Home » Claude D. Pepper Older Americans Independence Center (OAIC)

Claude D. Pepper Older Americans Independence Center (OAIC)

To understand and optimize reserve and resilience

sunflower-960×540 Pepper renewal text
GEMSTAR award-2022

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), Health and Mobility Measures Core (HMC), 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 Scholars Quartet Presents Posters At 2022 OAIC Annual Meeting In Washington DC
Four Duke Pepper Scholars presented posters at the 2022 OAIC Annual Meeting in Washington DC this spring.
Ming-Feng Hsueh, PhD: Cartilage Anabolism is Highly Regulated by miRNAs in Response to Osteoarthritis Stress
Richard Lee, MD: Metabolic profiles associated with incident fracture among older adults with type 2 diabetes mellitus: a nested case-control study
Daniel Parker, MD: Associations of YKL-40, GDF-15, eotaxin, and MCP-1 with physical and cognitive performance in the Duke Aging Center Performance Across the LifeSpan (PALS) Study
Juliessa Pavon, MD: Machine learning-based functional impairment classification with EHR-based clinical data
Dr Hsueh and Dr Parker are 2020 recipients of Duke Pepper Career Development Awards. Dr Lee and Dr Pavon are previous Duke Pepper Scholars, and Dr Pavon is currently a faculty member of the Health and Mobility Measures Core.
Data Integration Working Group (DIWG) Next Meeting --------> June 23rd, 2022 9:30am --------> Then DIWG Is On Summer Break Until September 8th
DIWG has resumed regular Zoom meetings on the 2nd and 4th Thursdays 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: Thursday June 23rd, 2022 9:30-11:00am
Where: Zoom link Meeting ID: 923 1032 9469 Passcode: pepper
Topic:Research Education Component Core members: Mentoring the Next Generation of Gerontology Researchers
Future talks:
Date: Thursday Sept 8th, 2022
Peter Abadir, MD: RAS (Renin-Angiotensin System) and Cognition in Preclinical Studies
Duke Box link for prior DIWG sessions
Duke Pepper Health & Mobility Measures Core Faculty Terrie E Moffitt, PhD, and Avshalom Caspi, PhD, Elected Members Of The American Academy Of Arts & Sciences
Two Duke Pepper Health & Mobility Measures Core faculty members: Terrie E Moffitt, PhD and Avshalom Caspi, PhD, have been elected members of the American Academy of Arts & Sciences. The Academy honors excellence and convenes leaders to examine new ideas, address issues of importance to the nation and the world, and advance the public good. This year’s election continues a tradition of recognizing accomplishments and leadership in academia, the arts, industry, public policy, and research. Caspi and Moffitt co-lead two longitudinal studies on the interactions of genes, environment, health and behavior from birth to death.

[Duke Today article]

Development Of The Sickle Cell Disease Functional Assessment Tool: A Feasibility Pilot Study
Pilot and Exploratory Studies Core Researcher and 2021 GEMSSTAR awardee Charity Oyedeji, MD, led a group of Pepper researchers to develop a dedicated instrument to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with Sickle Cell Disease. The life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. No dedicated instruments exist to measure functional decline and functional age in older adults with SCD. Researchers found the Sickle Cell Disease Functional Assessment (SCD-FA) is feasible, acceptable, and safe: 80% of approached patients consented to participate, 91% completed the SCD-FA, and nearly all participants reported no difficulties performing and understanding the SCD-FA measures. The researchers will use the results as the basis to optimize the SCD-FA into a briefer assessment that will inform the design of future research.

[Open access]

Use Of A Light Detection And Ranging (LIDAR) Device For Assessment Of Gait Characteristics
Health and Mobility Measures Core Researcher Kevin Caves, ME, was part of a research group that developed a novel approach to the unobtrusive assessment of a subset of gait characteristics using a light detection and ranging (LIDAR) device. Such a device may enable unobtrusive, nearly continuous monitoring and inference of patients’ gait characteristics to assess physical and cognitive states. Data are processed by custom algorithms that can potentially be used to estimate various gait characteristics such as step size, cadence, double support, and even step-size symmetry. Subtle changes in gait may indicate issues with physical and mental functionality. In addition to walking speed then, gait monitoring results can provide inferences about the physical and cognitive states of the unobtrusively monitored individuals using their own data as a baseline.

