDIATED BY SENESCENCE
CELLS AND EARLIER AT THE SUMMIT
WE TALKED ABOUT POSSIBLY USING
THESE INTERVENTIONS IN PREMATURE
OR ACCELERATED AGING CONDITIONS
LIKE IN CHILDHOOD CANCER
SURVIVORS AND CAN CONSIDER USING
INTERVENTIONS AND FATAL
KONLVENTIONS WITH HIGH
SENESCENCE AND BURDEN AND
IDIOPATHIC FIBR REAR -- THERE IS
CONDITIONS AND FACTORS WITHOUT
KNOWN TREATMENTS AND CLINICAL
STR ESKERS KNOWN TO GENERATE
SENESCENCE CELLS THAT I HAVE
GIVEN EXAMPLES HERE AND
CHEMOTHERAPY AND RADIO THERAPY
AND HYPOXIA REGENERATION
SCENARIOS, ET CETERA. I PUT IN
A FINAL CATEGORY THAT IS NOT
REALLY A THERAPEUTIC
INTERVENTION BUT IS CERTAINLY
SOMETHING THAT WE MUST DO
ESPECIALLY IN THE CONTEXT OF AN
INCREASINGLY LARGE NUMBER OF
PATIENTS WHO HAVE
SELF-ADMINISTERED AVAILABLE XENO
THERAPEUTIC AGENTS AND
OBLIGATION IS REALLY TO MONITOR
FOR SAFETY.
IF POSSIBLE, FOR TARRING
ENGAGEMENT.
I WOULD GO ON TO SAY THIS IS
ALSO AN OPPORTUNITY PROVIDING WE
CAN GIVE APPROPRIATE EDUCATION
AND DISSEMINATION AND
INFORMATION TO CLINICIANS THAT
CLINICIANS WITH THIS KNOWLEDGE
SHOULD BE ABLE TO PROVIDE
REFERRALS TO PATIENTS FOR
CLINICAL TRIALS BASED ON SOME
CATEGORIES OR TO MONITOR
ADEQUATELY SAFETY AND TARGET
ENGAGE
ENGAGEMENT.
I WILL END THERE. THANKS FOR
YOUR ATTENTION.
>>THANK YOU AND TO MEETING
ORGANIZERS FOR ALLOWING ME THE
INVITATION TO SPEAK HERE ABOUT
GEROSCIENCE AND MANAGEMENT.
I HAVE NO
DISCLOSURES OTHER THAN TO
ACKNOWLEDGE I'M A CARDIOLOGIST
AND GEROTRIGS WITH ACADEMIC
CAREER THAT EVOLVED FROM A
CLINICAL FOUNDATION AND IS
PERSPECTIVE AND RELEVANT FOR MY
TALK AND WE TALKED A GREAT DEAL
IN THE COURSE OF LAST TWO DAYS
ABOUT STANDARDS OF HEALTH CARE
THAT ARE DISEASE-BASED SILOS
THAT WE LIVE WITHIN SILO AS
CLINICIANS AND EACH SILO
INFORMED BY EVIDENCE-BASED
RATIONALE THERE IS INVESTMENT
AND PRIDE IN GUIDELINES BASED
CARE AND RESEARCH IS DISEASE
SPECIFIC AND ADMINISTRATION OF
CARE IS DISEASE SPECIFIC
MANAGEMENT IS ORIENT TODAY
SPECIALTIES BY CHOICE
CONSTRICTED FOCUS ON PANELO
PHYSIOLOGY DIAGNOSIS AND
THERAPEUTICS AND RESEARCH AND
EXPANSIVE RESEARCH RATIONALE IS
DISEASE SPECIFIC AND ASSOCIATED
WITH BUSINESS MODEL TO BE
RELEVANT AND ADMINISTRATIVE WITH
CLINICIAN HOLDERS AND ENTIRE
CARE AS WE THINK ABOUT IT.
PATIENT ORIENTED INTEGRATED CARE
GERIATRICS AND PREVENTION ARE
REALLY OFTEN DIMINISHED IN EYES
OF OTHER STAKEHOLDERS BECAUSE
THEY RUN IN OPPOSITION TO THIS
MODEL.
HERE WE ARE IN THIS WONDERFUL
SUMMIT TALKING ABOUT HEALTH
SAVING AND LAWEDIBLE GOALS --
POLYFARPCY AND DISABLE THE
GAPPED HEALTH FREE FROM CHRONIC
DISEASES AND DISABILITY OF AGING
AND ICON A CONVENIENT ICON AND
SO MANY PEOPLE GIVE LECTURES
SHOWING CARLOS LOPEZ ICON FROM
2013 AND GETTING UPDATED IN
COURSE OF THIS SEMINAR SHOWING
INTERCONNECTIONS AND SPECTACULAR
USE TO PROVIDE CONCEPTS.
THIS IS AN INTERESTING CARTOON
IN EDITORIAL TALKING ABOUT ICON
OF GEROSCIENCE BEING NIMBLE AND
DYNAMIC COMPARED TO JERONTOLOGY
ENTRENCHED IN DISEASES AND
GERIATRICS TINKERING WITH DEATH
AND NOTHING TO DO WITH
GERIATRICS NOVEL WITH
GEROSCIENCE THAT I AGREED WITH
THIS AS A CLINICIAN AND WE KNOW
GERIATRICS IS INFUSED WITH
VITALITY BY [INDISCERNIBLE]
CONCEPTION OF GERIATRIC 5MS
THINKING WHAT IS IMPORTANT TO
PEOPLE AND MATTERS TO THEM AND
MOBILITY AND MIND AND CHOICES OF
MEDICATIONS AND ACKNOWLEDGING
COMPLEXITY AND IS BIDIRECTIONAL
RELATIONSHIP WHAT WE CAN DO AND
THINK ABOUT WITH GEROSCIENCE AND
GERIATRICS AND ONE THING ABOUT
CARDIOLOGY AND DISEASE BASED
SOMEWHERE IN THE MIDDLE AGING
YOU ARE VULNERABLE TO DISEASES
WE CAN JERAT TRIS SIZE
SPECIALTIES WITH COMPLEXITIES WE
KNOW ARE PART OF GEROSCIENCE AND
INFORMING BEST CARE FOR OLDER
ADULTS THAT WE TALKED EARLIER
TODAY ABOUT THE COMPLEXITY OF
DISEASE THAT IS A SCHEMATIC I
USED IN 2015 WHEN I -- AS PART
OF A U13 SEMINAR IT TA IS STILL
VERY RELEVANT AND TALKS ABOUT
BURGEONING UNDERSTANDING THAT
CARDIOLOGY IS NOT DISEASE
SPECIFIC BUT MULTIPLE DISEASES
AND IT IS KNOWN BY DEFINITION TO
OCCUR IN ASSOCIATIONS WITH
CHANGE OF BODY COMPOSITION AND
CHANGES IN METABOLISM AND
ASSOCIATION WITH OTHER DISEASES
AND HEART DISEASE IS ONE DISEASE
IN CONTEXT OF MULTI-MORBIDITY
HARDWIRED TO ISSUES OF FRAILTY
AND ISSUES OF SOCIAL
DETERMINANTS OF HEALTH
PERMEATING WORKSHOP AND OLDER
ADULT WITH HEART DISEASE IS
DIFFERENT THAN YOUNGER ADULT
WITH HEART DISEASE AND ALL
COMPLEXITIES ARE BORN ON TOP
LAYER OF -- AND TOP LAYER FACT
THAT PATIENTS HAVE MULTIPLE
PROVIDERS WITH OWN GUIDELINES
BASED PERCEPTIONS AND BEST CARE
AND PATIENT CARE IS DIFFERENT
THERE IS ASSOCIATED ISSUES WITH
COGNITIVE AND FUNCTIONAL DECLINE
AND PREDISPOSITION TO FALLS THAT
IS CHALLENGE OF HEALTH CARE FOR
OLDER POPULATION AND LINDA'S
WORK AND WORK BY JEREMY WALSTON
AND MANY OTHERS WAS HUGE IN
IMPACTING JERAT TRIS SIZING CARD
YOL AND BASE CARE AND EXPLOSION
OF LITERATURE PEOPLE THAT ARE
FRAIL DON'T DO WELL -- EVIDENCE
-- BASED GUIDELINES ARE USED
NOTION GOES BACK TO FUNDAMENTAL
OF GEROSCIENCE AND GIVE RISE TO
DOWN STREAM EFFECT OF PHENOTYPE
AND DEFICIT ACCUMULATION HOW WE
MEASURE FRAILTY REMAINS
CONTROVERSIAL BUT SCIENCE IS
RICHNESS AND GEROSCIENCE
INFORMEDO HEALITY THAT IS
EXPLOSION OF LITERATURE MEANT TO
REPRESENT A EXAMPLE AND
[INDISCERNIBLE] WROTE A SERIES
OF ARTICLES MENTEE WENT TO DO
PHD AT HOPKINS PAPER AFTER PAPER
LOOKING AT ISSUES OF FRAILTY
THAT IS PREDICTIVE IN
CARDIOVASCULAR DISEASE AND
PEOPLE THAT ARE FRAIL ARE MORE
LIKELY TO HAVE CARDIOVASCULAR
DISEASE AND OTHER DISEASES AND
PEOPLE WITH CARDIOVASCULAR
DISEASE ARE FRAIL AND LIKELY --
LOSSIN DEPENDENCE AND MANY OF
YOU HAVE WRITTEN SIMILAR ARTICLE
MANDZ HAVE AND SO MUCH EXPLOSION
OF LITERATURE WITH OVERLAPPING
THEMES JERAT TRIS SIZING CARD
YOL AND KNOW WHOG WILL HAVE BEST
AND WORST OUTCOMES SCHEMATIC
THAT SUMMARIZES MY EVOLUTION AND
MY TRAINING WAS REALLY
PREOCCUPIED WITH BOTTOM TWO
CIRCLES KNOWS AS ONE GETS OLDER
THERE IS FUNDAMENTAL BIOLOGICAL
CHANGES WITH ENDOTHELIUM AND
[INDISCERNIBLE] BY OTHERS AT
INTRAMURAL PROGRAM TALKING ABOUT
INFLAMMATION AND OXIDATIVE
STRESS SOMEWHAT AMBIGUOUSLY AND
WITH EXPLOSION OF GEROSCIENCE WE
UNDERSTAND THIS REGULAR OTOPATHY
AND SUDDENLY BASIC CONCEPT OF
CARDIOLOGY WAS JERAT TRIS SIZED
AND INFORMED WITH GEROSCIENCE
PRINCIPLES I LOVE THE SCHEMATIC
AND I REALLY DO SIMILAR PERFECT
INSIM PUBLISHING AGAIN LAST
ARTICLE AND PICTURE AND THIS ONE
IN MAINSTREAM CARDIOLOGY
JOURNALS TALKING ABOUT CARDIAC
DISEASES END STAGE LEAVES ON THE
TREE AND MACRO VASCULAR PAD AND
HEART FAILURE AND STROKES AND
OTHER BRANCHES TYING IN ISSUES
OF CNS AND DEPRESSION COGNITIVE
AGING MUSCULOSKELETAL SARCOPENIA
AND BRANCHES DRIVEN BY TRUVENGS
OF HALLMARKS OF AGING AND
OVERLAPPING WITH HAENLER'S
WONDERFUL TALK TALKING ABOUT
STRESSES THAT THREATEN AND
EXACERBATE ISSUES WITH LOSS OF
RESILIENCE AND CHILD OBESITY AND
OTHER CARDIOVASCULAR RISK
FACTORS CHOLESTEROL AND
UNHEALTHY LIFESTYLE INTEGRATED
TOGETHER IN ONE SCHEMATIC THIS
IS CARDIAC DISEASE AND EVERY
OTHER DISEASE IN ONE TREE AND I
WANT TO DWELL ON THIS BY LUIGI
INFORMING MY CAREER TALKING
ABOUT HALLMARKS AND CONVERGING
-- ENDPOINT DRIVING DOWN
DISEASES AND THINKING ABOUT
INFLAM AGING WE ARE THINKING
PROFOUNDLY HOW TO CHANGE CARE
AND MANAGEMENT IN FUNTDMENTAL
WAY. CARD YOLSS ARE CARD YOLSS
THINKING OF THEIR DISEASE AS
CENTER OF THE WORLD IT HAS BEEN
PREDOMINATED BY INFLAMMATION OF
CARDIAC ISSUE SOLELY AND --
PREEM NAPT AND QUITE BRILLIANT
DOING LANDMARK WORK SEVERAL
HUNDRED ARTICLES LOOKING AT
INFLAMMATION AND EFFECTS ON
CARDIOVASCULAR DISEASE AND PAUL
HIS PROET ASHA WENT ON WITH
TOWERING STUDIES OF MY CAREER
TALKING IN THIS CASE OF KAN TOES
TRIAL AND [INDISCERNIBLE]
MONOCLONIAL ANTIBODY INHIBITOR
AND LOOKING AT OVER 10,000
PEOPLE IN HUGE EXPENSIVE TRIAL
ALL POST MI WITH HIGH
INFLAMMATION SHOWING GIVING DRUG
AT 150 MILLION DOSE ELATED 50
MILLIGRAMS EVERY THREE MONTHS NO
THE GOOD ENOUGH AND INFECTIONS
AND 150 WAS A SWEET SPOT WITH
CARDIOVASCULAR ENDPOINT FOCUS
LOOKING AT MI STROKE AND DEATH
AND POWERFUL AND MADE IT
POWERFUL TO ME IS GERIATRIC
CARDIOLOGIST SAME WEEK THIS
PUBLISHED THIS PUBLISHED IN
LANCIT SAME DATA AND PUBLICATION
LOOKING AT CANCER AND NEW
ENGLAND JOURNAL WOULDN'T PUBLISH
BOTH ARTICLES IN SAME ISSUE
BECAUSE THEY WERE SPECIFIC --
GOES TO LANCET TELLING US WITH
GREAT COLOR HERE IT IS
BEGINNINGS ALMOST BY ACCIDENT OF
GEROSCIENCE IN CARD YOL
COMMUNITY -- CANCER EFFECTED BY
ROBUST IL1 REDUCTION.
THE GROUP WENT ON TO LOOK AT
HOSPITALIZATIONS FOR HEART
FAILURE AND ANEMIA AND GOUT AND
THESE ARE GEROTHERAPEUTICS AND
REALLY NOT INTENDING TO BUT
BECOMING SO DEFACTO AND FOCUSES
REMAIN SAME FOR MANY ARD YOLSS
GOING ON TO LOOK AT OTHER TYPES
OF INFLAMMATORY AGENTS FOR
CARDIAC DISEASE.
-- GIVING .5 MILLIGRAMS
EFFECTIVE REDUCING
CARDIOVASCULAR ENDPOINTS AND
METHO TRECHLATE -- BENEFITS NOT
AS EFFECTIVE CLINICALLY FROM
THAT PERSPECTIVE AND NOT DOING
RELUCTANT TO DO I WOULD SAY IS
THINKING ABOUT HOW THEY MIGHT BE
ABLE TO REDUCE OTHER
ANTIINFLAMMATORIES REDUCE
CARDIAC DISEASE AND OTHER ISSUES
MORE BROAD IN FRAILTY AND IDEA I
BROUGHT FORWARD TO TEAM MANY
YEARS AGO [INDISCERNIBLE]
PREDOMINANTLY SITUATED AND GOT
THIS THAT IS NOT PUBLISHED YET
IN REVIEW IN PRESUMPTION SHOWING
THIS. IT IS AN IMPORTANT POINT
SHOWING SAME DRUG AND POPULATION
WITHOUT AN EFFECT AND SUDDENLY
RAISES ISSUE IS PARADIGM WRONG
AND LOU EENLI'S BEAUTIFUL
ARTICLE WRONG LOOKING AT
FRAILTIES 34 ITEM DEFICIT
ACCUMULATION INDEX WORKING ON IT
CLOSELY WITH KEN AND OTHERS
PREEM NEPT IN THE FIELD AND WHAT
WAS WRONG WITH THIS?
PUTTING TOGETHER SCHEMATIC OF
FRAIL -- OF INFLAM AGING AND
EFFECTS AND JUXTAPOSED WITH DATA
AND PAUL RICHTER PERSPECTIVE IS
DRUG IS WRONG USING ANOTHER
ANTIINFLAMMATORY DRUG THAT IS
TOO TOXIC THEY SAID IT MAY BE
WRONG FRAILTY INDEX AND MAYBE
DEFICIT ACCUMULATION IS NOT AS
ROBUST PERHAPS AS PHENOTYPE AND
MAYBE TALKING YOU KNOW WITH A
DIFFERENT MODEL THAT I THINK
FROM THIS SEMINAR WE WOULD SAY
MAYBE WE ARE NOT LOOKING
UPSTREAM AND MAYBE GETTING
SENOLYTICS OR THINKING ABOUT
MITOCHONDRIA OR THINKING ABOUT
RESILIENCE AND ARE ISSUES WHERE
PEOPLE LIVE THAT WERE NEVER
FACTORED IF LIVING IN BLUE ZONE
PEOPLE LIVE LONGER AND HEARD
FIRST DAY INDIGENOUS POPULATION
LOOKING WRONG WITHOUT DRUGS LIVE
LONGER MEDICAL DESERT NOT --
THESE ARE ALL ISSUES WE HAVE TO
THINK ABOUT AND CARD YOLSS
ARTICLE THAT IS IN REVIEW LIKELY
TO BE PUBLISHED SHOWING
PREDOMINANCE OF HALLMARKS OF
AGING THROUGHOUT MANY DIFFERENT
CARDIAC DISEASES AND WE SHOULD
TREAT THESE THINGS WITH AGENTS
TREATING HALLMARKS OF AGING AND
THIS WORK BY DOUG SALES TEAM IN
BOULDER TALK ABOUT THIS GROUP OF
POTENTIAL DRUGS INOK WOULD US TO
TAKE PRESUMABLY WITH SUCH
PROFOUND EFFECTS INCREASING
RESILIENCE MITIGATING CARDIAC
DISEASE AND PREMISE THAT THEY
HAVE IN THIS ARTICLE IS A
BEAUTIFUL ARTICLE SAYING PEOPLE
THAT -- THAT IS A FANTASY I
THINK WE DON'T HAVE DATA TO
SUPPORT IT. WE ARE NOT TESTING
IT OR THINKING ABOUT WHO IS
TAKING DRUGS MY EXPERIENCE TAKEN
BY MOST EDUCATED PATIENTS IN
GOOGLE AND NOT LOOKING AT INNER
CITY PEOPLE AND LIVING IN RURAL
KIND OF AREAS AND ARE MISSING
THE PROMISE THAT RESEARCHERS
TALK ABOUT AS BEING THEIR GOAL.
I DON'T THINK WE ARE THERE FOR
GEROSCIENCE TAKING OVER
MANAGEMENT THAT IS MORE OF A
FANTASY AND IF WE HAVE
GEROSCIENCE WE ACKNOWLEDGE
COMPLEXITY THAT INTERACTIONS
AMONG HALLMARKS THEMSELVES
VARIANCE RESILIENCE COMPLEX
RELATIONSHIPS BETWEEN DISEASES
AND HOW THESE EFFECT EACH OTHER
GOING BACK TO ACTUAL HALLMARKS
THEMSELVES THERE IS COMPLEXITY
WE HAVEN'T WORKED OUT AND POINT
TO IT FROM A FAR. CONTRACTING
THAT OPPORTUNITIES FOR
PREVENTION I THINK ARE SWEET
SPOT AMERICA HEART ASSOCIATION A
YEAR AGO GOAL TREATING HEART
DISEASE THAT IS CARDIOVASCULAR
HEALTH PREVENTION AND IMPLIES
ABSENCE OF CLINICALLY MANIFEST
CARDIOVASCULAR DISEASE AND
OPPORTUNITY TO THINK ABOUT
TAKING JEO SCIENCE AND LINKING
IT TO THESE LIFE'S ESSENTIAL AID
THINKING ABOUT HOW TO REALLY
THINK ABOUT DIET AND PHYSICAL
ACTIVITY AND SMOKING CESSATION
AND BODY MASS INDEX AND
ATTRIBUTES OF GOOD HEALTH TYING
INTO GEROSCIENCE PRINCIPLES
INTUITIVE TO THIS AUDIENCE AND
MAKING THAT PART OF 5MS HOW TO
AGE WELL. THIS IS NOT AN
ANTIQUE BUT WHAT MATTERS TO
PEOPLE AND HOW THEY WANT TO LIVE
LIVES AND MAINTAIN VITALITY THAT
IS BEST CARE FOR NEUR OLSZ AND
GOING BACK TO LOU EENLI FIRST
DAY GERIATRICS IS FOR ALL AGES
BEST CARE AND REFRAMES NOTION OF
AEROBIC EXERCISE PAIN IS FWAN
AND ENHANCING MITOCHONDRIAL
RESPONSES AND SIGNALING AND
ENHANCING -- ANTIINFLAMMATORY
PROPERTIES AND STIMULATING
MUSCLE GROWTH IS WHAT WE SHOULD
BE DOING AND PEOPLE WILL ARGUE
GETTING EXERCISE PHYSIOLOGIST
ABOUT DOSE AND FREQUENCY AND
MODE AND GETTING PEOPLE OFF
CHAIRS AND BEDS AND WORK OUT OF
FRANCE HIGHLIGHTS FACT THAT ANY
MOVEMENT BETTER THAN 0 THAT YOU
CAN GO UP FROM THERE AND WE GET
TOO BOGGED DOWN IN PROCESS
MISSING BASIC PRINCIPLES THAT
CHANGE MANAGEMENT DIET AND 41%
OF OLDER ADULTS ARE OBESE AND
SARCOPEENIC OBESITY BRINGS
NUMBERS UP HIGHER AND ENDEMIC
SENESCENCE AND INFLAMMATION AND
-- TIME RESTRICTED EATING SHOULD
BE UNIFORM AND SHOULD BE
THINKING ABOUT SINOLYTIC FOODS
DOING RESEARCH SEEING IF
EFFECTIVE IN MODIFYING TRENDS
PART OF BEST CARE AND SO MUCH
THOUGHT ABOUT HOW TO APPLY THESE
AND HAVE EXISTING MODELS TALKING
ABOUT YESTERDAY NOTIONS OF
PREHABILITATION AND VARIETY
STAYING ON PART OF FUNDED BY NIA
AND THEY ARE FUNDED BY VA AS A
HEALTH SERVICE GRANT THAT WE
KNOW THAT THESE THINGS HAVE SOME
BENEFIT AND WE DON'T USE THEM OR
OLDER ADULTS ABOUT 20% OF
ELIGIBLE OLDER ADULTS GO TO
CARDIAC REHAB IS 80% MISSING
POPULATION THAT NEEDS IT MOST
INCREASING RISK STRATIFICATION
AND TALK BEING FRAILTY AND
EPIGENETIC CLOCKS THERE IS SO
MANY THAT IS COMPLICATED AND
TALKING ABOUT RELATIVE
SPECIFICITY PERHAPS AND WOULD
SAY IT IS THE WHOLE PERSON NOT
JUST HEART DISEASE BUT ENTIRE
RISK PROFILE THAT WILL BE
REVELLENT FOR PEOPLE WITH
MULTI-MORBIDITY WITH CARDIAC
DISEASE AND WE DIDN'T TALK ABOUT
THIS ROBUST SKIEN LOOKING AT
CLONAL HEMOPOE ATTIC -- 20% HAVE
MODIFICATIONS OF LEUKO SITES AND
SPECIFIC MODIFICATIONS OF DNMT3A
AND PARTICULAR PREDISPOSITION TO
CARDIAC DISEASE AND WE DON'T
TEST FOR THIS AND PEOPLE THAT
ARE BEING TREATED FOR CANCER AND
ARE TREATED FOR MANY OTHER
DISEASES MAY HAVE PARTICULAR
PREDISPOSITIONS TO CARDIAC
DISEASE THAT WE DON'T KNOW
ABOUT. I WOULD SAY THAT
GEROSCIENCE IS ENRICHING
CARDIOVASCULAR HEALTH AND
MANAGEMENT AND DEMAND BIG DATA
AND ANALYTICS TO INTEGRATE RISK
BOTH HALLMARKS AND RESILIENCE
ARE TOPICAL AND NEED TO BE
STUDIED IN ASSOCIATION TOGETHER
AND BROADER HEALTH DYNAMICS
TALKING ABOUT FACT THAT EVERYONE
IS ON OWN PANEL WITH PHYSICAL
COGNITIVE FRAILTY BEHAVIOR
PSYCHOSOCIAL ASPECTS NOTIONS OF
RESILIENCY TALKING ABOUT IN LAST
FEW MOMENTS AGO INCREDIBLY
IMPORTANT IN EACH PATIENTS
TRAJECTORY OF BEST CARE
CONSIDERS PHYSIOLOGY THAT IS NOT
ORGAN SPECIFIC MICROVASCULAR
BODY COMPOSITION EFFECTING
ENTIRE INDIVIDUAL AND CROSS-TALK
WITH EXOSOMES AND MITOKINDS AND
SEEMS TOPICAL INTRODUCTION
HIGHLIGHTED FACT THIS HAS HUGE
FINANCIAL IMPLICATIONS FROM ANDY
SCOTT AND DAVID SINCLAIR ARTICLE
TALKING ABOUT THE FACT THAT WE
MITIGATE AND COMPRESS MORBIDITY
AND CAN SAVE TRILLIONS OF
DOLLARS A YEAR INTERNATIONALLY
$3 SEFRNL TRILLION A YEAR AND
$390 TRILLION OVER 10 YEARS
JUXTAPOSING WHAT WE LIVE WITH
MEDICAL AS INDUSTRY TAKING AWAY
37 TRILLION DOLLARS FROM
PARTNERS FROM MYOCLINIC WON'T BE
QUICK OR EASY AND LOTS OF ISSUES
ABOUT PEOPLE WITH BIG FANCY
HOSPITALS WITH LOTS OF
PROCEDURES AND HOW TO MAKE
TRANSITION AND REALLY TO CHANGE
MANAGEMENT AND SAY GEROSCIENCE
ASPIRATIONS ARE PERCEPTIONS OR
THAT ARE ASPIRATIONAL AND ARE
COMPLEXITIES WE HAVE TO WORK
WITH CURRENT STAKEHOLDERS WITH
INDUSTRY AND PROVIDERS TOING
TERRIBLE JOB WITH CARDIAC REHAB
AND 20% USING MOST ARE READING
IT AND TERRIBLE JOB WITH MASKS
DURING PANDEMIC AND WITH SOCIETY
MITIGATING GUNS AND HEALTH CARE
AND DOING BETTER JOB WITH
GEROSCIENCE AND WOULD SAY THAT
THERE IS A TREMENDOUS
OPPORTUNITY AND ARE MAJOR
CHALLENGES IN JUXTAPOSITION OF
PREVAILING CONCEPTS OF
MANAGEMENT AND IMPLEMENTATION IS
STILL FAR OFF AND ENRICHMENT OF
CURRENT PARADIGMS BETTER USE OF
FRAILTY ASSESSMENTS AND BETTER
USE OF VARIETY OF OTHER
ASSESSMENTS WE TALKED ABOUT AND
NEED TO INTEGRATE TO HAVE MORE
EFFECTIVE CARE THAT IS
ACCESSIBLE TO ALL PATIENTS NOT
JUST ONES BEST INFORMED ABOUT
YOU ONES PERHAPS MORE
MARGINALIZED AND TO REALLY BEST
ADDRESS CARE FOR BURGEONING
POPULATION FOR ADULTS THAT ARE
OLD. THANK YOU VERY MUCH.
>>GOOD MORNING, EVERYBODY.
FIRST OF ALL CONGRATULATING NOT
JUST ORGANIZERS BUT EVERYBODY
HERE AND ONLINE FOR WHERE THIS
HAS COME WITH THIS 4TH
NEUROSCIENCE SUMMIT THAT IS
SPECTACULAR AND I WOULD LIKE TO
-- I'M FROM.
>>YOU: [SPEAKING] CON AND WANT
TO SHARE WITH YOU TODAY THOUGHTS
ABOUT HOW TO BRING THIS ALL TO
REALITY AND TAKING WONDERFUL
EXCITEMENT AND AMAZING SCIENCE
AND HOW DO WE ACTUALLY MAKE AN
IMPACT ON HUMAN HEALTH?
PARTICULARLY FROM THE
PERSPECTIVE OF TRAINING
TRANSLATIONAL GEROSCIENTISTS
GIVEN HOW SMALL COMMUNITY IS
PARTICULARLY INVOLVING THOSE
ABLE TO TAKE DISCOVERIES FROM
BEFRNL AND FROM PEOPLE AND HOW
WE BRING THEM TO THE CLINIC IS
FOCUS OF MY TALK TODAY.
I AM SPEAKING ON BEHALF OF FIVE
OF MY AMAZING FRIENDS HERE AND
COLLEAGUES THAT ARE HERE TODAY
AS PART OF NIA GEROSCIENCE
EDUCATION AND TRAINING NETWORK
GRANT THAT IS FUNDED BY DIVISION
OF JERAT TRICKS AND CLINICAL
JERONTOLOGY AT NIA AND TALKING
ABOUT REMARKABLE GROWTH OF
GEROSCIENCE AND INTEREST WHICH
HAS BEEN NOTHING BUT SPECTACULAR
AND RAISED A LOT OF EDUCATIONAL
NEEDS AND OPPORTUNITIES I WILL
TRY TO COVER VERY BRIEFLY TODAY.
PARTICULARLY WITH REGARDS
GEROSCIENCE RESEARCH WORKFORCE
AND TRAINING PIPELINE ISSUES WHO
WILL DO ALL OF THE WORK BEING
PROPOSED NOW AND IN DECADES TO
COME AND HOW WE WILL TRAIN
CLINICIANS IN APPROPRIATE USE OF
SUCH THERAPIES SO THEY BECOME
PART OF EVERY-DAY PRACTICE WHEN
YOU SEE PHYSICIANS AND OTHER
PROVIDERS SHARING LESSONS WE
LEARNED IN JOURNEY AND THROUGH
REALM OF EDUCATION THAT IS NEW
FOR ALL OF US.
ONE THING WE LEARNED IS TALKING
ABOUT CONTENT PRESENTATION AND
LEARNER AND NEEDING TO ENSURE
SUSTAINABILITY AND WORK WILL
CONTINUE FOR YEARS TO COME AND
TOUCH UP ON A LITTLE OF THIS
ISSUE -- SPECIAL INTEREST GROUP
CREATED IN 2012 AND A LITTLE
OVER A DECADE AGO. AS OF
YESTERDAY, THERE IS 2000
CITATIONS ON PUB MED INVOLVING
TERM GEROSCIENCE AND 3/4 OF THEM
HAVE BEEN PUBLISHED IN LAST TWO
YEARS OR SO. IT IS A TREMENDOUS
EXPLOSION OF LITERATURE AND
INTEREST IN GEROSCIENCE. WHAT
CHANGED IN ADDITION TO PEOPLE
TALKING ABOUT GEROSCIENCE AND
PUBLISHING GEROSCIENCE AND WHAT
HAS CHANGED AND WORLD OF AGING,
WE TALK ABOUT
MULTI-DISCIPLINARITY IN AGING
THAT IS A CORE PRINCIPLE OF
AGING AND JER ONTOLOGICAL
SOCIETY IN AMERICA AND NIA THAT
GOES BACK DECADES AND HARD
REALITY THOSE THAT STUDY BIOLOGY
OF AGING AND OLDER ADULTS HAVE
LIVED IN TWO UNIVERSES UNTIL
RECENTLY AND NUMBER THAT DO BOTH
IS EXCEEDINGLY SMALL AND REALITY
IS TIME TO INTERACT IS AT ANNUAL
GSA MEETING AND NIA EVENT APDZ
LIVING IN DIFFERENT SPHERES NOT
INTERACTING AND QUOTING CLINICAL
COLLEAGUES -- IF IT HAS ZERO
IMPACT TAKING CARE OF PATIENTS
THAT HAS BEEN CASE UNTIL
RECENTLY AND THIS HAS CHANGED
AND IN TERMS OF KIND OF
TRANSFORMATIONAL CHANGE THIS IS
A TEXTBOOK MANY ARE INVOLVED IN
AND 8TH EDITION CAME OUT LESS
THAN A YEAR AGO IS FIRST
ADDITION WITH CHAPTER ON
GEROSCIENCE AND ANYTHING ON
GEROSCIENCE AND RECOGNIZING
NAMES OF PEOPLE AND SHOWING F
FROM.
REASON I DID THAT IS I'M
ABSOLUTELY CONVINCED THAT THERE
IS A CONVERGENCE BETWEEN WORLD
OF AGING AND GERIATRIC MEDICINE
AND COMMON INTEREST AND YOU WILL
BE PLEASED NEXT WEEK GOING TO
AMERICAN GERIATRIC SOCIETY THAT
[INDISCERNIBLE] ASKED ME TO
REPORT ON WHAT TOOK PLACE AT
THIS SYMPOSIUM AND TREMENDOUS
INTEREST THAT IS EMERGING AND
WHAT HASN'T CHANGED IS
UNFORTUNATELY WORD GEROSCIENCE
GOING TO WEBSTER'S ONLINE
DICTIONARY TELLS YOU WORD YOU
ENTERED IS NOT IN THE DICTIONARY
AND HEARD ABOUT IT EARLIER AND
IS A WONDERFUL TERM WE HAVE TO
COME UP WITH BETTER WAYS
COMMUNICATING WHAT IT MEANS AND
IT IS A STRUGGLE AND THIS IS ALL
TO DO WITH JEFF AND GOOGLE
FOUNDERS AND NOT SO MUCH REAL
WORLD PATIENTS AND MESSAGING IS
BETTER ON OUR PART TO EXPLAIN
THAT IS PEOPLE WITH MULTIPLE
MORBIDITIES OVERWHELMINGLY
COMMUNITIES OF COLOR AND SOCIAL
DISPARITIES BENEFITING MOST IF
WE DO JOB RIGHT AND WHAT WILL IT
TAKE FOR GEROSCIENCE TO BE ON
TIP OF EVERYBODY'S
[INDISCERNIBLE] AND NOT THOSE
SITTING HERE ONLINE AND I MEAN
EVERYBODY, CNN AND ALL OF THE
OTHER NETWORKS AND WHAT IT WILL
TAKE SIMPLY IS HIGH QUALITY
RANDOMIZED LOCAL TRIALS
DEMONSTRATING CLEAR IMPACT ON
CLINICALLY INDIVIDUALLY
MEANINGFUL OUTCOMES RESULTING IN
FDA APPROVAL AND IMPLEMENTATION
ROUTINE CLINICAL PRACTICE AND
SEEING PROVIDER THEY THINK ABOUT
IT IMMEDIATELY AND IS NOT
SOMETHING THAT THEY WILL ASK
YOU. WHAT IS GEROSCIENCE?
I WANT TO BRING UP THE FACT IF
INTERESTED IN WHAT PHYSICIAN AND
APR IN LEARNS ABOUT HOW TO HAVE
SCIENCE OF CLINICAL PRACTICE
THAT IS NOT A TEXTBOOK AND THEY
DON'T BRING THEM ANYMORE AND ARE
OUT OF DATE MOMENT THEY ARE
PUBLISHED AND USING SOMETHING UP
TO DATE THAT IS SOMETHING THAT
EVERY HOSPITAL AND MEDICAL
SCHOOL IN THE COUNTRY HAS
LICENSE TO CREATED BY HARVARD
PHYSICIANS A NUMBER OF YEARS AGO
THAT IS BROUGHT OUT BY A
PUBLISHER AND IS BASICALLY AN
ONLINE TOOL THAT PROVIDES HIGH
QUALITY REVIEWED INFORMATION BY
7 FOUNDER AUTHORS AND EDITORS
WHO APPLY DEEP DOMAIN EXPERTISE
TO EVALUATE LITERATURE PRODUCING
ORIGINAL CONTENT THAT HAS CLEAR
GUIDANCE EVALUATION AND
RECOMMENDATION OF TREATMENT AND
SCREENING IS EVIDENCE YOU CAN
HANG HAT ON AND USE IMMEDIATELY
TO APPLY TO PATIENT AND
DISCLOSURE HAS 1 OF 7,000
EDITORS AND ROYALTY CHECK EVERY
YEAR THAT BUYS ME I WOULD GUESS
IT WOULD BE MY.
INTRODUCTORY GEROSCIENCE CONTENT
TARGETING MEDICAL STUDENTS AND
PHD STUDENTS AND THIRDLY
GERIATRIC FELLOWS REALIZING
THERE ARE OTHER IMPORTANT
COMMUNITIES TO LEARN BUT WANTED
BEGIN WITH THREE GROUPS THAT WE
ALSO HAVE WORKED HARD TO DEVELOP
CERTIFICATE IN GEROSCIENCE
PROGRAM AND CURRENTLY IT IS
BEING DEVELOPED AND AVAILABLE AT
YUKON AND UCSF AND MYOAND THREE
SITES WITH TENTATIVE AGREEMENT
FROM UP TO DATE THAT IF AND WHEN
AND IS MORE OF A WHEN. THE
EVIDENCE IS THERE TO SUPPORT
CREATION OF UP TO DATE GE
GEROSCIENCE [INDISCERNIBLE] THAT
I WANT TO HIGH LIGHT A LONG
JOURNEY MOST GRANTS NEED TWO
ADVISORY BOARDS REASON BEING IS
COMMUNITY OF EXPERT WHO'S ARE
EXPERTS IN GEROSCIENCE CONTENT
AND PEOPLE WHO IF I SHOW YOU
NAMES THAT IMMEDIATELY
RECOGNIZING NAMES OF LEADERS IN.
COMMUNITIES OVERARCHING LESSONS
LEARNED AND TWO SKILLSETS NO
SURPRISE THERE AND WE NEED TO
BRING TWO VERY DIFFERENT
COMMUNITIES AND THERE HAS BEEN
REMARKABLE INTEREST WITHIN
GEROSCIENCE COMMUNITY NOT
SURPRISING AND REMARKABLE
CURIOSITY BEYOND GEROSCIENCE I
WAS IN KRCREDIBLY -- EAGER TO LN
WORDS AND CONCEPTS THAT THEY
HADN'T THOUGHT ABOUT THAT IS
WONDERFUL AND REMARKLENESS TO
LEARN AND YOU NEED TO MATCH
LEARNER NEEDS WITH CONTENT AND
ALSO MATCH THE LEARNING STYLE
WITH THE PRESENTATION.
