Improving the Health of Older Adults:
Centers Studying Aging Processes, Training Health Care Providers

What does it mean to be an older adult? John Glenn took flight into space for the second time at the age of 77. President George Bush recently parachuted out of a plane to celebrate his 75th birthday.

Approximately 35 million Americans are at least 65 years of age. Not only that, but many people are now living to see triple digits on their birthday cakes. According to a recent report from the U.S. Census Bureau, the number of centenarians (those 100 and above) in this country nearly doubled in the 1990s, from an estimated 37,000 at the start of the decade to approximately 70,000 today. Census analysts are predicting the number may reach approximately 834,000 by the middle of the 21st century.

As more Americans are living longer, researchers, educators and clinicians at the Huffington Center on Aging at Baylor College of Medicine and the Center on Aging at The University of Texas-Houston Health Science Center are working to help make the later years the best years possible.

Many issues face the aging population and those who care for them, one of which is the shortage of health care providers trained in the field of gerontology.

"We need 20,000-30,000 primary care physicians with certification in geriatrics in order to serve the growing older population," says Robert Roush, Ed.D., M.P.H., associate professor, Huffington Center on Aging and president of the National Association of Geriatric Education Centers. "Right now there are only about half that number.

"A lot of efforts to increase the number are under way, but we cannot let up because we are still not getting enough people," says Dr. Roush, who serves as director of the Texas Consortium of Geriatric Education Centers (TCGEC). This consortium, which is designed to advance the professional development of those who treat older Texans, consists of nine academic institutions including Baylor, UT-Houston Health Science Center, University of North Texas, The University of Texas-Pan American, Texas Southern University, The University of Texas Medical Branch at Galveston, Texas A&M University, University of Houston and Texas Woman's University.

The Huffington Center on Aging at Baylor offers a series of elective courses to medical students as a way of encouraging work in the area of geriatrics. The Center also trains fellows to become board certified as geriatricians.

The UT Center on Aging, through its affiliation with the School of Nursing, has a large gerontology program that trains geriatric nurse practitioners, long-term care administrators and other advanced practice nurses. The UT-Houston Medical School's department of family medicine and community practice created a geriatric fellowship training program last year.

Both the Baylor and UT Centers on Aging are participating in the Houston Geriatric Interdisciplinary Team Training grant from the John A. Hartford Foundation, Inc. The goal of the initiative is to train physicians, nurse practitioners and social workers as an interdisciplinary team for the care of older populations.

According to Vaunette Fay, Ph.D., RNCS, associate professor and division head of gerontology at the UT-Houston School of Nursing, people living longer means an older population of caregivers as well, which adds a new dimension to caring for the elderly.

"What is happening is that you have fewer and fewer people to be caregivers," says Dr. Fay, associate director of education at the UT Center on Aging. "Both in number and in the fact that now women - the traditional caregivers - are working. So now you may have a 90-year-old woman who has a 65- or 70-year-old daughter who is providing the care and the issue is how healthy is the caregiver."

When a loved one is in need of professional care, the caregiver, no matter what their age, may find themselves faced with a deluge of issues regarding Medicare, living wills, and power of attorney. The UT-Houston Center on Aging has developed a new program called ARISE (Aging Resource Information Support & Education) to help caregivers navigate the waters.

In some cases assisted living communities may be the answer for an older adult. "If you look at housing options, one of the fastest-growing areas is that of assisted living," says Dr. Fay. "I think these complexes are springing up because there is a need for people to have some support but they really don't need the total care that a nursing home would provide. This is a way they can maintain more independence, more of a homelike atmosphere.

"The problem with most assisted living communities, however, is that they are apartment complexes and frequently the managerial staffs do not have a lot of training or any training in geriatrics," she adds.

Dealing with dementia and Alzheimer's disease is another issue brought to the forefront as the population lives longer and the risk of a dementia increases with age. While there is currently no cure for Alzheimer's disease, ongoing research into the causes and treatments continues.

The Huffington Center on Aging is conducting research into the effects of hormones on Alzheimer's disease. According to Roy Smith, Ph.D., the Center's director, "It's becoming clear that estrogen may play a role in delaying the onset of Alzheimer's disease in women as well as delay the decline in cognitive function." The research is currently in the animal model stages.

Sharon K. Ostwald, Ph.D., director of the UT Center on Aging, and the Isla Carroll Turner Chair in Gerontological Nursing, has focused her research efforts on Alzheimer's caregiver support. Other research activities at the UT Center on Aging include the development of a geriatric assessment tool and the study of the role of the volunteer long-term care ombudsman, who acts an advocate for patients in long-term care nursing facilities. The Center also manages the Harris County Long-Term Care Ombudsman Program.

In Dr. Smith's lab at Baylor, he is studying the genes that may be pivotal to the biological pathways that change during aging. "For example, why is it that the frequency and amplitude of the neurotransmitters and hormones that are secreted in a pulsatile manner change during aging? In women these changes precede the onset of menopause. If we could intervene to prevent this change, it should be possible to delay menopause and the need for estrogen replacement by 10-20 years," says Dr. Smith.

The Center has additional research under way to determine how aging affects the central nervous system, muscle, bone, skin and fat as well as research on Parkinson's disease.

Dr. Smith emphasizes the importance of exercise during aging - both physical and mental exercise. Some suggestions: take challenging jobs, read broadly, take up painting or music, something that is a mental challenge to you.

In addition, Dr. Roush offers these tips:

Keep planning, both socially and financially. According to Dr. Roush, studies have shown that people who have plans live longer than those that do not.

Keep a circle of friends. Interaction with others is important.

As Dr. Smith recommends, keep your mind engaged and keep moving.

"Our society's image of aging is changing," says Dr. Roush. "However, we still need to continue debunking the stereotypes.

"Aging is not just for older folks," he says. "We need to learn from older adults so that we can teach what we learn to younger people who, in turn, can possibly begin preventing problems associated with aging."

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©2006 Texas Medical Center

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