frailty

What does it mean to grow old?  Put another way, what are the hallmarks of aging?  They are questions that have long since intrigued biologists and longevity researchers, with a wide range of theories about what drives the aging process.  We understand the impact of weaker muscles, frailty, cognitive challenges and greying hair, but it is the underlying factors - molecular and cellular mechanisms - that researchers are striving to understand.  Dr. Davide D’Amico, Research and Development Group Leader with the Swiss cellular nutrition brand, Timeline Nutrition, is studying how compounds derived from plants can be used to reverse muscle decline and boost mitochondrial health. 

In this conversation we cover:

- The 'hallmarks of aging,' which refers to the key features of human aging, such as genomic instability and mitochondrial dysfunction.

- How the understanding of aging is not simply a chronological process, but also includes the concept of biological aging and the potential for reversing or slowing down this process.

- The potential benefits of supplementing with Urolithin A, a compound found in certain foods that can improve mitochondrial health and reduce inflammation.

- The importance of muscle strength and physical health in promoting longevity and preventing age-related diseases.

- How the ability to convert the precursor molecules found in plants into beneficial compounds like Urolithin A can vary among individuals and is influenced by the diversity and composition of their gut microbiome.

- The potential benefits of Urolithin A for the immune system, cartilage health, and overall mobility and quality of life in older adults.

- The importance of personalized approaches to health and longevity, with a focus on maintaining quality of life rather than simply extending lifespan.

- The overall goal of preventing age-related diseases, supporting optimal health, and promoting a compressed morbidity, where the period of decline in health near the end of life is relatively short.

- The need for education and awareness about lifestyle interventions for healthy aging, involving doctors, researchers, politicians, and educators.

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DISCOUNT

Mitopure (a highly pure form of Urolithin A) boosts the health of our mitochondria – the battery packs of our cells – and improves muscle strength. Timeline is offering LLAMA listeners a 10% discount on its range of products – Mitopure powders, softgels & skin creams.  Use the code LLAMA at checkout

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The Live Long and Master Aging (LLAMA) podcast, a HealthSpan Media LLC production, shares ideas but does not offer medical advice. If you have health concerns of any kind, or you are considering adopting a new diet or exercise regime, you should consult your doctor.

What does it mean to grow old?  Put another way, what are the hallmarks of aging?  They are questions that have long since intrigued biologists and longevity researchers, with a wide range of theories about what drives the aging process.  We understand the impact of weaker muscles, frailty, cognitive challenges and greying hair, but it is the underlying factors - molecular and cellular mechanisms - that researchers are striving to understand.  Dr. Davide D’Amico, Research and Development Group Leader with the Swiss cellular nutrition brand, Timeline Nutrition, is studying how compounds derived from plants can be used to reverse muscle decline and boost mitochondrial health. 

In this conversation we cover:

- The 'hallmarks of aging,' which refers to the key features of human aging, such as genomic instability and mitochondrial dysfunction.

- How the understanding of aging is not simply a chronological process, but also includes the concept of biological aging and the potential for reversing or slowing down this process.

- The potential benefits of supplementing with Urolithin A, a compound found in certain foods that can improve mitochondrial health and reduce inflammation.

- The importance of muscle strength and physical health in promoting longevity and preventing age-related diseases.

- How the ability to convert the precursor molecules found in plants into beneficial compounds like Urolithin A can vary among individuals and is influenced by the diversity and composition of their gut microbiome.

- The potential benefits of Urolithin A for the immune system, cartilage health, and overall mobility and quality of life in older adults.

- The importance of personalized approaches to health and longevity, with a focus on maintaining quality of life rather than simply extending lifespan.

- The overall goal of preventing age-related diseases, supporting optimal health, and promoting a compressed morbidity, where the period of decline in health near the end of life is relatively short.

- The need for education and awareness about lifestyle interventions for healthy aging, involving doctors, researchers, politicians, and educators.

-

DISCOUNT

Mitopure (a highly pure form of Urolithin A) boosts the health of our mitochondria – the battery packs of our cells – and improves muscle strength. Timeline is offering LLAMA listeners a 10% discount on its range of products – Mitopure powders, softgels & skin creams.  Use the code LLAMA at checkout

-

The Live Long and Master Aging (LLAMA) podcast, a HealthSpan Media LLC production, shares ideas but does not offer medical advice. If you have health concerns of any kind, or you are considering adopting a new diet or exercise regime, you should consult your doctor.

