The Johns Hopkins Division of Geriatric Medicine & Gerontology

Photograph of Seniors

DNA model

Photograph of HEALTH PROFESSIONAL

Welcome to Research in the Division of Geriatric Medicine and Gerontology

The research performed within the Division of Geriatric Medicne and Gerontology is translational across a number of paths: between and from population-based studies identifying individuals at risk for rapid decline (for studies on interventions or not to intervene) and multisystem and moderating contributors to outcomes; to laboratory and clinical studies identifying biomarker, phenotype or genetic covariates (for diagnostics, prognostics or to be used to improve future research), modifiers and mediators; to genetic and molecular studies identifying pathways/targets (for clinical trials and pharmacotherapy); to laboratory and clinical studies establishing the evidence-base for clinical care. The research is organized in groups which include basic, clinical and population-based researchers.

Research Programs, Centers, and Groups

There are several research programs and centers within the Division of Geriatric Medicine. They include:

The Center on Aging and Health (COAH) East and West campuses
The Johns Hopkins (Claude D. Pepper)Older Americans Independence Center
The Biology of Aging Programs

There are nine research groups in the Division which include the following: (Click on the link to read more about each group)

Biology of Frailty Research
Energy Metabolism Research
Patient Oriented Research and Clinical Trials
Cardiovascular Research
Geriatric-Oncology Research
Geriatric-Immunology/Inflammation Research
Geriatric-Neuropsychiatric Research
Musculoskeletal Research
Pulmonary Research

Biology of Frailty Research Group

Studies within this group range from molecular and cellular approaches to understanding the mechanisms, risk factors and pathophysiology of frailty; to functional laboratory assessments of human volunteers; to epidemiologic investigations and clinical intervention trials [1-8]. The major aims of this group are t (1) determine genetic influences on age-related decline in strength; (2) develop and validate physiotypes of frailty by integrating cellular and clinical level phenomena into Integrative Biological Models; (3) investigate HPA axis dysfunctioning (either hypo- or hyper-activity) in frailty; (4) determine the associations of the trajectory patterns of dysregulation of multiple systems including immune, DHEA-S, IGF-1, and IL-6 over time and with the development of frailty; (5) develop and characterize mouse models of frailty; (6) characterize NFkB and inflammatory dysregulation in frailty; (7) refine phenotype(s) of frailty. Funding for this group includes

Faculty: Brock Beamer, Neal Fedarko, Linda Fried, Sean Leng, Cindy Roy, and Jeremy Walston.

Energy Metabolism Research Group

Studies within this group range from clinical and laboratory-based studies of energy metabolism and requirements in normal aging and disease to molecular and molecular-epidemiologic approaches to identify the genetic basis of diabetes and obesity; to intervention investigations of exercise and weight management strategies [8-17]. Specific projects initiated by faculty and trainees include studies (1) to determine rates of energy metabolism in subjects with pressure ulcers and in frailty, and whether nutritional supplementation alters metabolism or outcome; (2) to investigate the molecular and genetic basis of energy expenditure and related metabolic diseases such as obesity and diabetes; (3) to develop new molecular approaches to provide safe and effective therapy for older diabetics through studies of cells, tissue and human volunteers; (4) to perform epidemiologic analyses of populations of older adults, correlating incidence and prevalence of diabetes, obesity, body fat distribution, and mortality; (5) to identify changes in molecular energy pathways in skeletal muscle through NMR analysis; and (6) to design novel approaches to exercise which can reduce body fat, decrease fatigue and positively affect risk factors for cardiovascular and other metabolic diseases.

