Indoles from commensal bacteria extend healthspan.

Multiple studies have identified conserved genetic pathways and small molecules associated with extension of lifespan in diverse organisms. However, extending lifespan does not result in concomitant extension in healthspan, defined as the proportion of time that an animal remains healthy and free of age-related infirmities. Rather, mutations that extend lifespan often reduce healthspan and increase frailty. The question arises as to whether factors or mechanisms exist that uncouple these processes and extend healthspan and reduce frailty independent of lifespan. We show that indoles from commensal microbiota extend healthspan of diverse organisms, including Caenorhabditis elegans, Drosophila melanogaster, and mice, but have a negligible effect on maximal lifespan. Effects of indoles on healthspan in worms and flies depend upon the aryl hydrocarbon receptor (AHR), a conserved detector of xenobiotic small molecules. In C. elegans, indole induces a gene expression profile in aged animals reminiscent of that seen in the young, but which is distinct from that associated with normal aging. Moreover, in older animals, indole induces genes associated with oogenesis and, accordingly, extends fecundity and reproductive span. Together, these data suggest that small molecules related to indole and derived from commensal microbiota act in diverse phyla via conserved molecular pathways to promote healthy aging. These data raise the possibility of developing therapeutics based on microbiota-derived indole or its derivatives to extend healthspan and reduce frailty in humans.

The benefits of being a senior mentor: Cultivating resilience through the mentorship of health professions students.

Senior Mentor Programs (SMPs) pair community-dwelling older adults with health professions students to facilitate knowledge, improve communication skills, and promote positive attitudes regarding the aging process. Although evidence exists that SMPs meet these goals, the programs' psychosocial impact on the senior mentors remains unexplored. The current study assessed 101 mostly female (64.4%) senior mentors (M age = 77.6) pre- and postprogram. Although mentors had no change in the amount of perceived ageism experienced or expectation of experiencing ageism, their concern/anxiety over ageism significantly decreased from pre- (M = 21.58) to posttest (M = 20.19). Qualitative thematic analysis indicated meaningfulness of program and scheduling difficulties as prevalent themes. Mentors who reported less concern about ageism following the program were more likely to have experienced ageism in the year prior to the program and to attend religious services more often, another potential intergenerational contact. These results highlight possible benefits of mentor service for older adults.

Identifying landmark articles for advancing the practice of geriatrics.

Landmark articles from the peer-reviewed literature can be used to teach the fundamental principles of geriatric medicine. Three approaches were used in sequential combination to identify landmark articles as a resource for geriatricians and other healthcare practitioners. Candidate articles were identified first through a literature review and expert opinion survey of geriatric medicine faculty. Candidate articles in a winnowed list (n = 30) were then included in a bibliometric analysis that incorporated the journal impact factor and average monthly citation index. Finally, a consensus panel reviewed articles to assess each manuscript's clinical relevance. For each article, a final score was determined by averaging, with equal weight, the opinion survey, bibliometric analysis, and consensus panel review. This process ultimately resulted in the identification of 27 landmark articles. Overall, there was weak correlation between articles that the expert opinion survey and bibliometric analysis both rated highly. This process demonstrates a feasible method combining subjective and objective measures that can be used to identify landmark papers in geriatric medicine for the enhancement of geriatrics education and practice.

Use of a virtual classroom in training fourth-year medical students on care transitions.

BACKGROUND: Transferring complex patients between settings can be fraught with poor communication and adverse outcomes, yet few medical students nationwide are trained in specific skills to improve care transitions. OBJECTIVE: To give medical students the fund of knowledge and skills to develop and implement a safe discharge plan. DESIGN: A new care transitions curriculum imparted to all fourth-year medical students from August 2009 to April 2010 during their internal medicine sub-internship. SETTING: Emory University School of Medicine. INTERVENTION: Activities included: 1) discussion of an online case highlighting care transitions issues; 2) preparation of a discharge summary based on online templates; and 3) a postdischarge phone call to one of their patients. MEASUREMENTS: We evaluated the curriculum using questionnaires measuring changes in pretest to posttest confidence in performing discharge tasks, attitudes toward the care transitions process, and performance on a knowledge quiz. We also assessed course satisfaction and the quality of students' discharge summaries and postdischarge call reports performed during the module. RESULTS: Students' confidence in their ability to perform discharge tasks improved from 16.5 to 20.8 on a 25-point scale (P < 0.001). Knowledge quiz scores improved from 68 to 82 out of 100 (P < 0.001); 90.1% (109/121) of discharge summaries and 90.1% (109/121) of postdischarge call reports met all quality criteria. CONCLUSIONS: This curriculum showed that students could acquire the needed skills to prepare quality discharge summaries and communicate well with patients at discharge, as well as improve their overall knowledge surrounding care transitions.