In this episode, Angela Branche, MD, discusses the Advisory Committee on Immunization Practices recommendations for RSV vaccines in older adults, including: 

• Use of shared clinical decision-making 
• How to approach the conversation about the RSV vaccine with patients
• Key populations who may benefit the most, such as those at risk for severe RSV disease (eg, increasing age and persons who are frail or have cardiopulmonary comorbidities)

Faculty: 

Angela Branche, MD

Associate Professor of Medicine
Division of Infectious Diseases
Department of Medicine
University of Rochester
Rochester, New York

Link to full program: https://bit.ly/3nb25xe

Link to downloadable slides: https://bit.ly/3nb25xe

In this episode, Helen Y. Chu, MD, MPH, shares updates on RSV vaccines, including:

• An overview of vaccine candidates under investigation
• Recently FDA-approved RSV vaccines for older adults
• Considerations for the next respiratory viral season
• Coadministration of RSV vaccines with other respiratory viral vaccines (eg, influenza, SARS-CoV-2)
• Target populations for RSV vaccination
• RSV prevention in infants with the maternal vaccine and monoclonal

Faculty:

Helen Y. Chu, MD, MPH
Associate Professor of Medicine
Division of Allergy & Infectious Diseases
University of Washington 
School of Medicine
Seattle, Washington

Link to full program: https://bit.ly/3nb25xehttps://bit.ly/3nb25xe

Link to downloadable slides: https://bit.ly/3TsXym5

Geriatricians are doctors that specialize in providing medical care for older adults. They start by assessing the person to find out what medical conditions they may have. They also review their medications and care needs. They then make suggestions for care options and services in the community. There are many reasons someone should see a geriatrician such as a change in their ability to move around (walk etc.), an increase in falling or a change in their thinking skills. Geriatricians are also crucial members of our provincial health care team. In this episode of the DocTalks Podcast, host Ian Gillespie interviews St. Joseph’s President and CEO Roy Butler and Chief of Geriatrics Dr. Sheri-Lynn Kane to understand when people should seek geriatric care and what St. Joseph's is doing to prepare for the tsunami of older adults needing health care.

For more information visit www.sjhc.london.on.ca/podcast or follow us on Twitter @stjosephslondon. Brought to you in partnership with St. Joseph's Health Care Foundation.

Note: The content of St. Joseph's DocTalks Podcasts is for informational purposes only. The material is not intended for and should not be used as a substitute for direct medical advice from a licensed health care practitioner.

Produced by The Pod Cabin and Kelsi Break

Help a Patient Who Can't Go Home for the Holidays!

Season of Celebration began with a single question from the care-giving team, "How can we make Christmas a little brighter for those in our care, who can't go home for the holidays?" What began as a single wish, has now become a beloved community campaign in support of St. Joseph’s mission of care. 

Did you know there are more than 1,000 inpatient beds at St. Joseph's? We are a home for Veterans, residents in our long-term care facility, people in our mental health program and those requiring specialized care. Many of these people will not have the option of leaving our care to visit family over the holidays.

Your gift to Season of Celebration will support the purchase of care and comfort items that make a hospital feel more like home — everything from accessible furniture and exercise equipment to blanket warmers and interactive technology that keeps those in hospital connected to the outside world.

In this episode, hear Marta Boffito, MD, PhD, FRCP, and Julian Falutz, MD, FRCPC, discuss their approach to minimizing antiretroviral (ARV)-related intolerances in older patients with HIV, including:

• Consequences of polypharmacy
• Deprescribing ARV and non-ARV medications
• Complications associated with aging (eg, geriatric syndromes such as falls, frailty, multimorbidity)
• Mediations to avoid, such as anticholinergic medications, to minimize drug–drug interactions and risk of developing geriatric syndromes

Faculty:

Marta Boffito, MD, PhD, FRCP
Consultant Physician/Professor
HIV/Research
Chelsea and Westminster Hospital
Imperial College London
London, United Kingdom

