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PALS Study: Physical Performance Across the LifeSpan

The Physical Performance Across the Lifespan (PALS) Study is a collaboration between the Duke Pepper Center and the MURDOCK Study. Briefly, the PALS Study explores dimensions of health, function, behavior, and physiologic characteristics in a cohort of 1,000 adults aged 30-90+, with oversampling across the older decades. The PALS study includes a comprehensive assessment battery at two time-points: baseline and 2-year follow-up, which concluded in 2018.

The PALS Data Use Request Form streamlines requests for PALS data and facilitates communication between investigators and PALS/Pepper leadership. In addition to specifying what information is needed to make a request, a standardized description of the PALS cohort and publication-related details are provided.

[Data Request Form]

The PALS Data Dictionary is a reference for variable names, field types, and field descriptions for the current subsets of PALS data: Baseline questionnaire, Montreal Cognitive Assessment (MoCA) test battery, Health Self-assessment questionnaire, Physical performance tests, Two-year follow-up questionnaire, Metabolomics assays, and Accelerometer-derived variables.

[PALS Data Dictionary]

The PALS Codebook is a comprehensive overview of PALS data and associated MURDOCK data, including statistical summaries and graphs. The Codebook also includes an abbreviated version of the PALS data dictionary.

NOTE: The PALS Codebook will be updated as new data become available. Always check the revision date on the Codebook title page to insure you have the most recent reference.

[PALS Codebook]

Physical Measures Core (PMC)

The Physical Measures Core serves as the central resource for Center investigators seeking advice, training, laboratory access, and equipment for valid, sensitive, and reliable measures. The Physical Measures Core provides highly integrated, customized support to investigators supported by our Research Education Component, Pilot/Exploratory Studies Core, Externally Funded Projects, and the larger Duke Community engaged by the Duke Older Americans Independence Center.

AIMS of the Physical Measures Core
  1. Expertise and Consultation: To provide centralized expertise available for consultation on the measurement of reserve and resilience
  2. Development and Standardization: To develop measurement protocols and train personnel in administration and data collection
  3. Innovation and Standardization: To identify gaps in resiliency measures and develop or adapt innovative new measurement approaches across the adult lifespan for related outcomes

CORE LEADERS
Miriam Morey, PhD
Professor of Medicine in the Division of Geriatrics

The general focus of my work is exercise and aging. A number of studies examine how system-wide impairments serve as preclinical indicators of disability and overall decline in the quality of life of older adults. Ongoing studies examine the role of exercise training in attenuation or reversal of functional decline and examination of the effectiveness of different methods of physical activity counseling for home-based exercise.

Katherine S. Hall, PhD
Assistant Professor in the Division of Geriatrics, Duke Pepper Scholar, and Investigator in the Durham VA GRECC

My research is focused on developing evidence-based physical activity interventions for older adults with an eye to preserving functional independence and quality of life. I am particularly interested in developing exercise programs to promote physical and psychological well-being among older veterans with posttraumatic stress disorder (PTSD).


CURRENT SUPPORTED PROJECTS

Emerging Discovery/Health Innovation Projects
Co-sponsored with the Duke Institute for Health Innovation

Sheng Luo, PhD (Biostatistics & Bioinformatics)
Accelerometer-based physical activity features and associations with physical function in older adults.

  1. The clinical utility of the information embedded in the rich times-series data captured by accelerometers has been greatly understudied among older adults. Novel approaches to analyzing these data suggest that microscale features of complexity (e.g., active and sedentary bouts) and fragmentation metrics (e.g., transitions between activity and sedentary states) may be linked with measures of health and functional status. We propose to examine the association between novel physical activity features such as complexity and fragmentation, and physical function in 961 participants enrolled in the PALS Longitudinal Cohort Study. Aim 1: Characterize physical activity features (e.g., total volume, time related features, fragmentation metrics, intradaily variability) derived from minute-level actigraphy data and examine the association with physical function at baseline. Aim 2: Explore predictive models of change in physical activity features and changes in physical function over 2 years. This study provides a novel clinical application for wearable accelerometers, and seeks to explore the potential for accelerometry as a non-invasive biomarker of physiologic reserve, aging, and functional health. [PALS Study Description]

Lisa Hobson-Webb, MD (Neurology)
Development of two new tools to measure muscle reserve and function in older adults using electrical impedance myography (EIM) and quantitative muscle ultrasound (QMUS)

  1. Validation of electrical impedance myography (EIM) and quantitative muscle ultrasound (QMUS) as reliable, valid markers of function and muscle mass will provide inexpensive and non-invasive biomarkers for studies in physical resilience and rehabilitation. EIM and QMUS provide direct information about muscle structure and integrity. These two promising technologies offer an inexpensive, non-invasive alternative to BodPod or DEXA methods. This study is mid-way through recruitment. Preliminary data suggest a high correlation of a simple-to-use bioelectrical impedance method with muscle ultrasound and muscle isokinetic testing to examine skeletal muscle quality and function, respectively. Importantly, there were also positive correlations between the bioelectrical impedance device and functional tasks. This is a promising inexpensive and non-invasive method to measure muscle quality and to indicate muscle function potential. [Journal Link]

Jaime Hughes, PhD (Population Health Sciences)
Smart technologies to monitor/modify sleep-activity behaviors in older adults

  1. Project Overview. Smart home technologies are increasingly being used to support older adults’ functional capacity and manage daily health behaviors. However, no existing technologies actively monitor or modify sleep-activity behaviors, thereby missing an opportunity to address these upstream determinants of functional decline during both times of health and recovery. The proposed work aims to develop and evaluate the feasibility of sensor-triggered ecological momentary assessment (EMA) diaries to monitor older adults’ sleep-activity behaviors.