[Journal link to PDF download]

Factors In The Transition From Mild Cognitive Impairment (MCI) To Alzheimer’s Disease (AD)
Sheng Luo, PhD, recipient of an Emerging Discovery/Health Innovation Project Award from the Duke Pepper Center, and his research colleagues constructed a Polygenic Risk Score (PRS) by using 40 independent non-APOE SNPs from well-replicated AD genome-wide association studies (GWASs) and tested associations with the progression time from MCI to AD using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and the National Alzheimer’s Coordinating Center (NACC). They found that the PRS constructed with SNPs that reached genome-wide significance predicted the progression from MCI to AD after adjusting for demographic and clinical variables in both datasets. Further analyses revealed that PRS was associated with increased ADAS-Cog11/ADAS-Cog13/ADASQ4 scores, tau/ptau levels, and cortical amyloid burdens (PiB-PET and AV45-PET), but decreased hippocampus and entorhinal cortex volumes.

[Journal Access]

Research Team Led By Duke Pepper Pilot/Exploratory Studies Award Recipient Anna Mae Diehl, MD, Investigates Mechanisms Of Impaired Liver Regeneration In Aging
A research team led by Duke Pepper Pilot/Exploratory Studies Award Recipient Anna Mae Diehl, MD, examined the role of Hedgehog, a signaling pathway with critical mitogenic and morphogenic functions, in liver regeneration. The team found that Hedgehog inhibition promoted telomere shortening and mitochondrial dysfunction in hepatocytes, consequences of aging that promote inflammation and impair tissue growth and metabolic homeostasis. Hedgehog signaling is dysregulated in old hepatocytes. This accelerates aging, resulting in decreased resiliency and impaired liver regeneration and enhanced vulnerability to damage. Their findings identify a novel role for constitutive hepatocyte Hedgehog signaling in maintaining liver resiliency over the life span and suggest that restoring pathway activity in old hepatocytes might improve liver resiliency and thwart aging-related increases in susceptibility to liver damage.

[Open Access]

Recent Normative Data Now Available For The Short Physical Performance Battery (SPPB)
Researchers examined the 3-m usual walk, five repeated chair stands, and three static balance stance performances, the 3 components of the Short Physical Performance Battery, among age and gender subgroups of adults to generate survey weight-adjusted performance distribution in two national data sets: the 2015-2016 National Social Life Health and Aging Project and the 2016 National Health and Aging Trends Study, to present the largest, most current Short Physical Performance Battery reference data in U.S. adults aged 65 or older. Findings confirmed the gradual decline in function with age and allowed estimation of “relative” performance within age/gender subgroups. Data set distribution differences were noted, possibly due to recruitment, eligibility, and protocol variations. Demographic associations were similar across data sets but generally weaker among the 1948-1965 cohort and in models including the sizable “unable to do” group.

[Open Access]

Maintaining STRIDE During The Challenges Of Social Distancing In The COVID-19 Pandemic
STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans), a hospital-based walking program designed to mitigate the risks of immobility during hospitalization, faced challenges during the COVID-19 pandemic due to social distancing recommendations and infection control concerns. A research group led by Health and Mobility Measures Core member Susan Hastings, MD, applied principles of implementation science, including stakeholder engagement, prototype development and refinement, and rapid dissemination and feedback, to create STRIDE in Your Room (SiYR). Consisting of self-guided exercises, light exercise equipment (e.g., TheraBands, stress ball, foam blocks, pedometer), the SiYR program provided safe alternative activities when face-to-face walking was not available during the pandemic.

[Open Access]

Duke Pepper Health and Mobility Measures Core and Veterans Affairs Researchers Examine Relationship Between An Exercise Intervention And Dietary Behavior In Older Vets With PTSD
Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease, yet few studies have examined the relationship between PTSD and diet quality. Researchers explored if participation in a supervised exercise intervention spurred simultaneous changes in dietary behavior. Results revealed that the diet quality of older veterans with PTSD is poor, and while the exercise intervention improved health through exercise, it did not make veterans any more likely to adopt a more healthful diet. Interventions targeting diet, or diet + exercise, are needed to manage the increased risk of obesity and cardiometabolic disease present in older veterans with PTSD.