Julian Falutz, MD, FRCPC
Associate Professor of Medicine
Department of Medicine
McGill University School of Medicine
Director
Comprehensive HIV and Aging Initiative
Chronic Viral Illness Service
McGill
Montreal, Quebec, Canada

Link to full program:
https://bit.ly/3PM3nYe

Follow along with the slides at:
https://bit.ly/3NpAYI1

In this episode, Cristina Mussini, MD, shares her approach to caring for aging patients with HIV. This includes not just focusing on their HIV, but their over well-being, such as:

• Maintaining a healthy weight, eating healthy and staying mobile 
• Overcoming the obstacle of stigma from society and self-stigma
• Empowering patients to care for themselves
• In women who are often caregivers most of their life:
  • Encouraging self-care
  • Staying up to date with preventive care such as cancer screenings (eg, mammography, annual Pap smear, and colonoscopy)
• Teaching patients to love themselves
• Making sure the patient knows you truly care for them

Faculty:

Cristina Mussini, MD
Head of Department of Infectious Diseases and Tropical Medicine
Full Professor of Infectious Diseases
Infectious Diseases Clinics, University Hospital
University of Modena and Reggio Emilia
Modena, Italy

Link to full program:
https://bit.ly/3KkF4iZ

In this episode we sit down with the Chief of Trauma, Surgical Critical Care, Burns,  & Acute Care Surgery at the University of Arizona, Dr. Bellal Joseph, who share with us his thoughts and research findings on hot topics including frailty, geriatric trauma, leadership, and more.

Timestamps:
00:12  Introductions
01:30  What is frailty? Your physiologic NOT chronologic body.
06:58  Injured elderly trauma patients can have good outcomes
07:30  Trauma specific frailty index
10:48  Failure to rescue
13:57  Geriatricians and the trauma surgeons
15:08  4Ms-What Matters, Mobility, Mentation, Medication
16:48  Geriatric cohorting/wards
22:24  ACS geriatric centers of excellence
29:35  Brain Injury Guidelines (BIG)
38:17  The importance of teamwork & servant leadership
40:28  Imposter syndrome
43:19  Leadership considerations
45:25  Final thoughts

References:
Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, Wynne J, Tang A, O'Keeffe T, Rhee P. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014 Apr;76(4):965-9. doi: 10.1097/TA.0000000000000161. PMID: 24662858.

Joseph B, Obaid O, Dultz L, Black G, Campbell M, Berndtson AE, Costantini T, Kerwin A, Skarupa D, Burruss S, Delgado L, Gomez M, Mederos DR, Winfield R, Cullinane D; AAST BIG Multi-institutional Study Group. Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28. PMID: 35343931.v

Joseph B, Pandit V, Haider AA, Kulvatunyou N, Zangbar B, Tang A, Aziz H, Vercruysse G, O'Keeffe T, Freise RS, Rhee P. Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury: The Role of Acute Care Surgeons. JAMA Surg. 2015 Sep;150(9):866-72. doi: 10.1001/jamasurg.2015.1134. PMID: 26107247.

Joseph B, Pandit V, Sadoun M, Zangbar B, Fain MJ, Friese RS, Rhee P. Frailty in surgery. J Trauma Acute Care Surg. 2014 Apr;76(4):1151-6. doi: 10.1097/TA.0000000000000103. PMID: 24662884.

Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, Fain M, Mohler MJ, Joseph B. Emergency general surgery specific frailty index: A validation study. J Trauma Acute Care Surg. 2016 Aug;81(2):254-60. doi: 10.1097/TA.0000000000001120. PMID: 27257694.