Kevin Caves, ME (Medicine and Biomedical Engineering)
Integrating digital technology in the development of two new tools to measure mobility in older adults

  1. Project Overview. Aim 1: Develop a new activity monitoring device and analysis software to assess and analyze mobility in older adults in inpatient settings. Aim 2: Validate walking velocity measured by the Gaitbox, a compact digital device developed by Dr. Caves that automatically records, stores, and displays walking speed. This project is newly awarded and aims to respond to technology needs identified by Pepper investigators to advance the integration of technology in their work.

Marty Woldorff, PhD (Neuroscience and Neurobiology)
Assessing postoperative neurocognitive resilience in older adults using scalp EEG

  1. This project is testing the feasibility and usability of a LiveAmp EEG Amplifier device in the OR setting. Trajectories of neurocognitive resilience will be examined using resting-state 32-channel EEG collected preoperatively, intraoperatively, and postoperatively in older adults across three funded resiliency-related projects. This project is newly awarded and will enhance our ability to advance innovations in resiliency measurement.

Research Education Component
Nazema Siddiqui, MD Effects of aging and the urinary microbiome on recurrent urinary tract infections
Corey Simon, DPT, PhD Physical resilience to pain with activity influences among seniors
Tony Sung, MD High intensity interval training to improve pre- and peri-transplant function and outcomes

Pilot/Exploratory Studies Core
David Bartlett, PhD Exercise training to promote resilience in chronic lymphocytic leukemia in older patients by enhancing physical and immunological reserve
Anna Mae Diehl, MD Aging Effects on Hepatocyte Reprogramming and Liver Repair
Charity Oyedeji, MD Focused geriatric assessment and biomarkers to determine physiologic resilience in older adults with sickle cell disease
Mihai Podgoreanu, MD Metabolic modifiers and rehabilitation phenotypes in older adults subjected to extracorporeal support


FACULTY RESOURCES

Pepper researchers have an extraordinary opportunity for collaboration across Medical Center and University departments. These affiliated faculty members currently conduct interdisciplinary research with the Physical Measures Core.


Miriam Morey, PhD
Epidemiology/Exercise Science

Expertise and Access in assessment of:
Physical function: Performance-based and Self-report
Physical activity: Performance-based and Self-report
Services available
Portable telemetric oxygen uptake analyzer (Cosmed)
Activity tracking devices (SAM, Garmin)
Physical performance testing protocols & equipment


Katherine S. Hall, PhD
Exercise Psychology/Behavioral Medicine

Expertise and Access in assessment of:
Accelerometry
Psycho-social measures of behavior change
Physical activity: Performance-based and Self-report
Services available
Physical activity/sedentary monitoring (Actigraph)
Activity tracker analytic software (ActiLife)
Physical performance testing protocols & equipment
Psychosocial assessments/Health behavior theories


Amy M. Pastva, PT, MA, PhD
Physical Therapy/Exercise Physiology/Cell-Molecular Physiology/Biology

Expertise and Access in assessment of:
Translational science
Rodent models of disease, rodent exercise – young and aged mice
Cardiovascular and pulmonary fitness and function
Performance-based measures of physical status and function;
Rehabilitation and care transitions for medically complex patients
(acute, outpatient, home health)
Services available
Pulmonary function testing
Portable EKG
Physical status/Function (strength, mobility, cardiovascular, balance)/ Retraining equipment
Muscle physiology
Rodent: Treadmill exercise equipment


Avshalom Caspi, PhD
Psychologist/Neuroscientist

Expertise and Access in assessment of:
Psychiatric genetics
Mental health and personality
Longitudinal trajectories of mental health and predictors
Services available
Psychosocial measures of stress resilience
Genotyping
Personality assessment
Life-course epidemiology


Cathleen Colón-Emeric, MD, MHS
Geriatrician

Expertise and Access in assessment of:
Outcome measurement using administrative datasets and economic analyses
Measures of care delivery
Development of measures of reserve and resilience
Services available
Falls history/Falls risk assessments
Fall prevention strategies
Tele-technology


Deborah Gold, PhD
Sociologist

Expertise and Access in assessment of:
Psychosocial factors; Quality of life
Osteoporosis; Chronic illness; Pain
Services available
Measurement of quality of life, pain, psychological well-being, health behavior theories, self-efficacy