LEARNER SPECIFIC LESSONS LEARNED
IS THAT GENERATIONS Z AS WE SAY
IN CANADA THAT HAS INCREDIBLY
SHORT ATTENTION SPANS NO
SURPRISE THERE. I DON'T KNOW
HOW MANY WE AGREE WITH ME AND WE
HAD OVERWHELMING SENSE IT IS
WORSE AMONG MEDICAL STUDENTS AND
IS MORE OF AN OFFLINE
DISCUSSION. ACCESS TO MEDICAL
STUDENT TEACHING TIME IS HARD
AND MEDICAL CURRICULUM IS
INCREDIBLY COMPRESSED AND MAJOR
CHALLENGE AND REALIZATION ALSO
THOSE WORKING IN MEDICAL -- THAT
IS HAPPENING IN PHD TRAINING AS
WELL AND IDEA THAT WE TRAIN NOT
SO MUCH IN [INDISCERNIBLE] BUT
TRAINING IN SKILLS AND
COMPETENCIES NEEDING TO SUCCEED
IN CAREERS AND IN TURN XET 10TYS
-- CLINICAL TRIALS ARE IMPORTANT
AND WE HAVE GREAT INTERESTS
AMONGST PHD TRAINING PROGRAMS
AND GREAT INTEREST AMONG
TRAININGS AND BIOLOGICAL
SCIENCES AND ALSO WE ALSO
REALIZE THAT WE NEED TO CONSIDER
NEW EDUCATIONAL MEDIA AND WE
LEFT POWERPOINT AND THERE IS A
LOT -- THERE IS A LOT BETTER
WAYS TO COMMUNICATE IMPORTANT
INFORMATION WITH YOUNGER
GENERATIONS GIVING A SHOUTOUT TO
YOUNGER WOMAN ELEANOR WHO IS PHD
STUDENT AT UK AND AT KAIM BRIDGE
STUDYING BIOLOGY OF AGING IN
SPARE TIME RUNS YOUTUBE CHANNEL
USING ANIMATED FIGURES AND
CHAIRS RESULTS OF RECENT PAPERS
DOES A WONDERFUL JOB ABLE TO
COMBINE SWEET SPOT OF HIGH
QUALITY INFORMATION WITH FORMAT
THAT IS ACCESSIBLE TO PEOPLE
FROM DIFFERENT COMMUNITIES
INCLUDING PEOPLE WITHOUT A
STRONG SCIENTIFIC BASIS AND
THERE IS TALK ON SENESCENCE
CELLS AND PENDING NIH APPROVAL
HELPING DEVELOP CURRICULAR
MATERIALS TO HELP ADDRESS ISSUES
IN CONTEXT OF LEARNERS INCLUDING
MEDICAL STUDENTS WITH SHORT
ATTENTION SPANS AND HIGHLIGHTING
FACT THAT CERTIFICATE OF
TRANSLATIONAL GEROSCIENCE HAS
BEEN A LABOR OF LOVE AND UNIQUE
EFFORT. THINKING ABOUT IT, THIS
FIGURE IS FROM THE PAPER I
SHOWED AT BEGINNING OF MY TALK
THAT IS PAPER STEMMING OUT OF
SAN FRANCISCO MEETING TO TRAIN
SO MANY TRANSLATIONAL
GEROSCIENCE THEY NEED
COMPETENCIES AND SKILLS IN FOUR
VERY DIFFERENT DOMAINS THAT
DON'T CONVERGE IN INDIVIDUAL AND
GEROSCIENCE AND MECHANISM OF
AGING PRECLINICAL MARKERS
BIO-MACERS AND TALKING ABOUT IN
LAST THREE DAYS GERONTOLOGY FARM
CALLING IS IMPORTANT AND NEEDING
GENERAL SKILLS HOW TO DO HUMAN
SUBJECT RESEARCH AND SKILLS
TAUGHT TO CSAS AT INSTITUTION
AND THEY NEED TO KNOW HOW TO DO
CLINICAL TRIALS IN OLDER ADULTS
THAT IS QUITE DIFFERENT AND WHAT
ARE CHALLENGES WE HEARD ABOUT
THAT CHALLENGES MEASURING IN
FRAILTY AND OLDER ADULTS AND
GOAL IS NO THE TO TRAIN SOMEBODY
TO BECOME A GERIATRICIAN AND
WHAT CAREER GOAL IS AND RATHER
IF YOU DO TRANSLATIONAL
GEROSCIENCE AND SOME
UNDERSTANDING OF CLINICAL ISSUES
FROM GERIATRIC PERSPECTIVE TO BE
EFFECTIVE AND CURRICULUM IS
FOCUSED AROUND FOUR DOMAINS AND
ALLOWING INDIVIDUALS COMING FROM
VERY DIFFERENT BACKGROUNDS TO
FILL IN GAPS THEY MAY NOT HAVE
OR POSSESS. I WANT TO GIVE A
SHOUTOUT TO GSA PRECONFERENCE
WORKSHOP FUNDED BY NIA AND
SUPPLEMENT AND JAMIE JUSTICE
THAT ARE BOTH HERE AND HELD
TUESDAY NOVEMBER 7TH AND FOCUS
ON IT WILL BE DEVELOPING A
MULTI-DISCIPLINARY AGENDA FOR
GEROSCIENCE EDUCATION BRINGING
IN PEOPLE FROM ALL KINDS OF
DIFFERENT AREAS BEGINNING TO
DIALOGUE HOW WE CAN MOVE FORWARD
AND ENDING BY TALKING ALY ABOUT
AGISM. I THINK TO SOME EXTENT
I'M NOT A SOCIAL SCIENTIST BUT
DO THINK THAT IT IS KIND OF A
HIDDEN ELEPHANT IN THE ROOM AND
GIVING A SETH THAT AGISM TAKES
MANY FORMS AND OLDER ADULTS
EXPERIENCE EVERY DAY AND 82%
EXPERIENCE IT IN SOME FORM EVERY
DAY AND GIVING A SHOUTOUT TO BOB
WHO IS FIRST AND FOUNDING
DIRECTOR OF NIA WE ARE HERE IN
LARGE EXTENT BECAUSE OF HIM WHO
COINED THE TERM. WE TEND TO
THINK ABOUT AGISM AS BEING LIKE
RACISM AND BEING JUST
DISCRIMINATION AGAINST AND
ACTUALLY AS COINING IT AND TERM
COMING UP BY BOB BUTLER WHO
COINED THE TERM IS ACTUALLY THE
FEAR OF OURSELVES AND AGEISM
ALLOWS YOUNGER GENERATION AND
OLDER PEOPLE DIFFERENT FROM
THEMSELVES THEREBY REDUCING OWN
FEAR AND AGING AND THINK THAT
THE REASON I BELIEVE THAT
GEROSCIENCE IS OFTEN NOT CAUGHT
ON AS QUICKLY AS IT SHOULD. IT
IS OBVIOUS IN MANY WAYS AND
PARTLY BECAUSE OF THESE ISSUES
THAT MAY BE A BENEFIT AND
ANOTHER UNINTENDED BENEFIT OF
GEROSCIENCE IS IT MAY BE OR
MIGHT HELP COME UP WITH BETTER
WAYS DEALING WITH AGISM AND NONE
OF US IN SCIENCE COMMUNICATION
LEAVES TO COLLEAGUES AARP AND
OTHERS TO HELP US DEAL WITH THAT
AND ULTIMATELY CHALLENGE IS WHAT
EVERYBODY WANTS IS STOPPING THE
CLOCK WHEN IT COMES TO
ESPECIALLY WHEN IT COMES TO
ISSUES HAVING TO DO WITH
YOURSELVES AND PEOPLE CLOSE TO
YOU AND YOUR LOVED ONES AND IN
TERMS OF HOW WE DEAL IT, I THINK
MESSAGING AND IT WILL BE
ABSOLUTELY VITAL IN TERMS HOW WE
PROCEED. THANK YOU.
>>I WILL SPEAK TO YOU TODAY
FROM AN EDUCATIONAL PERSPECTIVE.
SO, IN ADDITION TO DOING ALL
KINDS OF FANTASTIC SCIENCE THAT
WE HAVE SEEN OVER THE PAST TWO
DAYS AND THAT IS WELL PUBLISHED
AND COMING UP WITH STRIKING DATA
AND IN PRECLINICAL MODELS THAT
IS HOPEFULLY IN CONTROLLED
TRIALS AND WHAT ELSE CAN WE DO
TO ATTRACT OUR COMMUNITIES TO
GEROSCIENCE?
SO, I'M GOING TO PROPOSE
SOMETHING TODAY THAT WE CAN
HOPEFULLY HELP ACCOMPLISH THAT.
ONE THING I LEARNED AS AN
EDUCATOR, WE INCREASED
LIKELIHOOD THAT PEOPLE WILL
RECALL AND USE WHAT WE TEACH BY
ENGAGING PRIOR KNOWLEDGE AND
CONNECTING NEW INFORMATION TO
PRIOR UNDERSTANDING.
SO, WHAT DO OUR CLINICIANS AND
OLDER ADULTS AND MEDICAL
STUDENTS AND CARETAKERS AND
OTHERS ALL KNOW THAT CAN HELP
THEM UNDERSTAND POTENTIAL OF
GEROSCIENCE WE ALL SEE IN OUR
GROUP AMONGST OURSELVES TODAY?
ON DAY 1, SEVERAL PROPOSED
INVITING ALIENS.
I WON'T DO THAT.
HOWEVER, I PROPOSE TAKING US ALL
BACK TO THE 1900S.
AS YOU CAN SEE IN THE GRAPH ON
THE TOP-LEFT CORNER, DISEASES
THAT WERE KILLING PEOPLE IN THE
EARLY 1900S WERE MOSTLY
COMMUNICABLE DISEASES AND THINGS
LIKE PNEUMONIA AND TUBERCULOSIS
AND DEP THEERIA WERE ALL KINDS
OF BACTERIAL AND VIRAL DISEASES
KILLING SO MANY PEOPLE.
YOU WERE LUCKY TO LIVE TO BE 47.
MAYBE THAT IS THE AVERAGE
LIFESPAN THEN.
IT WAS COMMON FOR A WOMAN TO DIE
IN CHILDBIRTH. A LOT OF PEOPLE
OR CHILDREN DIED BEFORE THEY
WERE FOUR YEARS OLD AND THAT HAS
CHANGED DRAMATICALLY AS YOU CAN
SEE NOW IN THE GRAPH ON THE
BOTTOM LEFT WHERE NOWADAYS
THINGS LIKE HEART DISEASE AND
CANCER HAVE REPLACED COMMUNIC
KABL DISEASES AS MAIN REASONS
FOR HUMANS DYING AND ON GRAPH ON
RIGHT FOR DISEASES IN UNITED ST
AND HOW IT QUICKLY DECLINED AND
MAIN FACTOR THAT HELPED THAT IS
THE DISCOVERY OF GERMS AND HOW
CLEAN WATER AND CLEAN FOOD ARE
IMPORTANT.
THEY WOULD HELP US, I GUESS,
LIVE LONGER AND STAY HEALTHIER.
AND SO THIS BRINGS ME TO A
COMPARISON I LIKE TO TALK TO
PEOPLE IN MY COMMUNITY AND
PEOPLE WHO ARE NONSCIENTISTS AND
THAT MAKE THIS COMPARISON.
I COMPARE TO THEM THE GERM
THEORY OF DISEASE, SOMEBO. PEOD
OUT GERMS WERE RESPONSIBLE FOR
MOST DISEASES KILLING PEOPLE.
WE FOUND SOLUTIONS AND WHEN WE
HAVE KNOWLEDGE AND INFORMATION
THAT SCIENTISTS FOUND OUT ABOUT
THINGS LIKE CLEAN WATER AND FOOD
AND MENTIONED HAND WASHING AND
STERILIZATION AND EVENTUALLY
ANTIBIOTICS WERE SOLUTIONS TO
MITIGATE THAT AND CAUSE OF DEATH
SHOWN IN THE PREVIOUS GRAPHS,
CHANGED FROM COMMUNICABLE
DISEASES TO OTHER TYPES OF
DISEASES.
SO, MY HOPE FOR THE GEROSCIENCE
HYPOTHESIS IS PEOPLE WILL BE
ABLE TO SEE THAT AS WE HAVE DONE
THIS ONCE, AND IXPROVED
INCREASED LIFESPAN WE CAN
HOPEFULLY NOW INCREASE HEALTH
SPAN. WE NOW HAVE EVIDENCE THAT
DISREGULATION OF BIOLOGICAL
MECHANISMS CAUSES DISEASES
REDUCING HEALTH SPAN AND
HOPEFULLY WE CAN START TO TEST
SOLUTIONS TO TARGET BILOGICAL
MECHANISMS.
AS A EXAMPLE THAT WE ALL KNOW
ABOUT SENOLYTICS TO GET RID OF
SENESCENCE CELLS IS ONE WAY AND
RESTORING -- AND INFLAMMATION
AND FIBROSIS ARE SOME WAYS THAT
ARE PROPOSE TODAY TARGET
BILOGICAL HALLMARKS OF AGING
THAT YOU HEARD MUCH ABOUT OVER
THE LAST TWO DAYS AND FINALLY
APOLOGIZE FOR THIS VERY BUSY
SLIDE THAT I FIND THIS ARTICLE
TO BE VERY INTERESTING AND VERY
RELEVANT TO THIS SESSION THAT
I'M SPEAKING TODAY.
THIS IS AN ARTICLE THAT WAS
CALLED BURDEN OF DISEASE AND
CHANGING TASK OF MEDICINE AND
AUTHORS IN THE ARTICLE IS
REVIEWING 200 YEARS OF ARTICLES
ABOUT DISEASES THAT HUMANS WERE
FACING AND CAME UP WITH THIS
LIST, I GUESS THIS PARAGRAPH
THAT WAS TAKEN WORD FOR WORD
FROM THE ARTICLE AND WOULD LIKE
US TO THINK ABOUT WHAT THEY
WROTE IN TERMS OF BY REPLACING
AGING WITH DISEASE.
I THINK WHAT WE HEARD IN THE
LAST TWO DAYS KIND OF SHOWS THAT
WE STILL HAVE TO DEFINE THINGS
THAT ARE IN THE SAME WAY THAT
THEY HAVE DEFINED IT FOR DISEASE
HERE. WE NEED TO DO THAT FOR
AGING.
SO, THEY SAY THAT DISEASE IS
ALWAYS GENERATED, EXPERIENCED
DEFINED AND AMELIORATED WITHIN A
SOCIAL WORLD. WE HAVE HEARD A
LOT ABOUT THAT IN THE PAST TWO
DAYS IN RELATIONSHIP WITH AGING.
PATIENTS NEED NOTIONS OF DISEASE
THAT EXPLICATE THEIR SUFFERING.
WE ALSO NEED NOTIONS OF AGING
THAT CAN EXPLICATE SOME OF THEIR
SUFFERING AS THEY GET OLDER AND
DOCTORS NEED THEORIES OF
ETIOLOGY AND PATHOPHYSIOLOGY
THAT CAN THE FOR THE BURDEN OF
DISEASE AND INFORMED THERAPEUTIC
PRACTICE AND POLICYMAKERS NEED
REALISTIC UNDERSTANDINGS OF
DETERMINANTS OF DISEASE AND
MEDICINE'S IMPACT IN ORDER TO
DESIGN SYSTEMS THAT FOSTER
HEALTH AND HISTORY OF DISEASE
OFFERS CRUCIAL INSIGHTS INTO
INTERSECTIONS OF THESE INTERESTS
THAT ARE WAYS THAT THEY CAN
INFORM MEDICAL PRACTICE AND
HEALTH POLICY. WORK WE ARE
DOING WITH GEROSCIENCE AND
GEROSCIENCE HYPOTHESIS. WE CAN
HOPEFULLY BEGIN TO ANSWER SOME
OF THESE QUESTIONS TO HELP OUR
COMMUNITIES UNDERSTAND OUR
VISION FOR GEROSCIENCE AND WHERE
IT CAN TAKE US WHERE HOPEFULLY
IN ANOTHER 100 YEARS WE ARE
FACING VERY DIFFERENT ISSUES AS
HUMANS.
THANK YOU.
>>[APPLAUSE].
>>HELLO. I'M DANIEL PARKER AND
GERIATRICIAN AT DUKE. IT HAS
BEEN FUN AND IMPRESSIVE TO SEE
EXCITING WORK THAT EVERYONE IS
DOING ON PUSHING THIS FIELD
FORWARD.
AND I'M ALSO REALLY THANKFUL TO
WORK THAT GEORGE AND PEOPLE ARE
DOING TO EXPAND THE WORKFORCE.
I WILL COMMENT ON TODAY HOW
GEROSCIENCE AND GEROPROTECTIVE
INTERVENTIONS WILL EFFECT
PRACTICE OF JERAT TRICKS AND
THINK THAT GEROSCIENCE OFFERS
OPPORTUNITIES FOR JERAT TRICKS
AND AS WELL AS CHALLENGES. IF
YOU GO ONLINE YOU CAN FIND A
WEBSITE WITH PRESCRIPTION FOR
MET FOR MIN AND [INDISCERNIBLE]
IN AS LITTLE AS 15 MINUTES
GEROSCIENCE PROTECTIVE
STRATEGIES ARE OUT THERE EVEN IF
NOT EVIDENCE BASED THAT IS
CONSIDERATION FOR PERHAPS MORE
ENTREPRENEURIAL COLLEAGUES THAT
ARE WORKING IN THIS SPACE AND
I'M AFRAID THAT WE WILL LOSE OUR
CLAIM TO THIS TURF.
IF IT ENDS UP BEING DOMAINS OF
ONLINE SERVICES AND, YOU KNOW,
PERHAPS A LITTLE BIT LESS SKRUP
YOU'LLOUS PROVIDERS WILL
STIGMATIZE FIELD AND POTENTIALLY
SET US BACK IF HARMS TO
TREATMENTS AND SAW ADVERTISEMENT
ON INSTAGRAM YOU COULD GET AT
HOME KETAMINE TREATMENT FOR YOUR
SEVERE DEPRESSION AND IS A BRAVE
NEW WORLD OUT THERE WITH RESPECT
TO SOME OF THESE TREATMENTS AND
THINK, YOU KNOW, IN GERIATRICS
WE CERTAINLY HAVE A PIPELINE
ISSUE. I THIS I IT WILL POSE A
CHALLENGE TO US REALLY BECOMING
LEADERS IN THIS FIELD.
AT THIS SAME TIME, IT IS A
TREMENDOUS OPPORTUNITY AND WHAT
WE HAVE TREATMENTS
EVIDENCE-BASED AND EFFECTIVE, IT
WILL EXCITE TRAINEES AND
MOTIVATE THEM TO GO INTO
GERIATRICS AND THINK WE HAVE TO
CLAIM IT.
I THINK IT HAS TO BE OUR KIND OF
AREA AND IT SHOULD BASED ON OUR
EXPERTISE AND COMFORT AND
COMPLEXITY IN WORKING WITH
PATIENTS WITH LOTS MORE MEDICAL
COMORBIDITIES AND WHAT HAS TO
HAPPEN IS A BIT OF A CULTURE
CHANGE IN GERIATRICS AND CULTURE
OF JER TRICKS IS WONDERFUL AND
ATTRACTED ME TO THE FIELD AND
THINK OF IT AS A FORCE IN
MEDICINE AND WE HAVE BEEN REALLY
FOCUSED ON THINKING ABOUT HARM.
THINKING ABOUT COMPLEXITY AND
THINKING ABOUT THE BIG PICTURE
AND HOLISTIC CARE OF OUR
PATIENTS AND KIND OF PUSHING
BACK OR MITIGATING SOME OF THE
NEGATIVE ASPECTS OF PERHAPS
UNINTENDED CONSEQUENCES OF
CURRENT KIND OF MEDICAL SYSTEM.
SO, HOW DO WE SHIFT FROM, YOU
KNOW, BEING A CULTURE THAT IS
REACTIVE TO SOME DEGREE THAT IS
FOCUSED ON DEPRESCRIBING AND
PERHAPS PROTECTING OUR, YOU
KNOW, MOST VULNERABLE PATIENTS
FROM SOME NEGATIVE CONSEQUENCES
OF HEALTH CARE DELIVERY SYSTEM
TO SHIFTING FOCUS TO BEING
PROACTIVE AND PERHAPS ENGAGING
PATIENTS THAT ARE WELL AND DON'T
HAVE LOTS OF MEDICAL
COMORBIDITIES THAT WOULD BENEFIT
FROM SOME INTERVENTIONS THAT IS
A REAL CHALLENGE. I DON'T HAVE
THE ANSWER TO THAT. YOU KNOW, I
WONDER IF IT IS FEASIBLE TO SET
UP CLINICS NOW GIVEN WORKFORCE
ISSUES AND IS THERE ACTUALLY A
BUSINESS MODEL THAT WOULD
SUPPORT CLINICS LIKE THIS AT
ACADEMIC INSTITUTION WHERE'S
THERE IS EXPERTISE TO REALLY USE
THESE INTERVENTIONS RESPONSIBLY
AND THINK IT IS AN EXCITING TIME
AND AS A PROFESSION WE HAVE TO
FIGURE OUT THE ANSWER TO SOME OF
THESE QUESTIONS.
I THINK WHEN WE DO THAT IT WILL
DEFINITELY HELP US WITH OUR
WORKFORCE ISSUES AND A COLLEAGUE
IS A RHEUMATOLOGIST AND SHARED
THERE ARE ISSUES GETTING PEOPLE
TO GO INTO RHEUMATOLOGY AND WHAT
TNF INHIBITORS COME OUT THEY ARE
ACTUALLY MOLECULARLY TARGETED
DISEASE MODIFYING THERAPIES FOR
CONDITIONS THEY SAW UPTICK IN
INTEREST IN THE FIELD AND IS
MANY I HOPE THAT WE WILL SEE
SOMETHING SIMILAR WITH
GERIATRICS WHEN WE HAVE
THERAPIES THAT ARE AVAILABLE.
YOU KNOW, AND SUPPORTED BY THE
EVIDENCE.
YEAH. I WOULD APPRECIATE
PEOPLES THOUGHTS HOW WE CAN KIND
OF CLAIM THIS TURF SO THAT IT IS
NO THE JUST A MONEY-MAKING
ENTERPRISE FOR ONLINE DOCTORS.
THANK YOU.
>>[APPLAUSE].
>>I WANT TO THANK ORGANIZERS
AND NIH STAFF FOR LEADING THIS
AND MAKING THIS ACCESSIBLE FOR
THEIR SPEAKERS.
I'M REALLY EXCITED BY WHAT I
HAVE HEARD TODAY.
I WANTED TO JUST TALK ABOUT DR.
-- TALKING ABOUT WHAT IS IT, YOU
KNOW?
AND TRYING TO PUT THAT, THE
WHAT. IF IT IS GEROSCIENCE, THE
WHAT IS POTENTIALLY LONGEVITY
AND HOW DO WE GET THERE AND
THANKING NOT ONLY ORGANIZERS BUT
NATIONAL ACADEMY OF MEDICINE AND
DR. [INDISCERNIBLE] WHO LED THE
GLOBAL ROAD MAP OF LONGEVITY
RELEASED ABOUT A YEAR AGO AND
CO-CHAIRS OF THE COMMISSION DR.
LINDA FROOED OF COLUMBIA
UNIVERSITY AND DR. JOHN WONG OF
NATIONAL UNIVERSITY HOSPITAL OF
SINGAPORE AND COMMISSION CHAIR
AND WANT TO TRY TO PUT ALL THIS
IN THE CONTEXT OF THIS CONSENSUS
REPORT.
SO, NO DISCLOSURES OTHER THAN
ARP IS A PRINCIPLE FUNDER OF THE
GLOBAL ROADMAP.
ROADMAP DEFINES HEALTH LONGEVITY
WHEN YEARS OF GOOD HEALTH
APPROACH BIOLOGICAL LIFESPAN
WITH WELL BEING THAT ESTABLISHES
2050 AS A TARGET YEAR TO ACHIEVE
THIS GOAL GLOBALLY. IF YOU
THINK YOU ARE AMBITIOUS THINK OF
GLOBAL HEALTH AND LONGEVITY AND
THAT NO SOCIETY HAS ACHIEVED IT
YET. IT IS ACHIEVABLE.
I THINK CONVERSATIONS WE HAVE
HAD TODAY HELP ME THINK ABOUT
HEALTH LONGEVITY GLOBALLY AND
NEUROSCIENCE SPECIFICALLY HAVE
POTENTIAL TO WORK TOGETHER. IF
YOU THINK ABOUT THE 5MS THAT DR.
FORMAN TALKED ABOUT THAT WERE
PROPOSED BY DR. TEN ETTI THEY
ARE OVERARCHING FIVE PRINCIPLES
OF HEALTH AND LONGEVITY THAT
GLOBAL WORLD ROAD MAP HAS
PROPOSED AND SEEING TODAY PEOPLE
OF OLD AGES AND OLDER ADULTS
REACHING FULL POTENTIAL AND
HEARD LECTURES ABOUT HOW TO PROG
NOFT INDICATE WHO WOULD BENEFIT
MOST FROM SURGERIES AND
PROCEDURES AND IN TERMS OF
PREDICTING, PREDICTION IS MUCH A
PART OF WHAT GEROSCIENCE IS
TODAY AND TALKING ABOUT SIZE AND
BEST HEALTH AND FUNCTIONING OF
INDIVIDUALS AT ALL AGES.
AT ARPRCO JAIN JENKINS TALKS --
SECOND 50 IS WHAT SOCIETY
PERCEIVES THAT AGE SHOULD MEAN
AND DR. KER SHELL TALKS ABOUT
AGEISM AS WELL; RIGHT?
GEROSCIENCE HAS POTENTIAL TO
REDEFINE 50 BEING 50 AND 90
BEING 90 AND IF YOU THINK ABOUT
WHEN WE NEED TO HAVE
INTERVENTIONS, 40 BEING NEW 40;
RIGHT?
I THINK IT IS SOMETHING OR 12
BEING NEW 12. THIS EFFECTS ALL
OF US ACROSS ALL LIFE STAGES AND
I'M REALLY HEARTENED BY WHAT DR.
WHITMAN STARTED WITH THIS FIRST
SESSION THE FIRST DAY WITH
ISSUES OF DISPARITIES THAT IS
CENTRAL TO WHO IS TAKING
OFF-LABEL, YOU KNOW, GEROSCIENCE
TREATMENTS HAVING EFFECTIVE
TREATMENT GETTING TO ENTIRE
OLYMPIC TEAM WHAT WOULD EFFECT
BE? NOT THAT MUCH; RIGHT?
ACCESSIBLE MENTIONED EARLIER BY
THOSE IN INTRODUCTION IF
INTERVENTIONS THAT ARE EFFECTIVE
AND TAKEN BY PEOPLE WITH ACCESS
TO GOOD HEALTH CARE AND
RESOURCES WE HAVE POTENTIAL TO
WORSEN DISPARITIES THROUGHOUT
THE COUNTRY AND THE WORLD AND IS
ALSO HUGE FINANCIAL BENEFIT OF
POTENTIAL FOR ECONOMIC IMPACT OF
GEROSCIENCE. FINALLY, DATA.
ONE THING THAT IS INTERESTING IS
THAT THE COMMISSION WASN'T ABLE
TO COME UP WITH GLOBAL
DEFINITION OF HEALTHY LONGEVITY
AND THEY RAN OUT OF TIME AND
HERE TODAY WE ARE TALKING ABOUT,
YOU KNOW, WHAT ARE BIOMARKERS
FOR GEROSCIENCE AND TALKING
ABOUT ODOMETER AND SPEEDOMETER
AND ALL ASKING THE VERY SIMILAR
QUESTIONS.
SORRY GOING BACK.
SO, TO ACHIEVE THIS IN 2050,
THESE ARE SUPPORTING STRUCTURES
AND FIVE SUPPORTING STRUCTURES
LISTED HERE AND LIST
RECOMMENDATIONS THAT COMMISSION
HAS AND WON'T GO OVER ALL OF
THEM. THEY BECOME, YOU KNOW,
COMPLETED IN THE NEXT, YOU KNOW,
5 TO 10 YEARS IF WE HAVE -- WE
WILL HAVE GLOBAL HEALTH
LONGEVITY IN 2050. THESE ARE
FOUR DOMAINS OF ALL OF THE
COMMISSION RECOMMENDATIONS AND
AS WE TALK ABOUT SOCIAL
INFRASTRUCTURE, AGEISM IS
ESSENTIAL; RIGHT?
MENTIONED EARLIER HOW
PERCEPTIONS OF AGING COULD
SOMETIMES PREDICT FUTURE HEALTH
COURSE AND PERCEPTIONS OF AGING
ARE DOCTORS THAT TOGETHER YOU
CAN SEE PERCEPTIONS OF AGING
MODULATE RISK FACTORS FOR
COGNITIVE DECLINE AND DEMENTIA
AND IN TERMS OF SOCIAL
INFRASTRUCTURE. YOU KNOW, YOU
KNOW, DR. WHITSON, YOU TALKED
ABOUT RESILIENCE AND SO MUCH
RESILIENCE IS COMMUNITY AND
CAREGIVERS AND FAMILY AND PEOPLE
THAT PROCEDURES OCCUR WITHIN AND
HOW WE MEASURE THAT AND HOW WE
HAVE INTERSECTION BETWEEN SOCIAL
INFRASTRUCTURE AND PHYSICAL
ENVIRONMENT AND THINKING ABOUT
PHYSICAL ACTIVITY AND DIET IS
VERY MUCH PART OF IT. CAN
GEROSCIENCE THEN MEASURE OR
POTENTIALLY MOTIVATE PEOPLE TO
CONTINUE THESE INTERVENTIONS
MUCH LIKE IT MIGHT -- OR
ACTIVITY MONITOR MIGHT, YOU
KNOW, PROMOTE AN INDIVIDUAL TO
MAINTAIN PHYSICAL ACTIVITY.
COULD A GEROSCIENCE PEDOMETER
THAT TELLS YOU HOW YOUR -- YOUR
CURRENT PACE OF AGING IS EFFECT
HOW YOU MIGHT RESPOND TO
INTERVENTIONS.
YOU KNOW, AND I THINK THAT THIS
IDEA OF DR. FORMAN MENTIONED
THIS IDEA OF INFLAMMATORY AGING
AND PHYSICAL ENVIRONMENT IS VERY
MUCH A KEY PART OF THAT AND
HEARD EARLIER THIS WEEK ABOUT
EXPERIENCE AND CARDIOVASCULAR
DISEASE IN SUBSISTENCE FARMING
COMMUNITY AND HOW WE
AUTOMATICALLY FEEL THAT WE SEE
IN OUR OWN SOCIETY DISCUSSION
INFLAMMATION AND HEART DISEASE
MAY NOT ALWAYS BE THE CASE
DEPENDING ON PROOIR EXPOSURE TO
THE MICROBIOME THAT YOU LIVE
WITH AND GREW UP WITH. FINALLY,
JUST TALKING ABOUT HEALTH
SYSTEMS AND THIS IS CREATING A
CRITICAL PART OF THIS. WE
TALKED ABOUT HOW JERAT TRICKS
CAN INFORM THE HEALTH CARE
SYSTEM AND HOW IT CAN INFORM
GEROSCIENCE AND HOW GEROSCIENCE
CAN DO REVERSE AS WELL.
IF WE ARE, AGAIN, ABLE TO BETTER
PREDICT BETTER INTERVENTIONS AND
TALKING ABOUT R25 AND TALKING
ABOUT GEROSCIENCE TURNING AROUND
CREATING NEXT GENERATION OF
GERIATRICIANS AND NEXT
GENERATION OF PHYSICIANS AND
NURSES AND PROVIDERS.
SO, I REALLY JUST WANTED TO END
WITH THIS CHARGE THAT JOE AN
JENKINS CIO AND ARP CO-CHAIR
NATIONAL OVERSIGHT BOARD GLOBAL
ROADMAP AND PANDEMIC FIRST
INAUGURAL HEADQUARTERS AND
PEOPLE TODAY ARE LIVING LONGER
THAN EVER BEFORE AND THOSE EXTRA
YEARS WOULD BE GOOD ONES
SOCIETIES AND ECONOMIES AROUND
THE WORLD WOULD BENEFIT
POPULATION AGING DEPENDS THAT
MULTIPLE STAKEHOLDERS WOULD TAKE
ON AND WHAT YOU HAVE ALL TAKEN
ON AND AS DR. PARKER SAID, YOU
HAVE TO CLAIM IT. WITH THAT,
THANKS VERY MUCH FOR BEING IN
ATTENDANCE AND NEXT STEP IS
HAVING SPEAKERS AND PANELISTS
COME UP.
>>[APPLAUSE].
>>>>I'M NOT SURE WHO IS IN
CHARGE HERE. I SEE A QUESTION.
>>THANK YOU. SOPHIA FROM
ALBERT EINSTEIN COLLEGE OF
MEDICINE. I HAVE MORE OF A
COMMENT RATHER THAN A QUESTION.
I WOULD LOVE TO HEAR YOUR INPUT
ON THIS.
SO, I THINK EFFORTS THAT YOU ARE
ALL MAKING IN SPREADING THE
GOSPEL OF GEROSCIENCE AND
EDUCATION IS VERY IMPORTANT. I
WOULD ALSO CAUTION YOU TO NOT
KEEP IT SILOED WITH GERIATRICS.
THERE ARE -- THE REALITY IS,
RIGHT, MOST OLDER ADULTS ARE NOT
TAKEN CARE OF BY GERIATRICIANS.
THAT IS THE WAY IT IS. I'M AN
ENDOCRINOLOGIST AND SEE LOTS OF
ADULTS AND PHYSICIANS IN THE
ROOM ARE SUBSPECIALISTS. IT IS
IMPORTANT I THINK FOR THE ENTIRE
MEDICAL COMMUNITY TO BE AWARE OF
GEROSCIENCE.
I LIKE EFFORTS BEING DONE TO
INTRODUCE IT INTO MEDICAL SCHOOL
AND MEDICAL STUDENTS AND REALITY
IS WHEN I TRAIN AND SUSPECT IT
IS THE SAME PHYSIOLOGY OF AGING
IS NOT TAUGHT; RIGHT?
THERE IS PHYSIOLOGY OF
CARDIOVASCULAR SYSTEM AND
ENDOCRINOLOGY BUT IS NO FIZZ YOL
OF AGING.
THERE IS EVERY SYSTEM THAT
EXPERIENCES THAT; RIGHT?
ENDOCRINOLOGY WE KNOW ENDOCRINE
SYSTEM AGES AND CHANGES AND WAY
YOU TREAT OLDER ADULT WITH
ENDOCRINE CONDITION IS DIFFERENT
AND REALLY HOPE WE CAN SPREAD
THIS EVERYWHERE. WE ARE TRYING
TO DO THAT SO THAT THERE IS
TEXTBOOK ON ENDOCRINE DISEASES
WILLIAM'S TEXTBOOK OF
ENDOCRINOLOGY.
THIS YEAR ACTUALLY I'M
[INDISCERNIBLE] AND WE ARE
TASKED WITH WRITING CHAPTER ON
ENDOCRINOLOGY AND AGING AND
CHAPTER TALKED ABOUT THINGS
GOING WRONG WITH AGING AND TAKEN
GEROSCIENCE APPROACH TO DESCRIBE
CHANGES THAT ARE CURRENT AND
WHEN ATHEY NEED AND WHAT FUTURE
HOLDS AND IS COMMENT ON REALLY
TRYING TO NOT KEEP IT SILOED IN
JERAT TRICKS.
>>CAN YOU HEAR ME OKAY? I
AGREE AND DAN CAN SPEAK TO
GERIATRIC CARD YOL. YOU ARE
ABSOLUTELY RIGHT. HAS TO
INCLUSIVE. IT WILL BE. IN
TERMS OF R25 GRANT REASON WE
FOCUS ON THOSE THREE GROUPS OF
LEARNERS IS SIMPLY BAND WIDTH
AND SMALL SHORT THREE-YEAR GRANT
THAT WE HAVE TO FOCUS AND THAT
ABSOLUTELY NEEDS TO BE EXPANDED
TO OTHER DISCIPLINES AND WANT TO
ECHO SENTIMENT AND TO EMPHASIZE
THAT WITHIN CARD YOL AND ALSO
WITHIN CANCER AND MANY OTHER
DISEASE STATES THERE IS MORE AND
MORE THE UNDERSTANDING THAT
AGING IS REALLY HARDWIRED TO
PHYSIOLOGY OF DISEASE THAT IS
LIFELONG AND TRAJECTORIES OF
AGING ARE RELEVANT FROM YOUNG TO
OLD AGE AND THINK THAT WHAT YOU
ARE SAYING HAS OR IS STARTING
AND TEXTBOOKS HAVE GERIATRICS
WITHIN CARDIOLOGY IS ONE CHAPTER
AND COMING FROM JOURNALS AND NIA
IS EFFORT TO TRY TO START IT AS
PART OF EVERY OTHER ASPECT OF
CARD YOL AND DISEASE AS
INTEGRATIVE CONCORRECT. THANK
YOU.
>>I WILL ISSUE GOING YONG
MEDICINE IN TERMS OF PHYSICIANS
SPECIFICALLY AND INCLUDING
NURSES AND INCLUDING DENTISTS
AND EVERYONE WHO TAKES CARE OF
THE WHOLE PERSON.
MANY TIMES PHYSICIANS ARE NOT
NECESSARILY ALWAYS THE MOST
TRUSTED PERSON IN THE CARE TEAM
AND MIGHT BE SOCIAL WORKER AND
NURSE.
>>I THINK IN ANOTHER WAY WE ARE
TRYING TO DO WHAT YOU ARE SAYING
THAT IS BY TALKING ABOUT THESE
HALLMARKS OF AGING AS SEEN IN
SURVIVORS OF HIV OR SURVIVORS OF
CHILDREN WITH RADIO THERAPY, ET
CETERA, AS CHILDREN. WE ARE
REALLY TRYING TO SHOW HOW
GEROSCIENCE WILL PLAY A ROLE IN
POPULATIONS THAT ARE NOT JUST
GERIATRIC POPULATIONS.
>>SO, I THINK AN IMPORTANT
POINT WAS RAISED IN THE FIELD IN
GENERAL, LONGEVITY FIELD.
CERTAINLY, THERE IS MANY
DIFFERENT SPECIALTIES THAT COULD
TRY TO PROPPO GATE GR SCIENCE
TEACHING BUT CERTAINLY HAS BEEN
TAKEN UP AND PRETTY MUCH
HIJACKED BY A WHOLE DIFFERENT
GROUP THAT IS THE ONLINE
INFLUENCERS AND FITNESS GURUS
AND SOME SCIENTISTS WHO PROBABLY
MAY NOT HAVE A LOT OF CLINICAL
TRANSLATION AND ARE LOTS OF
PEOPLE OUT THERE THAT PROPAGATE
THESE QUOTE ON QUOTE LONGEVITY
HACKS THAT ADD ON SOME OTHER
SPECIAL QUALITIES TO IT LIKE
DETOXIFICATION AND IMMUNE
BOOSTING AND ALL THAT. I THINK
AT LEAST FOR ME I'M PERSONALLY
CONCERNED IT HAS GONE ON TO
BECOME THIS SORT OF QUACKERY
SCIENCE ONLINE. LOTS OF PEOPLE
ARE BUYING INTO THIS. PEOPLE
ARE TAKING A --
>>[INDISCERNIBLE].
>>HOLD ON.
>>>>OKAY.
>>YEAH. THERE IS A LOT OF
PEOPLE ONLINE TAKING ADVANTAGE
OF THIS AND GULLIBLE MINDS OF
LOTS OF PEOPLE ONLINE THEY ARE
SELLING PORTIONS THAT CONTAIN A
LOT OF SUPPOSED LONGEVITY
COMPOUNDS AND THEY ARE MAKING
MILLIONS OUT OF IT. I
PERSONALLY AM CONCERNED ABOUT
ETHICS OF THESE PRACTICES AND
WANT TO KNOW ABOUT THE PANEL AND
HOW AWARE THE SCIENTIFIC
COMMUNITIES ABOUT THESE
PRACTICES AND WHAT COULD BE
POTENTIAL STRATEGIES TO MITIGATE
TH
THIS.
