A new age in healthPhysicians, researchers increasing quality of life, health during later years by Catherine Duncan
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Emma-Stina, a beautiful 22-year-old from Stockholm, Sweden, came to the United States with friends for a visit in the 1940s. These same friends found Kenneth, a dashing 26-year-old college student, to serve as her escort for a dance. On the dance floor, Emma-Stina stole the heart of the young American who soon proposed to this young woman with movie-star looks. Now, more than five decades later, the two have enjoyed a long and rich life together. Dr. Kenneth and Emma-Stina Prescott raised two daughters, Tina and Trudy. Having served in World War II and the Korean War, Dr. Prescott is a retired captain in the United States Navy. After World War II, he earned his master’s degree and Ph.D. During his career, he directed three museums before joining the Ford Foundation as a program officer. The Prescotts moved to Austin where he served as chairman of the Department of Art at The University of Texas at Austin for 10 years. At ages 75 and 79, the Prescotts recently moved to a retirement community in San Antonio. They now enjoy traveling around the world. After moving here, the first business to take care of was finding a new doctor. Mrs. Prescott said friends referred her to John P. Howe, III, M.D., Health Science Center |
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president, who recommended Michael Lichtenstein, M.D., professor of medicine in the Division of Geriatrics and Gerontology and a practicing geriatric physician. “Dr. Lichtenstein called us himself to make sure we were the right patients for him and he was the right doctor for us,” she said. “We went to his office for our first appointment, and he did the most thorough job of learning our medical history. We felt we needed to go to a physician who specialized in geriatrics so we could get the best possible care.” Arlan G. Richardson, Ph.D., director of the Aging Research and Education Center (AREC) and professor of physiology, said more than 150 Health Science Center researchers and physicians are dedicated to finding ways to provide the aging population the highest quality of life and to help them maintain independence as long as possible. “We can’t be content with our current knowledge about aging. We must do research and understand what genes do in regard to aging. We are truly in the infancy stage regarding what we know about aging,” said Dr. Richardson, holder of the Methodist Hospital Foundation Chair in Aging Studies and a career scientist with the South Texas Veterans Health Care System. At the Health Science Center, Dr. Richardson and his colleagues are putting experts together who can deliver quality health care to aging citizens while also studying at the cellular and molecular level the causes and effects of aging. Dr. Prescott said he and his wife have always admired the Health Science Center and its teaching and research facilities so it made perfect sense that this would be the place to receive medical treatment. “Here is the opportunity to be treated by a highly respected doctor with research interests. We feel very fortunate to have this opportunity to enjoy such great medical treatment and services,” he added. A place for coordinated careWhile the Prescotts are currently seeing Dr. Lichtenstein through the Clinical Geriatric Program at The University Clinic, located next to University Hospital, they and many |
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others will soon be able to go to a center offering personalized, coordinated care. Dr. Lichtenstein is leading a team of experts from the Health Science Center and two other San Antonio universities in the creation of South Texas’ first Inter-disciplinary Geriatrics and Gerontology Program, a collaborative effort of the University Health System and the Health Science Center. Scheduled to open in the fall of 2000, the new center will be located at 302 West Rector Street. The existing Clinical Geriatric Program will be folded into the new program. The new center will offer primary care, dental care, nursing, rehabilitation and specialty care services to the elderly—in one location with physicians and other specialists working together on behalf of each patient. Law students will be able to identify legal issues and offer suggestions on finding legal services. In addition to Dr. Lichtenstein serving as program leader, others involved in the creation of this center are Toni Miles, M.D., Ph.D., School of Medicine; Mary Ann Matteson, Ph.D., R.N., School of Nursing; Robert Friberg, Ph.D., School of Allied Health Sciences; Michèle Saunders, D.M.D., M.P.H., and Eleonore Paunovich, D.D.S., Dental School; Ruth Bounous, Ph.D., and Phil Hall, Ph.D., Worden School of Social Service, Our Lady of the Lake University; and Patty Sitchler, J.D., St. Mary’s School of Law. “The center will allow us to test better ways of delivering care more effectively and efficiently to older people,” said Dr. Lichtenstein. Greg Rufe, vice president-operations for the University Health System, said county officials hope the new center will be a model for interdisciplinary care for seniors. “We later hope to set up a network of these centers around Bexar County. This truly is a one-stop shop to take care of seniors,” he added. Dr. Lichtenstein said the center will have three priorities: providing medical and social |