Gerda Fillenbaum, PhD
Gerontologist

Expertise and Access in assessment of:
Cognitive function; Neuropsychology measures
Health service use; Functional status
Services available
Measurement of functional status, comorbidity, quality of life, cognitive status, ADLs, depression


Heather E. Whitson, MD, MHS
Geriatrician

Expertise and Access in assessment of:
Cognition
Sensorial assessments
Services available
Measurement of sensorial impairments (cognitive, visual, pain, balance)
Comorbidity assessments


Helen Hoenig, MD
Physical Medicine and Rehabilitation

Expertise and Access in assessment of:
Performance-based measures of function using tele-technology
(gait, balance, motor coordination, ADLs)
GPS technology
Clinical measurement of physical, cognitive, I/ADLs
Services available
Functional retraining equipment
Tele-technology
Rehabilitation training equipment
Assistive technology/devices


Kevin Caves, BSME
Biomedical Engineer

Expertise and Access in assessment of:
Assistive technology; Technology and design for people with disabilities; Rehabilitation engineering
GPS/Spatial assessments
Design and fabrication of clinical and research tools
Integration of micro controllers and sensors
Software specification and development
Services available
Fabrication facilities (build and prototype custom devices)
3D printers
Assistive technology/devices
Remote monitoring of activities/physical performance
Fabrication of mechanical and electronic devices
Creation of software


S. Nicole Hastings, MD
Geriatrician

Expertise and Access in assessment of:
Cognition
Pharmacotherapy and comorbidity
Health service use
Services available
Assessment of healthcare utilization
Medication exposure/Prescribing practices


Terrie E. Moffitt, PhD
Psychologist/Neuroscientist

Expertise and Access in assessment of:
Mental health and bio-behavioral risk factors
Longitudinal trajectories of mental health and predictors
Gene-environment interplay and psychological health
Services available
Behavioral genetics
Mental health epidemiology
Psychological assessments


William E. Kraus, MD
Cardiologist

Expertise and Access in assessment of:
Cardiopulmonary exercise testing
Metabolic testing (RMR; OGTT, IVGTT)
Anthropometry assessments
Muscle molecular physiology
Integrative physiology
Services available
Body composition (Bod Pod, DXA)
Exercise physiology testing: CPET and strength testing; 6 MW
Metabolic testing (RMR; OGTT; IVGTT; infusion studies)
Physical activity tracking devices (RT3, Actigraph)
Mobile Health devices
Skeletal muscle biopsies
Phlebotomy
Clinical coordinator time for exercise, drug interaction studies
CV physical exam and EKG


RECENT PUBLICATIONS

Hall KS, Hyde ET, Bassett DR, Carlson S, Carnethon M, Ekelund U, Evenson K, Galuska D, Kraus WE, Lee I, Matthews C, Omura J, Paluch A, Thomas W, Fulton J. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int J Behav Nutr Phys Act. 17(78). PMCID:7305604

Fillenbaum GG, Sloane R, Burchett BM, Hall K, Pieper CF, Whitson HE, Colón-Emeric CS. Determinants of Maintenance and Recovery of Function in a Representative Older Community-Resident Biracial Sample. J Am Med Dir Assoc. 2020 Feb 6. pii: S1525-8610(19)30891-6. Minority Research Publication PMID:32037299 PMCID in process Institutional access

Hall KS, Morey MC, Bosworth HB, Beckham JC, Pebole MM, Sloane R, Pieper CF. Pilot randomized controlled trial of exercise training for older veterans with PTSD. J Behav Med. 2019 Jul 1. PMCID:6938572 Available 08/01/2021

Whitson HE, Cohen HJ, Schmader KE, Morey MC, Kuchel G, Colon-Emeric CS. Physical Resilience: Not Simply the Opposite of Frailty. J Am Geriatr Soc. 2018 Mar 25. PMCID:6157007

Hall KS, Cohen HJ, Pieper CF, Fillenbaum GG, Kraus WE, Huffman KM, Cornish M, Shiloh A, Flynn C, Sloane R, Newby LK, Morey MC. Physical performance across the adult lifespan: correlates with age and physical activity. J Gerontol A Biol Sci Med Sci 2017 Apr;72(4):572-578. PMCID:6075535

Whitson HE, Duan-Porter W, Schmader KE, Morey MC, Cohen HJ, Colón-Emeric CS. Physical Resilience in Older Adults: Systematic Review and Development of an Emerging Construct. J Gerontol A Biol Sci Med Sci 2016 Apr;71(4):489-495. PMCID:5014191

Research Education Component (REC)

The Research Education Component (REC) recognizes that training in aging research faces several unique challenges, including difficulties recruiting geriatricians into research careers and a lack of training in the principles of aging research by other medical disciplines.

The objective of the Research Education Component will be to develop the next generation of researchers who will become leaders in integrating basic science and clinical insights into innovative interventions promoting reserve and resilience in late life.