>>I WILL ATTEMPT A FIRST ANSWER
TO THAT.
PART OF OUR JOB IS ALSO
DEBUNKING A LOT OF WHAT YOU ARE
SAYING.
AND I THINK THAT THIS IS NOT A
NEW PROBLEM WITH AGING RESEARCH
EITHER.
SO, I THINK THAT BECAUSE
GEROSCIENCE REALLY HOLDS --
HOLDS, I THINK, SOME, YOU KNOW,
PROMISE TO DO SOME VERY
IMPORTANT THINGS.
I THINK THAT WE NEED TO MOVE
FORWARD VERY CAREFULLY WITH
INSIGHT INTO WHAT OTHER PEOPLE
ARE DOING OUTSIDE OF THE FIELD.
AND TO, AGAIN, IT IS AN
EDUCATION AND DISSEMINATION TASK
TO NOT ONLY TELL PEOPLE WHAT THE
EVIDENCE IS AND IS NOT.
ALSO, TO BE -- TO DEBUNK AND TO
CAUTION PEOPLE ABOUT THINGS THAT
ARE SORT OF OUTSIDE OF THE
EVIDENCE BASE.
>>AND JUST TO ADD TO THAT, CAN
YOU HEAR ME OKAY? ADDING A
NUMBER OF LONGEVITY CLINICS
OPENED IN THE WORLD IN RECENT
MONTHS AND YEARS AND YOU MIGHT
HAVE HEARD ABOUT THAT AND THINK
THERE IS A PLACE FOR THAT AND
OFFERING MY PERSONAL OPINION AND
SPEAKING ON OWN BEHALF AND MANY
PROFESSIONAL SOCIETIES AND NOT
SPEAKING ON BEHALF OF ANY OF
THEM AND MY PERSONAL VIEW IS
THAT PRACTICE OF GERIATRICS
WITHOUT PREVENTION IS
INCOMPLETE.
AND -- AND MISGUIDED.
AND PREVENTION, FOCUSING ON
LONGEVITY IN HEALTHY INDIVIDUALS
WITHOUT EXPERTISE AND IN
INTEREST OF TAKING CARE OF
INDIVIDUALS THAT SUFFER FROM
DISEASES THAT OCCUR AND
MORBIDITIES THAT OCCUR WITH
AGING IS ALSO A MISGUIDED AND
INCOMPLETE AND WE NEED TO BRING
THE TWO TOGETHER, I THINK. I
WILL USE ANALOGY IF YOU WANT TO
SEE A CANCER OR CARDIAC
SPECIALIST THAT FOCUSES ON
PREVENTION AND NEVER SEEN A CASE
THEY ARE TRYING TO PREVENT OR
SOMEONE WHO ONLY FOCUSES OR
DEALS WITH COMPLICATIONS BUT
NEVER HAS THOUGHT ABOUT
PREVENTION AND THINK THAT TWO
PERSPECTIVES NEED TO BE BROUGHT
TOGETHER AND IS MY POINT OF
VIEW.
>>I WOULD LIKE TO MAKE AN
ADDITIONAL POINT AND ONE THING I
HAVE REALLY BEEN LEARNING I
THINK FROM GEORGE AND JIM AND
OTHERS ABOUT VALUE OF NETWORKS
OF RESEARCH THERE IS A -- YOU
KNOW STANDARDS WHAT IS A
MEANINGFUL CHANGE AND TARGET OF
AGING AND SENSE OF PROCESS THAT
IS RIGOROUS THAT MAKES OUTCOMES
MEANINGFUL AND WHEN YOU SEE
SOMETHING ONLINE THAT THERE IS
SOME METRIC WITH NO CONTEXT, IT
COULD BE VERY CONFUSING AND
CURIOUS TO HEAR FROM JORNL AND
OTHERS THAT ARE LEADING THESE
EFFORTS AND NOTION OF HAVING A
STANDARD AND DATA INTEGRATED
WITH ARTIFICIAL INTELLIGENCE AND
BIG DATA THAT PROVIDE REALLY
MEANINGFUL OUTCOMES FOR ME AS A
RESEARCHER AND PATIENT AS A
CONSUMER THAT I THINK IS PART OF
NOTIONS OF QUALITY ENDPOINTS
THAT WILL BE MORE MEANINGFUL.
>>CAN YOU HEAR ME?
>>ONLINE WORLD AND BLOGS AND
STUFF CAN BE SCARY AND HELP SEND
OUT WRONG INFORMATION AND BE
ALSO USEFUL. I THINK AS
SCIENTISTS OUR ROLE WILL BE TO
MAKE SURE THAT WE ALSO GET THE
RIGHT KIND OF INFORMATION OUT
THERE SO PEOPLE CAN FIND BOTH
NOT JUST TALK BEING SCIENCE AND
MEETINGS, ET CETERA. SEVERAL
SCIENTISTS ARE MAKING EFFORTS TO
MAKE TIKTOK VIDEOS, ET CETERA
AND YOUTUBE VIDEOS TO HELP SEND
CORRECT INFORMATION SO PEOPLE
ARE HOPEFULLY ABLE TO FIND THE
RIGHT INFORMATION AS WELL JUST
AS THEY ARE FINDING THE WRONG
INFORMATION THERE WILL ALWAYS BE
SOMEONE TRYING TO SELL A SNAKE
OIL OUT THERE AND HOW IT HAS
BEEN FOREVER SO.
>>YEAH. CAT IS OUT OF THE BAG
WITH INTERNET AND PEOPLE HAVE
ACCESS TO TREMENDOUS AMOUNTS OF
INFORMATION AND ADDING AND
ACCURATELY APPLYING AND
INTERPRETING INFORMATION IS
ANOTHER QUESTION AND WE HAVE TO
COMPETE WITH SOURCES OF
INFORMATION AND MEANS BEING OUT
THERE AND PROACTIVE AND GIVING
PEOPLE AN ALTERNATIVE. IF THERE
IS A PRIVATE FOR PROFIT
LONGEVITY CLINIC AND HEALTHY
AGING CLINIC AT ACADEMIC MEDICAL
INSTITUTION WITH REPUTATION,
PEOPLE WILL GO TO THE NAME THEY
TRUST.
I THINK THAT ALTERNATIVE HAS TO
BE OWE TLUT. I THINK WE WILL
SEE MORE OF THIS AS, YOU KNOW,
GENETICS AND MILLENNIALS AGE.
THEY I THINK WILL HAVE GREATER
EXPECTATIONS OF HEALTHCARE AND
ACCESS TO INFORMATION AND LESS
OF A PATERNALISTIC RELATIONSHIP
WITH PROVIDER AND PROVIDER WHO'S
ARE MOREL TO WORK WITH THEM AND,
YOU KNOW, KIND OF LISTEN TO
THEIR IDEAS AND THINK WE HAVE TO
COMPETE AND NO WAY TO SHUT IT
DOWN OR STOP IT.
>>I WOULD LOVE TO CONTINUE IF
IN THIS CONVERSATION AND
TRAINING IN JER YA THE TRICK
MEDICINE AND AARP AND FOLLOW UP
WITH INVESTIGATORS IN THE ROOM
TACKLING ISSUES AND ELEVATING
WITH PROMISE OF OVERSELLING AND
PRESHURES OF UNDERMINING GOALS
OF GEROSCIENCE.
>>I WANT TO COMMENT REGARDING
SOMETHING GEORGE MENTIONED ABOUT
-- BECOMES RECOGNIZED AS A TERM
IN THE DICTIONARY AND WE HAVE
RESOURCES AND SHOULD START TO
INTRODUCE THE TERM EVERYWHERE BY
MENTIONING TERMINOLOGY AND
SPECIFICALLY GEROSCIENCE IN
PUBLICATIONS IN ORDER TO PUT
REPORTABLE IN SCIENTIFIC
JOURNALS AND MORE USING THE WORD
THAT MORE WORD IS CAPTURED BY
SCIENTIFIC AND CLINICAL
COMMUNITY. THIS IS SOMETHING
THAT IS MISSED SOMETIMES IN
PUBLICATIONS IS TERM GEROSCIENCE
IS NOT USED AS A KEY WORD. THIS
IS AN INVITATIONAL.
BECAUSE IN THE CASE, FOR
INSTANCE, IN THE JOURNAL OF
GERONTOLOGY, WE JUST TOGETHER WE
AS EDITORS OF BIOLOGICAL AND
MEDICAL SCIENCES, WE CONVERTED
OUT TRANS ISSUE AND
TRANSLATIONAL SECTION NOW WOULD
BE PERMANENT TRANSLATIONAL
SECTION IN JOURNAL AND THESE ARE
RESOURCES WE AS SCIENTIFIC
COMMUNITY COULD USE TO INTRODUCE
TERMINOLOGY AMONGST OUR
COLLEAGUES.
>>I TOTALLY AGREE. I WAS
REFERRING MORE TO THE DIFFICULTY
IN TALKING TO THE PUBLIC AND
WHEN EACH OF US TALKS TO MEDIA,
WE DON'T HAVE TO EXPLAIN TERM
CANCER OR HEART DISEASE BUT HAVE
TO ALWAYS BEGIN BY EXPLAINING
WITH GEROSCIENCES AND WONDERING
IF COLLEAGUES FROM AARP, FOR
EXAMPLE, HAVE THOUGHTS ON THAT.
WE ARE NOT EXPERTS ON MESSAGING
AND PERHAPS YOU MIGHT HAVE SOME
THOUGHTS.
>>YOU KNOW, I THINK IT IS A
GREAT QUESTION ABOUT HOW TO
ELEVATE PROMISE WITHOUT
OVERSELLING THIS THAT IT WILL BE
CRITICAL AND ACTUALLY I THINK
HAVING THIS CONVERSATION WITH
DR. KIRKLAND EARLIER THIS WEEK.
BECAUSE IF WE OVERSELL IT, WE
HAVE POTENTIAL TO UNDERMEAN WHAT
WE DO FINALLY HAVE I THINK AS
DR. WHITMAN SAID WHEN WE HAVE
GEROSCIENCE INTERVENTION AND IS
CONVERSATION TO CONTINUE WITH
INVESTIGATORS AND THOUGHT
LEADERS IN THIS MEETING.
>>HI. STEVE, WAKE FOREST. ON
THE VERY LAST TOPIC I WILL SAY
WHEN I FIRST START TODAY
SOCIALIZE THE TERM GEROSCIENCE
ASSOCIATE DEAN OF RESEARCH GREG
WHO IS SOPHISTICATED
CARDIOVASCULAR EPIDEMIOLOGISTS I
LOVE THE CONCEPT YOU HAVE TO
TELL US WHAT IT IS NO ONE KNOWS
WHAT IT IS THAT IS ABOUT FOUR
YEARS AGO AND POINT THAT I HAVE
AN OBSERVATION THAT I WOULD LIKE
TO SHARE AND SEE IF THIS
RESONATES WITH ANY OF THE PANEL.
WHEN PEOPLE -- WHEN I GOT TO
WAKE, PEOPLE APPROACH AENLING
CORRECTOR FROM SUBSPECIALTIES.
THINGS THEY DID FOR THAT
PERSON'S ORGAN WAS NOT MAKING
PERSON AS MUCH BETTER AS THEY
HOPED IT WOULD.
THEY TENDED TO BE OLDER PATIENTS
THAT I THINK THAT THERE HAS BEEN
A 100 YEAR INVESTMENT IN HEALTH
AND AS SEEN THROUGH THE LENS OF
OR BEGAN SPECIFIC UNDERSTANDING
AND JUST TREMENDOUS AMOUNTS OF
HEALTH GAINS THROUGH BETTER
UNDERSTANDING EXACTLY HOW THE
HEART AND KIDNEY WORKS AND MY
OBSERVATION IS HEALTH RETURNS ON
THAT VIEW ARE ASYMPTOTING AND WE
ARE NOT GETTING AS MUCH BANG FOR
THE BUCK IN THAT VERY SILOED
VIEW. I THINK MAYBE IF THAT
OTHER PEOPLE IF MAKING IT
EXPLICIT MIGHT DRAW OTHER PEOPLE
TO GEROSCIENCE THAT REALLY
PRESENTS AN ATTRACTIVE
ALTERNATIVE PARADIGM THAT MIGHT
BE MORE PRODUCTIVE AS SORT OF
THE VEINS OF THIS ORGAN-CENTRIC
WAY OF LOOKING AT HEALTH GET
PLAYED OUT.
SO --
>>I WILL COMMENT ON THAT. I
ABSOLUTELY THINK THAT, YOU KNOW
W HE ARE ALL SOMEWHAT STIEMIED
BY THE VERY SINGLE ORGAN OR
SINGLE DISEASE PARADIGM THAT HAS
BEEN OUT THERE FOR A LONG TIME
IN WESTERN MEDICINE AND THINK
WHEN I WAS THINKING OF YOUR
QUESTION, IT RAISES TO ME TOO
WHERE GEROSCIENCE AS A FIELD
APPLIED TO HUMANS WILL HAVE MOST
BANG FOR YOUR BUCK. I THINK
MAYBE SOME TENSION I'M HEARING
TOO IN THE CONVERSATION IS SO
MANY INTERVENTIONS, I THINK, MY
STUDY POPULATIONS ARE GETTING
YOUNGER AND YOUNGER AND
ENROLLING PEOPLE AS YOUNG AS 25
NOW.
I THINK THAT WHERE MUCH OF THE
WHAT IS DETERMINING OUR SORT OF
OUTCOMES IN LATE LIFE IS
HAPPENING IN MUCH EARLIER
DECADES.
SO, TO -- ON ONE HAND,
GEROSCIENTISTS WILL LIKELY BE
INTERVENING ACROSS THE LIFESPAN
AND AGING ACROSS THE LIFESPAN
AND ALSO THERE IS A QUESTION
THAT PEOPLE COME TO US WHEN -- I
THINK THAT YOU ARE ABSOLUTELY
RIGHT THERE IS ASYMPTOTIC RETURN
ON SINGLE DISEASE FOCUSED
MEDICINE AND PEOPLE COME FOR
THAT AGING EXPERTISE THAT IS AT
THE TAIL END OF LIFE WHEN --
WHEN SINGLE DISEASE FOCUS
APPROACH IS FALLING APART AND
THERE IS NOT ENOUGH OF US TO
SORT OF DIRECT CARE TOWARDS END
OF LIFE AND THINK THIS MAYBE
SPEAKS TO SOME OTHER COMMENTS
ABOUT THE NEED TO SORT OF
GEROSCIENCIZE THE WORLD.
I THINK IT IS SOMETHING THAT
APPLIES -- IT MIGHT BE DIFFERENT
QUESTIONS AND ANSWERS THAT WE
ARE GIVING WHEN APPLYING IT IN
EARLY LIFE VERSUS WHEN APPLYING
IN THAT VERY LATE STAGE OF LIFE
WHEN COMPLEX DYNAMICAL SYSTEM IS
ALREADY SHOWING SIGNS OF
FAILURE.
YOU KNOW, I THINK WITH
GEROSCIENCE WE ARE ESSENTIALLY
REVISING MEDICINE AND SHIFTING
AWAY FROM WHAT DEVELOPED JUST BY
VIRTUE OF HISTORY AND WHAT WAS
EASY FOR PEOPLE TO STUDY TO ONE
FOCUSED ON FUNDAMENTAL MOLECULAR
MECHANISMS AND SYNERGIES TO
MEDICINE TA DO DEEP MOLECULAR
PHENOTYPING LIKE IN CANCER AND
PERSONALIZED MEDICINE.
SORRY.
OH. M THAT WE COULD WORK WITH
THEM TO FURTHER ENHANCE THAT AND
TO BUILD ON THAT. I THINK IT IS
A REALLY AMBITIOUS PROJECT WITH
LOTS OF POTENTIAL TO BETTER
TREAT PATIENTS AND MOVE THE
FIELD A BIT.
>>I HAVE ONE OTHER COMMENT.
THAT IS THAT WE COULD PROBABLY
GAIN MORE TRACTION ONCE WE START
TO INCORPORATE MULTI-MORBIDITY
INTO SOME CLINICAL TRIALS RIGHT
NOW. YOU KNOW, THE FIRST IN
HUMAN TRIALS ARE SMALL AND ARE
PILOTED AND FOCUSED ON SINGLE
DISEASE STATES WITH KNOWLEDGE OF
SENESCENCE CELL BURDEN AND THINK
THAT AS THOSE TYPES OF STUDIES
SXHAND AND WE LOOK AT MULTIPLE
OUTCOMES RELATED TO MORE THAN
ONE DISEASE WILL ALSO, I THINK,
GAIN TRACTION IN THE -- AND
PERCEPTION THAT WHAT WE ARE
DOING IS DIFFERENT FROM OTHER
APPROACHES.
>>JUST TO ADD TO THAT, I THINK
THAT I WANT TO JUST, AGAIN, GIVE
A SHOUTOUT TO ORGANIZERS OF
CONFERENCE FOR HAVING MADE
SOCIAL DISPARITIES A KRENT PIECE
AT THE BEGINNING OF THE
CONFERENCE AND NOT ONLY IS RIGHT
THING IN TERMS OF POPULATION
HEALTH BUT RIGHT THING IN TERMS
OF GEROSCIENCE AS BOB SAID AND
MADE A BRIEF COMMENT ABOUT THIS
DURING MY TALK. A NUMBER OF US
STRUCK BY PUSHBACK THAT WE HAVE
GOTTEN FROM SOME MEDICAL
STUDENTS INTRODUCING CONCEPT OF
GEROSCIENCE AND MEDICAL AND PHD
STUDENTS THESE DAYS ARE MORE
SOCIALLY CONSCIOUS AND AWARE
THAT MANY OF US WERE AWARE AT
THAT STAGE IN OUR CAREERS AND
THEY HEAR ALL OF THIS AND ABOUT
THE BILLIONAIRES THAT ARE
INVESTING IN AGING RESEARCH.
THAT IS WONDERFUL. WE WELCOME
ALL SUPPORT, OBVIOUSLY.
PERCEPTION THEY HAVE THAT THIS
IS ABOUT IMPROVING LIVES OF
THOSE BILLIONAIRES AND ABOUT
ELITISM. I THINK WITH WE LOOK
AT -- IN TERMS OF ALSO HAVING
FOCUS AT THIS CONFERENCE ON
MULTIPLE MORBIDITY GEROSCIENCE
GUIDED THERAPIES WILL BENEFIT
PEOPLE MOST WITH MULTIPLE
MORBIDITIES THAT IS KEY AND
PANEL WE NEED TO PURSUE.
>>I WILL READ A QUESTION FROM
ZOOM AUDIENCE FOR YOU THIS IS
ALLISON PALM MER AND -- THERE
NEEDS TO BE BUY-IN FROM MCHL BME
GIVEN LEARNING IS ASSESSMENT
DIFFERENT IN THAT SETTING CAN
YOU COMMENT ON END ROADS THAT
ARE BEING MADE IN THAT AREA?
>>ALL RIGHT. IF I HEARD THE
QUESTION WELL SHE WAS ASKING
ABOUT HOW WE INTRODUCE THESE
MATERIALS TO MEDICAL STUDENTS.
OKAY. WORKING ON R25 WITH
GEROSKEENS EDUCATION AND
TRAINING NETWORK WE HAVENA
DEFINITELY ASKED HELP FROM THE
DISSEMINATION COMMITTEE HOW WE
COULD BEST DO THAT. WE FOUND
THAT IT IS EXTREMELY DIFFICULT
TO GET MATERIALS INTO THE
CURRICULUM. WE ARE CREATING
MATERIALS AND WILL MAKE THEM
AVAILABLE AND SUGGEST WAYS THAT
THEY CAN BE INCORPORATED INTO
DIFFERENT TYPES OF CURRICULA AND
DR.CUR SHELL SPOKE EARLIER WE
WILL TRY TO SEE IF WE COULD HAVE
COMPETENCIES INCLUDED SOMEHOW
AND WILL BE DOWN THE ROAD AND
DIFFICULT PATH THAT IS FRAUGHT.
WE HAVE -- WE HAVE HEARD ABOUT
MANY OBSTACLES AND WE -- IT IS
DEFINITE THAT THERE ARE MANY
CONVERSATIONS HAPPENING ABOUT
HOW TO EVENTUALLY HOPEFULLY MAKE
THAT HAPPEN.
>>ADDING TO THAT THERE IS A
TREMENDOUS MONTH OF IN MEDICAL
EDUCATION WHERE CLASSROOM
TEACHING AND SUCH ENDED IN MOST
PLACE APDZ TEACHING IN SMALL
GROUP CASE-BASED LEARNING AND
ABILITY TO CREATE ONLINE
MATERIALS THAT CAN PROVIDE EASY
ACCESS TO INFORMATION WITH A
CLICK OF A MOUSE IS WAY TO GO
AND WHAT WE ARE TRYING TO
DEVELOP IN A WAY THAT WILL
HOPEFULLY BE SUSTAINABLE.
>>GOING ON TANGENT IN RESPONSE
AND TEACHING AND AGING TO
MILLENNIALS IS A CHALLENGE THAT
IS REALLY A CONCEPT TO MANY THAT
SEEMS FOREIGN AND IN MANY CASES
THEY ALMOST PUSH IT AWAY AND
THEY STRUGGLE TO HAVE A SENSE OF
EMPATHY I THINK WITH MANY
PATIENTS AND TEACHING IN WAY
THAT IS COMPELLING BECOMES
CHALLENGING. THERE ARE WAYS TO
OVERCOME THAT AND IN CONTRAST
THIS IS A BIT OF A TANGENT THAT
IS RELEVANT AND INTERESTING TO
ME DURING SUPERBOWL CONVERSATION
ABOUT AN AGING DOG MADE MY THREE
DAUGHTERS CRY AND STAGGERED ME
LISTENING ABOUT COMPANION DOGS
THERE ARE DIFFERENT WAYS WE CAN
TEACH ABOUT AGING THAT IS
RELEVANT TO YOUNG PEOPLE IN A
WAY THAT IS MEANINGFUL TO THEM
TO EMBRACE IT AND IN TERMS OF
GRASPING TRAINEES THERE ARE
PROBABLY NEW MODELS WE SHOULD
THINK ABOUT AS A SOCIETY TO TRY
TO MAKE AGING RELEVANT AND
TRAJECTORIES OF LIFE STARTING
MUCH EARLIER AND THAT ARE REALLY
RELEVANT IN HOW PEOPLE GRASP
AGING IN THIS LIFE-LONG CONCEPT
AND SEEMS TRIVIAL AND WE HAVEN'T
REALLY EMBRACED OPPORTUNITIES
AND IS STRIKING TO ME WATCHING
TRAINEES THEY ALWAYS BRING UP
THEIR DOGS THAT IS STAGGERING.
WE DON'T USE THAT OR LEVERAGE
THOSE KINDS OF OPPORTUNITIES TO
THINK ABOUT AGING IN DIFFERENT
WAYS.
>>HELLO. NAT ASHIA,
VETERRINARIAN IN THE GROUP. I
ABSOLUTELY LOVE THAT YOU BRO UTH
THAT UP. ONE COMMENT I WANTED
MAKE IS I INTRODUCED GEROSCIENCE
INTO OUR VETERINARY CURRICULUM
AND WOULD LIKE TO TALK MORE
ABOUT SUCCESSES AND FAILURES I
HAVE HAD WITH THAT AND ALSO
SOMETHING I'M REALLY INTRIGUED
ABOUT IS TAKING ADVANTAGE OF THE
LEARNING EXPERIENCE THAT DOG
OWNERS GO THROUGH WHEN THEY CARE
FOR AN AGING GERIATRIC PET AND
REACH AN END OF LIFE SCENARIO.
THERE IS ENORMOUS LESSONS TO BE
LEARNED FOR THE WHOLE FAMILY
THAT COULD BE APPLIED. YOU
KNOW, AS A FOREWARNING WHAT THEY
WILL GO THROUGH WITH THEIR
FAMILY. THIS IS SOMETHING I
WOULD LOVE TO REALLY EXPLORE
FURTHER AND COMPLETELY AGREE.
>>THANK YOU.
>>AND ALSO THAT THERE MIGHT BE
AN OPPORTUNITY TO COLLABORATE
WITH ASSOCIATION OF AMERICAN
MEDICAL COLLEGES AAMC, GROUP OF
EDUCATIONAL AFFAIRS THAT MIGHT
BE A GROUP TO COLLABORATE WITH.
AND ALSO IF THERE IS LIKE A
COHORT OF OF EXCITED AND
ENERGIZED AND YOUNG PEOPLE.
THEY CAN PUT A LOT OF PRESSURE
ON MEDICAL SCHOOLS TO CHANGE
CURRICULUM AND RIGHT NOW THERE
IS A BIG MOVE TOWARDS CLIMATE
CHANGE BEING INCLUDED IN THE
CURRICULUM. THERE IS A WHOLE
COHORT AND ORGANIZATION OF YOUNG
PEOPLE THAT ARE REALLY
ADVOCATING FOR THIS TO BE
INCLUDED IN THE CURRICULUM.
SO, THAT PERHAPS WOULD BE PART
OF THE STRATEGY TOO. THANK YOU.
>>WE HAVE INTRODUCED AS WELL IN
THE CURRICULUM AND IN SOME OF
THE GEROSCIENCE CONCEPTS AND
ACTUALLY SOCIETY OF JERAT TRICKS
HAS A DOCUMENT IT THIS AIS
LISTING COMPETENCIES THAT
MEDICAL SCHOOL SHOULD INTRODUCE
INTO THEIR CURRICULUM AND MAYBE
IS SOMETHING TO LOOK THERE TO
SORT OF STANDARDIZE IN ACROSS
THE POND, IF YOU WANT.
ONE THING WE FIND DIFFICULT IS
THAT ACTUALLY IS PERSUADING
COLLEAGUE THAT HAVE RUN COURSES
TO SORT OF CHANGE WAY THEY TEACH
AND SOMETIMES THERE IS MORE
CHANGE THAT CAN MAKE A BIG
DIFFERENCE.
OTHER THING PERSUADING WE NEED
MORE GERIATRICIAN THAT THERE IS
NOT ENOUGH OF THEM AND FIND
DIFFICULT TO PURSUE STUDENTS TO
TAKE THAT PANEL. I DON'T KNOW
WHETHER YOU HAVE ANY SUGGESTION
THE
THERE.
>>I WILL TRY TO ANSWER. ONE
THING WE HAVE HEARD OFTEN IS
THAT MAYBE MEDICAL STUDENTS ARE
NOT GOING INTO GERIATRICS AND
FEEL THEY CAN'T DO MUCH FOR
OLDER ADULTS AND HEARD TODAY
ABOUT HOW MAYBE MORE PEOPLE
START TODAY GO INTO RUM TOLL AS
TNF INHIBITORS, ET, CAME ON.
THEY COULD HELP THEIR PATIENTS
BETTER AND TRULY ARE HOPING WITH
GEROSCIENCE INITIATIVES AND WITH
NEW THERAPIES THAT -- THAT MAYBE
GERIATRICS WILL MAYBE ONE DAY
BECOME SOMETHING MORE MEDICAL
STUDENTS WILL WANT TO GO INTO.
WE DEFINITELY NEED MORE, SO --
>>I WANT TO -- I KNOW I'M
BIASED ABOUT YOU FEEL WE HAVE
SOME GEROSCIENCE TECHNIQUES
AVAILABLE AND I EMPHASIZE
EXERCISE.
IT WORKS AND I KNOW IT IS
CHALLENGING AND JEREMY YOU KNOW
THERE IS SAYING AND TOM GILL IT
IS HARD TO DO IT. INCREMENT
ALLEY WORKS AND IS HARD TO
CHANGE PEOPLE. THESE ARE
PATTERNS OF DISABILITY THAT ARE
ENTRENCHED AND TAKEN THEM 30
YEARS TO BECOME DISABLED
PROGRESSIVELY AND IS HARD TO FIX
IT IN A 6 MONTH PERIOD. THERE
IS PROGRESS. I THINK PART OF
THE ISSUE IS IMPLEMENTATION NO
THE JUST WAITING FOR THE NEW
PILL BUT USING TOOLS WE HAVE AND
WE HAVE DIET AND NUTRITION AND
WE HAVE OTHER WAYS OF ENRICHING
THE ENVIRONMENT IN HELPING WITH
RESILIENCE IN WAYS THAT ARE
ACCESSIBLE TO US NOW. I DON'T
FEEL SATISFIED SAYING WAIT UNTIL
WE GET THE NEW PILL.
>>ADDING TO THAT THERE IS
INCREASING EVIDENCE THAT WE
HEARD ABOUT MEDICATIONS THAT ARE
REPURPOSED AND USED ALREADY AND
THAT HAVE POTENTIAL TO WORK FROM
A GEROSCIENCY PERSPECTIVE AND
FOR EXAMPLE THERE IS A WHOLE
CLASS OF DIABETES MEDICATIONS
THAT ARE WIDELY USED AND
INCREASING EVIDENCE TO INDICATE
THAT THEY MAY HAVE OFF-LABELED
BENEFITS TO -- IN TERMS OF
DEMENTIA PREVENTION, ET CETERA.
IT IS TRANSFORMATIONAL. IN
GERIATRICS, THERE IS ALL KINDS
OF OFF-LABEL ISSUES AND ALWAYS
IS A PROBLEM AND NEVER SOMETHING
GOOD AND IT IS A QUESTION OF
FRAMING AND EXPLAINING THAT
THERE IS THINGS TO DO IN GERO
SCIENCE --
>>I WORK IN MEMORY CLINIC AND
SEE PATIENTS WITH SUBJECTIVE
COGNITIVE CHANGE AND LOTS IS
FOCUSED ON PREVENTION AND LOTS
USES GEROSCIENCE INTERVENTIONS
AND CONCEPTS LIKE DIET AND
EXERCISE AND LOTS TO DO THERE
WITH PERSONALIZED EXERCISE
PRESCRIPTIONS AND BLOOD FLOW
RESTRICTION FOR HYPERTROPHY AND
LOTS WE CAN USE OUT OF WHAT WE
KNOW THAT CAN MAKE A HUGE
DIFFERENCE IN PEOPLES LIVE AND
IF WE CAN PACKAGE AND MARKET
THAT IN A WAY THAT IS YOU KNOW A
LITTLE MORE SEXY WE CAN DRAW
PEOPLE IN AND ALSO SERVE AS AN
ALTERNATIVE TO LESS RELIABLE
SOURCES THAT PEOPLE ARE LOOKING
AT ONLINE.
>>ADDING TO ADDITION TO WHAT WE
KNOW ABOUT EXERCISE AND
NUTRITION I LEARNED NUTRITION
DOING INTEGRATIVE MEDICINE
FELLOWSHIP -- GERIATRIC MEDICINE
AND NEVER HAD THE ISSUE OF
NUTRITION BEEN DISCUSSED UNTIL I
DID AN INTEGRATIVE MEDICINE
FELLOWSHIP THAT IS A EXAMPLE AND
GLARING HOLE AND I WILL TAKE
PANEL D- YOU MENTIONED
MULTI-MORBIDITY AS OUTCOME AND
UNDERSTANDING IS NOT CURRENTLY
ICD9 DIAGNOSIS AND BRIEFLY THIS
COULD BE A FOLLOW UP
CONVERSATION IS THERE ADVANTAGE
THINKING ABOUT PUSHING FORWARD
FDA APPROVAL AND MULTI-MORBIDITY
AS ICD9 DIAGNOSIS AND AGING IS
NOT A DISEASE BUT WHAT ABOUT
MULTI-MORBIDITY?
>>GREAT QUESTION AND PEOPLE IN
THE AUDIENCE HAVE BEEN WORKING
ON THESE ISSUES IN CONTEXT OF
PAIN TRIAL THAT IN A WAY IS
LOOKING AT THAT AND YOU WOULD
THINK THAT PREVENT WUNG BAD
DISEASE IS IMPORTANT AND
PREVENTING SECOND DISEASE IS
IMPORTANT AND THIRD ONE. IF YOU
CAN PREVENT COMBINATIONS OF
THESE TO VARIOUS EXTENT WOULD BE
BETTER AND AGAIN GETS AT ISSUE
OF HOW WE HEARD FROM DAN HOW
HEALTHCARE IS SILOED AND WILL
TAKE A NEW WAY OF THINKING AND
ULTIMATELY WILL COME DOWN IF
RESULTING IN BETTER OUTCOMES FOR
PATIENTS LOWER COST AND BETTER
OUTCOMES YOU GET BUY IN
IMMEDIATELY AND WE NEED TO FOCUS
ON THAT.
>>GOOD MORNING. I'M WITH THE
JER ON TOLL ONL CAL SOCIETY AND
NEED NATIONAL CENTER TO REFRAME
AGING ON BEHALF OF 10 LEADING
ORGANIZATIONS INCLUDING AARP AND
GSA AND WOULD LIST ALL 10 AND
I'M NERVOUS UP HERE AND AFRAID I
WILL FORGET SOMEBODY.
I REALLY APPRECIATE THE COMMENTS
THAT ARE ABOUT UNDERSTANDING
AGING FOR HOW THE PUBLIC
UNDERSTANDS AGING AND PERCEIVES
WHAT WE ARE WORKING ON AND
TRYING TO ACCOMPLISH HERE.
I ENCOURAGE MOVING FORWARD THAT
WE HAVE WORKED WITH A RESEARCH
PARTNER AND FRAMEWORKS INSTITUTE
TO DEVELOP COMMUNICATION
STRATEGIES TO BE SURE THAT WE
DON'T CONTINUE TO ENCOURAGE
PEOPLE TO THINK ABOUT AGING IN A
WAY THAT IS ALWAYS IN DECLINE,
DEATH, AND DISABILITY.
WE WOULD BE HAPPY FROM THE
NATIONAL CENTER TO CONTINUE TO
WORK WITH YOU AS THIS. AS
GEROSCIENCE CONTINUES TO BE
COMMUNICATED OUT IN THE PUBLIC
AND WANTED TO THANK YOU.
>>THANK YOU.
>>HI.
>>THANKS. I WAS GOING TO
RESPOND QUICKLY TO THAT. I
THINK AN IMPORTANT PART OF THIS
TOO IN ADDITION YOU KNOW ASKING
THE QUESTION WHY AREN'T MORE
PEOPLE WANTING TO GO INTO EITHER
BIOLOGY OF AGING RESEARCH OR
GERIATRICS OR AGING FOCUSED
FIELDS OR SPECIALISTS WANTING TO
DO AGING IN THEIR FIELD IN
ADDITION TO MAYBE WE ARE WAITING
FOR TREATMENTS AND THINGS TO
OFFER TO INTERRUPT THE AGING
PROCESS WITH EVIDENCE.
I THINK THAT -- I THINK THAT THE
NEEDLE HAS MOVED IN A GOOD
DIRECTION JUST BY THE FIELD OF
GEROSCIENCE AND ACTIVITIES LIKE
WHAT WAS JUST DISCUSSED.
TO JUST KIND OF DEFINE WHAT THE
FIELD IS AND WHAT THE EXPERTISE
IS THAT THE FIELD BRINGS.
THAT IS SOMETHING THAT WHEN I
WAS IN RESIDENCY, I CAN REMEMBER
SAYING TO CARDIOLOGY ATTENDING
YOU KNOW WHAT FELLOWSHIP ARE YOU
PLANNING TO DO?
I SAID JERAT TRICKS THIS IS
20 + YEARS AGO. HE SAID WHY
WOULD YOU DO A FELLOWSHIP IN
GERIATRICS ALL MY PATIENTS ARE
IN THEIR 70S I'M A GERIATRICIAN
I RISKED A TONGUE LASH TO THIS
ALL MY PATIENTS HAVE A HEART SO
I WILL BE A CARDIOLOGIST TOO IT
IS PREPOST TROUGHS AND THINK
CONVERSATION MOVED BEYOND THAT
NOW IN 20 + YEARS INCREASINGLY
MORE PEOPLE MORE ATTENDING LEVEL
PEOPLE IN MEDICAL SCHOOL
UNDERSTAND THAT IT IS NOT JUST
TAKING CARE OF OLDER PEOPLE AND
THERE IS, YOU KNOW, CURRICULAR
ELEMENTS AND CHAPTERS IN BOOKS
AND AREAS OF EXPERTISE. THEY
MIGHT NOT BE ABLE TO ARTICULATE
WHAT THOSE ARE AND WHEN THEY
WERE IN MEDICAL SCHOOL THEY
DIDN'T EXIST BUT THEY AT LEAST
RECOGNIZE THAT THERE IS A
CURRICULUM AND AREA OF EXPERTISE
AND SOMETHING THAT GEROSCIENCE
IF IN THIS FIELD REALLY BRINGS
TO.
>>IN MEDICAL SCHOOL BIGGEST
DETOUR ENTTO ME GOING INTO
GERIATRICS WAS FACE THAT DOCTORS
MADE WHEN I TOLD THEM I WANTED
GO INTO GERIATRICS.
>>[LAUGHING].
>>THAT IS SAD.
>>HI. I'M CHRISTIE CARTER FROM
NIA, DIVISION OF AGING AND
BIOLOGY AND A GROUP OF LEARNERS
TO CONSIDER TO GET GEROSCIENCE
MESSAGE OUT IS LAY PUBLIC.
WHEN AT UNIVERSITY OF FLORIDA WE
CREATED ONLINE MASTERS PROGRAM
IN GERONTOLOGY AT THE TIME THAT
WE OPENED TO THE WHOLE
COMMUNITY. WE SOLD IT AS ANYONE
WHO IS GOING TO COME INTO
CONTACT WITH AN OLDER PERSON IN
THEIR LIFE THAT IS JUST ABOUT
EVERYONE NEEDS TO KNOW ABOUT
GERONTOLOGY.
WE HAD IN THAT COURSE A
SHERIFF'S DEPUTY FUNERAL HOME
DIRECTOR PHYSICIANS AND NURSES
AND WAS A REALLY COOL GROUP OF
PEOPLE BRINGING INDIVIDUALIZED
PERSPECTIVE AROUND AGING TO THE
STUDY OF GERONTOLOGY.
IT WAS REALLY SUCCESSFUL AND THE
COMMON THING ABOUT PEOPLE COMING
TO THE PROGRAM WAS THAT THEY
JUST EITHER HAD TO KAIR GIVE FOR
A DYING PATIENT WANTING TO SEE
HOW -- YOU KNOW, IT WAS GOING TO
HAPPEN TO THEM EVENTUALLY. THEY
WANTED TO LEARN TO NAVIGATE THAT
BETTER.
SECOND THING, THEY REALLY CARED
ABOUT PEOPLE.
SO, THIS ASPECT OF BEING A
CARING PROFESSION I THINK IS
REALLY IMPORTANT TO GET OUT
THERE TO THE PUBLIC AND TO HAVE
THIS KIND OF HOLISTIC GROUP OF
LEARNERS TOGETHER I THINK COULD
BE REALLY ADVANTAGEOUS WHEN
TARGETING LAY PEOPLE AND WANT TO
MAKE THAT COMMENT.
>>THERE IS A MODEL OUT THERE
WITH GENETIC MEDICINE BEING A
SPECIALTY AND YOU HAVE GENETIC
COUNSELORS THAT IS A PROFESSION
ALLOWING EVERYONE TO DO WHAT
THEY DO BEST.