Faculty: D. Abernethy, B. Beamer, C. Christmas, W. Greenough R. Spencer, J. Walston, C. Weiss;

Patient Oriented Research and Clinical Trials Group

Studies within this group range from analyses of causes and consequences of disability, frailty and specific diseases using population-based studies (e.g., the Women's Health and Aging Study, the Cardiovascular Health Study, the Salisbury Eye Evaluation Study, and NHANES); to clinic- and unit-based studies assessing new approaches for common geriatrics problems in vulnerable patients (e.g., wound care and infections among nursing home patients); to studies of systems of care (e.g., transitions in care, Hopkins Home Hospital and Hopkins ElderPlus, a PACE replication site); to studies designed to improve outcomes through medical management strategies for common diseases of older adults (e.g., asthma, congestive heart failure, dementia, and polypharmacy issues) [18-26]. The major aims of this research group are: (1) to investigate opportunities for the prevention of major adverse health outcomes associated with aging, including disability, frailty, cardiovascular diseases, and falls, through population-based and clinical studies; (2) to evaluate improved health care delivery for disabled adults; (3) to design and evaluate innovative care delivery models for older multimorbid, and functionally impaired adults; and (4) to design and carry out clinical research projects to define and improve outcomes associated with common conditions and diseases (e.g., pressure ulcers, anemia and urinary incontinence) and multimorbidity among institutionalized and community-dwelling older adults. Within this large research group there are four subgroups performing translational research. These include Health Disparity Research; Aging, Function and Health; Long Term Care; and Health Care Transitions.

Faculty: K. Bandeen-Roche, J. Barron, M. Bellantoni, C. Boyd, P. Chaves, C. Durso, T. Finucane. L. Fried, B. Leff, M. McNabney, E. Simonsick, C. Simpson, E. Tan, J. Wolff, Q-L. Xue

Cardiovascular Research Group

Studies within this group range from molecular and physiologic studies of cells and subcellular organelles to understand myocyte and endothelial cell function; to clinical laboratory investigations of cardiovascular function in intact animals and human volunteers; to clinical intervention trials and epidemiologic investigations [27-40]. The major aims of this group are: (1) to delineate the mechanisms involved in excitation-contraction coupling and of energy-yielding oxidative pathways in cardiac muscle; (2) to identify changes with aging in the chemical nature and sequence of intermediate reactions controlling the movement of ions through ionic channels and pumps present in myocardium (specifically with respect to how the affinity, capacity and selectivity of ion translocation through membranes are affected by age and disease); (3) to identify the mechanisms that govern normal and abnormal function of vascular smooth muscle and endothelial cells across the life span both de novo and in response to drugs; (4) to establish the potentials and limitations of new therapeutic approaches for heart disease such as gene transfer techniques; (5) to identify age-related changes that occur within the cardiovascular system and the mechanisms underlying these changes; (6) to determine how age interacts with chronic disease states and affects myocardial function and structure; (7) to define the effects of exercise as a treatment for patients with advanced ischemic heart disease; and (8) to identify risk factors for hospitalization among heart failure patients (the leading cause of hospitalization among older adults) and develop interventions to decrease the morbidity associated with congestive heart failure.

Faculty: D. Abernethy, W. Greenough, E. Lakatta, R. Spencer, R. Varadhan G.B. Windham.

Geriatric-Oncology Research Group

Studies within this group are translational, ranging from bench research to clinical trials [41-54]. The major aims of this group are: (1) to identify variations in oncogenes which affect the progression of lymphoma; (2) to identify cytogenetic and molecular genetic markers predictive of cancer among hyperplastic cells; (3) to define mechanisms of chemotherapy resistance among neoplastic cells; (4) determine the utility of novel serum-based markers for detection and response to treatment in breast, prostate and ovarian cancer; (5) to identify new agents for treating cancer through in vitro testing; (6) to study novel chemotherapeutic agents in phase I trials for common malignancies of older adults (e.g., breast cancer and prostate cancer); and (7) to perform multi-center trials of phase III chemotherapy among older adults with cancer.

