Aging

Follow-Up – Summer 2018

Research doesn’t stop when we report it. Here are updates on past UConn Health Journal stories:


Glycogen Storage Disease

The world’s first gene therapy clinical trial for Glycogen Storage Disease (GSD) Type Ia is expected to start this year, hosted by the GSD Program at Connecticut Children’s Medical Center and UConn Health, under the direction of Dr. David Weinstein. The FDA–approved trials will be done in conjunction with biopharmaceutical company Ultragenyx.

Spring 2017, “Free to Be Imperfect”


Advancing Surgical Care for Older Adults

UConn John Dempsey Hospital will be one of seven U.S. hospitals to pilot-test newly developed guidelines for improving the quality of surgical care for older adults for the American College of Surgeons’ Coalition for Quality in Geriatric Surgery (CQGS), the American Geriatric Society, and the John A. Hartford Foundation.

Fall 2017, “Pinpointing Risk Factors to Prevent Postoperative Delirium”


Detecting Hearing Loss

Findings presented at the 53rd American Neurotology Society annual spring meeting reveal the first potential biomarker for noise-induced hearing loss. A collaborative study by UConn Health and Sensorion showed changing levels of prestin, an outer hair cell protein, in the blood correlated with the severity of hearing loss.

Fall 2016, “Detecting Hearing Loss, Vertigo Via Blood Tests”


Breast Health

UConn Health assistant professor and breast surgeon Dr. Christina Stevenson has begun providing breast health education in hair salons, funded by the Connecticut Breast Health Initiative. The program aims to reach women in Hartford County who may be at risk for late- stage diagnosis of breast cancer due to health care access barriers.

Fall 2016, “On the Ground for Breast Cancer Awareness”


Skin Cancer Screening

Up to 60 percent of UConn Health patients with a suspicious skin lesion or mole can now avoid invasive biopsies thanks to confocal microscopy technology, according to dermatologist Dr. Jane Grant-Kels. The technology uses a painless laser light to see skin cells on a cellular level and help doctors identify skin cancers, including melanoma.

Summer 2016, “Finding Skin Cancer in a Flash”


Cooling Cap Therapy

Marisa Dolce, a Carole and Ray Neag Comprehensive Cancer Center breast cancer patient, reported keeping 70 percent of her hair as the first UConn Health patient to use optional scalp-cooling technology while undergoing chemotherapy. UConn Health is the only Connecticut institution outside Fairfield County to offer the FDA-approved DigniCap.

Fall 2017, “Cooling Off Chemotherapy’s Side Effects”

Follow-Up – Spring 2018

Research doesn’t stop when we report it. Here are updates on past UConn Health Journal stories:


Longevity Indicators

A new large-scale international study published in the journal Aging has expanded the number of genetic markers known to be associated with exceptional longevity from 8 to 25. Researchers at UConn, the University of Exeter, University of Wisconsin, and University of Iowa studied 389,166 volunteers who took part in U.K. Biobank, identifying genes that could one day be targeted to help prolong human life.

Fall 2016, Lab Notes, “Parents Living Longer Is Good News for Offspring, Study Says”


Health Disparities Institute

Wizdom Powell, Ph.D., associate professor of psychiatry, is the new director of the Health Disparities Institute at UConn Health. Powell’s focus in the eradication of health inequities is improving men’s mental health awareness, resources, and services. As chair of the American Psychological Association’s Working Group on Health Disparities in Boys and Men, Powell testified Jan. 30 to the Congressional Briefing on Men’s Mental Health in Washington, D.C., and proposed policy solutions to create a more supportive social climate for men suffering from depression.

WIzdom Powell

Summer 2016, “Fighting for Equity”

Pinpointing Risk Factors to Prevent Postoperative Delirium

by Lauren Woods


With rising surgery demands among the growing population of older adults, the UConn Center on Aging and UConn John Dempsey Hospital are teaming up to identify older patients at the greatest risk of developing postoperative delirium in order to prevent it.

