GNOSIS OF AGING
The nose knows: study suggests it may be wise to screen for smell loss to predict frailty and unhealthy aging
Peer-Reviewed Publication In a study using data from nearly 1,200 older adults, Johns Hopkins Medicine researchers have added to a growing body of evidence that loss of the sense of smell is a predictive marker for an increased risk of frailty as people age. Building on previous research showing that olfactory dysfunction is a common early sign of brain-linked cognitive decline, the new findings suggest the link to frailty is likely not just in the brain but also in the nose itself.
If further studies affirm the findings, the researchers say, screening older adults’ ability to smell various scents could be as important as testing hearing and vision over time.
Results of the study, published Jan. 10 in the Journal of Gerontology, looked at the prevalence of frailty, an age-related syndrome of physiological decline, along with two different ways of assessing the ability to smell: olfactory sensitivity (the ability to detect an odor’s presence) and olfactory identification (the ability to detect and name an odor). Olfactory identification is a central measure of smell function, which has been linked to frailty and relies on higher-order cognitive processing to interpret and classify an odor. This suggests that neurological function may help to explain the relationship between smell and frailty. However, researchers say the ability to merely detect an odor without having to use higher-level neurological processes and the relationship of the ability to detect odors alone with frailty have been understudied.
“We use our sense of smell to identify the threat of a fire or to enjoy the fragrance of flowers on a spring day. But just like vision and hearing, this sense weakens as we age,” says Nicholas Rowan, M.D.,, associate professor of otolaryngology–head and neck surgery and corresponding author of the study. “We found that both impaired olfactory identification and sensitivity functions are associated with frailty, which is interesting because it shows that it’s not just your aging brain at work here, but it may also be something peripheral, like something at the level of your nose that is able to predict our impending frailty and death.” Rowan remarks that although these findings in older adults add to a body of literature that suggests the sense of smell can be a bellwether of frailty and impending mortality, the relationship of these unique sensory losses with unhealthy aging over time is unclear.
What is clear, he notes, is that common consequences of smell loss include a loss of appetite, difficulty monitoring personal hygiene, depression and an inability to detect toxic fumes. In older adults, this may be associated with weight loss, malnutrition, weakness, inadequate personal care and even potential injuries caused by gas leaks or fires.
In the United States, the population of older adults is estimated to double in the next three decades, driving efforts to sort out which older adults are most likely to experience frailty, a strong marker of impending death compared to those without it. The new study used a standard assessment of frailty (called a Physical Frailty Phenotype, or PFP, score) that looks at five markers: weight loss, exhaustion, weakness, slow walking speed and low physical activity.
To examine the relationship between frailty and olfaction, the research team analyzed data from 1,160 older adults enrolled in the National Social Life, Health and Aging Project between 2015 and 2016. The mean age of subjects was 76 and 55.7% were female. Participants were exposed to five scents to measure olfactory identification and six scents to measure sensitivity levels. Results were then matched to a subject’s frailty score.
Researchers concluded that for every one-point increase in both olfactory identification and sensitivity scores, there was a significant and meaningful reduction in frailty status, implying that improvements in smell were associated with improved health status and resilience of older results. Conversely, the worse the sense of smell, the frailer a subject was, suggesting that smell loss can be a measurable biomarker and potential risk factor for frailty in older adults.
As a matter of practical medical care, Rowan says the findings mean that smell tests could become part of routine screenings as a way to identify someone’s risk of unhealthy aging, and a tipoff to whether additional tests of cognition and other conditions are needed.
“We already do tests to assess how well we can see or hear, and it’s just as easy to conduct a simple smell test that takes only minutes, which could potentially be used as a valuable tool to assess the risk of frailty or unhealthy aging,” says Rowan. “For example, if someone flunks a smell test then maybe this patient needs to improve their nutrition or undergo a more detailed neurological or medical workup.”
In an effort to answer this question, Rowan and his colleagues from the Johns Hopkins University Claude D. Pepper Older Americans Independence Center are actively investigating how more detailed smell tests may help researchers and clinicians alike in identifying physiologically vulnerable older adults. Rowan notes that these results are especially important in the setting of the COVID-19 pandemic, which has caused lasting smell loss for millions of individuals. “The really interesting question, though, is what happens to these novel relationships when you seek to treat the smell loss,” he says.
Other researchers involved in this study include Nimesh Nagururu, Isaac Bernstein, Kristin Voegtline, Sarah Olson and Yuri Agrawal.
Funding from this study was supported by the Johns Hopkins Biostatistics, Epidemiology and Data Management (BEAD) Core; and the Johns Hopkins University Claude D. Pepper Older Americans Independence Center funded by the National Institute on Aging of the National Institutes of Health.