AIMS of the Research Education Component
  1. Coordinate delivery of Aging research curriculum to early investigators across the University
  2. Provide a structure for individualized Aging and Research mentorship at Duke
  3. Evaluate the effectiveness of Aging research across the Duke OAIC

CORE LEADERS
Cathleen Colón-Emeric, MD, MHS
Professor of Medicine
Chief, Division of Geriatrics
Associate Director-Clinical at the Durham VA Geriatrics Research Education and Clinical Center (GRECC), Adjunct Faculty at the Duke School of Nursing and Duke Clinical Research Institute

Current research focuses on the epidemiology, prediction, and prevention of osteoporotic fractures in elderly persons, and in improving the quality of care delivered to residents in skilled nursing facilities. Ongoing projects include a large, administrative database study of osteoporosis screening in men, a randomized trial of different staff education strategies to improve fall prevention in nursing homes, and several clinical demonstration projects. In 2017, Dr Colón-Emeric received the Clinical Sciences Research Mentoring Award from the Department of Medicine, and in 2018 she was appointed Associate Dean for Research Mentoring for the School of Medicine.

Kimberly Johnson, MD
Associate Professor of Medicine
Associate Director of the CTSA KL-2 program

Dr Johnson leads the Duke Center for REsearch to AdvanCe Healthcare Equity (REACH), where researchers study the effect of a clinician communication coaching intervention—teaching empathic skills and eliciting participatory behaviors—on the quality of communication in cardiology encounters with African American patients; test the use of a mobile app for African American patients receiving palliative care in the ICU and their families to self-report needs, obtain information about patient/family needs, and access decisional support; and develop and pilot test an implicit bias training intervention for providers.

2020 PEPPER CAREER DEVELOPMENT AWARDS
Brian Andonian, MD (Division of Rheumatology and Immunology/Dept. of Medicine)
Accelerated metabolic aging in rheumatoid arthritis immune cells and skeletal muscle: A pilot study

    1. Rheumatoid arthritis (RA) is a model disease for studying premature aging. Persons with RA suffer from
      early aging-associated metabolic comorbidities, and are at risk for low resilience, a decreased ability to resist
      functional decline. Mitochondrial function in RA and aging is a marker of cellular reserve, and is thus important for preserving resilience. RA and aged immune cells have abnormal mitochondrial function, which coincide with immune dysregulation. Skeletal muscle in both RA and aging is also marked by altered mitochondria. The pilot study will investigate whether dysfunction of mitochondria, the cellular metabolic “engine,” connects RA peripheral helper T-cells, macrophages and skeletal muscle abnormalities. Objectives are twofold:
      1) to determine whether RA T cell, macrophage and skeletal muscle mitochondrial function abnormalities are associated, and
      2) to determine associations of exercise training on RA immune cell and skeletal muscle mitochondria.

Ming-Feng Hsueh, PhD (Dept. of Orthopedic Surgery)
Harness human cartilage repair capability to prevent and reverse osteoarthritis

    1. Humans have a natural cartilage repair response which is high in the ankle, intermediate in the knee and low in hip cartilages. This repair response in humans is highly associated with the microRNAs used by salamanders and other limb regenerating animals to regenerate whole limbs. This project will evaluate the ability of microRNAs as a therapy to improve cartilage resilience to injury in vitro, and build the foundation for further evaluation in animals for microRNAs’ ability to prevent and reverse the most prevalent of age-related diseases, osteoarthritis, for which we currently have no disease-modifying treatments.

Daniel C. Parker, MD (Division of Geriatrics/Dept. of Medicine)
Identification of biomarkers of cognitive resilience in the Duke Performance Across the LifeSpan (PALS) Study

    1. Cognitive resilience is defined as preserved cognitive function in the setting of “stressors” that adversely
      affect cognitive function; it may explain – in part – the heterogeneity of cognitive function in older adults who
      otherwise appear clinically similar, especially with respect to risk factors for Alzheimer’s disease and related
      dementias (ADRD). Blood-based biomarkers of cognitive resilience would be useful to identify protective factors and test resilience-building interventions that preserve cognitive function in the setting of these stressors; currently, no such biomarkers exist. Building on previous work, I propose to develop a measure of cognitive resilience in a subset of community-dwelling older adults from the Duke Performance Across the LifeSpan (PALS; N=297) study with repeat cognitive testing over 3 years. Using this measure, I will identify biomarkers reflecting dysregulation in “Hallmarks of Aging” pathways that are predictive of cognitive resilience.

2018 PEPPER CAREER DEVELOPMENT AWARDS
Nazema Siddiqui, MD (Dept. of Obstetrics and Gynecology)
Effects of aging and the urinary microbiome on recurrent urinary tract infections

    1. Specific interests include: 1) pathophysiology of overactive bladder with particular emphasis on epigenetic mechanisms; and 2) studying the urinary microbiome with aging and in women with recurrent urinary tract infection. Additional interests include clinical outcomes research after surgery for prolapse and other pelvic floor disorders.

Corey Simon, DPT, PhD (Dept. of Orthopedic Surgery)
Physical Resilience to Pain with Activity Influences among Seniors (PRAISE) – Feasibility Study

    1. Research focuses on development of tailored multi-factorial interventions that prevent disability among older adults with low back pain. Low back pain poses a major risk to senior health, as it is the global leader in years lived with disability and strongly associated with mobility disability. However, it is not clear why some older adults with low back pain succumb to mobility disability while others do not. This REC study will determine the feasibility of assessing three factors that may explain mobility disability among older adults with low back pain: pain with activity, fear of movement, and dynamic inflammatory response to movement.