[Journal link]

Duke Pepper Research Team, Led By PESC Core Co-Leader Heather Whitson MD, To Investigate Factors That Predict Resilience and Recovery Following Total Knee Arthroplasty
Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, or system level, that are elicited in response to stressors. PRIME-KNEE is an ongoing, prospective cohort study that will enroll 250 adults ≥60 years undergoing total knee arthroplasty. Data are collected pre- and post-surgery and include cognitive, psychological, physical performance and biomarker variables. If PRIME-KNEE validates feasible clinical tests and biomarkers that predict recovery trajectories in older surgical patients, these tools may inform surgical decision-making, guide pre-habilitation efforts, and elucidate mechanisms underlying resilience.
Molecular Measures Core Co-Leader Receives Duke Distinguished Professorship Appointment
Virginia Kraus, MD, PhD, Professor of Medicine and Orthopedic Surgery, has been appointed the Mary Bernheim Distinguished Professor Chair. A rheumatologist, Dr Kraus leads large-scale research projects that are investigating the mechanisms of osteoarthritis, predicting the progression of the disease, and drug responses. Her research focuses on the early treatment of osteoarthritis (OA) before serious damage occurs.
Appointment to a named chair is one of the highest honors Duke confers upon faculty and recognizes excellence in research, teaching and contributions to the university community.

[Read more]

Katherine Ramos, PhD Develops Behavioral Interventions For Older Adults To Enhance Psychological and Physical Well-Being In the Context Of Medical Complexity/Metastatic Cancer
Dr. Ramos’ research focuses on developing and implementing behavioral interventions for older adults to enhance both their psychological and physical well-being in the context of medical complexity and/ or metastatic cancer. Despite the availability of interventions to improve functioning and quality of life in older adults by targeting their behaviors and mental health, there is a scarcity of research that focuses exclusively on older adults living with serious, life-limiting illness such as late-stage lung cancer. The objective of the Roybal study was to provide 8-12 sessions of Self-System Therapy (an evidenced-based psychotherapy treatment for depression) adapted and implemented for older adults over 65 years of age with Stage III or Stage IV lung cancer. The intervention primarily focuses on teaching older adults how to integrate promotion-focused and prevention-focused goal setting to improve self-regulation and increase behaviors that promote mental health and physical well-being. The study was recently completed with a sample of 12 focus group members, 5 user testers, 5 advisory members, and 30 participants enrolled in the pilot. Analyses are underway. An extension of this work has been recently funding by the NIA Research Centers Collaborative Network (RCCN) via Wake Forest School of Medicine. This study is currently underway with a focus on piloting measures targeting physical and psychological resilience(including accelerometry data collection) as older adults with late-stage lung cancer participate in the Self-System Therapy for Lung Cancer Intervention. Study completion is anticipated by March 2022.
Duke Pepper Pilot Study Awardee Elaine Guevara, PhD, Studies Our Primate Relatives Lemurs For Insights Into Physiological Reserves and Resilience and Healthspan
Elaine Gomez Guevara, PhD from the Dept. of Evolutionary Anthropology will study molecular aging processes in two species at the Duke Lemur Center: the ring-tailed lemur (Lemur catta) and Coquerel’s sifaka (Propithecus coquereli). The ring-tailed lemur exhibits fast maturation and a shorter lifespan than Coquerel’s sifaka, while Coquerel’s sifaka has extreme longevity for its body size, very slow development, and a low rate of actuarial senescence, as in humans. These lemurs are sympatric: they occupy the same environment on their native island of Madagascar.
The study will use matched urine and serum samples across the full recorded lifespan per species and measure multiple biomarkers to test two hypothesized pathways of aging, one involving oxidative stress and the other involving inflammation.
The lemur pictured above is Marcus (named after Roman emperor Marcus Aurelius). The blue box collar is an activity monitor developed in collaboration with Health and Mobility Measures Core researcher Kevin Caves, ME.
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 Health and Mobility Measures Core Co-Leader, Katherine S Hall, PhD Inducted Into 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.
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.


[Journals of Gerontology: Series A article]

[Duke SOM News Article]

Duke Pepper Center Health and Mobility Measures Core 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]

The Duke Pepper OAIC website is funded by the National Institute on Aging, P30-AG028716. ©2022