No authors report any conflict of interest.
In a study using data from nearly 1,200 older adults, Johns Hopkins Medicine researchers have added to a growing body of evidence that loss of the sense of smell is a predictive marker for an increased risk of frailty as people age. Building on previous research showing that olfactory dysfunction is a common early sign of brain-linked cognitive decline, the new findings suggest the link to frailty is likely not just in the brain but also in the nose itself.
If further studies affirm the findings, the researchers say, screening older adults’ ability to smell various scents could be as important as testing hearing and vision over time.
Results of the study, published Jan. 10 in the Journal of Gerontology, looked at the prevalence of frailty, an age-related syndrome of physiological decline, along with two different ways of assessing the ability to smell: olfactory sensitivity (the ability to detect an odor’s presence) and olfactory identification (the ability to detect and name an odor). Olfactory identification is a central measure of smell function, which has been linked to frailty and relies on higher-order cognitive processing to interpret and classify an odor. This suggests that neurological function may help to explain the relationship between smell and frailty. However, researchers say the ability to merely detect an odor without having to use higher-level neurological processes and the relationship of the ability to detect odors alone with frailty have been understudied.
“We use our sense of smell to identify the threat of a fire or to enjoy the fragrance of flowers on a spring day. But just like vision and hearing, this sense weakens as we age,” says Nicholas Rowan, M.D.,, associate professor of otolaryngology–head and neck surgery and corresponding author of the study. “We found that both impaired olfactory identification and sensitivity functions are associated with frailty, which is interesting because it shows that it’s not just your aging brain at work here, but it may also be something peripheral, like something at the level of your nose that is able to predict our impending frailty and death.” Rowan remarks that although these findings in older adults add to a body of literature that suggests the sense of smell can be a bellwether of frailty and impending mortality, the relationship of these unique sensory losses with unhealthy aging over time is unclear.
What is clear, he notes, is that common consequences of smell loss include a loss of appetite, difficulty monitoring personal hygiene, depression and an inability to detect toxic fumes. In older adults, this may be associated with weight loss, malnutrition, weakness, inadequate personal care and even potential injuries caused by gas leaks or fires.
In the United States, the population of older adults is estimated to double in the next three decades, driving efforts to sort out which older adults are most likely to experience frailty, a strong marker of impending death compared to those without it. The new study used a standard assessment of frailty (called a Physical Frailty Phenotype, or PFP, score) that looks at five markers: weight loss, exhaustion, weakness, slow walking speed and low physical activity.
To examine the relationship between frailty and olfaction, the research team analyzed data from 1,160 older adults enrolled in the National Social Life, Health and Aging Project between 2015 and 2016. The mean age of subjects was 76 and 55.7% were female. Participants were exposed to five scents to measure olfactory identification and six scents to measure sensitivity levels. Results were then matched to a subject’s frailty score.
Researchers concluded that for every one-point increase in both olfactory identification and sensitivity scores, there was a significant and meaningful reduction in frailty status, implying that improvements in smell were associated with improved health status and resilience of older results. Conversely, the worse the sense of smell, the frailer a subject was, suggesting that smell loss can be a measurable biomarker and potential risk factor for frailty in older adults.
As a matter of practical medical care, Rowan says the findings mean that smell tests could become part of routine screenings as a way to identify someone’s risk of unhealthy aging, and a tipoff to whether additional tests of cognition and other conditions are needed.
“We already do tests to assess how well we can see or hear, and it’s just as easy to conduct a simple smell test that takes only minutes, which could potentially be used as a valuable tool to assess the risk of frailty or unhealthy aging,” says Rowan. “For example, if someone flunks a smell test then maybe this patient needs to improve their nutrition or undergo a more detailed neurological or medical workup.”
In an effort to answer this question, Rowan and his colleagues from the Johns Hopkins University Claude D. Pepper Older Americans Independence Center are actively investigating how more detailed smell tests may help researchers and clinicians alike in identifying physiologically vulnerable older adults. Rowan notes that these results are especially important in the setting of the COVID-19 pandemic, which has caused lasting smell loss for millions of individuals. “The really interesting question, though, is what happens to these novel relationships when you seek to treat the smell loss,” he says.
Other researchers involved in this study include Nimesh Nagururu, Isaac Bernstein, Kristin Voegtline, Sarah Olson and Yuri Agrawal.
Funding from this study was supported by the Johns Hopkins Biostatistics, Epidemiology and Data Management (BEAD) Core; and the Johns Hopkins University Claude D. Pepper Older Americans Independence Center funded by the National Institute on Aging of the National Institutes of Health.