Tony Sung, MD (Division of Hematologic Malignancies and Cellular Therapy/Dept. of Medicine)
High intensity interval training to improve pre- and peri-transplant function and outcomes

    1. Research focuses on strategies to reduce complications of HCT and ranges from preclinical studies using murine models of HCT to Phase 1 and Phase 2 clinical trials. Areas of interest include the role of the microbiota (the trillions of bacteria living in and on our bodies), nutrition, and exercise in modulating HCT outcomes such as graft-versus-host disease (GVHD) and infections.

PREVIOUS PEPPER RESEARCH SCHOLARS

Since its inception, the Duke Pepper Center has produced an impressive portfolio of relevant research and innovations in faculty development. One of its many accomplishments is support and mentoring of numerous promising investigators whose careers focus on relevant aging related research at Duke. In 2009, in recognition of the contributions of these young investigators, career development and pilot project awardees, the Duke Pepper Center established a Duke Pepper Scholars Program.

Previous awardees:

Jason Allen, PhD, Cardiology

Kelli Allen, PhD, General Internal Medicine

Raquel R. Bartz, MD, Anesthesiology

Dan Belsky, PhD, Geriatrics

Beverly Brummett, MD, Medical Psychology

James T. Cavanaugh PT, PhD, Geriatrics

Jessica Chia, MD, Pulmonary, Allergy and Critical Care Medicine

Jennifer Dungan, RN, PhD, School of Nursing

William Michael Foster, PhD, Pulmonary and Critical Care Medicine

Farshid Guilak, PhD, Orthopedic Surgery and Cell Biology

Katherine Hall, PhD, Geriatrics

Rasheeda Hall, MD, Nephrology

Susan Nichole Hastings, MD, Geriatrics

Matthew Hirschey, PhD, Chemistry and Biochemistry

Kim Huffman, MD, Rheumatology and Immunology

Kimberly Johnson, MD, Geriatrics

Lee Jones, PhD, Radiation Oncology

Timothy Koves, PhD, Geriatrics

Richard Lee, MD, Endocrinology and Metabolism

Helen Lum, MD, Geriatrics

David Madden, PhD, Psychiatry and Behaviorial Sciences

Micah McClain, MD, Infectious Diseases

Mehri McKellar, MD, Infectious Diseases

Deborah M. Muoio, PhD, Endocrinology & Metabolomics

Kent Nilsson, MD, Cardiology

Amy Pastva, PhD, Community and Family Medicine

Juliessa Pavon, MD, Geriatrics

Matthew Peterson, PhD, Geriatrics

Thomas Povsic, MD, Cardiology

Jama L. Purser, PT, PhD, Geriatrics

Arati Rao, MD, Medicine

Gregory Sempowski, PhD, Duke Human Vaccine Institute

Svati H. Shah, MD, MHS, Epidemiology, Medical Genomics

Heather E. Whitson, MD, Geriatrics

RECENT PUBLICATIONS

Sung AD, Jauhari S, Siamakpour-Reihani S, Rao AV, Staats J, Chan C, Meyer E, Gadi VK, Nixon AB, Lyu J, Xie J, Bohannon L, Li Z, Hourigan CS, Dillon LW, Wong HY, Shelby R, Diehl L, de Castro C, LeBlanc T, Brander D, Erba H, Galal A, Stefanovic A, Chao N, Rizzieri DA. Microtransplantation in older patients with AML: A pilot study of safety, efficacy and immunologic effects. Am J Hematol. 2020 Jun;95(6):662-671. PMID:32162718 PMCID in process

Hall RK, Cary MP Jr, Washington TR, Colón-Emeric CS. Quality of life in older adults receiving hemodialysis: a qualitative study. Qual Life Res. 2020 Mar;29(3):655-663. PMCID:7028790

Hall RK, Zhou H, Reynolds K, Harrison TN, Bowling CB. A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease. J Gerontol A Biol Sci Med Sci. 2020 Feb 14;75(3):522-528. PMID:31644788 Open access

Pavon JM, Sloane RJ, Pieper CF, Colón-Emeric CS, Cohen HJ, Gallagher D, Hall KS, Morey MC, McCarty M, Hastings SN. Accelerometer-Measured Hospital Physical Activity and Hospital-Acquired Disability in Older Adults. J Am Geriatr Soc. 2020 Feb;68(2):261-265. PMCID:7002200 Available 02/01/2021 Institutional access

Whitson HE, Johnson KS, Sloane R, Cigolle CT, Pieper CF, Landerman L, Hastings SN. Identifying Patterns of Multimorbidity in Older Americans: Application of Latent Class Analysis. J Am Geriatr Soc 2016 Aug;64(8):1668-1673. PMCID:4988894