Patients with delirium have an altered level of alertness and are sometimes excessively drowsy, hyper-alert, or agitated. Although postoperative delirium is usually short-term, lasting hours or days, the brain may not recover for weeks or months in older adults. If the condition is not identified and addressed, delirium can lead to a decline in an older patient’s surgical recovery and cognitive and physical health, a need for caregiver or nursing home care, or potentially an increased risk of death.

“Our goal is to do everything in our power to screen older patients before surgery for delirium’s risk factors and to prevent it after surgery — or at least minimize its duration and effect,” says UConn Center on Aging’s Dr. Patrick Coll, who has been working closely with surgeons and anesthesiologists to modify preoperative delirium screening protocols at UConn Health. “All doctors really should be adding delirium-risk-factor screening to their preoperative evaluations for patients age 75 and above.”

Risk factors for postoperative delirium in older patients include prior delirium after a surgery, underlying or existing cognitive impairment such as dementia or Alzheimer’s disease, heavy alcohol consumption that increases withdrawal risk, depression, frailty, malnutrition, immobility, infection, or taking certain medications.

Historically, surgery risk-prevention primarily focused on such areas as cardiac or pulmonary health. Last year, the American College of Surgeons and the American Geriatric Society issued new guidelines for optimal geriatric surgery patient management, which for the first time included screening for delirium risk before and after surgery.

“If a patient is deemed high-risk, the patient should have a geriatric assessment prior to surgery to help mitigate their risk and, after surgery, the hospital care team should plan to very closely monitor the patient,” said Coll.

The hospital care team can take simple, proactive steps to quickly reorient an older patient after surgery, Coll says. Even having a patient’s reading glasses and hearing aids readily available can make a big difference, as well as avoiding or limiting medications that can contribute to delirium, such as opioids.

With the help of aging expert Dr. Lavern Wright, UConn Health’s NICHE (Nurses Improving Care for Healthsystem Elders) program is expanding its scope to the surgical floors of the hospital to reduce older patients’ risk of delirium and other health complications. Further, all nurses now have access to the Confusion Assessment Method (CAM) tool and an electronic medical record order set to guide them in decreasing delirium’s impact.

In addition, Dr. Richard Fortinsky and his team are studying the effect of visiting clinical care teams at the homes of older adults with a history of delirium and other cognitive vulnerabilities to improve patient outcomes. This study, funded by the Patient-Centered Outcomes Research Institute, involves an in-home care program featuring a nurse practitioner who assesses older adults for delirium using a brief version of the CAM. The nurse practitioner also assesses for depression and dementia and teaches the patient and family members how to manage these conditions at home.

Aches, Age & Influenza:

What We Know About Flu-Induced Muscle Loss and How to Prevent It

By Kim Krieger

the Flu


Why does age impact flu-related muscle loss, and how can we prevent it? UConn Health researchers are on the case.

Muscle mystery

Most of us have seen it happen to a relative, friend, or patient. A formerly healthy senior gets a bad case of the flu. When they recover, they’re weak from muscle loss, sometimes permanently disabled. We don’t know exactly why the muscle loss happens, but UConn researchers are finding ways to prevent it.

It used to be that losing muscle was just a part of getting old. It’s considered normal aging. You can’t get a drug approved by the FDA to treat aging, because aging isn’t considered a disease. But influenza, the virus that causes the flu, is. If getting the flu speeds up muscle loss in seniors, then muscle loss is potentially preventable. But how could a virus that only infects the lungs cause muscle loss?

Wasting away

When immunologist Laura Haynes first came to UConn Health, she knew that when mice get the flu, they lose weight. In fact, that’s the way researchers can tell that a mouse has the virus. Some mice lose more, some less. Haynes’ work had previously shown that older mice with the flu not only get much sicker, but also lose more weight than younger mice. But as an immunologist, her research focused on how aging immune systems decline. Differences in weight loss were an afterthought. But when she sat down with Dr. George Kuchel, director of the UConn Center on Aging, they made the connection that weight loss might indicate future disability.