No authors report any conflict of interest.
JOURNAL
Journal of Gerontology
Journal of Gerontology
Does the risk of stroke from common risk factors change as people age?
MINNEAPOLIS – High blood pressure and diabetes are known risk factors for stroke, but now a new study shows that the amount of risk may decrease as people age. The study is published in the January 18, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“High blood pressure and diabetes are two important risk factors for stroke that can be managed by medication, decreasing a person’s risk,” said study author George Howard, DrPH, of the University of Alabama at Birmingham School of Public Health. “Our findings show that their association with stroke risk may be substantially less at older ages, yet other risk factors do not change with age. These differences in risk factors imply that determining whether a person is at high risk for stroke may differ depending on their age.”
The study involved 28,235 people who had never had a stroke. Of this group, 41% were Black and 59% were white. Participants were followed for an average of 11 years.
At the start of the study, participants were interviewed and given physical exams to assess risk factors. Risk factors included high blood pressure, diabetes, smoking, atrial fibrillation, heart disease and left ventricular hypertrophy which is the thickening of the heart’s left ventricle. Because of the well-known higher stroke risk in Black people, race was also considered as part of the assessed risk factors, Howard added.
Researchers followed up with participants every six months, confirming strokes by reviewing medical records.
During the study, there were 1,405 strokes over 276,074 person-years. Person-years represent both the number of people in the study and the amount of time each person spends in the study.
Participants were divided into three age groups, which were then compared. The age ranges for those groups varied slightly depending on the data being analyzed by researchers. In general, the younger group included participants ages 45-69, the middle group included people in their late 60s to 70s and the older group included people 74 and older.
Researchers found that people with diabetes in the younger age group were approximately twice as likely to have a stroke as people of similar age who did not have diabetes, while people with diabetes in the older age group had an approximately 30% higher risk of having a stroke than people of similar older age who did not have diabetes.
Researchers also found that people with high blood pressure in the younger age group had an 80% higher risk of having stroke than people of similar age without high blood pressure while that risk went down to 50% for people with high blood pressure in the older age group compared to people of similar age without high blood pressure.
In addition, when researchers examined race as a risk factor, they found a higher stroke risk for Black participants in the younger age group compared to white participants in that group. The race difference decreased in the older age group. For stroke risk factors such as smoking, atrial fibrillation and left ventricular hypertrophy, researchers did not find an age-related change in risk.
“It is important to note that our results do not suggest that treatment of high blood pressure and diabetes becomes unimportant in older age,” said Howard. “Such treatments are still very important for a person’s health. But it also may be wise for doctors to focus on managing risk factors such as atrial fibrillation, smoking and left ventricular hypertrophy as people age.”
Howard also noted that even where the impact of risk factors decreases with age, the total number of people with strokes at older ages may still be larger since overall risk of stroke increases with age. For example, in the younger age group for high blood pressure, researchers estimate that about 2.0% of people with normal blood pressure had a stroke, compared to 3.6% of people with high blood pressure. In the older age group, about 6.2% of people with normal blood pressure had a stroke, compared to 9.3% of people with high blood pressure.
A limitation of the research was that participants’ risk factors were assessed only once at the start of the study, and it’s possible they may have changed over time.
The study was supported by the National Institutes of Health, including the National Institute of Neurological Disorders and Stroke and the National Institute on Aging.
Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.
When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.
JOURNAL
Neurology
Blood-based markers may reveal Alzheimer disease ten years before symptoms show
Alzheimer disease begins decades before any symptoms, such as memory loss, start to show. Consequently, early diagnosis increases the chances of slowing the disease down with drugs. A new study on an inherited form of the disease shows that a protein called GFAP is a possible biomarker for very early stages of the disease. The study, conducted by researchers at Karolinska Institutet and published in the journal Brain, could one day lead to an earlier detection of this serious and common disease.
“Our results suggest that GFAP, a presumed biomarker for activated immune cells in the brain, reflects changes in the brain due to Alzheimer disease that occur before the accumulation of tau protein and measurable neuronal damage,” says the study’s first author Charlotte Johansson, doctoral student at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden. “In the future it could be used as a non-invasive biomarker for the early activation of immune cells such as astrocytes in the central nervous system, which can be valuable to the development of new drugs and to the diagnostics of cognitive diseases.”
Alzheimer disease causes 60 to 70 percent of all dementia cases, according to the Swedish Brain Foundation. In Alzheimer disease, nerve cells in the brain degenerate as a result of the abnormal accumulation of the proteins beta-amyloid and tau. As more brain neurons become damaged, this manifests in dysfunction of cognitive functions such as memory and speech.