Johnson KS, Payne R, Kuchibhatla MN. What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area? J Palliat Med. 2016 Feb;19(2):183-189. Minority Research Publication PMCID:4753631

Claude D. Pepper Older Americans Independence Center (OAIC)

To understand and optimize reserve and resilience

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The overall goal of the Duke Claude D. Pepper Older Americans Independence Center (Duke OAIC) is to support research and training that improves the independence of older Americans. Our primary focus is understanding and optimizing reserve and resilience. Our approach is founded on the insight that independence in older adults is related to an individual’s ability to withstand or recover from functional decline following acute or chronic health stressors. Our overall strategy for the OAIC is to serve as a sustained resource to our investigators through a broad range of training and research studies; the goal will be to address knowledge gaps in our focus with an emphasis on translational and interdisciplinary research. We recruit and develop early stage investigators in aging research related to our focus and utilize the substantial strengths of the Duke academic and health system environment to advance our focus.

Our goals are accomplished through the synergistic activities of the Leadership and Administration Core (LAC), Research Education Component (REC), Pilot/Exploratory Studies Core (PESC), and 3 Resource Cores: Molecular Measures Core (MMC), Physical Measures Core (PMC), and Analysis Core (AC).

AIMS of the Duke Pepper Center
  1. To better understand and optimize reserve and resilience in older adults through an integrated research program.
  2. To develop and evaluate new methods that advance the study of reserve and resilience.
  3. To identify and develop the next generation of researchers who will become leaders in aging and geriatrics research related to the Duke OAIC focus.
  4. To support pilot studies through the PESC that acquire information needed to select or design successful, more definitive research studies related to the Duke OAIC focus.
Duke Pepper Center Review Of Longitudinal Studies Demonstrates Association Of Walking With Lower Risk Of All-Cause Mortality, Independent Of Age, Gender, and Weight Status
In a systematic review of seventeen prospective longitudinal studies involving over 30,000 adults, Katherine S. Hall, PhD, and her colleagues found data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. The shape of the dose-response relation is not yet clear. These associations appear to hold across age, gender, and weight status.

[Journal article]

Duke Pepper Center Physical Measures Core (PMC) Co-Leader, Katherine S Hall, PhD Inducted In 2020 Class Of Fellows of the Gerontological Society of America (GSA)
Katherine S Hall, PhD, FGSA is a member of the 2020 Class of Fellows of the GSA, the world’s oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. Her unanimous selection to Fellow status — the highest category of membership — is an acknowledgment of outstanding and continuing work in the field of gerontology. The 2020 Class of Fellows will be honored at the GSA Annual Scientific Meeting in November in Philadelphia.
Dr Hall’s research is focused on developing evidence-based physical activity interventions for older adults with an eye to preserving functional independence and quality of life, with a particularly interest in developing exercise programs to promote physical and psychological well-being among older veterans with posttraumatic stress disorder (PTSD). Congratulations Katherine!
Duke Pepper Center Announces Inaugural 'Pepper Incubator Awards' For Two Researchers
Kathryn Porter Starr, PhD, RD and Seth Cohen, MD, MPH are the inaugural recipients of Pepper Incubator Awards. The award includes seed funding, a consult studio, and access to the multi-dimensional expertise of the Pepper Center Core faculty.
The award will support their collaborative and inter-disciplinary efforts to improve outcomes in older surgical patients by addressing the inter-related problems of dysphagia and inadequate nutrition in the peri-operative period. Dr Starr is a nutrition scientist whose research interests include nutritional vulnerability in older adults and the association of protein intake with physical function and resilience. Dr Cohen is an ENT surgeon whose research interests include quality of life challenges for patients with voice and swallowing problems and the development and implementation of evidence-based treatments to resolve these problems.
Duke Pepper Center Co-Director and Physical Measures Core (PMC) Leader, Miriam Morey, PhD, Receives Prestigious Paul B. Magnuson Award for Outstanding Achievement in Rehabilitation Research and Development from the VA
Miriam Morey, PhD, is the 2020 recipient of the VA Rehabilitation Research and Development Service’s highest honor—the Paul B. Magnuson Award. The honor is presented to a VA RR&D investigator who exemplifies the entrepreneurship, humanitarianism, and dedication to veterans displayed by Dr. Magnuson during his career.
“Dr. Morey’s research is a compelling example of blended clinical and research activities,” said Dr. Jean Beckham, co-chair for the research and development committee at the Durham VAMC. “Her clinical demonstration program, Gerofit, has provided robust improvements to aging Veterans by increasing their physical fitness, functional status, and well-being.”
Congratulations Miriam!

[Read award citation]

A Sample Of Duke Pepper Center Research Presentations at 2020 OAIC Nat'l Virtual Meeting
Heather Whitson, MD, MHS, Director of the Duke Center for the Study of Aging and Co-Leader of the Pilot/Exploratory Studies Core moderated a symposium on sensory loss and comorbidity. Presenters reviewed a sensory domain of health and its impact on aging outcomes and mechanisms, including suggestions for measures and biomarkers related to that domain.
A paper by Daniel Parker, MD on age-related adverse inflammatory and metabolic changes was included in a session on high-impact publications of 2019.