>>HI. I'M MINA CEDRIC FROM
CITY OF HOPE AND WONDER IF YOU
CAN COMMENT A LITTLE ABOUT THE
POLICYMAKING EFFORT THAT NEEDS
TO HAPPEN IF WE LOOK AT
SUBSPECIALIST DISEASES LIKE HIV
AND CANCER, YOU SEE LOTS OF
PROGRESS AND IMPACT HAS COMELE
FROM, YOU KNOW, CONGRESS AND
LEGISLATIVE DECISIONS THAT HAVE
LED TO CREATING INFRASTRUCTURE
AND AUTHORIZING FDA FOR
BREAKTHROUGH DRUG THERAPIES AND
ADVOCACY TO MOVE IS SCIENCE
FORWARD WHAT IS COMMUNITY OF
GEROSCIENTISTS DOING IN THAT
SPACE?
>>ANYBODY HEAR FROM JIM HERE?
YOU WANT TO SPEAK ABOUT AFARS
EFFORTS? DON'T KNOW IF JIM IS
HERE.
>>YOU PROBABLY KNOW ABOUT IT.
>>WHY DON'T YOU WANT TO COMMENT
ON IT?
>>PARDON ME?
>>DID YOU WANT TO COMMENT ON
THAT?
>>VERY BRIEFLY, AFAR HAS BEEN
HEAVILY INVOLVED IN IT AND
WORKING TOGETHER WITH GSA AND
OTHER ORGANIZATIONS THERE HAS
BEEN AN EFFORT TO -- THERE HAS
BEEN TESTIMONY IN FRONT OF
CONGRESS THAT IS REGARDING
GEROSCIENCE AND LANGUAGE
INCLUDED. THERE WAS LANGUAGE --
THERE IS JIM. THERE IS LANGUAGE
THAT INCLUDED IN THE LAST MAJOR
APROPRIATION ASKING NIH TO COME
UP WITH AN INVENTORY OF WORK
THAT IS RELATE TODAY GEROSCIENCE
TAKING PLACE ACROSS NIH AT ALL
INSTITUTES AND BELIEVE THAT WORK
IS HAPPENING AND EFFORTS TO ALSO
ONGOING DISCUSSIONS REGARDING
POTENTIALLY IDENTIFYING NEW
RESOURCES FOCUSING ON
GEROSCIENCE IN SAME WAY THERE
HAVE BEEN ADDITIONAL RESOURCES
COMING TO NIH DEALING WITH
ALZHEIMER'S DISEASE AND NIH
STAFF CAN'T BE INVOLVED IN THIS
TAKING PLACE THROUGH NIFR. WANT
TO COMMENT ON ANYTHING? YOU ARE
IN THE BACK.
>>SORRY I LEFT THE ROOM
BRIEFLY. [INDISCERNIBLE]'S
MOTHER JUST DIED. I'M DEALING
WITH THAT. YOU WERE ASKING
ABOUT THE POLICY.
>>QUESTION IS WHAT IS HAPPENING
IN TERMS OF GEROSCIENCE AT THE
FEDERAL LEVEL IN TERMS OF
LOBBYING AT FEDERAL LEVEL? IF
YOU CAN SUMMARIZE AFAR'S EFFORTS
IN THAT DIRECTION.
>>I THINK IT IS BEYOND LOBBYING
AND A DISCUSSION THAT I THINK A
LOT OF PEOPLE IN CONGRESS, YOU
KNOW, SEE WHAT IS HAPPENING TO
THEMSELVES AND BOTH PARTIES ARE
IN AGREEMENT ABOUT THIS. AS YOU
WERE MENTIONING IN BUDGET
RECONCILIATION ACT THERE WERE
THREE ELEMENTS INTRODUCED AND
PASSED BY BOTH PARTIES NOW
SIGNED INTO LAW FOR REPORT
LANGUAGE AND ONE THING
MENTIONING ABOUT NIA AND CAN PAY
LINES BE BROUGHT UP TO BE MORE
SIMILAR TO THE ALZHEIMER'S
WITHOUT TAKING AWAY FROM ALZ
HIEMERS TO DO A REPORT ACROSS
ALL 27ICS THAT IS UNDERWAY AND
NCI IS ESPECIALLY ENGAGED IN
THIS ABOUT WHAT IS HAPPENING
WITH RESPECT TO GEROSCIENCE
WITHIN INSTITUTES AND ISSUES
RELATED TO THE FDA AND
CONSIDERATION OF EVENTUALLY
CREATING ARGUABLY A BRANCH OF
FDA THAT DEALS WITH GEROSCIENCE
AND ONGOING EFFORT GOING ON NOW
WITH DEFENSE APPROPRIATIONS
COMMITTEE LOOKING ATTACKTIVE
DUTY MILITARY AND GEROSCIENCE
INTERVENTIONS WITH RESPECT TO
COMBAT READINESS AND TALK BEING
IT LATER AND NAVY IS FUNDING
CLINICAL TRIALS OF
GEROTHERAPEUTIC INTERVENTIONS
AND SURGEON GENERAL OF THE NAVY
HIMSELF IS BEHIND IT AND EFFORTS
LOOKING AT VA AND ALSO EFFORTS
THAT WILL BEGIN EVENTUALLY WITH
AGRICULTURE AND LOOKING AT --
LOOKING AT, YOU KNOW, SHEEP AND
MILK PRODUCTION AND EGG LAYING
WITH RESPECT TO SOME
GEROTHERAPEUTIC INTERVENTIONS
THAT HAVE A HUGE EFFECT AROUND
THE WORLD AND IS A NUMBER AND
WILL BE LATER AND CURRENT
INITIATIVE IS WITH MAINLY THE
DOD AND GETTING LANGUAGE
INSERTED INTO DARPA THAT WOULD
ALLOW -- YOU KNOW, IT HAS TO BE
CONGRESSIONALLY MANDATED NOOBD
GEROSCIENCE LANGUAGE IN DARPA AT
MOMENT THAT WOULD UNLOCK A HUGE
AMOUNT OF FUNDING.
>> WANT TO TALK ABOUT ARPAH?
>>YEAH. RON AND MYSELF AND
OTHERS HAVE TALKED A LOT WELL
OFFLINE ABOUT ARPAH WHICH IS YOU
KNOW IT IS A NEW INITIATIVE
WHERE PROGRAM OFFICERS WILL HAVE
MORE SAY ABOUT SETTING DIRECTION
AND WE NEED TO GET GOOD PEOPLE.
WHO ARE WILLING TO GIVE UP 3 TO
5 YEARS TO WORK FOR ARPAH TO ACT
AS PROGRAM OFFICIALS AND IF, YOU
KNOW, I -- AND WE NEED TO PACK
ARPAH WITH RESPECT TO PEOPLE
INTERESTED IN GEROSCIENCE
OTHERWISE FUNDING WILL GO
ELSEWHERE. I THINK ARPAH WILL
BE A REEL OPPORTUNITY.
IT WILL NEED TO WORK CLOSELY
WITH NIA ESPECIALLY AND WITH NIH
IN GENERAL.
SO, THAT IS A WORK IN PROGRESS.
THEY ARE AT -- THAT EXISTS NOW
AND THEY ARE AT THE POINT OF
HIRING PEOPLE.
>>LAST QUESTION.
>>THIS IS A COMMENT MORE THAN A
QUESTION.
SO, THIS IS A PROFESSIONAL
MEETING BY PROFESSIONAL
GEROSCIENTISTS THAT IS LOOKING
AT WAYS TO GO OUT TO THE
PRACTITIONER COMMUNITY AND
MEDICAL SCHOOLS AND IN THE
PRIVATE SECTOR THERE HAVE BEEN
VARIOUS PRODIGIES INTERESTED IN
CURING AGING SO-TO-SPEAK VENTURE
CAPITALISTS AND CONSULTING
PEOPLE AND SPEAKER IN SESSION
MADE A DECISION TO GET INTO THE
FIELD VERY EARLY ON.
I'M HERE TO TELL YOU DON'T KNOW
HOW DEEP BOTTOM IS HERE WE HAVE
GOTTEN REQUEST FROM HIGH SCHOOL
STUDENTS ESTABLISHING CHAPTERS
AND WOULD URNL PROFESSIONAL
GEROSCIENCE COMMUNITY YOU ARE
STARTING OUT HITTING MEDICAL
SCHOOLS AND SO FORTH.
PARTICULARLY AS YOU GET OUT INTO
THE COMMUNITY AND GENERAL PUBLIC
THINKING ABOUT HOW YOU CAN
REALLY INSPIRE THE YOUTH AT HIGH
SCHOOL OR EVEN EARLIER LEVELS.
>>SO, THE CURRENT R25 NETWORK
THAT WE DR. CURBEL DESCRIBED
EARLIER LOOKS AT MEDICAL
STUDENTS PHD STUDENTS AND
GERIATRIC FELLOWS AND RECENTLY
NIA DIVISION OF AGING BIOLOGY
ISSUED ANOTHER R25 FOR JERO
SCIENCE EDUCATION AND YUKON
SUBMITTED A GRANT TO
UNDERGRADUATE STUDENT EDUCATION.
WE ARE CERTAINLY -- IT GOT A
GOOD HOPEFULLY FUNDABLE SCORE
AND I'M COINVESTIGATOR ON THAT
GRANT AND WE ARE DEFINITELY
TRYING TO EXPAND. WE -- I KNOW
THAT AFAR HAS A HIGH SCHOOL
GEROSCIENCE EDUCATION EFFORT
THAT I BELIEVE THAT THEY HAVE
DESCRIBED IT AND I THINK THAT
THEY SENT OUT SOME INFORMATION
ABOUT SOME OF THE INITIATIVES
THAT THEY JUST STARTED.
SO THROUGH I BELIEVE THROUGH
AFAR THERE IS A HIGH SCHOOL
EFFORT FOR GEROSCIENCE
EDUCATION.
>>SO, WE WILL RECONVENE AT 1
O'CLOCK. THANK YOU TO THE
AUDIENCE AND PANELISTS AND
SPEAKERS FOR THIS EXCELLENT
SESSION. THANK YOU!
>>I'M AT SCHOOL OF SOUTHERN
CALIFORNIA. THIS SESSION IS OWE
ON GEROSCIENCE CLINICAL TRIALS
AND AIM OF THE SESSION IS
EXPLORING CHALLENGES ASSOCIATED
WITH DEVELOPING AND CARRYING OUT
GEROSCIENCE BASED CLINICAL TRIAL
AND SPEAKERS WILL HIGHLIGHT
POTENTIAL PANELS FORWARD AND
WILL HEAR FROM PROFESSOR JAMES
KIRKLAND WHO IS AT MYOCLINIC.
FROM SARA ESPIN OEZA WHO IS
GOING TO TALK ABOUT PRIMARY AND
SECONDARY OUTCOMES OF A
GEROSCIENCE TRIAL AND FOLLOWED
BY PROFESSOR [INDISCERNIBLE]
FROM WHO WILL TALK ABOUT
GEROSCIENCE TRIAL DESIGNS ABOUT
MORBIDITY AND FRAILTY AND WHO
WILL TALK TO US ABOUT
GEROSCIENCE TRIAL IN HEALTH
DISPARITIES AND WILL START WITH
OUR FIRST SPEAKER.
>>THANK YOU. I HAVE 15 MINUTES
AND WILL START OUT SAYING I
STARTED AS A GERIATRICIAN AND
MAYBE 70% OF TIME IN BASIC
SCIENCE LAB AND OTHER 30% OF MY
TIME I'M INVOLVED IN CLINICAL
TRIALS AND WILL SAY PROBABLY A
LOT OF VERY STUPID THINGS ABOUT
BOTH AREAS. WE HAVE SEEN THIS
SLIDE BEFORE. IT IS A PINCH
POINT BETWEEN BIOLOGICAL
MECHANISMS THAT APPEAR TO
UNDERLIE FUNDAMENTAL AGING
PROCESSES AND DOWNSTREAM EFFECTS
OF PROCESSES COMPRISE VARIOUS
PILLARS OR FUNDAMENTAL
MECHANISMS OF AGING AND THIS
MIGHT BE AN INTERVENTION POINT
WHERE WE CAN DEVELOP AGENTS
TARGETING PROCESSES AND
THROUGHOUT CONCEPTION AND
THROUGHOUT LIFE THAT INVOLVED
FUNDAMENTAL AGING PROCESSES.
SO, SOMETHING THAT THE NIH HAS
FUNDED IS AN R TLAE 3
TRANSLATI
TRANSLATIONAL GEROSCIENCE
NETWORK AND INCLUDES 8
INSTITUTION AS CROSS THE US'S
PRIMARY PLAYERS AND ARE MANY
OTHERS WHO ARE AFFILIATE MEMBERS
AND HOPEFULLY IN THE RENEWAL OF
THE PROCESS AND WE WILL ADD A
NUMBER OF CENTERS TO THIS
PROGRAM. BASICALLY, THIS -- I
WILL GO THROUGH WHAT WE ARE
DOING IN CONCERT WITH THE AIMS
OF WHAT THE PARTICULAR PROGRAM
ARE. SO, THE FIRST AIM IS TO
SUPPORT DEVELOPMENT OF CLINICAL
TRIALS AND PROVIDE THINGS LIKE
REGULATORY ADVICE AND HELP WITH
INDS AND HELP WITH GETTING
VARIOUS KINDS OF APPROVALS AT
OTHER LEVELS WITH FDA AND SO
FORTH.
THE NETWORK DOES NOT ITSELF FUND
TRIALS AND TRIALS ARE ALL FUNDED
BY OTHER -- BY VARIOUS
COMPONENTS OF NIH AND BY PRIVATE
FOUNDATIONS AND BY SOME CASES
DRUG COMPANIES AND SOME CASES
PHILANTHROPISTS AND THE IDEA OF
THE TRIALS IS TO LOOK IN SERIOUS
AGE RELATED DISORDERS THAT I
MENTIONED CAN OCCUR FROM THAT AT
ANY POINT DURING LIFE AND FOR
WHICH THERE ARE NO GOOD CURRENT
TREATMENT OPTIONS TO SEE IF
USING GEROSCIENCE INTERVENTIONS
COULD DELAY AND PREVENT AND
ALLEVIATE OR TREAT SUCH
CONDITIONS.
SO, THIS IS OCCURRING IF IN
PARALLEL ONE DAY POTENTIALLY
WITH THE TAME APPROACH THAT IS A
SECONDARY PREVENTION TRIAL AND
THIS IS NOT AN OR APPROACH BUT
AND APPROACH.
MANY OF THE TRIALS INVOLVE NOT
ONLY LIFESTYLE INTERVENTIONS BUT
REPURPOSED AGENTS AND NATURAL
PRODUCTS AND IN SOME CASES NEW
CHEMICAL ENTITIES.
AND BUT DOING THINGS IN PARALLEL
AND LOOKING AT GERODIAGNOSTICS I
CALL THEM AND OUTCOMES IN
PARALLEL. IT WAS MENTIONED
ALREADY THAT ONE OF THE FIRST
TRIALS THAT WE DID WAS, YOU
KNOW, I'M -- I'M FOCUSED TO SOME
EXTENT ON SENOLYTICS AND LOOKING
AT RANGE OF INTERVENTIONS --
RESISTANCE EXERCISE THROUGH
SEARCH 1 AGONISTS TO METFORMIN
TO SENOLYTICS AND OTHER AGENTS
AND ANTIINFLAMMATORIES AND TRIAL
WAS MENTIONED AND EARLY PROOF OF
CONCEPT TRIAL AND WILL EMPHASIZE
TOO THERE IS CRITICISM ABOUT
MOVING QUICKLY INTO TRIALS AND
PEOPLE HAVE SAID THERE WAS A
PROBLEM WITH GENE THERAPY TRIALS
IN THE 1990S AND THAT WAS BASED
ON TAKING A RADICALLY NEW
APPROACH THAT HAD NEVER BEEN
USED IN HUMANS BEFORE AND HAVING
A DISASTER OCCUR.
HERE WHAT WE ARE DOING IS TAKING
AGENTS OR INTERVENTIONS ALREADY
PROVEN TO BE SAFE AND EFFECTIVE
IN OTHER SITUATIONS IN HUMANS
LOOKING AT THEM IN CONTEXT OF
VERY SERIOUS DISEASES AND
DISORDERS FIRST IN HUMAN TRIAL
SENOLYTICS PULMONARY FIBROSIS
PHASE 1 TRIAL AND TAKING
EVERYTHING WITH A GRAIN OF SALT
AND IN OPEN LABEL TRIAL WITH
PLACEBO EFFECTS THAT OCCUR MIGHT
BE IMPACT ON FRAILTY PARAMETERS
LEADING TO PHASE 2 TRIALS THAT
HOPEFULLY WILL BEGIN AND IS
MENTIONED IN TRIAL LOOKING AT
FAT BIOPSIES TRIALS AT DAY 0 AND
14 AND SENOLYTIC COMBINATION
GIVEN 3 DAYS FROM DAY 0 TO 1 AND
2 AND SEEING IF TARGET
ENGAGEMENTS AND TRIALS WILL LOOK
AT TARGET ENGAGEMENT AND THIS
HAS A SHORT ELIMINATION HALF
LIFE AND REASON IT WAS CHOSEN
FOR TRIALS AND SARCKINDASE
INHIBITOR AND UNLIKE OTHER TIRO
SEEN KINDASE INHIBITORS THAT
SELECTIVELY KILLS CERTAIN KINDS
OF SENESCENCE CELLS AND HAS
LONGER ELIMINATION HALF
LIFEAROUND 11 HOURS THAT IS
OFTEN GIVEN IN CONJUNCTION WITH
TREATING LEUKEMIAS AND LYMPHOMAS
THAT HAS PROPERTIES REDUCING
POTENTIAL SIDE-EFFECTS AND IT
ALSO IS SENOLYTIC BUT ONLY IN
THE CASE OF ENDOTHELIAL CELLS.
COMBINATION KILLS A BROADER
RANGE OF SENESCENCE CELL TYPES
AND EMPHASIZE AGENTS ARE LONG
CLEARED FROM POPULATION AND ARE
LONG CLEARED BY 14 DAYS AFTER 11
DAYS AFTER LAST DOSE OF THE
DRUGS GIVEN LONGEST ELIMINATION
HALF LIFE AND 11 HOURS AND
COMPLETELY GONE FROM SYSTEM
WITHIN 33 HOURS DECREASE IN
INFLAMMATION AND ADIPOSE TISSUE,
ET CETERA AND THERE IS 41 TRIALS
CURRENTLY UNDERWAY AND THEY ARE
BEING DONE IN PARALLEL RATHER
THAN IN SERIES AND DON'T THINK
MY CLOCK IS WORKING EITHER AND
DON'T KNOW HOW MUCH TIME I HAVE
THESE TRIALS RANGE FOR
CONDITIONS AND I WILL EXPLAIN A
FEW OF THEM FROM DISEASES AND
DISORDERS IN YOUNGER INDIVIDUALS
TO THE ELDERLY AND I MENTIONED
THAT TRIALS ARE FUNDED BY
VARIOUS GRANTS FROM NIH OR OTHER
GRO
GROUPS.
THE NETWORK PROVIDES
INFRASTRUCTURE AND GOING THROUGH
A FEW UNDERWAY AT THE MOECHLT
SURVIVORS TRIAL IS IN
COLLABORATION WITH ST. JUDE AND
ACCELERATED AGINGLIKE STATE
DEVELOPED IN CHILDREN WHO HAVE
HAD CHEMOTHERAPY AND RADIATION
BEFORE AGE OF 10 IN LEUKEMIAS
AND CERTAIN PERCENTAGE OF PEOPLE
ACCELERATED AGING STATE THAT IS
TYPICALLY MANIFESTED BETWEEN
AGES 30 AND 45 THEY ARE DYING OF
ALZHEIMER'S DISEASE AGE 30 AND
40 AND THEY HAVE OSTEOPOROSIS
AND ARE FRAIL AND LOOK 70 YEARS
OLD AND ST. JUDE'S GROUP DID
SKIN BIOPSIES ON PEOPLE AND
RELATED TO SENESCENCE CELL
BURDEN AND NCI FUNDED TRIAL TO
PLACEBO IN CHILDHOOD CANCER
SURVIVORS TO SEE IF WE ARE ABLE
TO IMPROVE FRAILTY PARAMETERS
ESPECIALLY GAIT SPEED.
ANOTHER SET OF TRIALS ARE
DEVELOPED AND UNDERWAY AND
LOOKING AT 1, 2 PUNCH APPROACH
THAT NCI ES SUPPOSED ALTERNATING
THROUGH EXAMPLE THERAPEUTICS AND
CHEMOTHERAPY AND RADIATION FOR
TREATMENTS OF SEVERE CANCERS AND
ONE OF THE TRIALS THAT IS ABOUT
TO BEGIN IS SORT OF AN EMERGENCY
TRIAL FOR BLASTOMA
MULTI[INDISCERNIBLE] AND ONE
THING THAT OCCURS WITH THIS
TUMOR THAT I HATE AS A PHYSICIAN
AND IF IT IS GRADE 4 OR 5 IT IS
A DEATH SENTENCE BASICALLY
GIVING PEOPLE RADIATION AND
CHEMOTHERAPY AND I'M CANADIAN
AND TMZ THEY CALL IT HERE AND
ONLY ADVANCE IN DISEASE SINCE
2005 ADDING A MONTH TO LIFE
EXPECTANCY AND OFTEN PEOPLE LOOK
CURED AFTER THEY HAVE SURGERY
AND CHEMOAND RADIATION AND
TUMORS INVARIABLY COME BACK AND
THEY ARE MUCH WORSE WHEN THEY
COME BACK AND ARE RADIATION AND
CHEMORESISTANT AND LOCALLY
INVASIVE THAN AT THE INITIAL
ROUND OF TREATMENT.
SO, THE INTENT OF THE TRIAL
BASED ON PRECLINICAL STUDIES
SHOWING THAT IF YOU GIVE CHEMOOR
RADIATION TO A BLASTOMA MODEL
AND CULTURE MODELS AND OTHER
KINDS OF MODELS, YOU INDUCE AS
YOU DO WITH OTHER CANCERS NOT
ONLY NECKOSIS AND APOPTOSIS IN
CANCER CELLS BUT INDUCE
SENESCENCE AND CANCER HARBORING
SENESCENCE CELLS TO ESCAPE AND
STRONG ONES IN THE AUDIENCE
NOTING THAT ELEMENTS AND
TRANSITIONAL ELEMENTS CAN OCCUR
AFTER SENESCENCE HAS BEEN
SITTING AROUND A WHILE AND CELLS
GET EXTENSIVE MUTATION OCCURRING
AND ESCAPING SENESCENCE AND
COMING BACK AS THERAPY RESISTANT
CANCER AND IDEA OF THE TRIAL IS
TRYING TO DURING PHASE OF
REMISSION TO KILL THERAPY
INDUCED SENESCENCE CELLS
HOPEFULLY EXTENDING PERIOD OF
REMISSION AND NEW CLASS OF DRUGS
I CAN'T GO INTO MUCH DETAIL IN A
MOMENT THAT ARE SEINO
SENSITIZERS THAT MAY EXTEND
RESULTS OF THIS THING FURTHER
AND PARTICULARLY IN CASE OF
TRIPLE NEGATIVE BREAST CANCER
AND NCI HAD A COUPLE MAJOR
MEETINGS IN -- THAT WERE
PUBLISHED IN JNCI TALKING ABOUT
1, 2 PUNCH APPROACH FOR
TREATMENT OF CANCER AND NOT ONLY
TALKING ABOUT IN PREVIOUS
SESSIONS TALKED ABOUT MINA
TALKED AND I DID ABOUT ST. JUDE
TRIAL EFFECTS OF CANCERS BUT
TREATING CANCERS WITH SOME OF
THESE AGENTS.
THERE ARE ALSO TRIALS AND,
AGAIN, I APOLOGIZE FOR FOCUSING
ON SENOLYTIC SURGE AND LOTS OF
TRIALS WITHOUT SENOLYTICS ACROSS
THE NETWORK AND SEVERAL TRIALS
STOMP AD TRIALS AND
[INDISCERNIBLE] FUNDED BY
ALZHEIMER'S ASSOCIATION AND
LOOKING AT TRYING BASED ON SOME
FIVE DIFFERENT ANIMAL MODELS AND
ALL THAT ARE PRETTY POOR
REFLECTION OF ALZHEIMER'S
DISEASE THAT OCCURS IN HUMANS
AND MAYBE GREAT APES. THERE ARE
TRIALS UNDERWAY AND EARLY
EVIDENCE IN TRIALS LOOKING AT
CSF THERE IS TARGET ENGAGEMENT
WITH DIFFERENT KINDS OF
SENOLYTICS LOOKING AT THINGS
LIKE VARIOUS FORMS OF TAL YENTS
AND SO FORTH IN CSF AND LOOKS
LIKE A SAFETY SIGNAL AND TRIALS
ARE BLINDED AND UNDERWAY AND WE
DON'T KNOW ALL OF THE RESULTS.
THERE IS SEVERAL TRIALS UNDER
WAY FOR CORONAVIRUS A TRIAL IS
WELL COMPLETE NOW FOR HOSPITAL
PATIENTS FOR CORONAVIRUS AND
OUTPATIENTS AND ANOTHER IS
FUNDED BY NIA IN CORONAVIRUS AND
KNOW THAT SENESCENCE CELLS
UPREGULATE -- THEY DOWNREGULATE
I FIT M2 AND 3 WHICH ARE VIRAL
DEFENSE PROTEINS IN NEARBY
NONSENESCENCE CELLS THAT ARE
INFECTED ABOUT I CORONAVIRUS AND
3 TIMES MORE LIKELY TO TAKE UP
THAN OTHER CELLS AND CAN INDUCE
SENESCENCE THROUGH TRL3 AND
LOOKS LIKE THROUGH WORK THAT
ARE. NA VIRUSES ARE MUTATED
WITHIN SENESCENCE CELLS AND SOME
VARIANTS DEVELOPED THROUGH
SENESCENCE CELLS SUSCEPTIBLE TO
COMPLICATIONS OF THIS VIRUS AND
HAVE PREVIOUS CHEMOTHERAPY AND
HAVE COPD OR A** MA AND
ENCOURAGING LYSTHMA AND
ENCOURAGING LY -- IN 76 VERSUS 2
STANDARD CARE AND 18 TO 80 YEAR
OLD COVID POSITIVE OUTPATIENTS
OPEN LABEL TRIAL THAT WAS
RANDOMIZED AND LOOKED LIKE A
SUBSTANTIAL DECREASE IN
HOSPITALIZATIONS AND PERCENT OF
PATIENTS NEEDING OXYGEN AND ICU
CARE AND CURRENT TRIALS ARE
PLACEBO CONTROLLED TRIALS USING
A RELATED FLAFINNOID OR FLAFIN
OL ONE HYDRAULIC GROUP DIFFERENT
FROM [INDISCERNIBLE] AND
ADVANTAGE OF IT IS MUCH --
ELIMINATION HALF LIFE AND BRIEF
EXPOSURE TO SENOLYTICS TO KILL
SENESCENCE CELLS TAKES A WEEK OR
2 TO REFORM AND GIVING DRUGS HIT
AND RUN MANNER. TRIALS UNDERWAY
TO LOOK AT TRYING TO
REHABILITATE ORGANS FROM OLDER
DONORS TO TRANSPLANT RECIPIENTS
AND WORK WE DID WITH A GROUP AT
BRIG AM SHOWING IF YOU TREAT
DONORS, HEARTS OR RECIPIENTS IN
CASE OF YOUNG ANIMALS
TRANSPLANTED FROM HEARTS FROM
OLDER DONORS YOU CAN REDUCE
MORTALITY AND SENESCENCE FROM
TRANSPLANTED HEART TO YOUNGER
RECIPIENT WE ARE THROWING AWAY
35,000 KIDNEYS IN THE US FROM
PEOPLE THAT DIED OVER 50 OR DIED
IN A CAR CRASH WE ARE TRYING TO
REHABILITATE THOSE ORGANS TO BE
USED -- YOU CAN REDUCE AMOUNT OF
IMMUNOSUPPRESSION YOU GIVE AND
TRIALS UNDERWAY IN HOLLAND
TRYING TO LOOK TO REHABILITATE
LIVER FOR TRANSPLANTATIONS AND
OTHER TRIALS WITH OTHER ORGANS
AND ANOTHER THING WE ARE TRYING
TO DO IS A CROSS TRANSLATIONAL
GEROSCIENCE NETWORK AND ASSAYS
ARE PAID FOR BY INDIVIDUAL
TRIALS.
WE HAD A MEETING A YEAR AGO AND
I'M RUNNING OUT OF TIME AND
WON'T BE ABLE TO GO THROUGH
EVERYTHING. BUT, IT WAS WHERE
WE MET WITH THE FDA AND ELEMENTS
OF THE NIH AND ALSO VARIOUS
PHARMACEUTICAL COMPANIES
ANDACDEMIA. AND IT LOOKS LIKE
THERE ARE ABOUT 9 CRITERIA
HAVING TO BE MET TO BE TAKEN AS
A SURROGATE ENDPOINT LOOKING
BEYOND BIOLOGICAL CLOCKS AND
RESPONSE TO INTERVENTIONS TO BE
USED TO SELECT BEST GEROSCIENCE
INTERVENTIONS AND RIGHT TIMING
LOOKING FOR RESPONSES TO
TREATMENT AND COME UP WITH
COMPOSITE SCORES AND SIGNATURES
TO BE MINIATURIZED TURNING TO
BLOOD AND URINE TEST TO BE USED
FOR POINT OF CARE AND LIFESTYLE
INTERVENTIONS TO RE-ENFORCE
WHETHER SOMETHING IS WORKING FOR
A PATIENT OR NOT THAT IS
EFFECTIVE IN DIABETES PEOPLE
MEASURING OWN BLOOD SUGARS
CAREFUL ABOUT DIETS AND BLOOD
INSULIN AND PATIENTS SEEING THAT
PREDICTS PROBLEM YOU ARE LIKELY
TO HAVE LIFESTYLE WITH
INTERVENTION AND TRACKING WITH
BIOLOGICAL AGE WILL NOT MAKE IT
PART OF COMPOSITE SCORE AND
GDF15 BEING AN EXAMPLE THAT IS
PROTECTIVE FACTOR RISING IN
RESPONSE TO VARIOUS KINDS OF
DAMAGE AND TENDS TO PREDICT
THINGS LIKE SARCOPENIA AND GOES
UP FURTHER IF TREATING WITH
METFORMIN AND GOES IN WRONG
DIRECTION BECAUSE IT IS A
PROTECTIVE FACTOR WON'T MEET FDA
CRITERIA.
WE HAVE DEVELOPED EARLY
COMPOSITE OR SCORES USED IN
THESE TRIALS THAT SEEM TO TRACK
TREATMENT WITH VARIOUS AGENTS.
WE ARE FINDING FACTORS THAT ARE
-- YOU KNOW, THROUGH THIS
UNITARY FAIRY FUNDAMENTAL AGING
PROCESSES THAT ARE INTERLINKED
TREATING SOMETHING GETTING RID
OF BAD THINGS YOU GET
UPREGULATION OF GOOD THINGS AND
20 OUT OF 20 PATIENTS FIBROSIS
TRIAL -- FOLLOWING TREATMENT
WITH SENOLYTICS IN EVERY SINGLE
PAGIOENT AND IT IS PRODUCED IN
THE BRAIN AND FAT TISSUE
GEROPROTECTIVE FACTOR GOING DOWN
IN ALZHEIMER'S DISEASE -- IF YOU
TREAT ANIMALS WITH VARIOUS
THINGS JERO PROTECTIVE INCLUDING
CLOTHO RESTRICTION CLOTH GOES UP
AND USEFUL IN DENOMINATOR
CREATING RATIOS FOR FACTORS
DON'T WANT TO EXPRESS AS
FUNCTION OF CREATININE AND
MUSCLE MASS DOING THINGS IN
EUROPE AND DETRIMENTAL FACTORS.
SO, I WON'T GO THROUGH ALL
ANOLITES BEING MEASURED
MEASURING HUNDREDS OF THEM IN
BLOOD AND URINE AND TAKING
BUNKLE SWABS AND NAIL AND HAIR
CLIPPINGS AND MICROFECAL AND
SKIN MICROBIOME AND VARIETY OF
PRIMERS AS WELL AS STANDARDIZING
KIND OF TESTING THAT IS BEING
DONE FOR VARIOUS THINGS LIKE
COGNITIVE FUNCTION AND ECG
INTERPRETATION, ET CETERA ACROSS
ALL TRIALS TRYING TO PUT THIS
TOGETHER AND COMING UP WITH
SIGNATURES WE COULD USE THROUGH
AIM 3 OF TRANSLATION AL
GEROSCIENCE AND MEASURING 35
THINGS IN URINE AND SALIVA AND
CSF WHEN WE CAN GET IT AND FINAL
BIT I WILL SAY WE HAVE MANAGE BY
STEVE WHO IS A CENTRAL
DIAGNOSTIC KIND OF GROUP AND
STEVE CAN SPEAK TO THIS LATER.
HE MADE SOME OF THESE POINTS AND
THROUGH JORNL WE ARE BIOBANKING
SAMPLES AND IT IS LOOKING
INCREASINGLY LIKE IT WILL BE
ABLE TO USE BIOBANK AND FRED
RICK RUN BY NIH.
SO, GS I KNOW I'M OUT OF TIME.
I WILL MENTION EXCITING TRIALS
THAT ARE COMING ALONG.
ONE OF THEM THAT IS BEING
DEVELOPED AND THROUGH WHICH WE
HAVE GOTTEN A GRANT IS FOR DOWN
SYNDROME SENESCENCE DRIVEN
DISORDER AND IT LOOKS LIKE IT IS
HOW CHROMOSOMES ARE ANCHORED TO
NUCLEAR ENVELOPE AND HOW THEY
TOUCH EACH OTHER BEYOND
EPIGENETICS AND IT IS RELATED TO
THIS AND SCLERO DERMATHERE IS
GOOD EFTDZ THAT MANY
RHEUMATOLOGISTS ARE USING THIS
TREATMENT FOR SCLERO
DERMASENESCENCE -- THE
CONFERENCE THAT OCCURRED IN
BOSTON LAST YEAR 25% OF RUM
TOLLSES ARE USING
[INDISCERNIBLE] FOR TREATING
SYSTEMIC SCLEROSIS THAT IS FATAL
CAUSING DEATH THROUGH CARDIAC
FIBROSIS AND RENAL DISEASE AND
TRIALS ARE BEING PLANNED FOR
PREECOLLAPSIA SENESCENCE DRIVEN
DISORDER AND TO MOTHER ARE
BASICALLY TRANSMISSION AND THERE
ARE TRIALS BEGINNING FOR CHRONIC
WOUND HEALING AND CARPAL TUNNEL
SYNDROME AND SPACE TRAVEL IN
CONJUNCTION WITH SPACE X AND
TRIALS ARE FUNDED BY NAVY TO
LOOK FOR EXTREME EFFECTS OF
RESISTANCE EXERCISE CAUSING
STRESS FACTURES -- FRACTURES AND
BILIARY SOROSIS AND CHRONIC HIV
SYNDROME FUNDED BY HIV COMMUNITY
AS WELL AS A COUPLE NIH GRANTS.
SO, SORRY I DON'T HAVE TIME TO
GO INTO DETAIL ABOUT IT AND LOTS
OF PEOPLE ARE INVOLVED IN THIS.
AND THERE IS MANY AGENTS IN SOME
CASES WE ARE COMPARING AGENTS
RAPPO LOGS TO SENOLYTICS AND
METFORMIN OR WHATEVER. THANK
YOU VERY MUCH.
>>OKAY. GOOD AFTERNOON. I'M
SARA E SP INOZA AND WILL TALK
ABOUT OUTCOMES FOR CLINICAL
TRIALS IN GEROSCIENCE. MANY OF
US HAVE DISCUSSED CONCEPT OF
GEROSCIENCE. WE WON'T GO
THROUGH THAT. THINKING ABOUT
DOING CLINICAL TRIALS RELATIVE
TO GEROSCIENCE, WHAT ARE WE
TRYING TO MEASURE?
SO, WHEN THIS STARTED TO COME
ABOUT, THE CONCEPT OF HEALTH
SPAN HAS BEEN USED. IN RECENT
YEARS, I HAVE BEEN REALLY
THINKING ABOUT, WELL, WHAT IS
HEALTH SPAN?
HOW DO WE DEFINE IT?
TYPICALLY, WHEN YOU SEE IT
WRITTEN, YOU SEE ABSENCE OF
DISEASE AND DISABILITY.
BUT, YOU KNOW, WE ALL KNOW HOW
WE AGE AND WE WILL ALL -- I
MEAN, IT IS PRACTICALLY
IMPOSSIBLE TO NOT GET SOME
DISEASE; RIGHT?
SO, THEN HOW DO WE QUANTIFY THIS
OR DETERMINE THE LEVEL OF
DISEASE OR DISABILITY THAT IS
ACCEPTABLE, SO-TO-SPEAK?
GOOD HEALTH SPAN IS SUBJECTIVE
ACTUALLY. WHAT MAY BE
REASONABLE AMOUNT OF DISEASE AND
DISABILITY TO ONE PERSON MAY NOT
BE REASONABLE TO ANOTHER.
SO, THERE -- YOU KNOW, THERE IS
NO -- OBVIOUSLY, THERE IS NO
ACCEPTED DEFINITION FOR GOOD
HEALTH SPAN. ALSO, MANY OTHER
-- A COUPLE OTHER PEOPLE HAVE
BROUGHT UP TODAY, YOU KNOW, IN
THE LAST FEW DAYS, ALSO, ABOUT
HOW -- WHAT IS IMPORTANT TO
PATIENTS AND INDIVIDUALS AND
WHAT MATTERS MOST TO THEM.
THESE ARE ALL THINGS WE HAVE TO
CONSIDER WHEN CONSIDERING
OUTCOMES FOR OUR CLINICAL TRIALS
IN THIS SPACE.
AND THIS IS NOT AN EXHAUSTIVE
REVIEW. I JUST KIND OF LOOKED
THROUGH CLINICAL TRIALS.GOV AND
SOME CANDIDATE AGENTS THAT HAVE
BEEN TESTED WITH REGARDS TO
GEROSCIENCE HYPOTHESIS AND
SENOLYTICS -- AND YOU CAN SEE
ALL OF THE OUTCOMES ARE PRIMARY
OUTCOMES FOR MANY STUDIES RIGHT
NOW REGISTERED IN CLINICAL
TRIALS.GOV WITH GAIT AND VACCINE
RESPONSE, ET CETERA THERE IS A
WIDE RANGE OF OUTCOMES LOOKED IN
THESE TRIALS AND I WILL BRIEFLY
DO AN EXERCISE IN MEASURING
HEALTH SPAN TAKING APPROACH OF
ABSENCE IN DISEASE AND
DISABILITY TO JUST EXAMINE WHAT
THAT WOULD LOOK LIKE IN A
POPULATION-BASED STUDY I DID A
BRIEF EXERCISE IN SAN ANTONIO
STUDY OF AGING THAT WAS ABOUT
749 OLDER ADULTS 65 AND OLDER
AND PEOPLE WERE FOLLOWED
STARTING IN THE EARLY 90S AND IT
WAS UNTIL MID 2000S TO LOOK AT
PREDICTORS OF DISABILITY AND
DEFINED POOR HEALTH SPAN IN THIS
HOE HORT OF BASELINE OF EXAM IN
THE 90S PRESENCE OF MAJOR AGE
RELATED CHRONIC DISEASES
DEPENDENTS NEEDING HELP IN --
EXAM SCORE LESS THAN 18 AND
BASELINE EXAM OF THE STUDY OVER
70% OF INDIVIDUALS WOULD HAVE
QUALIFIED FOR POOR HEALTHSPAN
MEANING THEY HAD MAJOR DISEASE
NEEDING HELP WITH ADLS OR IDLS
AND MAJORITY OF HIGHER
PROPORTION OF PEOPLE WITH POOR
HEALTH SPAN WER OF MEXICAN
AMERICAN DECENT AND 56% OF POOR
HEALTH SPAN WERE MEXICAN
AMERICAN AND ETHNIC DIFFERENCE
IN PROPORTION OF POOR VERSUS
NORMAL HEALTH SPAN BRINGING IN
THEMES TALK BEING ON FIRST DAY
THAT IF WE ARE TALKING ABOUT
PREVENTIVE STUDIES, THERE WILL
BE KIND OF AN INHERENT EXCLUSION
OF ETHNIC MINORITY GROUPS
TALKING ABOUT PREVENTIVE TYPE OF
GEROSCIENCE GUIDED TRIALS AND
ESSENTIALLY IS COMPLETE
PREVENTION OF DISEASE AND
DISABILITY A REALISTIC GOAL?