The protective effect of social engagement on 1-year mortality in a long-stay nursing home population.

We examined the effect of social engagement (SE) on mortality in 30,070 long-stay nursing home residents who were > or =65 years of age and did not have a serious communication problem. Information on SE and resident characteristics were obtained from the Minimum Data Set, and death information was obtained from the National Death Index. Life table analyses show that greater levels of SE are associated with longer survival (P=.0001). Adjusted proportional hazards regression results show that for each increase in the SE scale, residents are 0.94 (range 0.92-0.95) times as likely to die during the follow-up period, independent of known factors associated with mortality. Future studies are needed to understand psychological and other factors related to residents' capacity and motivation for social engagement that could increase quality and quantity of life in nursing home residents.

Mortality-related factors and 1-year survival in nursing home residents.

OBJECTIVES: To identify factors associated with 1-year mortality in newly admitted and long-stay (in nursing home longer than 1 year) nursing home residents by linking Minimum Data Set (MDS) information with data from the National Death Index and use these factors to create a useful tool for estimating risk levels for 1-year mortality. DESIGN: Retrospective cohort study with development and validation cohorts. SETTING: All 643 Medicare and Medicaid certified nursing homes in New York State during the study period. PARTICIPANTS: The study included data on residents collected during full MDS assessments from June 1994 through December 1997. A total of 100,669 nursing home residents met the inclusion criteria for the newly admitted resident analysis. The newly admitted development cohort included 60,341 residents, and the newly admitted validation cohort included 40,328 residents. A total of 36,125 nursing home residents met inclusion criteria for the long-stay (residing in nursing home>1 year) cohort. The long-stay development cohort included 22,749 residents, and the long-stay validation cohort included 15,068 residents. MEASUREMENTS: The analytical approach was similar for the newly admitted and long-stay resident cohorts. Resident characteristics that were considered potential risk factors for mortality were examined individually in bivariate proportional hazards models, and factors with P <.05 were entered into a proportional hazards regression stepwise model. The strongest factors based on their chi-square values were selected for entry into a multivariate proportional hazards analysis. Hazard ratios (HRs), 95% confidence intervals, and P-values were derived from this model. A mortality risk index score was created for each resident by summing the value of each HR in the multivariate model for those who had the risk factor. A sensitivity analysis was performed to determine the effect of residents with an unknown death status. A similar analysis was performed on the validation cohort to validate the original results. RESULTS: Major factors associated with 1-year mortality were identified in both the newly admitted and long-stay cohorts. In both newly admitted and long-stay residents, a higher mortality risk index score was associated with increased 1-year mortality in both the development and validation cohorts. CONCLUSIONS: MDS data can identify major factors associated with 1-year mortality in newly admitted and long-stay nursing home residents. These factors can be used to stratify residents into risk categories for 1-year mortality. This information could be important to residents, their families, and their physicians when developing care plans, as well as to agencies interested in healthcare resource planning.

Common and gender specific factors associated with one-year mortality in nursing home residents.

OBJECTIVES: To identify common and gender-specific factors associated with mortality in two distinct nursing home (NH) populations: newly admitted (NA), and long-stay (LS) residents. DESIGN: A retrospective cohort study. SETTING: NH facilities in the state of New York. PARTICIPANTS: A total of 59,080 NA female and 28,080 NA male NH residents, and 24,260 LS female and 8,928 LS male NH residents evaluated between June 1994 and December 1997 who were at least 65 years of age. MEASUREMENTS: Minimum Data Set information including measures of health, functional, cognitive, psychological, and social status. RESULTS: Multivariate proportional hazards regression results indicate that in NA residents, use of feeding tubes, bowel incontinence, and refuses fluids were associated with mortality in women only, whereas fever was associated with mortality in men only. Cancer and congestive heart failure (CHF) were more strongly associated with mortality in women than men. In LS residents, deterioration in communication, refuses fluids, use of indwelling catheters, and deterioration in cognition were associated with mortality in women but not men. Bedfast most of the time, use of new medications, and a balance problem were associated with mortality in men but not women. Shortness-of-breath was more strongly associated with mortality in women than men. CONCLUSIONS: In both NA and LS residents, although men and women share many common factors associated with mortality, each gender has some unique factors associated with mortality. Furthermore, the strength of some common factors is significantly different across genders. These readily available data could be useful in making medical decisions and advance directive planning, and in the development of quality improvement initiatives and mortality prediction models.