1. Welcome to the Barshop Institute A world leader in aging research

2. 10,000 baby boomers turning 65 every day 85+ population will triple by 2050 100+ population will grow more than 7-fold by 2050 Why do research on aging?

3. How important is aging? Risk Factors for Cancer

4. Aging overwhelms all other risk factors for Cancer

5. Risk Factors for Alzheimer’s Disease

6. Aging overwhelms all other risk factors for Alzheimer’s Disease

7. AGING Stroke Arthritis Sarcopenia Heart Disease Type II Diabetes Cancer Neurodegenerative diseases (Alzheimer’s, Parkinson’s, ALS) Osteoporosis Aging as a therapeutic target Adapted from: Biochim. Biophys. Acta (2009) 1790: 1067-1074.

8. Target Discovery Nathan Shock Center of Excellence in the Biology Preclinical Testing Aging Interventions Testing Center Clinical Testing Older Americans Independence Center Research Models

9. Translation of Research into Practice

10. The South Texas Aging Registry and Repository (STARR) Donna Lehman, Ph.D. Associate Professor of Medicine

11. Primary Goals for STARR Recruit a diverse group of community-dwelling adults who are potentially interested in participating in translational research Multi-ethnic Range of ages Healthy adults as well as those with chronic illnesses

12. Community Outreach to Date Outreach to VA physicians & VA telehealth City of San Antonio Senior Centers & city programs Local health fairs within the VA and San Antonio community Toolkit for VA implementation created

13. Community Implementation – Senior Centers City of San Antonio and WellMed Salvation Army – Adult independent living facilities (ex: Air Force Villages) – Partnerships with outpatient clinics in the community Toolkit dissemination Recruitment of patients to other sites once established – Community events (ex: Silver Solutions) – Partnerships with organizations (ex: Age Well Live Well)

14. San Antonio Longitudinal Study of Aging (SALSA)

15. Mexican Americans n=394 European Americans n=355 Total n=749P-value n(%) or mean(SD)* Age, years (range: 65-80)69.3 (3.2)70.2 (3.6)69.8 (3.4)<0.001 Female227 (57.6)205 (57.7)432 (57.7)0.97 Education, years (range: 0-23)8.9 (4.6)13.4 (2.6)11 (4.4)<0.001 Income, category (range: 1-15)10.4 (3.2)12.8 (2.3)11.6 (3)<0.001 Comorbidity, excluding diabetes137 (34.8)149 (42.0)286 (38.2)0.043 Diabetes122 (33.5)35 (11.9)157 (23.9)<0.001 Frailty status0.04 Non-frail329 (88.7)320 (93)649 (90.8) Frail42 (11.3)24 (7)66 (9.2) Baseline Characteristics by Ethnic Group San Antonio Longitudinal Study of Aging (SALSA)

16. SALSA Mortality Findings Prior to covariate adjustment, mortality was higher in MAs compared to EAs After adjustment there was no ethnic difference Frailty, diabetes, and low income were significant independent predictors of mortality in SALSA

17. PROMOTING PHYSICAL ACTIVITY IN OLDER ADULTS Sara E. Espinoza, MD, MSc Associate Professor, Department of Medicine & Barshop Institute Associate Director/Clinical, San Antonio VA GRECC

18. Inactivity can have negative effects on physical health, lead to disability Increased physical activity beneficial at any age, even “frail” older adults Walking has few risks and can improve overall health Walking Clinic at the San Antonio VA, focus on increasing activity level Target population older (age ≥60 years) veterans enrolled in primary care Physical Activity in Older Adults

19. Baseline Face-to-Face Visit Safety screening and baseline assessments Patient education regarding diet (diabetic) and exercise Patient sets personal goals for the program Pedometer provided to patient and spouse/caregiver Telephone Follow-up (1 -2 calls per week) Weekly telephone contact Number of steps per day are recorded in patient log and reported Average number of steps per week calculated by Walking Clinic staff Follow-up Face-to-Face Visit (6 -8 weeks after Baseline Visit) Repeat assessments Encouragement to continue the program & follow-up resources provided

20. Improved Physical Activity and Gait Speed PATIENT CHARACTERISTICSN = 133 Age69.2 ± 7.9 years Male85.8% Overweight or Obese97.3% Ethnicity, Hispanic41.0% Ethnicity, Caucasian41.8% Diabetes52.2% Coronary artery disease18.7% RESULTS (N = 106)BaselineEnd of ProgramP-Value Number of steps per day4474 ± 23946046 ± 3476<.0001 Timed Up and Go (sec)10.2 ± 2.39.2 ± 2.0<.0001 Timed 10-foot gait speed (sec)2.72 ± 0.52.49 ± 0.5<.0001 In an analysis of 50 patients who had Hemoglobin A1c within 6 months prior and subsequent to participation in the Walking Clinic, we found Hemoglobin A1c decreased on average by 0.26 (p =.058).

21. Higher Gait Speed Predicts Survival Studenski et al., JAMA, 2011

22. Increase in Maximum Life Span Can we slow the aging process? Effect of Caloric Restriction on Lifespan Ad Libitum Caloric Restriction 77 79 n 30.9 38.3 Median 33 49 Maximum Lifespan (mos)

23. Extending lifespan/ slowing aging retards/prevents many age-related diseases Stroke Arthritis Osteoporosis Sarcopenia Heart Disease Diabetes Cancer Neurodegeneration Dietary Restriction ?

24. Rapamycin & Longevity

25. History Harrison, Strong, Sharp et al., Nature, 460, 392-396, 2009 2009:Nature publication showing that rapamycin increased lifespan of mice.

26. December 2009 Science selected the rapamycin study as one of the 10 scientific breakthroughs of 2009.

27. Effects of rapamycin (in mice) Extends longevity Delays Alzheimer’s disease Delays normal cognitive aging Prevents or delays several cancer types Delays development of atherosclerosis Rejuvenates stem cells (some kinds) Preserves balance and coordination Improves sleep, reduces depression/anxiety

28. Increasing brain blood flow reduces amyloid accumulation Control Rapamycin

29. Clinical trial at the VA Normalized score (SLUMS and TAPS) 1 mg/day Dr. Dean Kellogg, personal communication