I DON'T THINK SO. SO, THEN HOW
-- YOU KNOW, HOW DO WE DEFINE
HEALTH SPAN FOR THESE
GEROSCIENCE-GUIDED TRIALS AND
ANOTHER THING I THINK WE HAVE TO
THINK ABOUT IS HOW DO WE DO
GEROSCIENCE GUIDED TRIALS IN
PEOPLE THAT HAVE ALREADY DISEASE
AND DISABILITY AND IN THINKING
ABOUT AMELIORATING THESE THINGS
IN PEOPLE THAT ALREADY HAVE
POORER HEALTH SPAN AND
GERIATRICIAN AND CLINICIAN AND
SEEING HEALTH PATIENTS IN MY
MIND I PUT THEM SOMEWHERE ON
SPECTRUM OF LEFT SIDE ROBUST AND
A FEW HEALTH PROBLEMS ACTIVE AND
INDEPENDENT TO THE OTHER END OF
THE SPECTRUM AND FRAIL AND
VULNERABLE NEEDING HELP TO DO
ACTIVITIES NOT NEEDING HELP TO
DO INDEPENDENTLY AND SPECTRUM
HOST OF PROBLEMS TO THINK ABOUT
PREVENTING FURTHER DECLINE AND
TRYING TO OPERATIONALIZE THIS
CLINICAL OBSERVATION YOU CAN
THINK OF DOMAINS AND SIM FIEZ
VIEW.
BE HAVE PHYSICAL FUNCTION AND
DISABILITY AND COMORBIDITY AND
JER RAT TRICK SYMPTOMS THAT
FRAILTY FALLS INTO AND OTHER
TYPES OF BIOMARKERS THIS IS INTD
RELATED AND WAY TO CATEGORIZE
THESE AND MANY OF THE TRIALS
THAT WE HAVE SEEN ARE, YOU KNOW,
USUALLY INVOLVING ONE OR MORE
OUTCOMES WITHIN THESE DOMAINS
AND IS JUST THINGS THAT, YOU
KNOW, MY THINKING OUT LOUD ABOUT
THINGS TO CONSIDER FOR
GEROSCIENCE GUIDED CLINICAL
TRIALS AND MORE THAN LIKELY THE
PRIMARY AT LEAST THE PRIMARY
OUTCOME WILL BE BASED ON AGENT
THAT WE ARE TESTING AND WHAT WE
THINK THE MECHANISM OF THE AGENT
IS IT WILL ALSO DEPEND ON TARGET
POPULATION INCLUDING A ROBUST
AND HEALTHY GROUP OR SOMEONE OR
GROUP THAT ALREADY HAS SOME
DECLINE.
MANY TRIALS, FOR EXAMPLE IN THE
SARCOPENIA SPACE ARE ENROLLING
PATIENTS ARE LOW PHYSICAL
FUNCTION AND SPP SCORE UNDER AID
FOR EXAMPLE AND WILL INFLUENCE
OUTCO
OUTCOMES BECAUSE WHAT IS THE
DEGREE OF CHANGE YOU WILL EXPECT
BASED ON INCLUSION CRITERIA AND
SCALE AND PHASE OF THE TRIAL
WILL HAVE INFLUENCE IS THIS
PILOT STUDY OR PHASE 1 OR 2, ET
CETERA OR SMALL STUDY VERSUS
LARGER OR PRAGMATIC TRIALS THAT
I HOPE ARE IN FUTURE WITH
CANDIDATE AGENTS SHOWING BENEFIT
IN EARLIER PHASED TRIALS THAT I
FEEL IN THE FUTURE WE WILL NEED
LARGER PRAGMATIC TRIALS LARGER
POPULATION-BASED SCALE TO SHOW
TRUE BENEFIT AND POTENTIAL FOR
DELIVERING IN BROADER SENSE AND
FOLLOW UP PERIOD OF THE STUDIES
IS RELEVANT. HOW MUCH CHANGE DO
WE EXPECT TO SEE OVER TIME AND
PRACTICAL POINT OF VIEW
PRELIMINARY DATA IS IMPORTANT.
THAT HELPS YOU TO GET THE
GRANTS. IF YOU HAVE ONLY
PRELIMINARY DATA ON CERTAIN
OUTCOME PRACTICALITY HARD TO
PROPOSE FOCUSING ON ANOTHER
OUTCOME AND SOMETHING THAT WAS
BROUGHT UP ON THE FIRST DAY, I
BELIEVE, WAS ISSUE OF COMPARING
ACROSS STUDIES AND EXTERNAL
VALIDITY AND ARE CONSIDERATIONS
AND IN SAN ANTONIO WITH PEPPER
CENTER WE HAVE BEEN INVOLVED AND
ARE STILL INVOLVED IN CLINICAL
TRIALS WITH MANY AGENTS THAT ARE
DISCUSSED IN THIS SUMMIT
INCLUDING HEARING ABOUT SOME
DATA AND I WON'T GO INTO THIS IN
ANY GREAT DETAIL. YOU CAN SEE
AGENTS TARGET DIFFERENT
MECHANISMS AND SPECIFIC
MECHANISM WILL SORT OF I WON'T
SAY DICTATE BUT LEAD YOU IN A
DIRECTION OF A CERTAIN OUTCOME
YOU ARE TRYING TO MOVE AND BY
WAY OF EXAMPLE I WON'T SPEND A
LOT OF TIME BUT EXAMPLE OF
CLINICAL TRIAL AND THAT IS
PLACEBO PREVENTION OF FRAILTY
AND WE ARE DOING THIS TRIAL FOR
FRAILTY SPECIFICALLY THAT IS
SYNDROME AND INTEREST AND
SHOWING INL FLAMATION AND
RESISTANCE IS PREDICTOR FOR MANY
GROUPS AND MET FORMIN WILL
TARGET CONCEPTS TO PRODUCE OR
REDUCE FRAILTY AND FOR THIS
TRIAL WE ARE ENROLLING ONLY
OLDER ADULTS WITH ORAL GLUCOSE
INTOLERANCE AND SELECTING THAT
GROUP OF INDIVIDUALS THAT ARE
INSULIN RESISTANT WE THOUGHT
WOULD BE MORE LIKELY TO BENEFIT
FROM METFORMIN. WE ARE LOOKING
AT PREVENTING FRAILTY AND NO
PATIENTS ENROLLED AT BASELINE
ARE FRAIL AND EXCLUDING ANYBODY
FRAIL AT BASELINE AND FOLLOW UP
PERIOD IS 24 MONTHS AND DOING
AND COMPLETING ENROLLMENT
TARGETING 120 COMPLEERTS AND IN
THE 24 MONTHS FOLLOW UP WE HAVE
DEEP PHENOTYPING WITH BLOOD AND
SKELETAL MUSHLELE TISSUE AND
INSULIN CLAMP AND PHENOTYPIC
DATA I DON'T HAVE RESULTS TO
GIVE YOU I'M STILL BLINDED BUT
TOOK KNOWN PREDICTORS OF FRAILTY
AND IDEA OF MECHANISM OF
METFORMIN THAT GUIDED OUR
INCLUSION AND EXCLUSION CRITERIA
AS WELL AS OUTCOME AND I WILL
JUST SKIP THAT SLIDE FOR TIMES
SAKE. OUR PRIMARY OUTCOME IS
FRAILTY AND WE STARTED OFF WITH
THE FRAILTY PHENOTYPE AND DSMB
AND WHO IS VERY KNOWLEDGEABLE IN
THE FIELD SUGGESTED THAT WE
INCLUDE THE FRAILTY INDEX AS A
PRIMARY OUTCOME AND WE HAVE DONE
THAT AND YOU CAN SEE WE HAVE A
HOST OF SECONDARY OUTCOMES THAT
I -- YOU CAN SEE FOR YOURSELVES.
YOU KNOW, SOME PEOPLE MIGHT SAY
ARE YOU CRAZY? WHY DO YOU HAVE
SO MANY SECONDARY OUTCOMES AND I
FEEL LIKE LISTENING TO TALKS I
THINK IT IS IMPORTANT IN THESE
TYPES OF TRIALS TO -- IF YOU --
YOU KNOW, AS FEASIBLE AS IT CAN
BE TO MEASURE MANY THINGS IF YOU
HAVE NOT MEASURED IT YOU DON'T
KNOW HOW IT WILL CHANGE AND YOU
DON'T HAVE THE ABILITY TO
COMPARE ACROSS STUDIES AND IS MY
RECOMMENDATION FOR KEY MEASURES
LIKE GAIT OR STRENGTH FOR
EXAMPLE AND KEY BIOMARKERS AND
ENJOYED LISTENING TO A BUNCH OF
BIOMARKERS AND TOOK GOOD NOTES
TO SEE HOW THEY CHANGED EVEN IF
NOT PRIMARY OUTCOME THAT COULD
INFORM THE NEXT STUDY THAT MIGHT
IMPROVE UPON A NEGATIVE STUDY
AND METFORMIN WE HYPOTHESIZED IT
WOULD ACT WITH INFORMATION AND
INSULIN SENSITIVITY AND IT IS A
DRUG WITH POTENTIAL EFFECTS
TARGETING HALLMARKS OF AGING AND
WE HAVE ANOTHER STUDY WE ARE
LOOKING AT MARKERS OF CELLULAR
SENESCENCE AND MITOCHONDRIAL
FUNCTION AND EPIGENETIC CLOCKS
AND THESE ANALYSIS ARE UNDERWAY
AND THAT WAS A SMALL KIND OF
VERY TRANSLATIONAL INTENSE
TRIAL.
IT IS A EXAMPLE AND GIVING A
LARGER TRIAL EXAMPLE AND MANY
MIGHT BE FAMILIAR WITH A SPREE
THAT IS RANDOMIZED CONTROL TRIAL
FOR ASTHMA AND DISABILITY
PREVENTION AND TRIAL STARTED IN
2010 LIKE PROBABLY YOU KNOW
RIGHT AROUND THE TIME I GUESS
GEROSCIENCE WAS JUST GETTING
STARTED. I DON'T THINK THAT
THEY REALLY THOUGHT OF THEIR
OUTCOME AS GEROSCIENCE RELATED
BUT THINK IT WAS THE FIRST TRIAL
TO USE A COMPOSITE PRIMARY
ENDPOINT THAT WAS DISABILITY AND
DEMENTIA-FREE SURVIVAL.
SO, THIS STUDY, AGAIN, I SAID IT
STARTED IN 2010 AND TREATMENT
PHASE ENDED IN 2017 AND WE WERE
SITE IN SAN ANTONIO AND ENROLLED
ABOUT 300 OLDER ADULTS.
RANDOMIZED ASPIRIN VERSUS
PLACEBO WERE FREE OF
CARDIOVASCULAR DISEASE BASED ON
THE TRIAL AND MEDIAN FOLLOW UP
PERIOD WAS LESS THAN FIVE YEARS
NEGATIVE TRIAL AND FOUND NO
BENEFIT FOR LOW DOSE ASPIRIN FOR
PREVENTION OF DISABILITY AND
DEMENTIA-FREE SURVIVAL. YOU
MIGHT SAY, WELL, GOSH. THAT IS
TOO BAD. THIS TRIAL ACTUALLY
CHANGED THE CLINICAL PRACTICE
GUIDELINES AND IS NO LONGER
RECOMMENDED FOR OLDER ADULTS WHO
WORK WITHOUT CARDIOVASCULAR
DISEASE TO TAKE LOW DOSE
ASPIRIN. I'M NOT SHOWING YOU
THIS. IT LED TO MORE BLEEDING
EVENTS AND YOU OBVIOUSLY SEE
THERE IS NO BENEFIT WITHIN THAT
TRIAL WE STARTED TO LOOK AT
OUTCOMES AND LOOKED AT FRAILTY
AND NO BENEFIT WITH REGARDS TO
ASPIRIN ON FRAILTY AND FRAILTY
DOES PREDICT DISABILITY FREE
SURVIVAL.
SO, BOTH FRAILTY PHENOTYPE AND
FRAILTY INDEX AND THESE OUTCOMES
ARE LINKED. YOU CAN SEE THAT
THE FREED -- FREED AND FRAILTY
INDEX CLASSIFICATIONS ARE
SENSITIVE IN PREDICTING THIS
COMPOSITE ENDPOINT.
OKAY. SO, IN SUMMARY, I WILL
JUST KIND OF WRAP UP WITH MY
THOUGHTS THAT IS WORK BY MANY
PEOPLE THAT ARE HERE AT THE
SUMMIT IN OBSERVATIONAL AND
EPIDEMIOLOGIC TRIALS HAVE REALLY
INFORMED US OVER THE LAST MANY
YEARS THAT ARE ABOUT RISK
FACTORS FOR MANY GERIATRIC
SYNDROMES AND ENTITIES THAT ARE
IMPORTANT FOR OLDER ADULTS AS
THEY AGE.
AND GEROSCIENCE TRIALS WILL NOT
BE A ONE-SIZE FITS ALL. I MEAN,
THERE WILL PROBABLY IN MY VIEW
BE SOME AGENTS THAT MAY BE
BENEFICIAL IN ONE SUBGROUP AND
OTHERS THAT WILL BE BENEFICIAL
IN OTHER SUBGROUPS WITH CERTAIN
DISEASES OR INSULIN RESISTANCE,
ET CETERA.
THERE IS REALLY I THINK SO MUCH
TO BE DONE. THE OUTCOMES THAT
WE SELECT FOR TRIALS WILL DEPEND
ON MANY THINGS THAT I HAVE
ALREADY DISCUSSED AND I THINK
THAT WE NEED TO CONSIDER
CLINICAL RELEVANCE OF OUTCOMES
AS WELL AS MEANINGFUL CHANGE AND
CLINICALLY MEANINGFUL CHANGE
THAT TOM GILL MENTIONED IN HIS
TALK THAT IS REALLY IMPORTANT.
I ALSO THINK IT IS REALLY
IMPORTANT TO CONSIDER WHAT
MATTERS MOST TO PATIENTS THAT WE
SHOULD INCORPORATE
PATIENT-REPORTED OUTCOMES AS
MUCH AS WE CAN IN THESE TRIALS
AND DO THINK THAT IF, AGAIN, AS
MUCH AS FEASIBLE, WE SHOULD
INCLUDE OUTCOMES THAT CAN BE
COMPARED ACROSS TRIALS TO LEARN
FROM EACH OTHER AS WE MOVE
FORWARD. ON THAT NOTE, IF YOU
HAVE NOT SEEN THE GERIATRIC
RESEARCH INSTRUMENT LIBRARY THEY
CALL IT GRILL ON PEPPER CENTER
NATIONAL WEBSITE THERE IS A
COMPENDIUM OF MEASURES YOU CAN
FIND WITH REFERENCES HOW TO
MEASURE 6 MINUTE WALK OR
BASICALLY ALL -- THERE IS
DIFFERENT CATEGORIES AND THAT IS
A GOOD STARTING PLACE FOR ALL OF
US SO WE ARE USING SIMILAR
METHODS ACROSS THESE STUDIES.
WITH THAT, I WILL JUST STOP
THERE.
THANK YOU!
>>GOOD AFTERNOON, EVERYONE.
THANK YOU TO THE ORGANIZERS FOR
INVITING ME. TELLING YOU A
LITTLE ABOUT MY EXPERIENCE AND
JOURNEY THINKING ABOUT CLINICAL
TRIAL AND WILL BE A REALLY
EUROPEAN [INDISCERNIBLE] UK IN
THE LAST YEAR ESPECIALLY AFTER
EXIT FROM BREXIT AND HOW WE
THINK THERE AND NO DOUBT WE ARE
A LITTLE BIT BEHIND THE UNITED
STATES JOURNEY STARTED 8 YEARS
AGO FOUNDED BY EUROPEAN UNION TO
HAVE CONSORTIA TO THINK ABOUT
THIS AND CALLED MOUSE AGE AND
TITLE GIVES IT AWAY AND ACTUALLY
MANY OF US WERE PRECLINICAL
RESEARCHER DOING EXPERIMENTS IN
MICE AND WANTED TO KNOW WHAT WE
WERE SUPPOSED TO TEST AND HOW TO
DO EXPERIMENT PTS TO FACILITATE
TRANSITION TO A CLINICAL TRIAL
AND ANSWER WAS WE HAD TO LOOK
FIRST AT CLINICAL TRIAL DESIGN
AND WORK BACKWARDS EXPERIMENT IN
MICE THAT LED TO ASK QUESTION
WHICH PATIENTS WOULD BENEFIT
FROM THESE INTERVENTIONS AND AT
TIME A LOT OF THINKING WAS ABOUT
EXTENSION OF LIFESPAN. WE WERE
REALLY BROUGHT DOWN TO EARTH
WITH -- AND NOVARTIS IN THIS AND
BROUGHT US BACK TO REALITY AND
CONSENSUS WAS QUICKLY REACHED
AND REALLY FOCUSING ON FRAILTY
AND MULTI-MORBIDITY WAS THE WAY
TO GO. IT WAS BECAUSE OF THE
CHARACTERISTICS OF MOLECULE ABLE
TO LOOK AT MULTIPLE DEFICITS AND
MULTIPLE DISEASE AT SAME TIME
ALSO BECAUSE THERE WAS REALLY
IMPORTANT PROBLEM AND SINGLE
DISEASE MODEL DOESN'T WORK WELL
FOR THESE PATIENTS AND WE WERE
VERY AWARE OF FACT THAT WE HAD
TO AGREE TO DEFINITION THAT WE
HAD DEREGULATORS AND MEASURE OF
OUTCOMES AND WE HAD
CONVERSATIONS AND I HAVE TO SAY
RECEPTION WAS QUITE DIFFERENT
FROM THE START AND FOR REASONS I
WILL ELABORATE MORE IN THE NEXT
SLIDES AND BOTTOM LINE THEY
ADVISED US TO FOCUS ON TWO OR
THREE CASE STUDIES AND REALLY
WORK THEM OUT VERY WELL WITH
SAME DRUG DEVELOPMENT PARADIGM
USED FOR SINGLE DISEASE MODEL
LOOKING AT TRIAL SHORT DURATION
MAKING IT CLEAR TO US THEY
DIDN'T WANT TO KNOW ANYTHING
LIKE THE [INDISCERNIBLE] TRIAL
AND USE OF REPURPOSE MOLECULE.
AT LEAST ONE OF THE PROBLEM WITH
CHALLENGES WOULD HAVE BEEN
PUTTING IT TO BED IN A GOOD
SAFETY PROFILE.
AND SO ONE OF THE THINGS THAT
ALSO EMERGED WAS FACT THAT WE
NEEDED TO INVOLVE AND TALK TO
ALL OF THE STAKEHOLDERS AND WE
NEEDED TO IN A WAY INFLUENCE
BOTH IN TERMS OF FUNDING AND IN
TERMS OF THINKING ABOUT WHAT WAS
ROOT MARKET AND WHAT WAS
ACCEPTABLE.
SO, WE DID. WE BROUGHT TOGETHER
REGULATE YR AND PATIENTS
ORGANIZATIONS AND POLICY MAKER
AND LEADERS IN HEALTH SYSTEM AND
WRITING GRANTS WE HAVE TO TELL
HOW IS THIS GOING TO IMPLEMENT
IT IN THE NATIONAL HEALTH SYSTEM
WHO WILL ADMINISTER DRUGS AND
WILL BE GERIATRICIAN AND GP AND
WHEN YOU ARE JUST NOT EVEN
KNOWING WHAT PRIMARY MEASURE OF
OUTCOME IS BECOMES QUITE
DAUNTING WANTING TO REALLY
UNDERSTAND WHERE PEOPLE WERE
WITH THIS.
IT IS FAIR TO SAY THAT NOT MANY
KNEW ABOUT GEROSCIENCE AND
GEROSCIENCE DEPARTMENT AND THOSE
THAT KNEW, ACTUALLY, THEY WERE
NEGATIVELY, LET'S SAY SORT OF
IMPRESSED.
IDEA THAT WE WERE -- THEY KNEW
THINGS THAT WE WERE TALKING
BEFORE. INSISTENCE ON LIFE
SCIENCE EXTENSION AND REAL THINK
THEY DIDN'T LIKE THAT AGING
SHOULD OBVIOUSLY BE CONSIDERED A
DISEASE AND IF DISEASE IS NOT
WHAT WE WERE WANTING TO TALK
ABOUT, THESE MADE A CONVERSATION
REALLY DIFFICULT TO START.
THOSE THAT WERE NOT FAMILIAR,
OPINION BARRED IT. WE WERE
QUITE TAKEN ABACK BY LEVEL OF
OPPOSITION. THEY ARE -- YOU
KNOW, SOME THOUGHT IT WAS TOO
GOOD TO BE TRUE AND IS MOST
BENIGN. THEY WERE ANXIETY ABOUT
FACT THAT THEY WERE PROPOSING A
DRUG TO TACKLE ISSUES THAT
ACTUALLY WHERE VIEW PRIMARILY
DEALT WITH OTHER FACTORS AND
WAS, AGAIN, OVERMEDICALIZATION
OF THE PROBLEM.
AND THEIR WAY TO GO WAS
PRESCRIBING AND SOCIAL
PRESCRIBING AND WE REALIZED THAT
WE WERE ACTUALLY GETTING INTO
THE WAY OF OUR PEOPLE HAVING
OTHER STRATEGIES AND OTHER
VIEWS. THERE WAS NO MUCH
APPETITE FOR STARTING AND IT WAS
TOO COSTLY AND THEY WERE WORRIED
ABOUT SIDE EFFECT THAT WOULD
COME WITH PREVENTIVE
INTERVENTION.
SO, YOU KNOW, WE ARE ON BOARD
AND REALLY WE -- WE, YOU KNOW,
HAD TO GO BACK AND THINK A BIT
HARDER.
YOU KNOW, WE ALWAYS HAVE USED IN
THE PAST WAS NARRATIVE THAT WE
HEARD MANY TIMES ALSO IN THE
MEETING AND THIS WAS THE FACT
THAT LIFESPAN WAS EXTENDING BY
HEALTH SPAN WASN'T. THIS IS
DATA FOR UK. WHERE, YOU KNOW,
IT HAS LIFE EXPECTANCY IS
STAGNATING AT BEST GOING DOWN IN
LAST THREE YEARS AND WE WERE
TALKING TO PEOPLE ABOUT IDEA OF
HEALTH [INDISCERNIBLE] THAT WAS
INCREASING AND DOING THIS
LOOKING AT EURO STAT DATA WE
ACTUALLY STUMBLED ACROSS FACT
THAT THIS GRAPH WAS NOT TRUE FOR
EVERY COUNTRY AND LOOKING AT
SWEDEN, FOR EXAMPLE. IN SWEDEN
HEALTH LIFE EXPECTANCY INCREASED
BY 5 YEARS IN LAST 12 WITH THE
-- YOU KNOW, WITH LIFE
EXPECTANCY THAT HAS BEEN GOING
UP IN SIMILAR WAY TO THE UK.
THIS WAS ENCOURAGING IN ONE WAY.
ALSO, TOLD US THAT ACTUALLY IT
WAS HAPPENING ALREADY AND THERE
WAS NO REAL NEED OF DRUGS. AT
LEAST NOT IN THIS WAY.
SO, WE REALLY WENT BACK AND
LOOKED AT WHAT SWEDEN IS DOING
THAT OTHER COUNTRIES WERE NOT
DOING.
I -- AND IN 2003, PARLIAMENT IN
SWEDEN ADOPTED A NEW PUBLIC
HEALTH POLICY TO CREATE
STRUCTURALED CONDITION FOR
HEALTH AND ENTIRE POPULATION AND
THEY ACTUALLY SHIFTED THE
PARADIGM AND INSTEAD OF THINKING
ABOUT TREATING DISEASE, IT WAS
TO SORT OF ADDRESS DETERMINANTS
OF HEALTH AND ADDRESSING ALL
FACTORS WE TALKED ABOUT MONDAY
AND STRUCTURE OF SOCIETY AND
PEOPLE LIVING IN CONDITION AND
LIFESTYLE AND ALL THOSE FACTORED
EFFECT THAT HAD GOOD HEALTH AND
CAME UP WITH 11 DOMAINS AND ONE
YOU CAN SEE HERE IN THE GREEN
BOX.
AND, YOU KNOW, THERE IS NOTHING
IN THE 11 REMAINS THAT WE DON'T
KNOW ABOUT AND ARE VERY OBVIOUS.
WHAT THEY DID WAS APPLYING
SYSTEMATICALLY AT LOCAL AND
[INDISCERNIBLE] LEVEL AND
BASICALLY FOR ANY POLICY THAT
SWEDEN HAS TO THINK ABOUT, THEY
HAVE TO MAKE SURE IT DOESN'T
HARM THESE 11 DOMAINS AND THIS
IS THE INTEGRATIVE APPROACH THAT
PEOPLE TALKED ABOUT AMONG
INACTION.
WHAT THAT TELLS US IS ACTUALLY
SOCIAL POLICIES REALLY DO WORK
AND PEOPLE ARE OPPOSED TO DRUG
APPROACH HAVE A POINT. WE
REALLY NEED TO LISTEN TO THEM.
SO, THIS BROUGHT US BACK TO OUR
OWN STRATEGY AT THAT POINT.
REALLY, THIS WAS A TIME WHERE
THE UNIVERSITY WAS UNDERGOING
RESTRUCTURING AND GAVE US THE
OPPORTUNITY TO OPEN A NEW
INSTITUTE.
SO, THE NEW INSTITUTE WAS BASED
ON SCIENCE HYPOTHESIS. WE DO
AGREE THAT OUR RATE OF
BIOLOGICAL AGING IS VARIABLE AND
MALIABLE. WHAT WE THINK IS THAT
THE RATE OF AGING IS EFFECTED BY
ALL OF THE DIFFERENT FACTORS
ACROSS THE LIFE COURSE WHETHER
SOCIOECONOMIC STATUS, ETHNICITY,
LIFESTYLE AND ETHNICITY AND
WHATEVER ELSE. REALLY, AT THAT
POINT, ADDRESSING THIS IS
PRIORITY. OF COURSE, WHEN
POLICY FAILS, THEN WHERE MAYBE
THERE IS AN ADVANTAGE IN USING
DRUG AND REALLY SO THE INSTITUTE
IS VERY MUCH INTERDISCIPLINARY
AND EMBRACING THE INTEGRATIVE
APPROACH OF ALL MEASURES.
WITH THIS IN MIND WE WENT BACK
TO ADVICE OF MHRA AND IMA AND
WENT ABOUT WHAT ARE OUR TWO CASE
STUDIES?
ONE WAS ON FRAILTY. YOU HEARD
THIS BEFORE. DEFINITION THAT WE
LIKE IS ACCUMULATION OF DEFICITS
THAT LEAD TO REAL ACTIONARY IN
RESERVES AND WHEN YOU HAVE
REDUCTION IN RESERVES, I DON'T
KNOW WHETHER IN WILL WORK OR
NOT.
YOU HAVE A -- SO, YOU HAVE A
STRESSOR. YOUR RECOVERY IS
SLOWER AND NEVER GOES BACK TO
BASELINE.
AS A PRIMARY MEASURE OF OUTCOME,
WE REALLY LIKE THE FRAILTY IN
THIS AND WHAT AND HOW IT WAS SET
YESTERDAY AND REFLECTS WELL IDEA
OF ACCUMULATION OF DEFICIT AND
REDUCE RESERVES CORRELATING WITH
MORTALITY AND HOSPITALIZATION
AND USE OF SOCIAL CARE. ALSO,
CAN HAVE A GROUP DOING REALLY
GOOD WORK DEFINING CLINICAL
MEANINGFUL CHANGE AND FRAILTY
INDEX CHANGE OF .03 EQUIVALENT
TO CLINICAL FRAILTY SCARE OF 1
POINT GOING FROM MANAGING WELL
WHICH MEANS PATIENTS ARE STILL
INDEPENDENT AND CONSIDER THEIR
HEALTH GOOD HEALTH TO BE
VULNERABLE.
IT MEANS THAT THE PATIENT FEELS
THAT IT IS NOT COMPLETELY
INDEPENDENT AND NEEDS SUPPORT
AND HAS DIFFICULTY, YOU KNOW,
CLIMBING A FLIGHT OF STAIRS AND
CONSIDERED HEALTH POOR.
SO, IT IS QUITE A BIG DIFFERENCE
THERE.
ALSO, WE LIKE THIS BECAUSE, YOU
KNOW, SMALL CHANGES WILL MAKE A
BIG DIFFERENCE.
HAVING DONE WORK SHOWING THAT IF
WE MANAGE TO SORT OF PREVENT
SHIFT TO NO FRAILTY FOR 1% OF
THE POPULATION, THEN IT SAVES TO
THE UK4.4 MILLION IN SOCIAL CARE
ALONE WITHOUT COUNTING HEALTH
CARE. SO, IT IS -- YOU KNOW,
SMALL CHANGES COULD MAKE A BIG
DIFFERENCE.
SO, DO WE -- DO WE REACH THE
MINIMUM CLINIC OF MEANINGFUL
CHANGE OR CLINICAL MEANINGFUL
CHANGE?
IF WE LOOK AT MICE EXPERIMENTS,
WE DO. SO, WE HAVE SELECTIVE
[INDISCERNIBLE] AND YOU HEARD
ABOUT THEM ALREADY. I DON'T
NEED TO GO INTO DETAIL WITH
THEM.
EXCEPT THAT FOR THIS WE DID SHOW
THAT IT DOES [INDISCERNIBLE] TO
PATHWAY AND IT DOES PREVENT
SENESCENCE.
IN BOTH CASES FOR
[INDISCERNIBLE] WE HAVE
REDUCTION OF 0 TLE .3 AND .27
AND TRAJECTORY OF 20 MICE AND WE
CHOES THOSE 2 BECAUSE OF LOW
TOXICITY AND BECAUSE OF
INTERMITTENT USE TO TRY TO
ADDRESS CONCERN OF COST AND SORT
OF REPAY -- AND SORT OF
SIDE-EFFECTS.
SO, WHAT -- HOW DO WE WANT TO
IMPLEMENT THIS?
WE WOULD LIKE ELECTIVE SURGERY
AS A STRESSOR.
THIS IS SPECIFICALLY IN THIS
PARTICULARLY IN THE CASE OF
CANCER IT HAS A REALLY GOOD
ADVANTAGE. FIRST OF ALL, WE
KNOW WHEN IT WILL HAPPEN AND WE
DON'T NEED TO, YOU KNOW, TO
THINK ABOUT, YOU KNOW N WAYS OF
IDENTIFYING PATIENTS IN THAT WAY
AND YOU HAVE ACCESS TO SAMPLES
BEFORE AND AFTER TO MEASURE
SENESCENCE AND EFFECTS SHOULD
HAPPEN QUITE QUICKLY. I WILL
SHOW YOU SOME IN A MINUTE. WE
HAVE -- THIS IS LINDA WILD IN
THE INSTITUTE AND OLIVIA TURNER
WHO HAS WORKED ON A COHORT OR
AGE GAP STUDY THAT IS WOMEN OVER
AGE OF 70 WITH BREAST CANCER AND
ONGOING SURGERY AND MONITORED
FOR 24 MONTHS VARIETY OF
PARAMETERS AND QUALITY OF LIFE
PARAMETER AND IS ALSO TISSUES WE
CAN ANALYZE.
AND WHAT WE SEE HERE IS THAT --
SO, THEY CALCULATE FRAILTY INDEX
FOR POPULATIONS.
AND I CAN MOVE THE MOUSE MAYBE.
SO, YOU CAN SEE THAT IN ROBUST
AT BASELINE AND BEFORE SURGERY,
WOMEN HAVE NO LIMITATION. THIS
IS ACTIVITY OF DAILY LIVING AND
AFTER SURGERY IMMEDIATELY AFTER
6 WEEKS AFTER SURGERY THERE IS A
PROPORTION OF THE PATIENT THAT
IS SORT OF HAVING SLIGHT
LIMITATION OR MODERATE
LIMITATIONS THAT IS IN -- THIS
IS IN PROPORTION THAT INCREASING
DEPENDING ON LEVEL OF FRAILTY
THAT THEY HAVE. WE FIND IT IS
REALLY AN INTERESTING POPULATION
BECAUSE MOST OF THEM BEFORE
SURGERY HAS NO LIMITATION BUT
MORE THAN 50% DEVELOP LIMITATION
AND DON'T SEEM TO RECOVER AT 24
MONTHS AND ARE A GOOD GROUP THAT
WE THINK WE COULD INTERVENE WE
NEED TO ADDRESS IN PROCESS OF
MAKING HRA AND MECHANISM OF
[INDISCERNIBLE] IS FINE AND WE
DON'T KNOW THE TARGET OR PATHWAY
AND THIS SEEMS TO REPRESENT
PROBLEMS FOR THOSE RESPONSE
STUDIES ESPECIALLY AND JIM SAYS
THERE MIGHT BE WAY AROUND IT.
WE WILL TRY THAT. WE THINK
PATIENT SELECTION COULD BE
REFINED.
YOU KNOW, PARTICULARLY WE WILL
TAKE BIOSOCIAL APPROACH TO THIS
AND CAN MEASURE SENESCENCE CELLS
CORRELATING WITH ACTIVITY OF
DAILY LIVING AND OUTCOME AND WE
KNOW FRAILTY IS VERY ASSOCIATED
WITH DEPRIVATION AND
SPECIFICALLY CERTAIN ETHNIC
GROUP AND WE WANT TO DO
INTERSECTIONALITY ANALYSIS TO
SEE WHETHER IN THIS WAY WE CAN
IDENTIFY GROUPS OF PATIENTS MOST
SUSCEPTIBLE TO THE NEGATIVE
EFFECT OF SURGERY AND GIVING TWO
THINGS AND REFINING PATIENT
POPULATION AND SEEING WHETHER
THERE ARE OTHER SOLUTIONS THAT
MAY NOT BE DRUG-BASED OR IN
CONJUNCTION WITH DRUG-BASED
SOLUTIONS AND LOTS OF TALK ABOUT
ROOT OF REGISTRATIONS AND IN
THIS CASE, WE THINK THAT WHAT WE
WOULD LIKE TO DISCUSS IS REALLY
THE INDICATION THAT IT IS THE
DISEASE THAT IS ASSOCIATED WITH
FRAILTY AND WHETHER IT IS BREAST
CANCER OR COLON CANCER OR
WHATEVER IT IS. WE DO IMPROVE
THE OUTCOME OF THE SURGERY.
AND, OF COURSE, WE WOULDN'T WANT
TO DO ONLY ROCK OF FRAILTY INDEX
BUT WOULD LIKE IT TO BE PRIMARY
[INDISCERNIBLE] AND REGISTER IN
POINT AND WOULD LIKE TO DISCUSS
THAT AND HOW MUCH VALIDATION IT
WILL NEED AND REQUIRE.
OTHER CASE STUDIES IS TACKLING
ISSUE OF MULTI-MORBIDITY. SO,
HERE WE HAVE THOUGHT ABOUT IN
MANY DIFFERENT WAYS AND WHAT WE
DECIDED TO GO FOR IN THE END
AFTER SEVERAL CONSULTATIONS
REALLY IS TO TAKE SOMETHING VERY
WELL-KNOWN AND ASSOCIATED SO
PEOPLE COULDN'T ARGUE
CARDIOVASCULAR DISEASE AND
DEMENTIA AND SHOWING CAUSAL LINK
BETWEEN THE 2 THAT IS NOT
RANDOMLY ASSOCIATED THAT IS WORK
THAT IS LED BY SHEILA FRANCIS.
SHE HAS DONE AND INDUCED
ARTHROSCLEROSIS AND SEEING HERE
IF INDUCING ARJERRO SCLEROSIS 5
MONTH TIME PLAQUE OF HIPPOCAMPUS
AND WHERE WE SEE IMPROVEMENT IN
CARDIOVASCULAR AND BRAIN. NOW,
IT IS THE TIME WHERE WE ACTUALLY
THINK ABOUT HOW DO WE GO ABOUT
TRIALS AND WHAT DO WE WANT?
ONE TEASER WAS ONE OF TWO TRIALS
AND IN LONG TIME WE WANT A TRIAL
AND THERE IS AA LONG WAY TO GO
AND PREDICTIVE BIOMARKER AND
HERE IS AI APPROACH WE START
TODAY TAKE AND USE ROUTINELY
COLLECTED CLIN TAL DATA PRIMARY
CARE AND SOCIAL CARE AND FROM
EDUCATION AND HOUSING AND THIS
IS AN AREA THAT IS BLOOD FLOW
THAT IS PARTICULARLY DEPRIVED IN
THE NORTH OF ENGLAND AND HAS A
VERY HIGH LEVEL OF ETHNICITY
ALLOWING TO HAVE A NICE AND
SOCIAL INTERSECTIONALITY WORK
THAT WE CAN DO AND LOOKING TO
MAP THEM AND LOOKING FOR PATTERN
ACROSS THE TIME IT TAKES A LONG
TIME FROM WHEN YOU HAVE SOME
MARKER OF CARDIOVASCULAR DISEASE
OR HYPERTENSION AND LIPODEMIA
YOU SEE ACTUALLY DEMENTIA THAT
IS A SMALL PROPORTION AND YOU
NEED BIOMARKER TO IDENTIFY THOSE
AND APPROACH WE TAKE IS TO DO IT
WITH EITHER CLINICAL EVENTS OR
BIOMARKER THAT WE COLLECT
ROUTINELY FOR OTHER REASONS
BLOOD OR URINE AND MAY NOT BE
POSSIBLE AND GOING BACK TO CLOKZ
GDPS TAKE THEM ALL THE TIME AND
HAVE TO BE CHEEP TO USE MEDIUM
TIME GOING BACK TO SINGLE
DISEASE MODEL WE CAN DO AND LOOK
FOR THINGS IN COMMON AND FOR
EXAMPLE WE SEE REDUCTION IN
ACTIVATION OF ASTO SITES IN THE
BRAIN AND WE CAN MEASURE BOTH IN
MICE AND PATIENTS AND BEFORE
THAT COULD BE FIRST THINGS TO DO
TO SEE WHETHER MECHANISM OF
ACTION THAT IS PRESENT IN BOTH
AND IN HUMAN AS MUCH AS IN
ANIMALS IN CONCLUSION WE HAVE
[INDISCERNIBLE] AND YOU WANT TO
WORK HARD ON AND YOU HAVE SEEN
APPROACHES AND BIOSOCIAL AND
CONSIDER DRUG APPROACH ONLY IF
OTHER MEASURES ARE NOT AVAILABLE
AND ONE PLEA I WAS GLAD TO HEAR
THIS MORNING AND AS A
GEROSCIENCE COMMUNITY WE SHOULD
BE MINDFUL HOW WE PRESENT AND
WHAT NARRATIVE IS WITH ALL
STAKEHOLDERS AND MIX TALKING
ABOUT AGING DISEASE MAKES LIFE
INCREDIBLY HARD FOR ALL OF US
AND WOULD LIKE TO THANK ALL
LOVELY PEOPLE THAT WORK AND SOME
WERE HERE AT THE MEETING AND
WISH WE DID NOT GO ANYWHERE.