In this podcast, Jonathan Appelbaum, MD, FACP, AAHIVS, summarizes the many medical challenges faced by aging people with HIV, including:

• Underrepresentation of older patients in medical research
• Consequences of early experiences in the epidemic such as late HIV diagnosis and low CD4+ cell count nadir, incomplete or short-lived virologic suppression with early regimens, and toxicity associated with early antiretroviral agents
• Added challenges of multimorbidity and psychosocial challenges, especially mental health issues, loneliness, and social isolation
• The need to provide care for the aging HIV population using a holistic approach 
• Gaps in the current healthcare system in providing optimal care for aging people with HIV

Faculty:

Jonathan Appelbaum, MD, FACP, AAHIVS
Laurie L. Dozier Jr, MD, Education Director
Professor of Internal Medicine
Chair, Department of Clinical Sciences
Florida State University College of Medicine
Tallahassee, Florida

Link to full program: 
https://bit.ly/3KkF4iZ

No one likes to think about aging. Our natural reaction to aging is usually revulsion, but time is coming for you. And as uncomfortable as that makes us, or as painful as that may be, the better we are able to reckon with that idea, the wiser we will be, no matter how young or old we may be today. It’s never too early to remember your Creator, to remember that we are creatures, with an expiration date. We must take seriously our frailty, our impermanence, and our death, which pretends to, tries to, convince us that life has no meaning at all. But we can do more than remember our Creator. On this side of Jesus, when we see the whole testimony of God’s revelation to us, we can do one more thing here. We can hope in our Redeemer, because every passing day in Christ, we are one day closer to the renewal of all things. Yes, even as we age, renewal only gets closer. 

Sermon Notes: https://www.bible.com/events/48896336

22.05.29

In this episode, Fidelia Bernice, PharmD, and Jennifer Cocohoba, PharmD, share insights on new HIV data from CROI 2022, including:

• Islatravir tissue and plasma distribution after monthly oral dosing
• Pharmacokinetics, safety, and acceptability of a tenofovir vaginal ring
• PrEP and Hormone Therapy in Transgender Individuals
• Anticholinergic drug effects in older PWH
• Adherence in PWH

Presenters:

Fidelia Bernice, PharmD
Clinical Pharmacy Specialist, Infectious Diseases
Department of Pharmacy
University of Maryland Medical Center
Baltimore, Maryland

Jennifer Cocohoba, PharmD
Professor
Department of Clinical Pharmacy
University of California, San Francisco
San Francisco, California

Link to full program:
https://bit.ly/3tdkXfJ

Somewhere in here we discuss the movie Frailty, starring Bill Paxton; and express our excitement for the upcoming Elden Ring. And.....more....

Discussion around research, social media, charity work and frailty.
Jo McNamara and Naman Julka-Anderson catch up with Dr. Richard Simcock as part of the Leadership Series (Part 6).

To use this podcast as CPD, look at these reflection points: 

1) Reflect on your social media presence and if you feel comfortable have a look at #RadOnc journal.

2) Reflect on service improvement needs within your work place and consider how you could make a difference.

3) What considerations or adaptations could be made in your work place to make it more dementia friendly.

Complete this form for your accredited digital badge: https://bit.ly/3GbtR1X.

Links from podcast:

The radiationnation: https://radiationnation.com/

Online Journal Clubs: #RadOnc Journal on Twitter

History of Radiotherapy: https://wakelet.com/wake/vRRCxZ52zpwvA-pEONe6D

Crowd sourcing International consensus on managing radiation during the COVID-19 pandemic: https://www.sciencedirect.com/science/article/pii/S2405630820300227
Acupuncture for xerostomia: https://pubmed.ncbi.nlm.nih.gov/19734380/ 
Mummy's star charity: https://www.mummysstar.org 
NCRI Living with and beyond cancer group: https://www.ncri.org.uk/areas-of-interest/living-with-beyond-cancer/ 
Dementia friends: https://www.dementiafriends.org.uk/
Frailty: https://pubmed.ncbi.nlm.nih.gov/34782281/

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I. How usual and unusual this servant is, vv1-3 II. The despondence and confidence of the servant, v4. III. The world-wide mission of the servant, vv5-6. IV. The God-assured success of the servant, vv7-12. V. What should we do? Sing for Joy!

I. We need preaching that consoles us with the comfort of God's forgiveness, vv1-2. II. We need preaching that consoles us the coming of God's glory, vv3-5. III. We need preaching that consoles us with the constancy of God's Word, vv6-8. IV. We need preaching that consoles us with the care of God's Shepherd, vv9-11. 

I'm indebted to my Old Testament professor Dr. Ralph Davis for a significant portion of this outline, explanation, and illustrations.