[Whitson presentation PDF]

[Parker presentation PDF]

Duke Pepper Center Researchers Rasheeda Hall, MD, MBA, MHS, and Barrett Bowling, MD, MSPH, Develop Discordant Index For Older Adults With Chronic Kidney Disease
Rasheeda Hall, MD, MBA, MHS, is the lead author of a recent retrospective cohort study to develop a CKD-Discordance Index using electronic health records to improve recognition of discordance. Discordant conditions are comorbid conditions such as heart failure, dementia, or cancer, with treatment recommendations that potentially complicate CKD management. This CKD-Discordance Index may prove to be useful in both population health management and clinical practice for identifying older adults with CKD-discordant conditions at increased risk for hospitalizations, ED visits, and mortality. C Barrett Bowling, MD, MSPH, Associate Professor of Medicine, is the senior author.

[Read article]

Duke Pepper Center Physical Measures Core (PMC) Researcher, Charity Oyedeji, MD, Receives 2019 Maddox Award To Support Young Researchers
Charity Oyedeji, MD, is 1 of 2 Maddox Award winners for 2019. These prestigious annual awards support the academic endeavors of young and aspiring investigators. Dr Oyedeji is studying the relationship of biomarkers of inflammation, coagulation, and longevity to measures of resilience in older adults with sickle cell disease after hospitalization.
The award is named for the late Dr. George L. Maddox, a noted gerontologist and former director of Duke University’s Center for the Study of Aging and Human Development.

[View Dr Oyedeji’s Presentation at ASH Annual Meeting December 2019]

Duke Pepper Center Physical Measures Core (PMC) Researcher, David Bartlett, PhD, Receives 2020 ASH Scholar Award by the American Society of Hematology (ASH)
David Bartlett, PhD, has been selected to receive a $150,000 clinical-junior-faculty-level 2020 ASH Scholar Award by the American Society of Hematology (ASH) to study the underlying mechanisms and clinical usefulness of exercise training on the immune system of older patients with chronic lymphocytic leukemia (CLL). These scholars conduct basic, translational, and clinical research that furthers the understanding and treatment of blood disorders.
Data Integration Working Group (DIWG) Monthly (Cancelled until Summer 2020)
The Duke Pepper Data Integration Working Group meets the 4th Thursday of each month. The DIWG is open to members of the Duke community and is a wonderful inlet for individuals who want to learn more about the resources and opportunities of the Duke Pepper Center.
When: Thursdays, 9:30-11:00am
Where: Conference Room 3512 Blue Zone, Duke Clinics

Charlotte Observer Article Features Duke Pepper Center Research in MURDOCK Study
The Charlotte Observer recently featured the Duke Pepper Center’s PALS (Physical Performance Across the Life-Span) study in an in-depth article about the broader MURDOCK Study and the North Carolina Research Campus in Kannapolis, NC. A video accompanying the article illustrates some of the physical skills tests for participants and features a 97-year old woman who did 11 sit-to-stands in 30 seconds!

[Read more]

Duke Pepper Center Physical Measures Core Actigraphy Workshop Attracts Researchers Across The School Of Medicine For Insights Into Activity Measurement In Older Adults
Participants from various disciplines in the School of Medicine gathered in Trent Semans CHE to learn more about outcome selection and data processing as Katherine Hall, PhD, from the Duke Pepper Center Physical Measures Core led a hands-on workshop for clinical researchers interested in using the Actigraph-TM- accelerometer, a specific brand of research-grade device, to assess physical activity in older populations.

Pilot Study Of Exercise Training For Older Vets with PTSD Shows Clinical Improvement Following Supervised Group-Based Exercise In Warrior Wellness Study By Duke Pepper Research Team BREAKING: Duke School Of Medicine News Article Features Author and Participant Interviews
Katherine S. Hall, PhD, and her colleagues published the results of the Warrior Wellness Study, a randomized controlled exercise trial for older veterans with PTSD. Clinically significant improvements in PTSD and related conditions were observed following exercise. This group-based exercise program could be expanded and implemented into clinical practice to improve post-traumatic resilience and achieve physical and psychological outcomes in older veterans.

[PubMed]

[Journals of Gerontology: Series A article]

[Duke SOM News Article]

Duke Pepper Center Physical Measures Core (PMC) Researcher, Amy Pastva, PT, MA, PhD, Named Assistant Director in Duke Health Center for Interprofessional Education and Care
Amy Pastva, PT, MA, PhD, has been named 1 of 4 Assistant Directors in the new Duke Health Center for Interprofessional Education and Care (aka IPEC Center). The ADs will work with the Center director, Mitch Heflin, the Advisory Committee, and their respective professions to continue the work of building the Center and its programs. Focus areas of the IPEC Center will include preclinical and clinical education, faculty development, evaluation and scholarship. Congratulations Amy!
Duke Pepper Researchers Part Of International Team To Find Association Between Slow Gait Speed At Age 45 And Measures of Accelerated Aging In Several Additional Domains of Function BREAKING: WRAL News 5 Story: Interview With First Author Line Rasmussen, PhD
Terrie Moffitt, PhD, Harvey Cohen, MD, and Miriam Morey, PhD, were part of an international team that found slower gait speed at age 45 is associated with smaller brain volume, older facial appearance, and poorer physical function, in addition to other measures of aging. Data from 904 participants in the Dunedin Study, a longitudinal cohort survey in New Zealand, also show that those with poor neurocognitive functioning as early as age 3 years had slower gait in midlife.
Stephanie Studenski, MD, MPH, discusses research implications and directions for clinical interventions based on these findings.