THANK YOU SO MUCH.
>>[APPLAUSE].
>>>>HI. I'M HAENLER ALLORE
AND FROM YALE AND MAYBE YOU WILL
SEE MY SLIDES AT SOME POINT AND
ACKNOWLEDGING WE ARE ON
ANCESTRAL LAND OF THE POS CAT
AWAY PEOPLE THAT NO LONGER LIVE
HERE BECAUSE THEY HAVE BEEN
FORCED OUT. THINKING ABOUT
HEALTH EQUITY AND HEALTH
DISPARITIES, LET'S REMEMBER WHO
LIVED HERE FIRST AND TALKING A
LITTLE ABOUT SESSION MOTIVATION.
GEROSCIENCE CLINICAL TRIALS ARE
BASED ON GEROSCIENCE HYPOTHESIS.
WE HAVE BEEN HEARING A LOT ABOUT
THAT AND VERY RICH DISCUSSION
OVER THE THREE DAYS AND THESE
ARE REALLY TALKING ABOUT
INTERVENTIONS AGAINST MULTIPLE
CONDITIONS OF AGING AND TESTING
ANTIAGING THERAPY UTDICS THAT WE
HAVE BEEN HEARING ABOUT IT PAST
COUPLE DAYS AND LOOKING FOR
BIOMARKERS THAT MAY PRESENT A
SIGNAL AND APPEARS TO BE TWO
ROOTS AND IDEA TO TEST 1
THERAPEUTIC AND COMBINATIONS AND
TEST EFFECTS AGAINST MULTIPLE
GERIATRIC CONDITIONS AND
DISEASES REMAINING AGNOSTIC AS
TO WHICH THOSE ARE.
I'M TRYING TO BUILD IN HEALTH
EQUITY PREVENTING HEALTH
DISPARITIES BETWEEN CLINICAL
TRIALS, LAST PART ABOUT IT IS
IMPORTANT TO STRUCTURE TRIALS TO
BE INCLUSIVE INCORPORATING
SOCIAL DETERMINANTS OF HEALTH
AMONG PARAMETERS IS KEY IN WHAT
I WILL FOCUS ON. I WANT TO
REALLY BRING UP POINTS THAT
SPEAKERS FROM AARP AND DR. COHEN
AND KRUSHELL HAVE BROUGHT UP
ABOUT AGING NEGATIVE STEREOTYPES
WITH ADVERSE HEALTH IMPACTS AND
TALKING ABOUT DR. BUTLER'S WORK
EARLIER AND DR. LEVY AND
STEREOTYPE EMBODIMENT THEORY AND
THREE DISCRETE AGEISM PREDICTORS
AGE DISCRIMINATION AND NEGATIVE
STEREOTYPES AND NEGATIVE AGING
AND HAVE HEARD ACROSS MULTIPLE
COUNTRIES THAT WORLD HEALTH
ORGANIZATION HAS A GLOBAL
CAMPAIGN TO COMBAT AGEISM.
LOOKING FOR SOMETHING TO CROSS
MULTIPLE DISEASES AND CONDITIONS
WE NEED TO BE VERY SENSITIVE TO
LANGUAGE WE ARE DEVELOPING HERE
AROUND GEROSCIENCE. WHEN
TALKING ABOUT ANTIAGING, THAT IS
WORRISOME TO ME AND HEARING
SOMEONE FROM REFRAME AND GSA
EARLIER TOED THAT WE HAVE TO BE
SENSITIVE TO OUR LANGUAGE AND
WHAT PART OF AGING IS BAD?
GOING FROM INTANT TO TODDLER IS
BAD AND WHAT IS BAD WITH AGING?
SENSITIVE THAT PEOPLE STUDY THIS
AND THERE ARE INTERVENTIONS AND
DR. FARUCCI WORKED WITH DR. LEVY
SHOWING IN NUMEROUS
INTERVENTIONS BIOLOGIC OUTCOMES
ASSOCIATED WITH NEGATIVE AGE
STEREOTYPES THAT ARE ABOUT IN
2020 AND DR. LEVY AND OTHERS HAD
AN ARTICLE THAT WAS IN THE
GERONTOLOGISTS THAT WERE SHARING
HEALTH CARE COSTS OF AGE
DISCRIMINATION NEGATIVE AGE
STEREOTYPES AND SELF-PERCEPTIONS
OF AGING ONE YEAR DATA HRS
LINKED WITH A NUMBER OF SOURCES
THAT IS BASED ON 8 VERY COMMON
HEALTH CONDITIONS AND WE SHOULD
BE AWARE AS PREVIOUS SPEAKER WAS
DEMONSTRATING NEXT K OR UK
EXAMPLE AS WELL AS SWEDEN THERE
ARE SOCIAL DETERMINANTS AND HOW
WE ARE INTERACTING WITH PEOPLE.
A PANELIST EARLIER SAID MOST
NEGATIVE PART GOING INTO
GERIATRICS WERE OTHER DOCTOR'S
PERCEPTIONS OF THAT REQUEST. WE
CAN ALL ACCIDENTALLY FALL INTO
THIS.
SO, THAT IS A CROSS-CUTTING
ACTIVITY.
I CAN'T TELL YOU EVERYTHING TO
KNOW ABOUT CLINICAL TRIALS BUT
THERE IS A PRINCIPLE ABOUT
EQUIPOISE AND BASICALLY THAT WE
HAVE UNCERTAINTY ABOUT AN
OUTCOME AND THERE IS CONFLICTING
EVIDENCE ABOUT MERITS OF A
TREATMENT THAT ARE ACTUALLY
ETHICAL IMPERATIVES AND THINK
YES. OKAY THIS IS IECHL
NEUTRAL. ARE WE REALLY?
I WOULD REALLY PRESS YOU TO BE
AGNOSTIC; RIGHT?
REALLY, BECAUSE WHEN WE ARE
RANDOMIZED PEOPLE THERE ARE MANY
DIFFERENT WAYS TO RANDOMIZE.
THIS IS AN ETHICAL PRINCIPLE
THAT HAS TO ALSO CONCERN RIGHTS
AND RESPECT OF ALL OF THE PEOPLE
IN THE TRIAL.
ARE WE REALLY MAKING TRIALS
REALLY AVAILABLE TO EVERYONE?
SO, THERE ARE SOME VERY BASIC
ETHICAL PRINCIPLES THAT UNDERLIE
ALL OF THESE. HEALTH EQUITY IS
NOT A NEW CONCEPT. NIH
REVITALIZATION ACT OF 1993
DESIGNATED RESEARCH THAT IS
DESIGNED FORAND REPORTS ON
EFFECTIVENESS OF INTERVENTIONS
BY SEX AND RACIAL ETHNIC GROUPS.
WE HAVE BEEN DOING THAT SINCE
1993, DON'T YOU THINK WE WOULD
KNOW A LOT MORE INFORMATION?
ISN'T IT KIND OF STRANGE WE ALL
THINK APOE FOR IS REALLY
STRONGLY ASSOCIATED WITH
DEMENTIA? THAT IS BASICALLY FOR
PEOPLE OF EUROPEAN DESCENT AND
STRONG HEART STUDY SHOWED IT IS
NOT TRUE FOR MANY INDIGENOUS
PEOPLE IN NORTH AMERICA AND SEE
BECAUSE THERE IS A VARIETY OF
BACKGROUNDS OF PEOPLE OF AFRICAN
HERITAGE THAT DEPENDING ON
MIXTURE COULD BE VERY WEAK
ASSOCIATIONS AND WHAT WE THINK
AS FIXED KNOWLEDGE IS REALLY
BASED ON WHO THAT RESEARCH WAS
BASED ON.
BECAUSE WE HAVE NOT FOR DECADES
BEEN FOLLOWING THIS, WE MAY
ACTUALLY NOT KNOW WHAT IS REALLY
TRUE.
WE HAVE TO REALLY INTEGRATE
HEALTH EQUITY INTO STUDY DESIGNS
WHEN WE ARE GOING TO TRY TO DO
ANYTHING THAT IS GENERALIZABLE.
IF TRYING TO REALLY LOOK INTO A
VERY SMALL GROUP AND BE VERY
MECHANISTIC TRYING TO GET RID OF
ALL VARIATION THAT WON'T BE A
HEALTH EQUITY STUDY; RIGHT?
I URGE YOU TO REALLY THINK THAT
YOU DO THIS AND FIND MECHANISM
THAT DOESN'T APPLY.
IS IT REALLY MEETING PRINCIPLES
OF EQUIPOISE AND GENERAL
RESEARCH FOR GENERAL PUBLIC? WE
DON'T HAVE EVIDENCE OF EFFICACY
SAFETY OR TOLLRABILITY OF
TREATMENTS THAT ARE IN MANY OF
THE GROUPS THAT HAVE NOT BEEN
INCLUDED IN SUFFICIENT
PROPORTIONS TO THRILL UNDERSTAND
THOSE.
CDC HAS SHARED HEALTH EQUITY
REFERS TO EVERY PERSON THAT IS
HAVING OPPORTUNITY TO ATTAIN HIS
OR HER FULL HEALTH POTENTIAL
THAT IS NOT SAME AS EQUAL;
RIGHT?
WE HAVE EQUAL PROPORTIONS OF
PEOPLE IN THE POPULATION AND
WHERE PEOPLE GET VERY CONFUSED
THAT HEALTH EQUITY IS TO OBTAIN
YOUR FULL HEALTH POTENTIAL AND
DISADVANTAGED FROM ACHIEVING
POTENTIAL BECAUSE OF SOCIAL
POSITION OR DETERMINATION
CIRCUMSTANCE AND FIRST DAY SAW
HEALTH INEQUITIES ARE REFLECTED
IN HEALTH OF LIFE QUALITY OF
LIFE RATES OF DISEASE AND
SEVERITY AND ACCESS TO TREATMENT
AND DR. KRIMING SHOWED DOING A
LOT OF WORK THAT A LOT OF
FACTORS WERE STARTING TO CHANGE
THEIR EFFECT SIZE THAT WE CAN
ONLY DO IF WE HAVE INFORMATION
AND CONSIDERING THIS AND WE
HEARD ABOUT TRAINING AND I WANT
TO GIVE YOU ALL TOOLS SO YOU CAN
START DOING THIS YOURSELF AND
HAVING OTHER PEOPLE TRAINED IN
IT.
NOW, I DON'T HAVE SLIDES FOR
THIS. I WILL SAY IT. BUT,
AMERICAN JERAT TRICK SOCIETY HAS
ALSO A WHOLE COURSEWORK THAT IS
AROUND MULTIPLE CHRONIC
CONDITIONS AND GREAT RESOURCE
SOMETHING THAT IS PART OF THE
THEME YESTERDAY TALKING ABOUT
NIA FUNDED -- LAUNCHING ONLINE
HEALTH EQUITY TRAINING PROGRAM
THAT IS WORK SUPPORTED FROM U54
GRANT SUPPORTED FROM NATIONAL
INSTITUTE OF AGING AND MANY
ASPECTS ARE AVAILABLE FROM THE
WEBSITE THAT IS LISTED HERE AND
THEY HAVE SET UP WITH MANY, MANY
PEOPLE AND PROFESSIONAL COURSE
DESIGNERS AND THAT DO ONLINE
TRAININGS AND KNOW ALL THESE
EDUCATIONAL PRINCIPLES AND BEST
PRACTICES FOR INTEGRATING HEALTH
EQUITY AND THEIR FOCUS IS
IMBEDDED PRAGMATIC CLINICAL
TRIALS FOR DEMENTIA CARE AND
THESE PRINCIPLES COULD BE
APPLIED TO MOST CLINICAL TRIAL
SETTINGS AND DON'T HAVE TO BE
IMBEDDED IN PRAGMATIC AND IS
ADDITIONAL RESOURCES AND
TRAININGS AND GUIDANCE AND HERE
YOU SEE 6 BEST PRACTICE SHEETS
THAT GO FROM GETTING STARTED IN
THE FIELD TO COMMUNITY AND
STAKEHOLDER ENGAGEMENT THAT I
WILL TALK MORE ABOUT THAT AND
DESIGN AND ANALYSIS AND LEAD
THEIR DESIGN AND ANALE SIS CORE
HEALTH CARE SYSTEMS AND
PARTICIPANT SELECTIONS AND
UNIVERSITY OF PITTSBURGH MEDICAL
CENTER WANTING TO REALLY DO ALL
THIS? WHAT ARE COSTS AND
LOSSES; RIGHT?
HOW DO WE IMPLEMENT THESE WHOLE
INTERVENTION DESIGN AND
IMPLEMENTATION SECTION AND HOW
WILL YOU GET COMMUNITY HEALTH
CENTERS TO BE DOING THINGS AND
HOW WILL YOU TRY TO GET RURAL
MEDICINE TO DO THESE THINGS AND
TREATING PEOPLE IN ACADEMIA AND
IN ACADEMIC MEDICAL CENTERS AND
SELECTING OUTCOMES AND HEARD
ABOUT PRIMARY AND SECONDARY
OUTCOMES AND IN MANY WAYS TO
CONSIDER THOSE AND CERTIFICATE
PROGRAM IS AVAILABLE THIS
SUMMER.
THERE IS 6 DIFFERENT COURSES AND
2 TO 5 VIDEOS PER COURSE AND
GLOSSARYIES AND ADDITIONAL
RESOURCES AND SELF-EVALUATIONS
AND USING PRINCIPLES OF
ATTENTION SPAN AND WE HAVE THESE
PROFESSIONALLY ANIMATED AND THEY
ARE THINGS THAT ANYONE AT ANY
LEVEL CAN ENGAGE WITH.
SO, I'M GOING TO TALK RATHER
BRIEFLY IN MY LAST MINUTES HERE
ABOUT A FEW CONSIDERATIONS.
SO, SELECT A RESEARCH QUESTION
THAT MATTERS TO THE POPULATIONS
THAT YOU ARE STUDYING AND HEALTH
DISPARITY POPULATIONS AND LOTS
OF TIMES WE ARE PICKING THE
QUESTION WE WANT TO ANSWER AND
WE WONDER WHY WE ARE HAVING SO
MANY PROBLEMS WITH ENROLLMENT
AND WOULD SAY WE SHOULD REALLY
ALSO AT LEAST AS A SECONDARY
OUTCOME HAVE SOMETHING THAT
MATTERS TO THEM AND HAVE HEARD
ABOUT THE FIVE MS.
WE HAVE BEEN HEARING ABOUT THE
IMPORTANCE OF COLLABORATING WITH
COMMUNITY MEMBERS AND MAKING
SURE THAT IT IS RELEVANT AND
RESPECTFUL AND INCLUSIVE. WE
HAVE TO ALLOCATE RESOURCES TO DO
THIS.
LOTS OF TIMES IT FEELS LIKE WE
ARE KIND OF LIKE, GO GIVE ME
YOUR SAMPLE OPPOSED TO LET ME
LEARN WHAT IS IMPORTANT TO YOU
AND TRY TO EXPLAIN TO YOU HOW I
THINK THAT THIS MIGHT BE A WAY
TO TRY TO ADDRESS WHAT YOUR
PRIORITY IS AND ALSO FOR THOSE
THAT WE HAD EARLIER TALKS TO SAY
THERE IS CERTAIN DISEASES AND
THERE IS NO EFFECTIVE THERAPIES
FOR.
SO, YOU CAN BUILD A DIVERSE
RESEARCH TEAM WE HAVE TALKED
ABOUT WORKING WITH PEOPLE ACROSS
DISCIPLINES AND THAT IS A GOOD
WAY TO GO. WE HAVE ALREADY
RECENTLY HEARD ABOUT SELECTING
OUTCOMES AND WHOLE BEST PRACTICE
AND VIDEOS ON THAT AND WE -- I
JUST TOUCHED ON AS OTHERS HAVE
COMMUNITY AND STAKEHOLDER
ENGAGEMENT AND THERE IS A NUMBER
OF VERY PRACTICAL WAYS AND
RESOURCES HOW TO START TO DO
TH
THIS.
HOW DO YOU PUT INTO OVERALL
HYPEROJ SIS? YOU CAN TEST IT
AND GO BACK TO HOW WE SHOULD
REPORT ON THESE POPULATIONS AND
CONSIDER SECONDARY OUTCOMES AND
WHETHER YOU HAVE FIDELITY IN THE
INTERVENTION ARM. DOES THAT
VARY BY MINORITIZED GROUPS?
YOU MIGHT HAVE 10% THAT ARE
NONADHERIENT. WHAT IF THAT IS
ALL IN ONE GROUP?
MIGHT GIVE YOU A LOT OF
INFORMATION ABOUT YOUR
INTERVENTION AND ITS ABILITY TO
BE ROLLED OUT EVEN FARTHER.
PRESPECIFY YOUR ANALYSIS TO TRY
TO START TO SEE IF YOU HAVE THE
SAME AFFECT IN DIFFERENT GROUPS
AND BE VERY EXPLICIT IN SAMPLE
SIZE JUSTIFICATION BECAUSE
USUALLY WHAT WE ALWAYS HEAR IS
THERE IS NOT ENOUGH X TYPE OF
PEOPLE.
AND THEN USUALLY WHAT PEOPLE ARE
DOING IS WHITE. WE HAVE LOTS OF
THOSE.
AND EVERYBODY ELSE.
SO, OF COURSE, YOU DON'T HAVE
VERY MANY. THEY ARE REALLY
HETEROGENOUS.
YOU HAVE ASIANS AND AFRICAN
AMERICAN AND INDIGENOUS PEOPLE
AND ALL OF THE [INDISCERNIBLE]
AND YOU ARE SAYING OKAY. WE
WILL JUST COMPARE THEM. IT IS
NOT EVEN AN APPROPRIATE
CONSIDERATION. SOMETIMES WE
NEED TO REALLY BE A LOT MORE
INSIGHTFUL AS WE WERE HEARING,
WHO ARE SOME OF THE HIGH-RISK
POPULATIONS?
ARE THERAPIES APPROPRIATE AND
EQUALLY EFFECTIVE WITH THEM?
CONSIDER DIFFERENT FORMS OF
RANDOMIZATION AND HERE I SUGGEST
STRATIFIED AND THERE ARE MANY,
MANY TYPES WORKING WITH
STATISTICIAN AND WE ARE LOVELY
PEOPLE AND YOU CAN MONITOR AND
REPORT DIFFERENTIAL RISK AND
BENEFITS.
WE HAVE ALSO HEARD SOMETIMES
THERE IS INCREASED RISK IN SOME
GROUPS AND THINGS WE MIGHT NOT
HAVE EXPECTED WITH DIFFERENT
COMORBIDITIES AND ANY NUMBER OF
FACTORS AND IN CLOSING, LET'S
JUST BE AWARE OF AGING THAT CAN
RESULT IN SUBSTANTIAL HEALTH
RELATED QUALITY OF LIFE AND
DIRECT AND ECONOMIC SOCIETAL
IMPACTS LET'S JUST PUT HEALTH
EQUITY IN ALL OF THE PHASES OF
OUR HUMAN-BASED RESEARCH AND
ADDRESSING AGEISM AND NEGATIVE
STEREOTYPES REALLY MAKE
CROSS-CUT ACROSS MANY IMPACTS
IMPROVING WELLBEING OF OLDER
ADULTS AND THANKS VERY MUCH.
>>I WAS ASKED TO GIVE A FEW
EMARKS ON THE SESSION AND FULL
DISCLOSURE I DON'T WORK IN
CLINICAL TRIALS BUT I'M IN
POPULATION SCIENCE I DON'T WORK
IN CLINICAL -- SOCIOLOGIST AND
DEMOGRAPHER I THINK ABOUT
HETEROGENEITY AND EQUALITY AND
THOUGHTS ON AGING REFLECT THIS
IMAGE HERE AND SHOWS IDEA THAT
SOME PEOPLE ARE APPROACHING
AGING AND AGING TRAJECTORIES
THAT ARE EASIER THAN OTHERS AND
MAYBE HAVE HAD GREATER SOCIAL
AND ECONOMIC ADVANTAGES
THROUGHOUT LIFE AND HAD BETTER
HEALTH AND OTHERS APPROACH AGING
AND WORKING WAYS THROUGH OLDER
AGES THAT IS PUSHING A BIG HEAVY
BLOCK UP A HILL AND THINKING
ABOUT CLINICAL TRIALS I THINK
ALONG LINES OF WHAT WE ARE
TRYING TO ACCOMPLISH AND WHO WE
ARE TRYING TO HELP AND WE HEARD
A LOT ABOUT ANTIAGING OR
REVERSING AGING AND THAT KIND OF
RHETORIC REMINDS ME OF A FAMOUS
GRADUATE [INDISCERNIBLE] QUOTE I
LIVE DYING TRYING AND
[INDISCERNIBLE] AND ADDING YEARS
TO LIFE IS NOT REALLY OUR ONLY
GOAL OR MAJOR PRIMARY GOAL. WE
THINK ABOUT AS WELL IS HOW DO WE
IMPROVE QUALITY OF THOSE LATER
YEARS?
THIS IS A GRAPHIC THAT IS MAKING
THE POINT THAT FOR ALL OF THE
PEOPLE THAT ARE REACHING OLDER
AGES THEY ARE NOT TAKING
DIFFERENT PANELS TO GET THERE
AND IS BASED ON WORKING I DID ON
A NATIONAL DATA SET GROUPING
OLDER ADULTS HAS BASED ON
CHRONIC DISEASE TRAJECTORIES AND
ARE PEOPLE THAT MADE IT TO AGE
90 AND ACHIEVED LONG-LIVED LIVES
AND FOLKS DID IT WITH INCREASING
BURDEN OF CHRONIC DISEASES AGING
FROM 70S TO 90S AND TINY LINE AT
BOTTOM FOLKS LARGELY AVOIDED
CHRONIC DISEASES WELL INTO THEIR
90S AND THINK ABOUT WHICH GROUP
ARE WE TRYING TO REALLY HELP
WITH INTERVENTIONS?
TWO LINES ON TOP AND FOLKS
DEALING WITH MULTI-MORBIDITY AND
PREVENTION IDEA OF KEEPING SUPER
HEALTHY FOLKS AT BOTTOM
CONTINUING TO HAVE SUPER GOOD
HEALTH.
I THINK WE HAVE TO THINK ABOUT
HOW TO DETERMINE WHAT WE WILL
INTERVENE ON AND WHAT ARE OUR
PRIORITIES?
WE CAN'T REALLY DO EVERYTHING
AND PEOPLE THINK ABOUT
INTERVENTIONS DESIGNED TO REDUCE
COSTS IN HEALTH CARE A PRIORITY
THAT WE HAVE IN THE UNITED
STATES AND THINKING ABOUT
INTERVENTIONS TO REDUCE
MORTALITY AND PERHAPS FOR
RECOVERY FROM AN OPERATION OR
FALL.
AND SHOULD WE BE PRIORITIZING
QUALITY OF LIFE?
SHOULD WE PRIORITIZE THE FAMILY
AND IDEA OF CAREGIVERS THAT TAKE
ON LARGER SHARE FOR CARING FOR
OLDER ADULTS AND THESE ARE OLDER
PRIORITIES AND ANY INTERVENTION
SHOULD PRIORITIZE THESE THINGS
AND WHAT IS MORE REALISTIC IS
PRIORITIZING THESE AND DECIDING
WHO TO HELP AND WHAT POTENTIAL
IMPACT WOULD BE IN POPULATION
HEALTH AND POINTING OUT THAT
AGING IS A PRIVILEGE AND IN
UNITED STATES WE CONTINUE TO SEE
REALLY LARGE SHOCKING AND
PERSISTENT GAPS THAT ARE
INCLUDING IN NUMBER OF YEARS
THAT PEOPLE WILL LIVE AND IS A
GRAPH USING DATA FROM CDC
SHOWING LIFE EXPECTANCY IN BIRTH
AGE 85 AND THERE CONTINUES TO BE
A FOUR YEAR AGE GAP AND LIFE
EXPECTANCY BETWEEN BLACK AND
WHITE WOMEN FOR INSTANCE AND
ACHIEVING AGE IS A PRIVILEGE AND
NOT ALL INDIVIDUALS IN A
POPULATION GET TO ENJOY.
FINALLY, I THINK WE SHOULD A
LITTLE BIT MORE ABOUT WHAT WE
ARE DOING WITH CLINICAL TRIALS
WHAT WE ARE INTERVENING AND WHAT
IMPACT MIGHT BE IN DISPARITIES
AND THINKING ABOUT INTERVENTIONS
THAT ARE QUITE SUCCESSFUL
IMPROVE OUTCOMES AT INDIVIDUAL
LEVEL EXACERBATE POPULATION
DISPARITIES HAPPENING UNDER A
COUPLE DIFFERENT SCENARIOS AND
INTERVENTION DOESN'T SCALE UP TO
DIVERSE POPULATIONS AND
INTERVENTION WORKING GREAT FOR
SOMEONE LIVING CLOSE TO MEDICAL
CENTER MIGHT NOT WORK WELL FOR
RURAL AGING POPULATION FOR
INSTANCE AND NOT EVEN WILL
NECESSARILY BE ABLE TO TAKE
ADVANTAGE OF SUCCESSFUL
INTERVENTION IF NOT SAME LEVEL
OF ACCESS TO HEALTH CARE OR
SOCIAL SUPPORTIVE INFRASTRUCTURE
THAT THEY ALL NEED AND TRIALS
DON'T ENROLL DIVERSE POPULATIONS
WE CAN'T NECESSARILY ASSUME THAT
THE OUTCOME WILL BE EQUALLY
SUCCESSFUL ACROSS THE POPULATION
AND SO IN THOSE CASES VERY
SUCCESSFUL INTERVENTION COULD
RESULT IN INCREASED DISPARITIES
ACTUALLY AND WE HAVE TO BE
REALLY THOUGHTFUL ABOUT WHERE IN
THE PROCESS WHERE WE ARE
INTERVENING AND HOW WE ARE
INTERVENING IN THE AGING PROCESS
AND IMPLICATIONS ARE NOT JUST AT
AN INDIVIDUAL LEVEL BUT AT
POPULATION LEVEL.
OKAY. I THINK WE HAVE A FEW
MINUTES FOR QUESTIONS AND DON'T
KNOW IF WE WILL RUN OVER AND IF
PANELISTS WANT TO MAKE WAY UP TO
STAGE AND IF YOU HAVE A QUESTION
YOU CAN LINE UP IN ONE OF THE
TWO MICROPHONES.
>>SOPHIA FROM EINSTEIN. I GREW
UP IN THE ENVIRONMENT WHERE
GEROSCIENCE AND GEROTHERAPEUTICS
WERE DISEASE OF DIAGNOSTIC AND
SEEMS TWO APPROACHES PEOPLE ARE
CONSIDERING; RIGHT? DISEASE
DIAGNOSTIC APPROACH AND SOME
DESCRIBED AN APPROACH WHERE WE
SELECT PATIENTS WITH CERTAIN
UNDERLYING CONDITIONS FOR
CERTAIN THERAPIES AND I'M TRYING
TO KIND OF RECONCILE THESE
CONCEPTS. YOU KNOW, ARE THEY
CONTRADICTORY OR COMPLEMENTARY?
IF A MEANS TO AN END WE ARE
TRYING TO CLIMB UP A MOUNTAIN
AND IF SMALL STEPS YOU FEEL WE
NEED TO TAKE TO GET TO THE NEXT
STEP; RIGHT?
TO GET RECOGNITION OF THESE
DRUGS AND TO GET FDA APPROVAL
THAT IS ONE THING.
HOW ARE WE THINKING ABOUT THIS
AS A COMMUNITY OF GEROSCIENTIST
SNZ.
>>I -- CAN YOU HEAR ME?
I DON'T WANT TO SPEAK FOR
EVERYONE. IN THE CASE OF MY
TRIAL FOR -- WITH METFORMIN, I
REALLY ACTUALLY THOUGHT ABOUT
THE CONTEXT OF INSULIN RESISTENT
OR OLDER ADULTS WITH DIABETES
THAT ARE BASED OFF CLINIC OVENG
IN MY CLINIC AND SOUTH TEXAS
DIABETES ARE SO PREVALENT AND
PATIENTS ARE DISABLED AND NEED
HELP AND START TO THINK ABOUT
THAT SYNDROME AND FRAILTY AND
OVERLAP OF DIABETES AND INSULIN
RESISTANCE AND FRAILTY AND THAT
TO ME WAS, YOU KNOW, I GUESS IT
CAME ABOUT FROM CLINICAL OVENGSS
AND IT WAS VERY HELPFUL THAT I
DIDN'T NEED FDA APPROVAL FOR
METFORMIN. I'M USING IT FOR
PEOPLE WITH ORAL GLUCOSE
INTOLERANCE AND THAT IS MY
EXPERIENCE AND NO THE SURE IF
ANYONE WANTS TO CHIME IN THERE.
>>FOR US -- OKAY. FOR US, I
THINK IT IS WHERE WE ARE WITH
MINDSETS AND SO WE THOUGHT THAT
ADA IS TO FOCUS ON TWO THINGS
THAT REALLY DEMONSTRATE SOME
LEVEL OF SUCCESS OF SOME SORT
AND USING THESE TO LEARN
LEARNING TERMS OF MEASURING
OUTCOMES AND LEARNING IN TERMS
OF RECRUITING AND USUALLY
PATIENTS ARE NOT VERY EASY TO
RECRUIT EITHER. SORT OF
STARTING WITH SMALL STEPS IF YOU
WANT AND MOVING FORWARD AND
WHERE WE ARE IN UK THIS IS BEST
WE CAN DO WE COULDN'T DO WHAT
JEAN IS DOING HERE.
>>I VIEW AS AN AND APPROACH,
YOU KNOW? HAVING TO DO
EVERYTHING AT ONCE AS FAST AS
POSSIBLE AND SEE WHAT STICKS TO
THE WALL AND MOST TRIALS FAIL 5
TO 30% OF PHASE 2A TRIALS WORK
AND TAME 2A TRIAL COULD WORK AND
METFORMIN MIGHT NOT BE RIGHT
AGENT PREPARING A PATH TOWARDS
SECONDARY PREVENTION TRIAL AND
IF DOESN'T WORK PUBLIC PREPARES
IT IS PANEL FOR AGENT IN
SECONDARY PREVENTION TRIAL AND
SAME WITH TRIALS GOING ON WITH
LIFESTYLE INTERVENTIONS AND
THERAPEUTICS ACROSS ACUTE
CHRONIC SEVERE STATES FOR
ADVANCED DISORDERS FOR WHICH
THERE IS NO GOOD TREATMENT AND
IDEA IS TO DO MULTIPLE TRIALS IN
PARALLEL RATHER THAN IN SERIES
RECOGNIZING MOST WILL FAIL AND
WAY THINGS ARE AND HOPING THERE
WILL BE A FEW WINS AND PUBLIC
HAS TO BE PREPARED THAT MOST
TRIALS WILL FAIL AND WE CAN'T
OVERPROMISE AND IF A FEW DO WORK
THAT IS A PANEL TOWARDS
EVENTUALLY WORKING BACK
GRADUALLY TOWARDS PRIMARY
PREVENT IN CASE OF DRUGS OR
NATURAL PRODUCTS THAT IS WITH
LIFESTYLE INTERVENTIONS WE CAN
GO TO RIGHT CIRCUMSTANCES
PRIMARY INTERVENTION A LOT
EARLIER AND HAVE TO BE CAREFUL
DON'T WANT TO DO CALORIC
RESTRICTIONS IN 90 YEAR OLDS AND
SEVERING INVERTED U-SHAPE CURVE
AND EVERYTHING DONE AT RIGHT
PLAIN.
>>WE DIDN'T HAVE TIME TO GO
INTO THIS IN THIS SUMMIT. THERE
IS MANY DIFFERENT SORTS OF TRIAL
DESIGNS THAT ARE NOT JUST
PARALLEL TO DESIGNS.
WE COVID WE KNOW THAT SUDDENLY
PLATFORM DESIGNS THAT HAD BEEN
PRIMARILY USED IN CANCER AND
AMINA IS PROBABLY OUT THERE
SOMEWHERE AND WHERE IT IS FIRST
DEVELOPED AND TRYING DISEASE AND
TRYING THERAPEUTICS INTERVENTION
FOR THAT DISEASE. YOU MAY BE --
YOU ARE DOING ADAPTIVE DESIGNS
AND YOU ARE CHANGING
RANDOMIZATION BASED ON END
POINTS MAY BE IN A PATHWAY. SO,
THERE IS A LOT OF DIFFERENT
TRIAL DESIGNS WHERE THEY CAN BE
MORE EFFICIENT.
SO, I THINK THAT AS THE FIELD
GROWS THEN THESE OTHER MORE
EFFICIENT DESIGNS THAT TOOK OVER
DURING COVID MIGHT BE APPLIED.
>>I WILL MAKE ONE OTHER POINT
TOO I DIDN'T HAVE TIME TO MAKE
SEEING WHAT OTHER PEOPLE THINK
THAT IS THAT WE SHOULDN'T GET
TOO HUNG UP ON PRIMARY OUTCOMES
NOT OUTCOMES TRYING FOR
REGISTRATION AND POINT MADE
EARLIER SECONDARY AND
EXPLORATORY OUTCOMES COULD BE AS
OR MORE IMPORTANT THAN PRIMARY
OUTCOMES LOOKING FOR
COMMONALITIES AND INITIATED WITH
DRUG COMPANY TRIALS THAT IS
PERFECTLY REASONABLE AND FOR
LOTS OF AGENTS WE DON'T NEED
PHASE 3 TRIALS IF TALKING ABOUT
REPURPOSING AND YOU ONLY NEED
REALLY PHASE 3 AND 4 IF YOU GO
TO -- IF YOU GO FOR REGISTRATION
ON A FORM YOU'LLARY AND LOTS OF
INTERVENTIONS ARE LIFESTYLE
INTERVENTIONS NO THE TRYING FOR
FORM YOU'LLARY AND REPURPOSE
DRUGS AND NATURAL PRODUCTS NOT
TRYING FOR A NATURAL PROFIT.
>>CAN I POP -- HELLO. CAN I
FOLLOW UP ON YOUR COMMENT THERE,
JIM? YOU OR SOMEONE STATED REAL
POP IN COMMUNITY THAT WILL
HAPPEN THAT IS INTERVENTION THAT
IS EFFECTIVE AND SAFE APPROVED
TO STYLE PRACTITIONERS AND COULD
YOU CLINICIANS OUT THERE SPEAK
TO HOW YOU SEE THE PROSPECTS FOR
BRIDGING FROM THE FRAILTY INDEX
OR FRAILTY PHENOTYPE, ET CETERA,
TO REGISTERABLE ENDPOINTS AND
LOOKING FOR DIFFERENT DISEASES
AND SO FORTH AND FASCINATED BY
EXPERIENCE OF NHEMR AND EMA AND
FDA DOESN'T CONSIDER SARCOPENIA
DISEASE YET ORE HASN'T YET AND
IF CLINICIANS OR GEROSCIENTISTS
ON THE PANEL COULD COMMENT,
PLEASE.
>>SARCOPENIA IS AN ENDPOINT IN
THE ICD JUST NOT WELL DEFINED WE
HAVE TO GET INSERTED INTO ICD
AND WORK WITH WHO AND GENEVA
HARD TO GET MULTI-MORBIDITY IN
THERE. SARCOPENIA IS IN THE ICD
JUST NOT PROPERLY OR CLEARLY
DEFINED AT THIS POINT AND IS ON
US TO DO THAT AND FDA AND EMA
AND SO FORTH WILL ONLY FOLLOW
WHAT IS IN ICD.
>>I THINK THAT BEST WAY TO
TRANSITION TO CLINICIANS IS TO I
MEAN OBVIOUSLY ONCE WE HAVE
EVIDENCE THAT IS CREATING
CLINICAL PRACTICE GUIDELINES
THAT IS WHAT GENERALLY IS
FOLLOWED IN MEDICINE AND TAUGHT
TO TRAINEES.
YEAH.
>>I WANT TO FOLLOW UP ON A
REALLY IMPORTANT COMMENT THAT
HEATHER MADE AND PUT UP THE
QUESTION AND ISSUE WITH
EQUIPOISE IS VITALLY IMPORTANT
NOT JUST GOOD SCIENCE. WE HAVE
TO REALIZE HOW SKEPTICAL
CLINICAL COLLEAGUES ARE OF
EVERYTHING THAT GEROSCIENCY.
PART OF IT TO EXPLAIN TO --
WHERE THIS IS COMING FROM I
THINK A LOT HAS TO DO WITH FACT
THAT WHEN YOU TAKE CARE OF OLDER
PATIENTS EVERYTHING IS FACT
TORIAL AND MESSY FOR LACK OF A
DIFFERENT WORD AND LONG HISTORY
OF ACUTE DISAPPOINTMENT WHEN
INVESTIGATORS INTERESTED IN A
PARTICULAR MOLECULE AND DRUG
CLAIMED TO HAVE SOLVED AN ISSUE
THAT THEN DOESN'T WORK IN REAL
WORLD AND EXAMPLE OF THAT WE
HAVE CURED ALZHEIMER'S DISEASE
IN MICE 500 TIMES AND EVERY
COUPLE WEEKS WE CURE IT. WE
DON'T HAVE TREATMENT THAT REALLY
WORKS IN PATIENTS AND HAVE TO BE
VERY, VERY CAREFUL BECAUSE IN
DIFFICULTY WITH GEROSCIENCES IS
GEROSCIENCE CONCEPT MAKES SUCH
GOOD SENSE THAT IF SOMEBODY
DOESN'T BELIEVE IT IT IS ALMOST
LIKE WHAT IS WRONG WITH YOU?