Faculty: R. Bennett, I. Browner, W. Ershler. N. Fedarko, G. Shapiro,

Geriatric-Immunology/Inflammation Research Group

This research group has arisen as an outgrowth of the Biology of Frailty Research Group. Observations by those researchers of altered inflammatory markers and apparent dysregulation in immune cell function associated with frailty [3, 5, 7, 8, 55-60] led to the development of close ties with experts in immune research. Similar observations of altered inflammatory status (termed “microinflammation” or “inflammaging” [61, 62]) in age-related cardiovascular and neurological disease as well as in diabetes and obesity [63-76], gave further impetus to formalizing a multidisciplinary Geriatric-Immunology research group. This group includes faculty from the Division of Geriatric Medicine and Gerontology, Division of Immunology and the NIA Gerontology Research Center. Studies within this group are translational from a bench to bed and back again perspective. The major aims of this group are: (1) to characterize age-related changes in immune cell type and function; (2) to measure contributory genotypes to asthma susceptibility; (3) to determine chemokine and chemokine receptor phenotypic profiles in immune-stimulated clinical studies; (4) to analyze the robustness of cytokine and cytokine receptor signal transduction in isolated immune cells in normal aging and in disease; (5) to characterize inflammatory response and resolution in influenza-challenged subjects; and (6) to test efficacy of influenza immunization in frail older adults.

Faculty: N.F. Adkinson, B. Bochner, V. Casolaro, S. Leng, D. Taub, J. Walston

Geriatric-Neuropsychiatric Research Group

Studies in this group range from laboratory-based investigations of effects of disease and drugs on brain function among animals and human volunteers; to clinical investigations of new vaccine and drug therapies for the prevention and treatment of Alzheimer's disease; to the development of strategies to improve the care of older adults with dementia; to rehabilitation strategies following stroke [77-88]. The major aims of this research group are: (1) to identify the effects of CNS-active drugs on brain function through PET scan imaging studies; (2) to identify new treatments or a combination of treatments to prevent or slow the progression of Alzheimer's disease; (3) to identify risk factors and early signs of cognitive decline and Alzheimer's disease prospectively among participants of the ADRC, WHAS and BLSA studies; (4) to define new ways of caring for demented patients in institutional settings; and (5) to investigate issues in end-of-life care among patients with advanced dementia.

Faculty: D. Abernethy, M. Carlson, T. Finucane, L. Fried, B. Leff, E. Oh, S. Yasar

Musculoskeletal Research Group

Studies within this group range from molecular and cellular analyses of specimens from patients with metabolic bone disease (e.g., osteogenesis imperfecta and osteoporosis); to basic laboratory studies of myocytes; to clinical studies to identify risk factors for suboptimal outcomes following hip fracture; to intervention trials to improve treatment of patients with osteoporosis or following hip fracture [89-99]. The major aims of this group are: (1) to identity potential candidate genes responsible for accelerated or premature osteoporosis; (2) to characterize the cell biology and pathophysiological consequences associated with bone collagen genes in osteogenesis imperfecta (0I) in humans and in a murine model of 0I; (3) to investigate the iatropic effects of bisphosphonates in certain subsets of elderly at risk patients; (4) to identify biomarkers for bone loss and bone formation; (5) to study the biophysical properties of cartilage in vivo and in vitro using NMR analysis; and (6) to identify risk factors (e.g., depression and noncompliance with osteoporosis treatment) associated with suboptimal outcomes following hip fracture and develop intervention strategies in this regard.

Faculty: C. Christmas, N. Fedarko, S. Ling, S. Mears, R. Spencer

Pulmonary Research Group

This is a nascent Research Group comprised of translational researchers with shared interests in sleep apnea and chronically ventilated patients, and asthma disparities in older adults. Studies within this group range from molecular and cellular studies to identify the basis of allergic disease and pulmonary function; to clinical laboratory studies of human volunteers in response to allergens and/or new treatments and vaccines; to clinical intervention trials investigating new therapeutic approaches to treat allergic and pulmonary diseases; to descriptive and interventional studies of chronically ventilated patients [9, 25, 100-104]. The major aims of this group are (1) to determine the cardiovascular consequences of sleep apnea, (2) to determine the metabolic sequelae of sleep apnea; (3) to investigate the mechanisms involved in the association of adipokines with sleep apnea in young and old adults; (4) to establish new therapeutic approaches for treating and preventing sleep apnea; (5) to develop new vaccines to prevent respiratory illnesses; (6) to describe issues in caring for chronically ventilated patients including end-of-life and ethical issues; and (7) to develop new approaches for weaning chronically-ventilated patients. Additionally, there is developing research on patient-oriented approaches to improving asthma recognition and treatment in African-American older adults.

Faculty: C. Durso, T. Finucane, N. Punjabi, A. Schwartz, C. Simpson, P. Smith

References:

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