Haynes teamed up with kinesiologist Jenna Bartley to further investigate. They confirmed that a significant amount of the weight lost by mice infected with the flu was muscle. And older mice infected with influenza lost more muscle than younger mice, and continued to lose it over a longer period of time.

It’s really hard to improve elderly immune response. So if we can’t prevent them from getting the flu, maybe we could at least prevent muscle loss and future disability.

“In mice there are changes in gene expression in muscle during influenza infection. Genes that degrade muscle go up, genes that build muscle go down. But in young mice, the gene expression goes back to normal more quickly,” says Haynes. The older mice, on the other hand, had higher levels of inflammation, muscle wasting, and atrophy, and it all persisted longer.

Exacerbated muscle loss wasn’t the only problem experienced by the older mice recovering from the flu. They also moved less and took fewer, narrower steps. It was as if they had become frailer and more easily tired. Decreasing gait speed, or how fast someone walks, indicates increasing frailty in humans, and taking narrower steps also increases the risk of falling. [See ‘UConn Pilots Quick Gait-Speed Measurement’]

Haynes and Bartley’s research was the first that directly linked flu-induced inflammation in a controlled setting to muscle atrophy and functional impairment. It was published in the April 2016 issue of the journal Aging. But now that they knew flu really was causing muscle wasting, how could they stop it? Even yearly vaccination doesn’t provide 100-percent protection.

“It’s really hard to improve elderly immune response. So if we can’t prevent them from getting the flu, maybe we could at least prevent muscle loss and future disability,” says Bartley.

Stemming the tide

Haynes and Bartley suspected that influenza-induced inflammation was related to, and possibly the cause of, the destruction of muscle tissue in the elderly mice. They theorized that if they could stem the tide of inflammation in the body, they might prevent the muscle tissue from degrading so much. But there was a catch: inflammation helps mobilize the immune system. If you block inflammation totally, you block the body’s defense against the flu virus. So Haynes and Bartley needed a more subtle tool.

In mice there are changes in gene expression in muscle during influenza infection. Genes that degrade muscle go up, genes that build muscle go down. But in young mice, the gene expression goes back to normal more quickly.

The first drugs Bartley and Haynes found that might be good candidates are COX-2 inhibitors. They’re non-steroidal anti-inflammatories, like aspirin and ibuprofen, but COX-2 inhibitors are very specific. They block just one molecule in the body’s web of inflammatory responses. Other researchers have shown that COX-2 inhibitors can slow muscle wasting in cancer patients. And most importantly, COX-2 inhibitors don’t seem to block the body’s antiviral immune reaction.

Haynes and Bartley are currently testing the COX-2 inhibitors to see if they prevent muscle loss in geriatric mice after the flu. They’re also testing whether improving immune memory of the flu in mice — that is, vaccinating them — protects them against muscle wasting.

Their work is intriguing, but Kuchel cautions that adult humans are more complicated than lab mice.

“Factors that may contribute to an older individual becoming more vulnerable to losing muscle function during or after flu infection are complex but may include a sedentary lifestyle, slow walking speed at baseline, low muscle mass, poor nutrition, plus chronic inflammation as a result of any number of chronic infections, being frail, etc.,” he says.

Bartley and Haynes agree. They’re applying for more grant money to explore how COX-2 inhibitors interact with other factors such as exercise. And they hope to eventually test muscle-protection strategies in people. Because while influenza is one of the most common serious infections in the elderly, it probably isn’t alone in causing muscle wasting.

“We’re trying to establish the relationship between any infection and inflammation, and how it leads to muscle loss and disability,” says Bartley. “Overall, we’re trying to help people get better and stay stronger for longer.”