WE HAVE TO BE CAREFUL DOING
TRIALS KEEPING HEARING OVER AND
OVER AGAIN THAT BELIEF IS NOT A
GOOD -- BELIEF IS NOT A GOOD
INGREDIENT TO BE PART OF SCIENCE
WHEN YOU ARE TRYING TO DO
PARTICULARLY WHEN TRYING TO DO
CLINICAL TRIALS AND WANT TO
RE-ENFORCE THAT. QUESTION I
WANT TO PUT UP IS JIM I LEFT
THROWING STUFF AT THE WALL AND
SEE WHAT STICKS I LOVE THAT
ANALOGY AND DOING THAT. I'M
WONDERING IF WE HAVEN'T REACHED
THE STAGE NOW WHERE THERE IS
ENOUGH EXPERIENCE WITH ANIMAL
MODEL TRIALS AND ANIMAL MODELS
AND IN EARLY STAGE HUMAN TRIALS
THAT WE CAN KIND OF START TO GET
A SENSE OF WHAT DOESN'T WORK FOR
WHICH CONDITION AND WHY. WHAT
I'M TRYING TO GET AT IS YOU KNOW
INSTEAD OF THINKING OF HALLMARKS
AND SPOKE OF A WHEEL THINKING
ABOUT EVENTS THAT OCCUR MORE
UPSTREAM AND KIND OF LIKE YOU
KNOW UNDERLYING FACTORS AND THEN
THE DRIVERS AND ACCELERATORS
THAT ARE FURTHER DOWNSTREAM AND
MAYBE WE CAN LEARN ABOUT WHY
ANTIINFLAMMATORY STRATEGIES
WORKED FOR CARDIAC DISEASES AND
NOT FOR FRAILTY AND WHY CERTAIN
INTERVENTIONS ARE MORE UPSTREAM
AND WORK FOR MULTIPLE CHRONIC
DISEASES AND OTHERS ARE MORE
DOWNSTREAM AND DON'T WORK FOR
MULTIPLE CHRONIC DISEASES
GETTING THOUGHTS ON IT AND
STARTING SLOWING AT WALL AND
MORE SELECTIVE WHAT WE THROW AT
WALL OR MORE TARGETED.
>>[INDISCERNIBLE].
>>I THINK YOU ARE SAYING THERE
NEEDS TO BE PERSONALIZED
APPROACHES THAT IS ONE THING AND
IS TRUE AND WE HAVE TO LOOK AT
WHICH INTERVENTION TO GIVE WHEN
DURING LIFESPAN AND ARGUING NED
PRECURSORS WOULD BE BAD AND
THOSE WITH CANCER AND POTENTIAL
MET AFT KRIZ AND THEN THERE WILL
BE QUESTION OF IF YOU COMBINE
INTERVENTIONS ARE THEY LESS
ADDITIVE OR MORE ADDITIVE AND
COMBINING GEROSCIENCE
INTERVENTIONS WILL THERE BE SIN
ERNLY AND LOOKING LIKE THAT IS
THE CASE AND LATTER APPEARS TO
BE CASE WITH FIBROTIC DISEASES
AND FIVE OF THEM IN PRECLINICAL
MODELS AND WILL BE ONCE WE GET
AN IDEA ABOUT WHICH
GEROTHERAPEUTIC INTERVENTIONS
HAVE A SIGNAL AND THEY MIGHT
WORK NEXT STEP IS COMBINING THEM
WITH DISEASE SPECIFIC AND
POPULATION SPECIFIC KINDS OF
INTERVENTIONS AND USING
PERSONALIZED APPROACHES THAT
WILL REQUIRE ITERATIVE
DEVELOPMENT OF GERODIAGNOSTICS
TO INFORM WHICH INTERVENTIONS TO
USE AND THERE WILL NEVER BE A
SINGLE SORT OF COMPOSITE OR
SIGNATURE SCORE THAT WE WILL USE
AND WILL BE EVOLVING OVER TIME.
>>RIGHT.
>>SAME WAY AS INTERVENTIONS.
>>SYSTEMS BIOLOGY AND
SIGNATURES MORE PREDICTIVE OF
CERTAIN DISEASE CLUSTERS VERSUS
OTHER DISEASE CLUSTERS.
>>ONE PROBLEM TOO THAT KEEPS
COMING UP IS PEOPLE TALK ABOUT
LOOKING FOR PATHWAYS WE DON'T
KNOW WHAT THEY ARE AND GSOGA
DATA BASES DON'T HAVE PATHWAYS
IN THERE LOOKING AT CLASSIC ONE
NOW HYDROCARBON PATHWAY FOUND IN
ROCK FISH APPLYING TO HUMANS
LOOKS MORE IMPORTANT THAN IGF1
PATHWAY IN RELATIONSHIP TO
LIKELIHOOD OF EXTENSIVE AND HAS
ANYWHERE FROM 14 TO 200 YEARS
DEPENDING ON SPECIES AND
ANCESTRAL ROCK FISH LIVED OVER 2
CREPTURIES AND SECOND PATHWAY
IMPORTANT ONE IS IGF1 AND FIRST
IMPORTANT ONE IS HYDROCARBON ONE
SEEMS TO BE TRUE IN HUMANS
COMPARED TO NON-SEINE 10ARIANS
NEVER LOOKED FOR IT PEOPLE
DIDN'T THINK OF PUTTING FACTORS
TOGETHER AND NOBODY THOUGHT
PATHWAY STILL EXISTED AND GOING
BACK AND FORTH BETWEEN SPECIES
THINKING OUTSIDE OF THE BOX NOT
STUCK WITH EXISTING PATHWAYS
THAT PEOPLE [INDISCERNIBLE].
>>DISCOVERIES OF MECHANISMS
UNSUPERVISED REVERSE TRANSLATION
IS INCREDIBLY IMPORTANT AND WHAT
YOU ARE DOING IN R33 AND BIOBANK
EXAMPLES FROM TRIALS AND TAKING
BACK TO BASIC SCIENCE LABORATORY
AND APPROACHES WILL BE SO
ESSENTIAL.
>>YEAH. IT IS A LOT WE DON'T
KNOW AND WE DON'T KNOW FOR
EXAMPLE WHETHER THERE IS
HIERARCHY AMONG TISSUES WHERE
AGING HAPPENS IN DIFFERENT RATES
AND PLACES AND DON'T KNOW
WHETHER MOLECULE ACTS AND IN
WHAT TISSUES AND WHAT CELL TYPE
AND DIFFERENT MOLECULES WILL
PROBABLY HAVE DIFFERENT TARGETS
AND SO I THINK THERE IS A LOT TO
DISCOVER.
>>[INDISCERNIBLE].
>>IF NO FURTHER QUESTIONS,
THANKING THE PANELISTS AND
SPEAKERS AND THE AUDIENCE
>>WILL BEGIN
WITH REVIEWS OF THE SESSIONS
DONE BY THE NEXT GENERATION OF
INVESTIGATORS AND WILL HEAR FROM
JESSICA SMITH FROM SESSION 1.
>>GOOD AFTERNOON, EVERYONE.
AND THANKS TO THE ORGANIZERS AND
ALL PARTICIPANTS FOR INFORMED
SESSIONS AND I'M JESSICA SMITH
AND WILL SUMMARIZE FIRST SESSION
ON BIOLOGICAL DETERMINANTS OF
HEALTH DISPARITIES AND AGING.
THERE WE GO. [INDISCERNIBLE]
BEGAN THE SESSION ESTABLISHING
DEFINITIONS OF SOCIAL
DETERMINANTS OF HEALTH AND
HEALTH DISPARITIES AND SHARED
SELF CONCEPTUAL RESEARCH
FRAMEWORKS THAT HAD MODELS OF
DOMAINS OF INFLUENCE SUCH AS
BIOLOGICAL, BEHAVIORAL AND
OTHERS TO AID REDUCTION OF
HEALTH DISPARITIES AND SHARED
SEVERAL EXAMPLES OF PAST
RESEARCH TO EMPHASIZE IMPORTANCE
OF CONSIDERING SOCIAL
DETERMINANT OF HEALTH IN
GEROSCIENCE AND NEED FOR
MULTILEVEL INTERVENTIONS WITH
EMPHASIS ON INTERSECTIONALITY
AND TRUST BETWEEN PATIENTS AND
CLINICIANS AND SOCIAL ORDER TO
BRING ABOUT HEALTH DISPARITIES
AND INTRODUCING CONCEPT OF
STRUCTURAL FACTORS AND SHARED
SEVERAL EXAMPLES OF INTERACTION
OF SOCIAL AND STRUCTURAL
DETERMINANTS OF HEALTH AND
EMPHASIZED IMPORTANCE OF
CONSIDERING STRUCTURAL AND
SOCIAL DETERMINANTS OF HEALTH
FOR HEALTH RESEARCH TO ADDRESS
UPSTREAM FUNDAMENTAL CAUSES OF
HEALTH DISPARITIES AND SHARED
NINR STRATEGIC PLAN TO ACHIEVE
HEALTH EQUITY THROUGH
UTILIZATION AND MULTILEVEL
STRUCTURAL APPROACHES AND DR.
WALLACE CONCENTRATED ON
PERSPECTIVE OF NCI AND RECENT
NATIONAL CANCER PLAN. SHE
SHARE
SHASHARE
NCI'S WORK AND DEVELOPMENT OF
DIVERSE CANCER MODELS AND DR.
WALLACE DEMONSTRATED SEVERAL
SPECIFIC AREAS OF RESEARCH INTO
BASIC MECHANISMS OF CANCER
DISPARITIES AND EPIGENETIC AGING
AND COAL OE RECTAL CANCER AND
SHARED EXAMPLES OF HEALTH
DISPARITIES ASSOCIATED WITH
EARLIER CANCER INCIDENCE AND
SURVIVAL AND CONTINUED THEME OF
MULTILEVEL FACTORS CONTRIBUTING
TO HEALTH DISPARITIES AND DR.
LAWRENCE -- CONNECTING
DETERMINANTS OF HEALTH WITH
CLINICAL OUTCOMES AND SHARED
POSSIBILITIES FOR FURTHER AGING
RESEARCH STRATEGIES ASSESSING
BIOLOGICAL ASPECTS OF HEALTH
DISPARITIES SUCH AS
IDENTIFICATION OF NEW BIOMARKERS
AND INVESTIGATION OF IPT ORGAN
COMMUNICATION AND STUDYING
HEALTH DISPARITIES VIA
STANDARDIZED METRICS OF HEALTH
AND DR. DAVIS DISCUSSED NEED FOR
PRECISION MEDICINE AS WELL AS
LIMITATIONS TO PRECISION
MEDICINE IMPLEMENTATION AND
HIGHLIGHTED NEED FOR PUBLIC
TRUST AND COMMUNITY ENGAGEMENT
AND DR. THORP RECOMMENDED
INTERDISCIPLINARY APPROACH
BEFORE BEGINNING PANEL
DISCUSSION THAT CONSISTED OF
SEVERAL FASCINATING DISCUSSIONS
INCLUDING INCORPORATION OF
HEALTH DISPARITIES INTO RESEARCH
AND HEALTH INTERVENTIONS THAT
CHANGED OVER TIME AND DISCUSSED
GLOBAL PERSPECTIVE OF HEALTH
DISPARITIES DISCUSSING CONTEXT
NEEDED TO INTERPRET SUCH
RESEARCH AND CONVERSATION ON
BIOLOGICAL QUESTION OF CAUSE AND
EFFECT WITH HEALTH DISPARITIES
WITH AGING AND PANELISTS SHARED
IMPORTANCE OF THOUKTFUL CARE TO
BEST DISSEMINATE FINDINGS AND IN
SUMMARY SPEAKERS AND PANELISTS
COVERED OVERVIEW OF STRUCTURAL
AND SOCIAL DETERMINANTS OF
HEALTH IMPACTING INDIVIDUAL AND
POPULATION HEALTH ACROSS THE
LIFESPAN AND ARE DRIVERS OF
HEALTH AND HEALTH INEQUITIES AND
HEALTH DISPARITIES AND
INEQUITIES AD -- CHARACTERISTICS
HISTORICALLY LINKED TO
DISCRIMINATION OR EXCLUSION AND
DISADVANTAGES AND ADVANTAGES
BECOME BIOLOGICALLY IMBEDDED IN
INDIVIDUALS CAUSING AND
SUSTAINING BIOLOGICAL CHANGES
RESULTING IN DIFFERENT HEALTH
LATER IN LIFE AND ALTERED LIFE
EXPECTANCY AND SPEAKERS AND
PANELISTS DISCUSS NUMEROUS
EXAMPLES OF RESEARCH DISPLAYING
HEALTH DISPARITIES IN SCIENCE
AND BIOMARKERS STRATEGIES AND
INTERVENTIONS TO REDUCE
INEQUITIES AND OVERALL SPEAKERS
AND PANELISTS RECOMMENDED
SEVERAL THINGS TO KEEP IN MIND
AND AIM FOR IN THE FUTURE GIVEN
HETEROGENEITY IN INDIVIDUAL'S
LIFE CONTEXT PRECISION MEDICINE
WOULD BETTER TAILOR
GEROSCIENTIFIC INTERVENTIONS FOR
EACH INDIVIDUAL AND RECOMMENDED
WAS A PUSH AWAY FROM SINGLE
DISEASE RESPONSES AND INDIVIDUAL
CENTRIC RESEARCH TOWARDS
STRUCTURAL CHANGE MULTILEVEL
INTERVENTIONS AND
INTERDISCIPLINARY APPROACHES.
IMPORTANTLY INTERVENTIONS
TARGETING STRUCTURAL FACTORS ARE
GENERALLY DISEASE AGNOSTIC AND
WILL BE ABLE TO BENEFIT MULTIPLE
HEALTH OUTCOMES.
PANELISTS SHARED ALSO THE IDEA
THAT GEROSCIENCE IS IN A GOOD
POSITION TO BREAK DOWN
SCIENTIFIC SILOS ADDRESSING
HEALTH DISPARITIES AND HELPING
THIS PROCESS IMPROVEMENTS IN
COMMUNITY TRUST AND ENGAGEMENT
ARE STRONGLY NEEDED INCREASED
TRUST AND ENGAGEMENT APPROVE
DIVERSITY IN STUDYING COHORTS
AND MAKING SURE NEXT GENERATION
OF SCIENTISTS IS TRAIN TODAY BE
AWARE OF INCORPORATING HEALTH
DISPARITIES INTO ALL RESEARCH
RESULTING AND IMPROVING
KNOWLEDGE AND AGING ACROSS THE
LIFESPAN FOR ALL POPULATIONS.
THANK YOU.
>>>>I WILL NOW HEAR FROM
[INDISCERNIBLE] KNIGHT ON
SESSION 2.
WE ARE MOVING STRAIGHT TO
SESSION 3 WITH [INDISCERNIBLE].
RIGHT. WILL BE DOING THIS BY
ZOOM.
SOMEBODY ELSE?
>>TODAY I WILL PRESENT ON ZERO
SCIENCE SUMMIT SESSIONS AND A
FEW KEYPOINTS DURING THE TALK ON
MONDAY.
PRIMARILY MOTIVATED WITH POE 10
INFORMING RESEARCH FROM PROCESS
OF CLINICAL AND BIOLOGICAL
STANDPOINT AND FIRST TALK
FEATURED SEINE 10ARIANS AND SHE
STATED IN THE BROAD SPECTRUM OF
GERONTOLOGY TWO GOALS STAND OUT
REDUCING PERIOD THAT MORBIDITIES
BEGIN TO OCCUR AND INCREASING
LIFESPAN AND MAKING INTRIGUING
AND HEALTHY AGING AND LONGEVITY
AND SEINE 10ARIANS AND OFFSPRING
LIVE IN POPULATION REGARDLESS OF
ENVIRONMENT -- SIGNAL PATHWAY
THAT DISPLAYED INCREASED
LONGEVITY AND RECENT FINDINGS
THIS FAMILY STUDY WAS CREATED AS
A RESEARCH TO FURTHER ZERO
SCIENCE RESEARCH AND COHORT OF
SEINE 10ARIANS FOR FOUNDATION OF
THE DATABASE AND MOVING TO
MICHAEL WHOSE TALK FOCUSED ON
POPULATION THAT WAS INDIGENOUS
HUNTER GANLRERS AND REMOVED FROM
INDUSTRIAL ENVIRONMENTS
PRACTICING CULTURE LONGER LIVES
AND SIGNIFICANTLY REDUCING
CHRONIC DISEASES TO BOTH
INDIGENOUS AND NORMAL
POPULATIONS AND INDUSTRIAL
ENVIRONMENTS FOR EXAMPLE THOSE
WHOM ARE INDIGENOUS TO BOLIVIA
HAVE SEVERAL HEALTH ISSUES TO
HYPERTENSION AND CORONARY
ARTIERY [INDISCERNIBLE] HIGH
CASH LOW FAT DIET AND ACTIVE
LIFESTYLE -- HELPING RESEARCHERS
TO UNDERSTAND MECHANISMS OF
AGING AND I WILL TRANSITION INTO
THE EFFECTIVE DISEASE PANEL OL
IMMINA EXPLAINED THAT
THERAPEUTIC TREATMENTS FOR
CANCER HAVE SIGNIFICANTLY
IMPROVED IN LAST FEW DECADES
CANCER PRESENTERS HAVE BEEN
PRESENTED WITH A NEW CHALLENGE
ACCELERATED AGING LEADING TO --
DR. CRED RICK DESCRIBED CYCOF
BETWEEN AGING AND CANCER AND
CANCER SUBSEQUENTLY EFFECTS THE
AGING PROCESS AND SUSPECT TODAY
BE CAUSE OF THESE AND DR. CRED
DRIK SUGGESTS 1, 2, PUNCH --
BIDIRECTIONAL APPROACH FROM LAB
TO HOSPITAL AND BACK ADDING JER
ON TOLL ONL CAL LENS FOR FUTURE
ONCOLOGY RESEARCH AND NEXT
CONTINUUM WITH THE DISEASE
PANELOLOGY FOCUS WE HAVE DR.
CHRISTINE'S EFFECTS AND SIMILAR
TO CANCER SURVIVORS CARRIERS ARE
LIVING LONGER ACCRUING MORE
MORBIDITIES ACCRUING -- ONE
STUDY NOTED THAT HIV HAS LOWER
BONE MARROW DENSITY THAN
COMPARISONS HELPING CONTROLS AND
INTERVENTIONS LIKE THERAPY FOR
EXAMPLE COULD BE IN FUTURE TO
SIGNIFICANT IMPROVING HEALTH
OUTLOOKS OF HIV CARRIERS AND
MULTI-FACETED APPROACH THAT IS
DESCRIBED FOR FUTURE TREATMENT
AND FINALLY LAST SESSION FOCUSED
TAKING A DIVE INTO IC SURVIVORS
AND CONTINUES THEME OF POST
TREATMENT ISSUES ICU SURVIVAL
RATES ARE AT ALL-TIME HIGH
COMING WITH PROBLEMS ASSOCIATED
WITH ACCELERATED HAZING AND
STUDIES CONFIRM THESE CLINICAL
AND BIOLOGICAL INDICATORS AND
FOR IC SURVIVORS COHORTS OF
VARYING AGE GROUPS HAVE SCORES
FOR LOW TO MEDIUM AVERAGE OF LOW
POBLATION AND STUDY HAS SHOWN
THAT WAS DONE ON SURVIVORS
DISPLAYED [INDISCERNIBLE] THAT
SIGNIFICANTLY SPIKES INFECTION
REMAINING AT LEVELS A YEAR INTO
THE FUTURE DUE TO INABILITY TO
EXERCISE CONSISTENTLY IC
SURVIVORS DEVELOP MITOCHONDRIAL
INTERVENTION AND TALKS
GEROSCIENCE PERSPECTIVE IN
FUTURE RESEARCH AND FUTURE OF
GERONTOLOGY RESEARCH SHOULD
EMPHASIZE -- FINDINGS FROM
SESSION 2 DISPLAYING
CHARACTERISTICS BETWEEN
POPULATIONS SIGNIFICANTLY ALTER
HEALTH OUTLOOKS AND HOW PIVOTAL
PATIENT SPECIFIC CARE IS IN THE
FUTURE AND LOVED COMMENT MADE
WHERE DR. VOOE JAY MADE A
STATEMENT -- TIGHT-KNIT
COMMUNITIES AND STATED PATIENTS
ARE SMARTER THAN WE REALIZE AND
SPREADING THIS PRESENTING ONE OF
MANY HEALTH ISSUES WE DO TODAY
AND INCLUDES SUMMARY AND THANKS
FOR ATTENDING THIS GEROSCIENCE
SUMMIT.
>>IF I ELEVATED YOUR
[INDISCERN
[INDISCERNIBLE].
>>I'M HERE TO SUMMARIZE SESSION
3 THAT DEALT WITH
MULTI-MORBIDITIES AND GERIATRIC
SYMPTOM WITH NATIONAL INSTITUTE
OF AGING AND STARTED THIS
SESSION AND FOCUSED ON SLOWING
DOWN AGING AND PRESENTED A CASE
FOR MITOCHONDRIA. HE MADE A
POINT THAT DISEASES THAT
TYPICALLY EFFECT OLDER PERSONS
WITH MULTI-MORBIDITY AND
DISABILITY AND MORTALITY THIS
KIND OF DECLINING AND PRESENTED
THIS ALTERNATIVE TO ECONCRIME
HEALTH CARE AND PUBLIC HEALTH
WITH PACE OF BIOLOGICAL AGING
AND FEELS DELAYING ONSETS OF
DISABILITY AT TIME DISEASES HAVE
NOT REACHED CLINICAL THRESHOLD
WE CAN CORRESPOND PERIOD OF LIFE
THAT PEOPLE CAN LIVE DISEASE
FREE AND PRESENTED EVIDENCE FOR
MITOCHONDRIA FUNCTION AND HOW IT
EFFECTS BIOLOGICAL PROCESSES
THAT ARE CASE OF AGING AND
MOVING FROM THERE DR. ALLAN
PRESENTED ON NON-HUMAN PRIMATES
PROVIDING UNIQUE OPPORTUNITIES
STUDYING MORBIDITIES AND THAT
TALK HIGHLIGHTED NON-HUMAN
PRIMATES HAVE BEEN MODELS FOR
STUDYING GERIATRIC SYNDROMES AND
MULTIPLE MORBIDITIES AND DEVELOP
MULTIPLE CHRONIC CONDITIONS THAT
RESEMBLE WHAT HAPPENS IN HUMANS
AND PRESENTING STUDIES FOCUSED
ON EXPOSURE TO LIFE STRESSES AND
IN HER CASE PRESENTED BODY
RADIAT
RADIATION.
RESOURCE SUGGESTED BASIS OF
AGING RELATED TO MORBIDITIES ARE
COMPLEX AND INVOLVED IBT PLAY
BETWEEN ENVIRONMENT AND GENETIC
AND BIOLOGICAL FACTORS AND
NON-HUMAN PRIMATES ARE UNIQUELY
POSITIONED TO BE SUITED FOR
PROBING THESE CONDITIONS AND
MOVING AT THAT TALK, DR. NATASHA
PRESENTED DOGS AS VALUABLE
MODELS FOR AGING RESEARCH AND
MADE SAME POINT THAT DOGS AND
HUMANS SHARE AGE RELATED
COMORBIDITIES AND MAKES VALUABLE
TRANSLATIONAL MODELS FOR AGING
RESEARCH AND PRESENTED FRAMEWORK
FOR K-9 GERIATRIC SYNDROME AND
ALSO PRESENTED FRAMEWORK THAT
INCLUDED LOOKING AT BEHAVIORAL
CHANGES AND ALSO METABOLIC
ALTERATIONS AND AGE ASSOCIATED
CLINICAL DISEASE AND HOW CHANGES
COULD PREDICT MORBIDITY AND
MORTALITY.
AND SHE PRESENTED CASE THAT
RESEARCH ON THESE FRONTS ARE
PROCEEDING RAPIDLY AND STILL
THERE ARE GAPS IN THE KNOWLEDGE
THAT ARE PARTICULARLY AROUND
RESILIENCE AND FRAILTY AND
CAREGIVER BURDEN AND RESEARCH
GOING FORWARD IN THIS DIRECTION
SHOULD START TO LOOK AT THOSE
AREAS IF YOU WANT TO FILL IN THE
GAPS.
AND FINALLY, DR. CAROLINE TALKED
ABOUT HOW WE CAN DEVELOP ACROSS
SPECIES FRAMEWORK TO TRANSLATE
INSIDE GAIN FROM ANIMAL MODELS
INTO THE CLINIC AND
[INDISCERNIBLE] POINTS MADE BY
DR. ALLAN AND DR. NATASHA
SHOWING SPECIES [INDISCERNIBLE]
CAN PROVIDE DEVELOPING INSIGHTS
INTO AGING BIOLOGY USED TO
EXPAND HEALTH SPAN AND ALSO MADE
A PO INT THAT TRANSLATES ALL OF
THE FUNDAMENTAL DISCOVERIES MADE
IN ANIMAL MODELS TO THE CLINIC
THAT IS IMPORTANT TO DEVELOP A
SHARED VOCABULARY OF MEASURED
COMPONENTS OF HEALTH SPAN AND
IDENTIFY PRODUCEABLE MECHANISTIC
RELATIONSHIPS THAT TRANSLATE
ACROSS SPECIES AND NEED TO
VALIDATE AND DEVELOP VALIDATED
BIOMARKERS PERMITTING
LONGITUDINAL ASSESSMENTS IN
VIVO.
SO, IN CONCLUDING WHERE WE GO
FROM HERE.
SO, FROM GETTING FROM LUIGI'S
TALK ABOUT THE NEED TO SLOW DOWN
AGING AND CASE FOR MITOCHONDRIA.
DR. ALLAN AND NATASHA CAME ALONG
TO SHOW ANIMAL MODELS NON-HUMAN
PRIMATES AND GERIATRIC DOGS ARE
HAVING SOME VALUABLE
TRANSLATIONAL MODELS WITH AGE
RELATED COMORBIDITIES WITH
HUMANS THEY SHARE AND RESEARCH
HAS POSITIVE MOMENTUMS THAT WILL
ENSURE [INDISCERNIBLE] IN FIELD
OF GEROSCIENCE THAT IS
PREVENTING DEBILITATING EFFECT
OF AGING AND WHERE DO WE GO FROM
HERE? MOMENTUM SHOULD BE
MAINTAINED ON GEROSCIENCE
MULTIMOBILITIES AND GERIATRIC
SYNDROMES AND RESOURCES TO
CONTINUE TO EXPAND ON USE OF
THESE ANIMAL MODELS AND OTHERS
IN GEROSCIENCE RESEARCH THAT IS
ON MULTI-MORBIDITIES AND
GERIATRIC SYNDROME AND
HIGHLIGHTED BY DR. CAROLINE, WE
HAVE TO DEVELOP ACROSS SPECIES
FRAMEWORK THAT IS LINKING ALL
THESE ANIMAL MODELS AND SPECIES
TO TRANSLATE INSIGHTS GAINED
FROM THESE ANIMAL MODELS INTO
THE CLINIC.
THANK YOU.
>>NEXT, WE WILL HEAR ON SESSION
4 FROM MICHAEL DUGAN.
THANKS FOR HAVING ME HERE. I'M
A CHEMIST BY TRAINING AND
PHYSICIST BY HEART AND DON'T
KNOW MUCH ABOUT THIS.
I WOULD LOVE TO GIVE YOU MY
UNDERSTANDING HOW TO MODEL USING
MODELING OF AGING HEALTH IN
GEROSCIENCE AND STARTING SESSION
WITH [INDISCERNIBLE] WHO SHOWED
A VERY NICE EXAMPLE OF
[INDISCERNIBLE] FRACTION OF SITE
AND WE CAN IDENTIFY LINEAR
ASSOCIATION WITH AGE AND
EVERYBODY HERE KNOWS THIS IS
WHAT PEOPLE NOW CALL
[INDISCERNIBLE] AND ON THE RIGHT
YOU CAN SEE DEVELOP ELASTIC
MODEL THAT IS RIG ORRIZED
VERSION OF REGRESSION AND ABLE
TO CORRECTLY PREDICT AGES AB
KRAETLY AND DOWN THE RIGHT YOU
SEE FIGURE THAT FEMALE AND MALE
HAVE DISTINGUISHED RATE OF
AGING.
SAYING INTERESTING AND MAJOR IT
AND THEN THEY ARE DOING
SOMETHING MORE INTERESTING AND
REALLY LOVE THAT. LET'S THINK
ABOUT WHY NOT TRY THIS ON DOGS
AND FOUND THAT THEY CAN ALSO
MAJOR IMAGINE ENNATION IN DOGS
AND TRANSLATING THAT AGE TO
HUMAN AGE IT IS NOT IN THERE BUT
RATHER LOGARITHM MIC THAT IS
INTERESTING POINT THAT FITS INTO
SITUATION AND WE KNOW THAT
DOGGY, YOU KNOW, AGES FASTER.
THEY FIND ALSO THIS EPIGENETIC
CLOCK IS CONSERVED ACROSS
SPECIES AND MEANS MULTIPLE SIDES
THAT IMAGINATION SHOWS FAST
AGING ACROSS SPECIES AND ON
RIGHT IS IMPLICATION HOW THEY
USE STUDY IF TREATMENT ACTUALLY
SLOWED DOWN AGING AND THIS IS
RESTRICTION SHOWING BY
[INDISCERNIBLE] THAT IS SLOWED
DOWN FOR AGING.
THIS GOT ME THINKING THIS IS A
GREAT EXAMPLE PROCESS OF
MODELING AGING AND THIS IS FOUND
BY DR. [INDISCERNIBLE]'S SLIDES
FOR PANEL DISCUSSION AND YOU CAN
SAY YOU MAJORED SOMETHING THAT
IS INPUT AND MODEL AND MACHINE
LEARNING IS FANCY THING AND THEY
EVALUATE MODEL IT SEE WHAT WE
CAN GAIN FROM IT.
AS A PHYSICIST BY HEART, I FEEL
THIS DOESN'T REALLY REVEAL HOW
THESE SCIENCES ARE. I DEVELOPED
THIS SORT OF FIGURE THAT FROM MY
UNDERSTANDING HOW AGING AND
DEMENTIA STARTING FROM HERE AND,
YOU KNOW, YOU HAVE AGENT
DISEASES AND YOU MAJOR IN OMICS
WHICH I HAVE KNOWLEDGE ABOUT AND
DIFFERENT EXPOSURE TO LIFESTYLE
ENVIRONMENT AND YOU HAVE
DEVELOPED DIFFERENT ABOUT I--O
MARKERS AND MEASURE SOMETHING
YOU CAN MEASURE METHYLATION AND
LIFESPAN AND COGNITION THAT IS
SPEAKING AS AN ENGINEER
PERSPECTIVE THAT IS HOW YOU
GENERATE DATA AND ONCE DO YOU
THAT YOU FIGURE OUT WAY TO HAVE
DATA BACK TO [INDISCERNIBLE] AND
HOW WE UNDERSTAND AGE AND
DEMENTIA AND GO TO RIGHT SIDE
THAT ONCE YOU COLLECT THAT IS
CROSS-SECTIONAL OR LONGITUDINAL
DATA AND YOU DO CORRELATION AND
DEVELOP BIOMARKERS THAT CANNOT
BE. THIS BIOMARKER YOU
UNDERSTAND THAT IF IT IS PURE
CAUSAL OR CORRELATION THAT YOU
DEVELOP OTHER MODEL TO GO BACK
AND UP AND ESSENTIALLY YOU WANT
TO USE ALL OF THE INFORMATION
YOU HAVE TO DIFFERENTIAL AGING
AND DISEASES AND THIS FITS
NICELY AS ENGINEER PERSPECTIVE
USING MATHEMATIC MODELING TO
AGING AND MOVE TO THE NEXT
SPEAKER OF THIS TO
[INDISCERNIBLE] AND THIS DIAGRAM
THERE IS INPUT PARAMETER OF
MODEL AGING THAT WE CAN SAY THAT
IS INPUT PARAMETER THERE IN MY
FIGURE AND THEY TALK ABOUT AGE
SENSITIVE PHONOTYPE AND HOW
LIFESPAN IS NOT SUFFICIENT WITH
AGING AND MORE REALISTIC MODEL
OF ASP THAT HAS A LOT OF
ASSOCIATED FUNDAMENTAL PROCESSES
OTHER THAN JUST 1.
AND THEN THESE ARE DIFFERENCES
BETWEEN SYMPTOM ATTIC
[INDISCERNIBLE] AND POINTING OUT
THAT WE REALLY HAVE TO BE ABLE
TO SHOW THIS AGE DEPENDENT
CHANGES NEXT SP TO CLAIM THERE
IS EVIDENCE FOR THIS
INTERVENTION SLOWING DOWN AGING.
MORE THIS IS THE RESULT OF MICE
AND YOU CAN MAJOR IN THESE OVER
TIME.
SORRY THIS SORT OF MEASUREMENT
OVER LIFESPAN OF MICE YOU CAN
SEE THERE ARE MULTIPLE
BIO-MACERS THAT COULD DECLINE OR
INCREASE OR ALMOST STAY THE SAME
AND REALLY THEY BEHAVE
DIFFERENTLY.
THERE IS A STUDY OF THREE
DIFFERENT MUTATION AND ALSO
INTERVENTION OF MICE AND MICE
SHOWS THAT MOST TREATMENT
FACTORS ARE SIMILAR ACTUALLY IN
YOUNG MICE AND OLD MICE THAT
MEANS IT IS SYMPTOMATIC NOT
CASUAL AND INTERVENTION HAS
LIMITED EFFECT ON SLOW AGING
FROM THEIR STUDY AND WE MOVE TO
THIS EXCITING TALK ABOUT USING
MACHINE LEARNING TO AN AGING
CLOCK FOR DRUG DISCOVERY AND
AGAIN PHASE 2 DIAGRAM MODEL AND
TALKING ABOUT HOW TO PLAN FORMS
AND FREE PLAN FORMS HERE THAT
THEY USE TO REALLY FIND AGE
PROTECTORS INTO PRACTICAL
THERAPIUTE CAL AID TARGET WITH
MUCH, MUCH MORE FACTOR TIMEFRAME
PARTICULARLY TALKING ABOUT PAN
DOMICS PLATFORM AND THERE IS
HUGE AMOUNT OF DATA ACROSS
DOMAINS AND OMICS DATA AND
COMBINED BIOLOGICAL GRANTS
PATTERNS CONNECTING TRIALS AND
USING THAT THEY WERE ABLE TO --
ONE EXAMPLE, THEY WERE ABLE TO
IDENTIFY POTENTIAL TARGET USING
PANDOMICS AND LAST ONE IS
ORIGINATION TO MODEL AGING THAT
I DON'T KNOW WHERE TO FIT IT.
BUT, TURNS OUT IT IS JUST
DIFFERENT AND WHY?
BECAUSE THIS CONCEPT OF
EXCHANGING BLOOD IS SORT OF BY
NATURE IS NOT EXISTING NATURE.
IT IS A NEW WAY AND ENGINEERED
WAY OF STUDYING AGING PERMITTING
NEW WAY OF INTERVENTION. RIGHT?
SO, DR. COBALT FOUND THAT BLOT
OR ACTUALLY DILUSION IS
AGE-RELATED [INDISCERNIBLE] AND
FOUND BY DILUTING PLASMA THAT
THEY -- MICE SHOWED IMPROVED
COGNITION AND ALSO IN HUMAN
STUDY THAT DEFINED DILUTING
PLASMA AND SHOWED LOTS OF
POSITIVE INQUIRIES.
THAT IS THE SAME. THEY ALSO
SHOW WITH MORE TREATMENT THAT
YOU CAN SEE THOSE PATHWAYS
RELATED COULD ACTUALLY GRADUALLY
REJUVENATE WITH MORE AND MORE
TREATMENT TO YOUNGER STAGE AND
MY THINKING FOR THIS ENGINEER
PERSPECTIVE IS WHAT IS A FUTURE
OF THIS? WE HAVE LOTS OF
BIOLOGICAL MEANS TO COLLECT DATA
AND OBSERVE BIOLOGIC DISCOVERY
WE CAN DO AND DATA COLLECTION WE
CAN DO WE HAVE SO MANY
BIOMARKERS AND SENSE AND DATA
FUSION AND BORROW METHOD AND YOU
HAVE DEDUNTANT INFORMATION AND
IMAGE PROCESSING AND NEW
PATHWAYS AND THEORIES AND
EXCITED HOW THIS WILL GO IN THE
FUTURE AND THANKS FOR THE TIME.
>>WE WILL TAKE A STEP BACK FOR
SESSION 4. MICHAEL DUGAN IS
ONLINE.
>> CAN YOU HEAR ME?
>>WE CAN HEAR YOU.
>>OKAY.
>>SLIDES ARE COMING UP.
>>GOOD AFTERNOON I'M MICHAEL
AND WILL DISCUSS KEY TAKEAWAYS
FROM 4TH SUMMIT AND 4TH SESSION.
IN THIS SESSION WE HEARD FROM
DR. HOW LET WHO PRESENTED ON
INVESTIGATIONS TO FRAILTY INDEX
IN AGING MICE THAT HER LAB
DEVELOPED AND VALIDATED AND
FRAILTY INDEX REFLECTS FREQUENCY
-- BY MAXIMUM DEFICITS THAT
COULD BE OBSERVED AND
INTERVENTIONS COULD HELP REDUCE
INCREASING FRAILTY SCORES
OBSERVED IN MICE INCLUDING
EXERCISE AND POLYPHARMACY
DEPICTED ON THE RIGHT AND
PUBLICATION OF THESE COULD BE
DETECTED IN COMPLEMENTARY
MEASURES OF TISSUE DAMAGE AND
TISSUE REPAIR AND BLOOD AS
INDEPENDENT METRIC WENT ON TO
SHOW FRAILTY DEVELOPED IN MICE
TRANSLATES WELL TO HUMANS
SUGGESTING DYNAMIC WAY TO
FRAILTY SCORES RESPOND TO
DELETERIOUS AND BENEFICIAL
FACTORS MAKE IT PARTICULARLY
ATTRACTIVE AS METHOD TO TEST
GEOPROTECTIVE INTERVENTIONS AND
HEARD FROM DR. GILL FROM YALE
UNIVERSITY ON APPLICATION OF
PHYSICAL MOBILITY AND PHYSICAL
PERFORMANCE METRICS OF AGING AND
HE DISCUSSED PDF10, PHYSICAL
FUNCTION 10 THAT HE NOTED
UNFORTUNATELY CAN SUFFER FROM
SIGNIFICANT EFFECTS AND
DISCUSSED SEVERAL OTHER MEASURES
BETTER PREDICTING VARIATION AND
PHYSICAL VISIBILITY AND
HIGHLIGHTED WAS PROMISED
PHYSICAL FUNCTION ASSESSMENT YOU
SEE IN UPPER RIGHT THAT IS
EVALUATED IN FDA FUNDED GRANT TO
STUDY WITH POTENTIAL APPLICATION
IN SARCOPENIA TRIALS AND
PERFORMANCE PLACING GREATER
EMPHASIS ON ASSESSING PHYSICAL
LIMITATIONS DR. GILL DISCUSSED 6
MINUTE 400 METER WALKING TASKS
AND SPENT TIME ON WIDELY USED
SHORT PERFORMANCE BATTERY
CONSISTING OF TIMED 4 METER WALK
CHAIR NOTING IT IS THE GAIT
SPEED OF WALKING TASK THAT IS
ACCURATE DEPENDED IN ROC CURVE
TO THE RIGHT AND SCORES COULD
PREDICT AGE RELATED OUTCOMES
AGAINST MICE RATS AND NON-HUMANS
SUGGESTING APPLICATION OF
TRANSLATIONAL MEASURES OPENING
FOR FUTURE GEROSCIENCE
DISCOVERIES AND THERAPEUTIC
AGENTS AND NEXT DR. WOLSON FROM
JOHNS HOPKINS UNIVERSITY AND
IMPORTANCE OF RESILIENCY AND
AGING AND INTERSECTIONS OF
CONCEPTS AT MOLECULAR LEVEL AND
FRAILTY ASSESSMENT PRESENTED
FIVE HALLMARKS IN WAIT LOSS AND
Z- EXHAUSTION AND LOW PHYSICAL
ACTIVITY INDIVIDUALS CONSIDERED
FRAIL TO SOME DEGREE OR ANOTHER
PRESENTING WITH THREE OR MORE
CHARACTERISTICS FOCUSING ON
AGING AS BIOLOGICAL CONSTRUCT
INDICATED IN SCHEMATIC TO THE
RIGHT AND CHAFKS MULTIPLE
SYSTEMS IN MOLECULAR LEVEL AND
LEAD TO BIOLOGICAL VULNERABILITY
THAT MAY PERSIST FOR YEARS AND
BEFORE SIGNS OR SYMPTOMS ARE
ULTIMATELY APPARENT AND IS THIS
VULNERABILITY THAT CAN INCREASE
RISK FOR AGE RELATED DISEASES IN
COMORBIDITIES AND FRAILTY IS
ASSOCIATED WITH SUCH
SUSCEPTIBILITY TO AGE RELATED
OUTCOMES THAT WE KNOW NOTED
DISTINCT WITH RESILIENCY
REFERRING INDIVIDUAL'S
RESPONSIBILITY TO RESPOND TO
STRESSORS AND OBSERVING COMPLEX
SYSTEMS TO MAINTAIN HOMEOSTASIS
AND DISCUSSED ONGOING SPRING
INITIATIVE TRACKING OLDER ADULTS
AND TRANSPLANTS AND DIALYSIS AND
MEASURING BIOLOGICAL MECHANISMS
ACCOUNTING FOR INDIVIDUAL
DIFFERENCES IN AGE RELATED
OUTCOMES AND HEARD FROM DR.