[JAMA Open Access PDF]

[Studenski Commentary]

[WRAL News 5 Story October 30, 2019]

New York Times Features Duke Pepper Center Researchers and 10-Year Legacy Effects of Exercise on Cardio-Metabolic Health Parameters
Duke Pepper researchers William Kraus, MD and Kim Huffman, MD, PhD, from the Molecular Measures Core, are among the authors of a study that looked at the legacy effects of exercise training interventions in participants from the STRRIDE (Studies Targeting Risk Reduction Interventions through Defined Exercise) protocol. Their research appears in the April issue of Frontiers of Physiology and was recently featured in the New York Times. Researchers found that vigorous intensity groups experienced less of a decrement in cardiorespiratory fitness than control or moderate intensity groups, and moderate intensity group members experienced the greatest 10-year reduction in fasting insulin and had greater reductions in mean arterial pressure. Their findings highlight the critical need to better understand the sustained legacy health effects of exercise training interventions.

[NY Times Article link]

[Frontiers in Physiology Article link]

[OVID link to original STRRIDE protocol]

Meaningful Change Estimates for the Late-Life Function and Disability Instrument (LLFDI) in Older Adults: An Exploratory Study
A team of university and VA GRECC researchers performed a secondary analysis of the Boston Rehabilitative Impairment Study of the Elderly (RISE) in order to estimate the minimal clinically important difference (MCID) of the Late-Life Function and Disability Instrument-Function Component (LLFDI-FC) and its subscales among community-dwelling older adults with mobility limitations. The LLFDI-FC is a patient-reported measure of function. The MCID for each LLFDI-FC scale over 1 year of follow-up was estimated by a variety of methods. These estimates can assist clinicians and researchers of functional disability in the elderly.

[Journal link]

Duke Pepper Center Researchers Investigate Quantitative Muscle Ultrasound (QMUS) as an Alternative Reliable, Inexpensive Method to Measure Muscle Health
Muscle health is recognized for its critical role in the functionality and well-being of older adults. Duke Pepper researchers Lisa Hobson-Webb, MD and Amy M. Pastva, PT, PhD, along with the director of the Michael W. Krzyzewski Human Performance Lab, Timothy Sell, PT, PhD, examined the reliability of quantitative muscle ultrasound (QMUS), standard electrical impedance myography (sEIM), and handheld electrical impedance myography (hEIM) measures of anterior thigh musculature in the December 2018 Special Issue of Geriatrics: Geriatric Assessment: Multidimensional, Multidisciplinary and Comprehensive. Multiple correlations with measures of strength and body composition were noted for each method. These point-of-care technologies may provide an alternative means of measuring health compared with more expensive traditional scan technologies.

[Journal link]

Duke Pepper Center Researcher Stresses the Importance of Stored Biospecimen Research As Complementary Investigative Path With Long-Term Clinical Trials on Human Healthspan
Duke Pepper researcher Daniel Belsky, PhD and Amal Harrati, PhD, a Stanford researcher, discuss the relevance of biospecimen research in their article, To the freezers! Stored biospecimens from human randomized trials are an important new direction for studies of biological aging, in the January 2019 issue of The Journals of Gerontology, Biological Sciences & Medical Sciences. Clinical trials testing effects on healthspan-relevant endpoints, like age-at-onset of chronic disease or disability, require many years or even decades of follow-up. While the field awaits a new generation of human trials of geroprotective therapies, analysis of stored biospecimens from now-completed studies can help test candidate surrogate endpoints in briefer research timeframes.

[Article link]

Duke Pepper Center Researchers Find Correlation Between Physical Activity and Physical Function in Persons 50 and Older Living With HIV/AIDS
Researchers from the Duke Pepper Center and the Duke Center for AIDS Research found that higher levels of physical activity were associated with better physical function in an older population of Persons Living with HIV/AIDS. This is believed to be the first study to examine these variables in this cohort. The researchers recommend that providers promote physical activity to improve physical performance in this population.

[Read more]

Duke Pepper Center Researchers Investigate Relationships of SES and Physical Functioning
Duke Pepper researchers, led by Grace Noppert, PhD, examined associations between multiple early and late life SES indicators with physical function. The research team discovered higher participant education and household income were associated with increased physical function. In an age-stratified analysis, SES disparities widened with increasing age among those in the two younger strata: lower SES was associated with worse physical function. Their findings highlight the significance of considering multiple dimensions of the social environment as important correlates of physical functioning over the life course.

[Article link]