The disease progresses insidiously and biological changes in the brain begin already 20 to 25 years before memory loss and other cognitive symptoms become evident. The earlier a patient is correctly diagnosed, the sooner he or she can be offered the right treatment. This is one of many reasons why more research is needed on precise, easy-to-use methods of early diagnosis.
Researchers at Karolinska Institutet and their colleagues at Landspitali University Hospital in Iceland, Gothenburg University and University College London in the UK have been studying biomarkers in blood for very early pathological changes in a rare and inherited form of Alzheimer disease that accounts for less than one percent of all cases. Individuals with a parent with Alzheimer disease caused by a mutation have a 50 percent risk of developing the disease themselves.
For their study, the researchers analysed 164 blood plasma samples from 33 mutation carriers and 42 relatives without the inherited pathogenic predisposition. The data were collected between 1994 and 2018.
Their results reveal clear changes of several blood protein concentrations in the mutation-carriers.
“The first change we observed was an increase in GFAP (glial fibrillary acidic protein) approximately ten years before the first disease symptoms,” says the study’s last author Caroline Graff, professor at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet. “This was followed by increased concentrations of P-tau181 and, later, NfL (neurofilament light protein), which we already know is directly associated with the extent of neuronal damage in the Alzheimer brain. This finding about GFAP improves the chances of early diagnosis.”
The study was financed by grants from several bodies, including the Swedish Brain Foundation, the Swedish Alzheimer’s Foundation and with ALF project grants (see the study for a full list). Authors Kaj Blennow and Henrik Zetterberg are involved in several collaborations with private pharmaceutical companies. There are no other reported conflicts of interest.
Publication: “Plasma biomarker profiles in autosomal dominant Alzheimer’s disease”, Charlotte Johansson, Steinunn Thordardottir, José Laffita-Mesa, Elena Rodriguez-Vieitez, Henrik Zetterberg, Kaj Blennow and Caroline Graff. Brain, online 11 January 2023, doi: 10.1093/brain/awac399.
JOURNAL
Brain
SUBJECT OF RESEARCH
People
ARTICLE TITLE
"Plasma biomarker profiles in autosomal dominant Alzheimer’s disease”
Does social isolation affect older adults’ risk of developing dementia?
New research published in the Journal of the American Geriatrics Society indicates that social isolation is common among older U.S. adults, and it increases their likelihood of developing dementia.
Among 5,022 participants of the National Health and Aging Trends Study, a longitudinal and nationally representative study of older adults in the United States, nearly one-quarter (1,172 participants, or 23.3%) were socially isolated. After adjusting for demographic and health factors, being socially isolated (versus not socially isolated) was associated with a 28% higher risk of developing dementia over 9 years, regardless of race or ethnicity.
“Social connections are increasingly understood as a critical factor for the health of individuals as they age. Our study expands our understanding of the deleterious impact of social isolation on one’s risk for dementia over time,” said corresponding author Thomas K.M. Cudjoe, MD, MPH, of Johns Hopkins University School of Medicine. “I hope this serves as a wakeup call for all of us to be more thoughtful of the role of social connections on our cognitive health.”
URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/jgs.18140
Additional Information
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About the Journal
Journal of the American Geriatrics Society is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age.
About Wiley
Wiley is one of the world’s largest publishers and a global leader in scientific research and career-connected education. Founded in 1807, Wiley enables discovery, powers education, and shapes workforces. Through its industry-leading content, digital platforms, and knowledge networks, the company delivers on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.
JOURNAL
Journal of the American Geriatrics Society
ARTICLE TITLE
Social isolation and 9-year dementia risk in community-dwelling Medicare beneficiaries in the United States
New three-year partnership aligns teams across Sharp HealthCare’s largest hospital to develop, codify and share best practices for coordinated care, helping older adults maintain function, dignity and independence.
Business AnnouncementSAN DIEGO—Jan. 10, 2023—Through a three-year partnership that seeks to enhance the healthcare journey of older adults, West Health and Sharp Memorial Hospital will work together to create a new integrated geriatric care model spanning the entire health care continuum, from the emergency department and operating room to primary care.
As a central outcome of the partnership, Sharp Memorial and West Heath will create a roadmap of how their successful, age-friendly practices can be implemented across a health system and will share their techniques, lessons learned and programmatic details in a way that can be adopted by others nationwide.