KRIMONES FROM UNIVERSITY OF
SOUTH CAROLINA PRESENTING
COMPREHENSIVE RESULTS FROM
INVESTIGATION AND EXAMINED
BIOMARKERS ACROSS 13 BIOLOGICAL
SYSTEMS THAT COULD PREDICT MORE
MORTALITY AND BIOMARKERS AND
MACHINE LEARNING AND
PARTICIPANTS FROM HEALTH AND
RETIREMENT STUDY AND FOUND THAT
DR. BIOMARKERS CONTRIBUTE TODAY
DIFFERENTIAL VARIATION IN
SPECIFIC SYSTEMS INDICATED IN
TABLE ON RIGHT INCLUDING
EPIGENETIC CLOCK ON GENERAL
AGING AND LOADING ON TO THE
CARDIOVASCULAR SYSTEM AND IN
REGRESSION ANALYSIS DR. KRIMONES
SAW BIOMARKERS UNDERLYING
GENERAL AGING CARDIOVASCULAR AND
VES PTORY SYSTEM WERE ESPECIALLY
STRONG PREDICTORS OF MORTALITY
AND BIOMARKER GENERAL AGING
ACCOUNTS FOR PREDICTIVE EFFECTS
OF ADAPTIVE IMMUNITY AND
CIRCULATORY AND NEUROLOGICAL
SYSTEMS AND IMPORTANT WILL I DR.
KRIMONES FOUND VARIANCE
ACCOUNTED FOR BY BIOMARKERS
COULD BE EXPLAINED BY SOCIAL AND
DEMOGRAPHIC FACTORS AND FINAL
SPEAKER IS DR. LITH CO FOR
INSTITUTE ON AGING AND
INCREASING REVELLENT ASPECT OF
AGING RESEARCH AND NEED TO
ENHANCE AGING INTERVENTION
PIPELINES AND REMINDED US IF NOT
MAKING ANIMALS LIVE LONGER --
INDICATED IN THE TABLE ON THE
RIGHT AND DEVELOPED IN MODEL
ORGAN SYSTEMS C ELEGANS SHOWN TO
ENHANCE LONGEVITY AND PROVIDED
RESULTS FROM NUMBER OF
EXPERIMENTS SHOWING COMPOUNDS --
CAN INDUCE SIMILAR BENEFITS
PUTTING DECREASES IN PROTEIN
AGGREGATION AND IMPROVEMENTS IN
FUNCTIONAL PARALYSIS ASSAYS AND
LIFESPAN ACROSS MULTIPLE MODELS
INDICATED IN THE PANEL ON BOTTOM
RIGHT AND PARTING WORDS FOR
INSPIRATION AND POINTED OUT 40%
COMPOUNDS THAT GROUP PRESELECTED
TO IMPROVE LIFESPAN WORMS
INHIBIT AGING PROCESSES IN MICE
AND PROVIDING MUCH APPRECIATED
OPTIMISM UNDERSTANDING AGE
INTERVENTIONS QUANTIFYING
EFFECTS ACROSS DIFFERENT DOMAINS
AND HOW BEST TO TRANSLATE
FINDINGS INTO BROADER
GEROPROTECTIVE STRATEGIES AND
WITH THAT I WILL PASS IT OFF TO
THE NEXT SPEAKER WHO WILL
DISCUSS IN THIS CASE THE
SUCCESSION.
THANK YOU.
>>NOW, [INDISCERNIBLE] WILL
SPEAK ON SESSION 6.
>>HELLO, EVERYONE I'M FROM
NATIONAL INSTITUTE ON AGING AND
THRILL TODAY PRESENT SUMMARY OF
BIOMARKERS OF GEROSCIENCE
SESSION BEGINNING WITH DR. CHRIS
OH, MY GOD PRESENTED THE
BEGINNING MANY STATES OF
BIOMARKERS AND WHAT HE
ESSENTIALLY TRIED TO MAKE OUT OF
IT WAS HOW DIFFERENT RESEARCHERS
SEE THE VERY DEFINITION OF A
BIOMARKER AND I WILL MAKE ONE
STEP BACK AND ACTUALLY ASK
BIOMARKER OF WHAT.
SO, AS YOU ALREADY KNOW, WE
ALREADY HAVE ALL THIS BIOLOGICAL
MATERIAL FOR EXAMPLE CELLS AND
BIOPSIES WE ARE TAKING
MEASUREMENTS FROM MOLECULAR AND
[INDISCERNIBLE] MEASUREMENTS AND
WE MEASURED SPECIFIC AGING
PHENOTYPES AND IN THIS CASE WE
ALSO SAY RATE OF AGING OR FOR
EXAMPLE THE MITOCHONDRIAL
FUNCTION.
OUT OF THESE INDICES THEN, WE
SAY WE FEED MODELS GENERATE
REALLY POWERFUL COMPUTATIONAL
TOOLS THAT WE CAN ESSENTIALLY
ASSESS TO SOME EXTENT OR PREDICT
AGE OR SPECIFIC FEATURES OF
AGING. FOR EXAMPLE, PACE OF
AIDS.
AS YOU CAN SEE HERE THOUGH THIS
IS A CIRCLE ESSENTIALLY. AFTER
WE HAVE PREDICTIONS WE HAVE THIS
GOING BACK AND ARE GOING BACK TO
THE LAB AND TRYING TO TEST
WHETHER PREDICTIONS ARE ACTUALLY
ACCURATE AND OF COURSE WHETHER
WE CAN TRULY INTERVENE SO WE CAN
REESTABLISH EQUILIBRIUM BETWEEN
DAMAGE [INDISCERNIBLE] AND
INEFFECTIVE REPAIR THAT IS WHAT
ESSENTIALLY CAUSES BIOLOGICAL
AGING AND I DON'T KNOW ABOUT
YOU, BUT WHENEVER WE ARE TALKING
ABOUT TOOLS LIKE BIOFORMATICS
TOOLS FIRST THING COMING IN MIND
IS EPIGENETIC CLOKZ AND FOR
EXAMPLE FIRST GENERATION OF
EPIGENETIC CLOCKS COULD PREDICT
CHRONOLOGICAL AGE AND SECOND
GENERATION OF CLOCKS PROVIDE
SURVIVAL BASED ON DNA
METHYLATION MEASUREMENTS AND
ANOTHER ONE PRESENTED BY DR.
BELSKY IN AMAZING TALK HE TALKED
ABOUT NEW GENERATION OR
SO-CALLED X GENERATION OF
EPIGENETIC CLOCKS TO PREDICT
PACE OF AIDS IN OTHER TERMS HOW
QUICK OR SLOW WE AGE AND
PRESENTED BIOFORMATIC TERM NAMED
[INDISCERNIBLE] THAT IS A SPEED
OM TER PACE OF AIDS AND THIS
TOOL IS VERY IMPORTANT IN CASE
THAT WE ARE MISSING DATA FROM
LONGITUDINAL STUDIES SUCH AS,
FOR EXAMPLE, BLSA AND SLAM AND
GUEST AULT AND MENTIONING ALL
THESE AND TO SOME EXTENT I
PRAISE MY OWN HOME, THE NIA. IN
CASE WE HAVE DATA FROM THESE
STUDIES ALL THESE MAGNIFICENT
TOOLS COULD INFORM US ABOUT HOW
WE ACTUALLY AGE.
NOW, ANOTHER VERY IMPORTANT
ASPECT BROUGHT UP BY DR.
[INDISCERNIBLE] AT LEAST IT WAS
REALLY FASCINATING TO ME WAS TO
CONSIDER ACTUALLY THAT THERE
MIGHT BE SPECIFIC TOOLS OR LIKE
SPECIFIC CLOCKS THAT COULD BE
APPLIED TO SPECIFIC TISSUE AND
IN THAT CASE WE NEED TO CONSIDER
THAT EVERY TISSUE MADE AIDS IN A
DIFFERENT RATE AND NEED TOOLS TO
DRAW CONCLUSIONS FOR
CHRONOLOGICAL AGE AND
SUBSEQUENTLY APPLIED LATER ON
INTO THE CLINICS AND CLINICIANS
FOR EXAMPLE TRY TO POINT OUT OR
DESIGN SPECIFIC INTERVENTIONS.
NOW, DR. PICARD ACTUALLY HERE
REMINDS US THIS IS AN ACTUAL
CIRCLE AGAIN. DESPITE FACT WE
HAVE ALL MEASUREMENTS AND ALL
OUR GREAT TOOLS WE HAVE TO GO
BACK AND TEST THE MEASUREMENTS
THEMSELVES.
SO, IN HIS CASE WE FOCUS ON
MITOCHONDRIA AND AIDS AND
ACCUMULATE STRESS AND IMPAIRMENT
TO MITOCHONDRIA AND CONSEQUENCE
WE HAVE ACCELERATED AGING OR ANY
OTHER AGE-RELATED DECLINE.
INITIALLY ONLY KNOWN AS SIMPLY
THE -- THE PART HOUSE OF A CELL
AND IS VERY WELL KNOWN NO YOU
THAT MITOCHONDRIA CAN MEDIATE
SIGNAL TRANSDUCTION PATHWAYS
RELATED TO AGING AND RAISING
QUESTION THAT MITOCHONDRIA
SHOULD BE CONSIDERED AGING
BIOMARKER AND LASTLY, DR. KING
CAME. OH, MY GOSH. HAS ANOTHER
REPORT ON ASPECT OF GEROSCIENCE
THAT IS HOW YOU CAN REALLY
UTILIZE MODEL ORGANISMS THAT IS
FOR EXAMPLE MICE NOT ONLY TO
START WITH GEROSCIENCE AND
GENERAL LIFESPAN AND POTENTIAL
INTERVENTIONS THAT WILL ACTUALLY
ASSESS EFFICIENCY OF
INTERVENTIONS TO EITHER
DECELERATE OR IMPROVE AGING AND
TRYING NOW TO SUMMARIZE OR MORE
LIKE GIVE KIND OF AN OVERVIEW ON
WHAT IT WOULD CONSIDER AS A
REALLY GOOD BIOMARKER, I THINK
DR. [INDISCERNIBLE] GAVE
SPECIFIC BULLET POINTS HOW YOU
COULD DEFINE A REALLY GOOD
BIOMARKER. FIRST OF ALL, NEEDS
TO BE MEASURABLE IN SHORT TERM
AND HAS TO BE PREDICTOR OF
DISEASE IF TALKING ABOUT DISEASE
AND ESPECIALLY BEFORE CLINICAL
ONSET IN CASE WE WANT TO REALLY
INTERVENE AND IN TERMS OF AGING,
WE HAVE TO FIND SOMETHING THAT
IS LET'S SAY INDICATIVE OF
TECHNICALLY HEALTHY AGING OR
DECELERATE AGING TO INTERVENE
AND TRY TO HAVE THE OUTCOME AND
DESIRABLE OUTCOME.
OF COURSE, IT NEEDS TO BE
INFORMATIVE ENOUGH ABOUT THE
CURRENT AND ALSO THE FUTURE
HEALTH AS WELL AS INFORMATIVE
ENOUGH ABOUT THE PACE OF AIDS
AND WE NEED TO CONSIDER ALSO
WHAT WE ARE ADDRESSING WITHOUT
SPECIFIC BIOMARKER AND
ADDRESSING ORGANIS MAL HEALTH IS
IT CELL OR TISSUE SPECIFIC AFRND
WHEN WE ARE ACTUALLY ASSESSING
BIOMARKER, WHAT EXACTLY
QUESTIONS AND WHAT
[INDISCERNIBLE] ARE WE
ASSESSING?
OF COURSE, THEN, WE HAVE REVERSE
TRANSLATION THAT KICKED IN IN
VIVO MODELS AND MOUSE AND
NON-HUMAN PRIMATES THAT IS
SOMETHING THAT DR.
[INDISCERNIBLE] BROUGHT UP
YESTERDAY TO ONE OF HIS
QUESTIONS HOW ARE ALL THESE
BIOMARKERS REALLY TRULY
TRANSLATED IN THE IN VIVO
STUDIES AND HOW TO ACTUALLY
UTILIZE THEM AND TAKE ADVANTAGE
OF THEM AND LASTLY OF COURSE
CONTEXT OF USE AND BRINGING TWO
QUICK EXAMPLE THAT IS THE
STRATIFICATION OF PATIENTS
INTERVENTIONS AND TRACKING
RESPONSE OF ANY PARTICULAR
INTERVENTIONS TO JUST ASSESS THE
OUTCOME.
SO, WHAT IS THE FUTURE HOLDING
FOR US?
WELL, I WOULD SAY FIRST AND
FOREMOST WE HAVE TO REALLY FIND
A GOOD WAY TO ASSESS IN THE
CLINICS AGING.
SOON AS WE DO THAT, WE NEED TO
START TO ASK QUESTIONS. FOR
EXAMPLE, WHETHER WE HAVE AGE
ACCELERATION AND IN THAT CASE,
IT IS AGE ACCELERATION COMPARED
TO WHOM AND WE NEED TO REALLY
CONSIDER OUR POPULATION AND
REFERENCE COVER. OF COURSE,
BIOMARKER IF USEFUL AND UNIQUE
BIOMARKER ASSOCIATED WITH AGING
PHENOTYPES NEEDS TO BE
CROSS-VALIDATED AMONG OTHER
POPULATIONS AND AMONG OTHER
COHORTS AND LIFE COURSE
CONSIDERATION THAT IS SOMETHING
I PERSONALLY HADN'T THOUGHT
ABOUT IT AND HEARD OF IT THE
VERY FIRST TIME HERE A 70 YEAR
OLD PERSON THAT IT WAS 30 YEAR
OLD 40 YEARS AGO ESSENTIALLY IS
COMPLETELY YOU WILL HAVE
COMPLETELY DIFFERENT BIOMARKER
COMPARED TO A 30 YEAR OLD PERSON
RIGHT NOW AND LASTLY TEST AND
RETEST AND ACCURACY AND ANALYTIC
VALIDATION OF A BIOMARKER AND
SPENDING A COUPLE OF SECONDS FOR
THE LAST PART THAT IS
ESSENTIALLY MEASUREMENT OF
BIOMARKER ITSELF. IT IS JUST AN
ESSAY BUT A FEW TIMES IT IS
ACTUALLY NOT AS GOOD AS WE MAY
THINK AND THAT ACTUALLY IS A FEW
TIMES CAUSING CAVEAT OF
ASSESSING EFFICIENCY OF A
BIOMARKER AND WITH THAT I DON'T
KNOW WHETHER DOCTOR -- YOU DON'T
WANT TO DO IT. OKAY. WITH
THAT, I WILL CONCLUDE
PRESENTATION AND HAND IT OVER TO
THE NEXT SPEAKER. THANK YOU.
>>[INDISCERNIBLE].
>>NEXT, VERNON KENNEDY.
>>GOOD AFTERNOON, EVERYONE.
VERNON KENNEDY AND POST DOC AT
INSTITUTE OF AGING GIVING
REMARKS ON SESSION 7 ENTITLED
GEROSCIENCE AND MEDICINE IN THE
CLINIC AND IN THE COMMUNITY.
OKAY. SO, I REALLY APPRECIATED
IN THE BEGINNING OF THE SESSION.
WE TOOK TIME TO DISCUSS LINK
BETWEEN GEROSCIENCE AND PRACTICE
IN THE CLINIC. THAT DISCUSSION
BEGAN WITH DR. HEATHER WHITSON
FROM DUKE UNIVERSITY DISCUSSING
GEROSCIENCE IN SENSE OF
PREDICTING OUTCOMES FOR PATIENTS
AND WE WERE TALKING ABOUT
FINDING WAYS TO USE GEROSCIENCE
AS TOOL TO PREDICT HEALTH
TRAJECTORY OF PATIENTS BEFORE
AND AFTER INTRODUCTION OF A
STRESSOR THAT COULD BE CHRONIC
LIKE DIALYSIS OR SHORT TERM AND
ACUTE LIKE A KNEE REPLACEMENT
SHE TALKED ABOUT IN HER SESSION
AND PREDICTING GEROSCIENCE FOR
OUTCOME FOR PATIENTS HITTING IT
FROM THREE LENSOID YAF COMPLEX
-- IT CAN EXTEND TO THINGS
EXTERNAL AND SOCIAL NETWORKS AND
DETERMINANTS OF HEALTH TO GIVE
IDEA OF THE PATIENT'S
PROGRESSION AFTER INSULT AND
MOVING TO IDEA OF RESILIENCE
THAT I THOUGHT THIS QUOTE FROM
HER TALK WAS A GREAT WAY TO SUM
UP WHAT SHE MEANT BY POINT THAT
IS DISEASES LOWER BIOLOGICAL
RESILIENCE AND LOWER RESILIENCE
IS FOR PATIENT IT MAKES THEM
MORE VULNERABLE TO DISEASE AND
IS SOMETHING THAT IF YOU PUT
INTO CONTEXT OF OTHER
GEROSCIENCE TERMINOLOGIES IT CAN
HELP TO PREDICT OUTCOME FOR
PATIENTS RECEIVING INSULTS AND
LAST MARKER OR POINT WE USE FOR
THIS TOPIC IS THE IDEA OF
INCORPORATING PILLARS AND
HALLMARKS OF AGING AND THINGS
YOU ARE WELL FAMILIAR WITH
SENESCENCE AND MITOCHONDRIAL
DISFUNCTION AND MOVING ON FROM
HOW TO USE GEROSCIENCE TO GIVE
PREDICTIONS ABOUT PATIENTS
TRAJECTORIES DR. ROBERT CAME UP
WITH A DISCUSSION TALKING ABOUT
HOW GEROSCIENCE IS INTEGRATED
INTO THE TREATMENT OF PATIENTS
AT PRESENT TIME BEGINNING WITH
ASSESSING PRECLINICAL EVIDENCE
AND NUMEROUS GEROSCIENCE-BASED
INTERVENTIONS THAT CORRELATE
WITH HEALTH SPANS OF AGING
POPULATIONS AND PRESCRIBE TO
AGING PATIENTS ALREADY MODERATE
EXERCISE AND REBERMYCIN AND
METFORMIN AND DEMONSTRATED BASED
ON STUDIES HAPPENING IN THE
CLINIC AND CENTERED AROUND
SINOTHERAPEUTICS THAT ARE
ALREADY BENEFICIAL FOR PATIENTS
IN MULTIPLE DISEASE SETTINGS FOR
EXAMPLE IN PULMONARY FIBROSIS
AND ANTIDIABETIC EFFECTS
CORRELATING WITH FRACTIONS IN
PATIENTS AND BONE DENSITY FOR
PATIENTS ON [INDISCERNIBLE]
EXCUSE ME.
TAKING THESE TOGETHER WE ARE
ABLE TO GATHER PRECLINICAL AND
CLINICAL EVIDENCE THAT
SUBJECTINGS THAT MORE
CONSIDERATIONS ARE NEEDED TO
INVESTIGATE HOW TO LINK
GEROSCIENCE PLAUSIBLE TREATMENTS
FOR PATIENTS IN THE CLINIC.
AND SO TO TAKE IT A STEP FURTHER
YOU HAVE AN IDEA OF GEROSCIENCE
AND HOW YOU PREDICT DISEASE AND
TREAT PATIENTS AND CULTURE OF
GEROSCIENCE AND CLINICAL SETTING
IS IMPORTANT TOPIC AS WELL AND
DR. DANIEL FORMAN LED THIS
DISCUSSION AND MODERN HEALTH
CARE IS DISEASE SPECIFIC WITH
CLINICAL ASPECTS AND RESOURCES
DIRECTED IN SIMILAR FASHION AND
IS CASE IN MANY CLINICAL
SETTINGS FOR YEARS THAT COULD BE
DIFFICULT TO UNDO SOME OF THAT
OR PARADIGMS THAT EXIST AND HE
BOUGHT FROM APPROACH INSTEAD OF
UNDOG THINGS ALREADY IN PLACE
WHY CAN'T WE USE GEROSCIENCE TO
ENRICH HEALTH CARE APPROACHES
RATHER THAN REVAMPING THEM AND
GAVE EXAMPLE OF CARDIOVASCULAR
DISEASE AND SEEING INCREASE IN
CARDIOVASCULAR DISEASE AND
PATHOPHYSIOLOGY TAKING THAT AND
PUTTING IN CONJUNCTION WITH
GEROSCIENCE FRAMEWORK COULD
INCREASE HEALTH SPAN OF PATIENTS
AND LAST SPEAKER FOR SESSION WAS
DR. GEORGE WHO I REALLY LIKE THE
PRESENTATION AS WELL. IT WAS,
AGAIN, REITERATING THIS POINT WE
NEED TO WORK TO BRIDGE GAP
BETWEEN GEROSCIENCE AND WHAT IS
HAPPENING IN CLINIC WITH
PRACTITIONERS AND TRADITIONALLY
GEROSCIENTISTS AND PEOPLE
PROVIDING JER ON TOLL JI CARE
EXISTED AND IF ABLE TO BRING
COMMUNITIES TOGETHER IT ENSURES
SYNERGY BENEFICIAL IN AGING
PATIENTS AND WAYS BROUGHT UP IN
SESSION HOW TO DO THAT AND FOR
EXAMPLE WOULD BE NICE TO BE MORE
INTENTIONAL IN MEANING OF TERM
GEROSCIENCE AND LOVE THAT HE
GAVE AND SHOWED THAT YOU LOOK IN
YAM WEBSTER DICTIONARY AND USE
FREELY IN SESSIONS LIKE THIS AND
AMONG COLLEAGUES WHEN YOU ARE
NOT SPEAKING TO SOMEONE THAT MAY
BE AN EXPERT IN THE FIELD AND
BEING INTENTIONAL WILL HOW WE
COIN THAT TERM WILL HELP TO
BRIDGE THE GAP BETWEEN TWO
COMMUNITIES AND ANOTHER THING
BENEFICIAL IS TO INCREASE AMOUNT
OF MEANINGFUL OUTCOMES AND
AMOUNT OF MEANINGFUL
IMPLEMENTATION THAT IS HAPPENING
IN CLINIC AND OVERWHELMING DATA
SHOWING GEROSCIENCE BASED
PRACTICES ARE BENEFICIAL IN
CLINIC INCREASING CONVERSATION
AT LARGE WHY THIS IS IMPORTANT
AND HOW TO IMPLEMENT IN DAILY
LIVES AND NEXT MOVING TO DISCUSS
HOW TO REACH EVERYONE IN THE
PIPELINE THAT IS IN THE
CONVERSATION THAT INCLUDES MORE
THAN JUST A GERONTOLOGIST AND
THOSE STUDYING -- PEOPLE
TRADITIONALLY UNAWARE OF THIS
TERM UNLESS GOING TO EVENT LIKE
THIS AND HEARING ABOUT IT
FIRSTHAND AND REACHING EVERYONE
IN THE PIPELINE IS GREAT WAY TO
BRING SYNERGY NEED TODAY
PROGRESS THE FIELD AND DELIVERY
OF THIS INFORMATION AND
MENTIONING THINGS COMING ABOUT
WITH TECHNOLOGY AND SOCIAL MEDIA
AND NEW AGE OF SCIENTISTS AND
NEXT GENERATION IS ACCESSING
INFORMATION IN A DIFFERENT WAY
THAN PEOPLE WHO ARE STUDYING
GEROSCIENCE AT LARGE ARE NOT
TRADITIONALLY USED TO FINDING
WAYS TO DIVERSIFY DELIVERING
CONTENT WILL IMPROVE BETTER IN
TERMS OF FOSTERING RELATIONSHIP
BETWEEN GEROSCIENTISTS AND THOSE
THAT PRACTICE JERONTOLOGY CARE
AND THANK YOU. PASSING IT TO
THE NEXT PERSON.
>>>>THIS IS [INDISCERNIBLE]
WHO WILL PRESENT ON SESSION 8.
VIA ZOOM.
>>HI. ARE MY SLIDES UP?
>>YES. YOU WANT TO GO FULL
SCREEN? PRESENTER MODE.
THERE YOU GO.
>>EXCELLENT.
>>OKAY. GREAT. THANK YOU.
HI. DAISY AND ASSOCIATE
PROFESSOR AT UC CHAPEL HILL. I
WILL TALK ABOUT SECTION 8 THAT
IS CLINICAL TRIALS SPECIFICALLY
IN GEROSCIENCE.
MOTIVATION FOR THIS SESSION WAS
THAT CLINICAL TRIALS FOR THIS
POPULATION REQUIRE SPECIAL
ATTENTION AND WE ARE TALKING
ABOUT INTERVENTIONS THAT EFFECT
MULTIPLE CONDITIONS OF AGING.
I WILL TALK ABOUT IT. IT IS
MORE THAN SINGLE DISEASE MODEL
AND APPEAR TO BE TWO TESTS TO
TESTING AGING THERAPEUTICS
TESTING THEM OR COMBINATION
AGAINST MULTIPLE CONDITIONS IN
SERIES OF TRIALS AND TESTING
EFFECTS OF CONDITIONS AND
DISEASES REMAINING AGNOSTIC TO
WHICH THEY ARE AND IMPORTANT TO
STRUCTURE CLINICAL TRIALS TO BE
INCLUSIVE INCORPORATING SOCIAL
DETERMINANTS OF HEALTH AMONG
PARAMETERS AND GOALS OF THIS
SESSION CARRYING OUT GEROSCIENCE
BASED CLINICAL TRIAL AND
HIGHLIGH
HIGHLIGHTING PATHS FORWARD AND
WE HEARD FROM SARA AND LARA WHO
TALKED ABOUT TRIAL DESIGN
MOBILITY AND FRAILTY AND HEATHER
ABOUT [INDISCERNIBLE] FOR HEALTH
DISPARITIES AND THESE ARE POINTS
THAT SEVERAL OF THE SPEAKERS
MADE AT DIFFERENT POINTS AND I
PUT THEM ALL TOGETHER AND IT IS
INTO THIS COMPOSITE SLIDES.
AND SO SOME OF THE CHALLENGES
THAT WERE MENTIONED IS THAT
THERE IS A LOT OF COMPLEXITY IN
SELECTING BIOLOGICAL AND
CLINICAL ENDPOINTS FOR EXAMPLE
DEFINING HEALTH SPAN THERE IS NO
ACCEPTED DEFINITION AND MARKERS
MIGHT TRACK WITH BIOLOGICAL AGE
AND DISEASE RISK THAT IS NOT
REALLY SUITABLE ENDPOINTS.
THEY MIGHT ACTUALLY LIKE CHANGE
IN THE OPPOSITE DIRECTION WHEN
YOU HAVE INTERVENTION THAT
ACTUALLY DECREASES DISEASE RISK
AND OTHER CHALLENGES INCLUDE
THINGS LIKE AGEISM AND ONE OF
THE SPEAKERS SPOKE ABOUT THERE
BEING AGISM EVEN IN HOW WE TALK
ABOUT ANTIAGING TREATMENTS OR
ANTIAGING INTERVENTIONS AND HOW
THIS COULD BE A PROBLEM NOT ONLY
IN -- YOU KNOW, IN TRYING TO
HELP PEOPLE AND ADDRESSING
STAKEHOLDERS AND WE HAVE
POPULATION THAT IS VERY COMPLEX
AND DIF VERSE ON MANY LEVELS AND
AT SAME TIME WE HAVE A HISTORY
OF STUDY FINDINGS HAVING A LACK
OF GENERALIZABILITY DUE TO
POPULATIONS NO THE BEING DIVERSE
ENOUGH.
WHILE LOTS OF THEM AGREED THAT
THIS MODEL MIGHT NOT WORK FOR
THIS POPULATION, THERE IS
CONCERNS THAT FIELD MIGHT NOT BE
READY TO ENTIRELY FOCUS ON -- ON
ENDPOINTS THAT ARE SUCH AS
HEALTHSPAN AND THAT ARE NOT --
YOU KNOW, MIGHT NOT BE AS
WELL-DEFINED AND ARE SUBJECTIVE
AND THERE IS -- SO, WE ACTUALLY
MAY NEED TO GO BACKING TO SINGLE
DISEASE MODEL FOR SOME ASPECTS
AND HAVE AN ITERATIVE PROCESS TO
GET TO A BETTER LEVEL OF
KNOWLEDGE.
CONSIDERATIONS FOR DESIGN AND
CHOICE OF ENDPOINTS POPULATIONS
IN CLINICAL TRIALS ARE VERY
SIMILAR TO CLINICAL TRIALS.
SO, LIKE REALLY IN ANY FIELD,
IT IS -- THINGS WILL DEPEND ON
FACTORS LIKE AGING THAT IS BEING
TESTED AND POTENTIAL MECHANISM
AND TRIAL PHASE AND SCALE AND IF
YOU HAVE A PILOT MECHANISTIC OR
EFFICACY STUDY AND PRAGMATIC
TRIAL YOU WILL HAVE DIFFERENT
REQUIREMENTS FOR THE POPULATIONS
THAT YOU ARE GOING TO INCLUDE
AND INCLUSION EXCLUSION CRITERIA
AS WELL AS HOW MUCH OR HOW MANY
THINGS YOU WILL WANT TO MEASURE
LIKE THE FOCUS OF THE RESEARCH.
THE LENGTH OF TRIAL WILL ALSO
DETERMINE WHICH A LOT OF THE
DECISIONS THAT WE HAVE TO MAKE
AVAILABLE FUNDING AND EXPERTISE
AND IT WILL BE IMPORTANT TOO.
THE PRELIMINARY DATA FOR
PRELIMINARY DATA THAT IS
IMPORTANT. YOU -- IT HELPS TO
DO FUNDING AND ALSO -- IT ALSO
MEANS THAT A LOT OF THE
ENDPOINTS THAT ARE BEING USED
ARE THINGS THAT YOU PROBABLY
HAVE USED BEFORE OR OTHER
RESEARCHERS HAVE USED BEFORE.
WE OFTEN SEE LIKE FRAILTY
INDICES OR DIFFERENT SURROGATE
MARKERS USED FOR OTHERS AND
COMPARABILITY AND THERE IS A WAY
TO JUSTIFY THINGS LIKE SAMPLE
SIZE CALCULATIONS AND ANOTHER
CONSIDERATION WOULD BE WHAT
MATTERS MOST TO PATIENTS.
OFTEN TIMES WE SEE WHAT OR STUDY
WHAT MATTERS MOST TO US AS
RESEARCHERS.
WE MAY NEED TO PAY MORE
ATTENTION TO THINGS THAT MATTER
MONTHEST TO PATIENTS AND OTHER
STAKEHOLDERS.
IN A NUTSHELL GEROSCIENCE TRIALS
[INDISCERNIBLE] AND NO THE MANY
RECOMMENDATIONS COULD BE MADE
ACROSS THE BOARD INSTEAD THEY
CAN BE, YOU KNOW, VERY LOOSE
GUIDELINES THAT WILL REALLY
DEPEND A LOT ON THE FACTORS THAT
I JUST DESCRIBED.
HOWEVER, FOR SPECIFIC
RECOMMENDATIONS THAT CAME OUT OF
THE TALKS, HERE WE GO. THEY ARE
NEED FOR IMPROVED OR
STANDARDIZED ENDPOINTS AND
SURROGATES THAT COULD CHANGE
WITH INTERVENTIONS AND
TRANSLATIONAL GEROSCIENCE
NETWORK WORKING ON
GERODIAGNOSTICS THAT ARE USING A
LOT OF DIFFERENT MARKERS AND I
THINK THEY HAVE 41 CLINICAL
TRIALS.
RIGHT NOW PURPOSE IS TO TEST A
LOT OF THINGS AT ONCE. AND USE
DATA TO GENERATE BETTER
BIOMARKERS AND THERE IS AN
AGREEMENT THAT MEASURING
SECONDARY OUTCOMES WOULD BE
USE
USEFUL.
IN A CLINICAL TRIAL YOU CHOOSE
AND HAVE TO BE SELECTIVE WHAT
PRIMARY OUTCOMES ARE AND BEING
ABLE TO MEASURE DIFFERENT THINGS
AND IN TRACK, WHAT CHANGES? YOU
DON'T KNOW WHAT WILL CHANGE. IT
MIGHT BE BETTER THAT AN
INTERVENTION OR AGENT CAN -- IS
NOT EFFECTIVE FOR SOMETHING AND
IN YOUR SECONDARY OUTCOMES WHEN
YOU ANALYZE DATA YOU REALIZE IT
WAS ACTUALLY VERY IMPORTANT FOR
SOMETHING ELSE THAT COULD INFORM
THE NEXT TRIAL AND BE.
IT COULD BE A WAY TO HAVE MORE
COMPARABLE DATA WITH OTHER
CLINICAL TRIALS.
LISTENING TO STAKEHOLDERS WAS A
BIG MESSAGE.
THAT INCLUDES NOT JUST PATIENTS
BUT OTHER, YOU KNOW, BROADER
STAKEHOLDERS.
AND BEING MINDFUL OF AGEISM,
AGAIN, AND HOW WE TALK ABOUT THE
BENEFITS OR NEEDS FOR ANTIAGING
TREATMENTS.
A BIG -- A VERY LARGE COMPONENT
OF RECOMMENDATIONS THAT FOCUSED
ON BUILDING HEALTH EQUITY INTO
THE DESIGN CONDUCT AND ANALYSIS
OF A TRIAL.
AND THESE ARE SOME EXAMPLES FOR
EXAMPLE BEING EXPLICIT IN SAMPLE
SIZE JUSTIFICATIONS THAT ARE
REGARDING HEALTH EQUITY THAT
MEANS NOT -- NOT ONLY -- OR
MOVING AWAY FROM A SAMPLE BASED
ON CONVENIENCE AND BEING MORE
DELIBERATE ABOUT POPULATIONS
THAT ARE RECRUITED AND
CONSIDERING STRATIFIED
RANDOMIZATION ON HEALTH EBBING
WITHIT RELEVANT PARAMETERS AND
TO DO THIS WE NEED TO HAVE
ADEQUATE SAMPLE SIZE.
ONLY -- IT DOES REQUIRE
ENLISTING AT EXPERTISE OF
STATISTICIANS THAT WERE ABLE TO
-- YOU KNOW. TO CALCULATE
SAMPLE SIZE APPROPRIATELY AND BE
ALSO ABLE TO DO ANALYSIS AS --
YOU KNOW BASED ON MOST UP TO
DATE METHODS.
FINALLY MONITORING AND REPORTING
DIFFERENTIAL RISK BENEFIT AS
CROSS EQUITY HEALTH RELEVANT
GROUPS AND THAT IS THE END.
THANK YOU.
>>GRATITUDE GOES TO THE PEOPLE
THAT PRESENTED THESE SUMMARIES.
NOT A SIMPLE TASK AND IT IS
RATHER DIFFICULT AND WHETHER YOU
DID IT FOR ALL CONCERNED.
JUST TO WRAP UP, I WOULD LICK TO
REMIND EVEN THAT IN SCIENCE, WE
-- IN ALL WALKS OF SCIENCE, WE
COLLECT INFORMATION AND TRY TO
INTERPRET IT AND TRY TO
COMMUNICATE IT TO OUR PEERS.
IN GEROSCIENCE WE POINTED OUT
REPEATEDLY THAT WE HAVE TO
GATHER INFORMATION THAT MEANS WE
CAN BEGIN WITH LISTENING TO
PEOPLE WHO WE HOPE WILL BENEFIT
FROM THE WORK THAT WE ARE DOING.
WE HAVE TO HAVE INFORMATION IN
WAYS THAT ARE ATTRACTABLE
SCIENTIFICALLY IN REALMS OF
SCIENCE AND HAVE TO BE ABLE TO
COMMUNICATE THAT TO PEOPLE THAT
WE THINK WOULD BENEFIT FROM IT
IN WAYS THAT ARE RESPONSIVE NOT
JUST WAYS THAT WE THINK ARE
NECESSARY.
ON THE TOPIC OF -- I THINK WE
WILL DO THAT AND THINK THAT PART
OF WHAT HAS HAPPENED HERE IS
THAT PEOPLE FROM WIDELY
DIFFERENT DISCIPLINES IN SCIENCE
HAVE COME TOGETHER TO THINK
ABOUT THE SAME QUESTIONS.
AND TO EXCHANGE HOW WE THINK
ABOUT THOSE QUESTIONS AND WHAT
WE CAN DO GOING FORWARD.
I WOULD LIKE TO IN THE
STORYTELLING REALM JUST TO TELL
A SHORT STORY ABOUT AGEISM.
IT IS ANECDOTAL MEANING IT
HAPPENED TO ME.
30 YEARS AGO WITH MY OLDER
CHILDREN WHO WERE AT THAT TIME
TEENS AND PRETEENS AND WE WOULD
BE OUT AND ABOUT TOGETHER.
PEOPLE THOUGHT I WAS THEIR
GRANDFATHER. THAT DID NOT JUST
EFFECT ME BUT EFFECTED THEM.
AGISM DOESN'T JUST IMPACT THE
OLDER PERSON. IT EFFECTS THE
PEOPLE AROUND THEM.
HOW AGISM MAKES A PERSON FEEL
BAD AND HOW IT MAKES THOSE THAT
ARE INTERACTING WITH THEM AND
THEIR FAMILIES FEEL THE SAME
WAY.
POINT OF THE STORY IS NOT HOW
BAD I FELT OR HOW I PUT OFF MY
KIDS BUT IT IS A DEMONSTRATION
OF AGING THAT IS REVERSIBLE.
WHEN THEY BECAME ADULTS, NO ONE
ASKED ME IF I WAS THEIR
GRANDFATHER AND TAKE IT AS
EVIDENCE THAT AGING IS
REVERSIBLE. THANKS ALL FOR YOUR
ATTENTION AND FOR ATTENDING THE
MEETING AND WISH YOU ALL THE
BEST IN YOUR TRAVELS AND IN YOUR
WORK. THANK YOU.
>>[APPLAUSE].