“In collaboration with Sharp Memorial Hospital, we’re bringing together incredible advancements in geriatric care that have, until now, been largely siloed within medical specialties such as emergency medicine or surgery,” says Shelley Lyford, CEO and Chair of West Health, a family of nonprofit organizations centered on successful aging. “By coordinating senior-friendly care across the entire health system, we’ll be amplifying those advancements and helping older patients achieve the best-possible healthcare experience.”
Diane Wintz, M.D., a Sharp-affiliated critical care specialist and medical director of the Trauma Program at Sharp Memorial Hospital, helped forge the alliance with West Health after observing throughout her career how older patients often struggle to recover from traumatic injuries or illnesses. These patients typically enter the healthcare system through the emergency department or for a planned operation, and some experience loss of function and independence after discharge.
“Injuries and illnesses in older patients can have immediate, permanent consequences on their independence and mobility,” Dr. Wintz says. “We see the best results when there’s an exceptional level of teamwork across departments and specialties. We want to see emergency teams, surgeons, pharmacists and primary care providers taking collaboration to a whole new level for our older patients.”
Seeing the value of coordination among teams, Dr. Wintz already started an interdisciplinary “Generational Care” program at Sharp Memorial Hospital, under the John M. Sachs Family Center for Generational Health, which will serve as a foundation for the new partnership.
In addition to heightening medical coordination, the partnership will focus on ensuring older patients have access to aggressive, accelerated therapy sessions and are treated in a way to prevent delirium or other cognitive issues, Wintz says.
The program is just the latest chapter in a movement championed by West Health to improve healthcare for older adults. Maintaining dignity and independence are paramount, West Health’s Lyford notes.
With support from West Health, all hospital emergency rooms in San Diego—including Sharp’s Emergency Departments—have already achieved Geriatric Emergency Department accreditation by the American College of Emergency Physicians (ACEP) and have committed to providing emergency care that takes into consideration the unique needs of older adults.
West Health is also a leader in the development of California’s Master Plan for Aging. By joining with organizations such as Sharp, West Health can apply funding and expertise on projects that have meaningful and long-lasting impact on patient care.
“Our population is rapidly shifting; by 2030, the number of older adults in San Diego will be 80 percent higher than the decade earlier,” says Tim Smith, senior vice president and CEO of Sharp Memorial Hospital. “These are valued members of our community who deserve the best-possible care. But, the needs of older patients are quite different than those of the average adult, and that’s what’s driving our commitment to create new and better standards of care.”
Notably, Sharp expects to be the first health system in San Diego County to earn the Geriatric Surgery Verification from the American College of Surgeons, Smith says. This is in addition to Sharp’s recent certification from the Institute for Healthcare Improvement as an “Age-Friendly Health System.”
“West Health and Sharp Memorial are reimagining what successful system-wide care can look like for older-adult patients, and we’ll share the model with the world in the hopes others will make the same transformation,” Lyford says. “Already, hospital systems are seeing the positive impact of geriatric specialty care in emergency settings and operating rooms. Just think of the impact when that level of care extends throughout the entire system in an intentional and coordinated manner.”
About West Health
Solely funded by philanthropists Gary and Mary West, West Health is a family of nonprofit and nonpartisan organizations including the Gary and Mary West Foundation and Gary and Mary West Health Institute in San Diego, and the Gary and Mary West Health Policy Center in Washington, D.C. West Health is dedicated to lowering healthcare costs and enabling seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence. Learn more at westhealth.org and follow @westhealth.
Sharp Memorial Hospital
Sharp Memorial Hospital is an acute care hospital, which is home to comprehensive and advanced programs for cardiac, oncology, orthopedics, physical rehabilitation, bariatric surgery and multi-organ transplantation. Sharp Memorial is comprised of more than 3,700 employees, 1,200 affiliated physicians representing a robust range of specialties, and more than 200 dedicated volunteers. The hospital first earned the Planetree Person-Centered designation in 2012, achieved Designation with Distinction in 2014, and was redesignated in 2015. In 2019, Sharp Memorial earned Planetree Gold Level Certification for Excellence.
Since 2008, Sharp Memorial has been a proud recipient of the prestigious Magnet designation for excellence in nursing practices and quality patient care. Furthermore, the hospital has earned an "A" grade on The Leapfrog Group Hospital Safety Survey—the nationally recognized, gold-standard measure of patient safety—10 consecutive times. Sharp Memorial is also a three-time recipient of the ENA Lantern Award, which recognizes emergency departments demonstrating exceptional and innovative performance. The Sharp Experience promotes a culture supporting our employees and physicians so they focus on each patient as the center of everything we do. Additionally, Sharp Memorial's person-centered experience includes health information ambassadors, an Arts for Healing Program, integrative therapies, pet therapy, and more.