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services, offering educational opportunities to students, and performing patient-oriented research that can benefit others. Dr. Lichtenstein said the center, which will be available to those 65 and older, will be unique because of the coordination of care that is essential to providing quality care to older people. “Some seniors have complex health problems. It is important to have all of the older person’s health care providers working together to create a ‘care plan.’ Having it in a single geographic location improves communication,” he said. Learning from researchIn addition to learning how to better care for the aging population, Health Science Center faculty members are working on understanding the complex biological causes and effects of aging. The Nathan Shock |
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Center of Excellence in the Basic Biology of Aging, which is overseen by Dr. Richardson, is playing a major role in such studies. Sponsored by the National Institute on Aging, the San Antonio center is one of five national centers. The Shock Center is a joint effort with the South Texas Veterans Health Care System. Some of the research cores of the Shock Center are housed in the VA. Named for Nathan W. Shock, known in the scientific community as the “father of gerontology,” the center’s research is based on the use of rodent models to study aging and age-related diseases. The Health Science Center was awarded the honor of receiving a Shock Center in 1995 because of its international reputation for transgenic rodent research. “Rodent systems are very similar to the human system. Eighty percent to 90 percent of the things that you see change with age in rodents, you also see in humans,” said Dr. Richardson. “Examples of these similarities are the changes in the immune system and hormonal systems as well as the responses to disease.” One of the main functions of the Shock Center is to provide special services to investigators who are performing research on aging using rodent models, he said. Dr. Richardson explained the Shock Center offers its researchers three types of resources: Transgenic core: Assists researchers in enhancing or suppressing a specific gene in mice that they can use in studying the aging and disease processes. Animal core: Maintains Shock Center rodents throughout their lifespans. This means a colony of rodents can be maintained for three years and remain free of disease. Pathology core: Screens the animals to determine the cause of death and other related information. Current areas of research emphasized by the Shock Center involve studying the role of DNA damage in aging and cancer, the role of oxidative damage in aging, and the role of the metabolic and hormonal systems in aging. Dr. Richardson, who is performing research on oxidative damage, said cells use oxygen to |
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generate energy. As one ages, there is a high likelihood of oxidated damage to these molecules. “I liken it to rusting. In time, oxidative damage leads to aging. It reduces the function of the organs. This accumulation of oxidative damage means the cells won’t function as well as they used to,” he said. “But, not only do the cells lose their normal functions, they also become abnormal, which can result in disease. Research is showing that oxidative damage is related to cataracts.” Scientists have created mice with alterations in their oxidative defense systems, he said. By either increasing or decreasing the defense system, researchers can see how it affects the aging process. This knowledge can lead to learning how to prevent or better treat age-related ailments and illnesses. Geriatric oncologyWhile researchers at the Shock Center study a wide range of diseases related to aging, another group at the Health Science Center is preoccupied with cancer in the elderly. Jan Vijg, Ph.D., an internationally respected expert in the molecular genetics of aging and cancer, is a professor in the Department of Physiology and an AREC researcher. He also serves as program leader of the Geriatric Oncology Program, sponsored by the San Antonio Cancer Institute (SACI). SACI is the working partnership between the Health Science Center and the Cancer Therapy & Research Center (CTRC). The Dutch-born scientist left Harvard Medical School to come to San Antonio, where he also serves as director of basic research at the CTRC’s Institute for Drug Development. “This type of research is imperative because cancer in the elderly is different than cancer in younger people,” Dr. Vijg said. “Something about aging changes how we respond to cancer—our susceptibility to cancer, the way cancer grows, and how it responds to treatment. We are now trying to tailor current prevention and treatment to the elderly.” Geriatric oncology researchers are studying several methods of improving the prevention and treatment of cancer in the older population. These include learning how nutritional and hormonal manipulation can be used against cancer; understanding how damage to DNA causes breakdowns in the cellular defense system; learning how to control gene deregulation, which means the genes stop doing what they are supposed to do; figuring out how to tailor treatment (A certain amount of one drug would be appropriate for someone age 50 but toxic for a 75-year-old.); and gaining a better understanding of the aging of cells (some of which originally protect against cancer but later stop providing this function). Armed with numerous National Institutes of Health-supported grants, Dr. Vijg said the first priority for the team of scientists is performing basic research that will give additional insights into the causes of cancer in the aging. The next priority is treating cancer in the elderly. This involves early |
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diagnosis and promising new interventions, he said. “We are studying vaccine therapy for cancer. When you know how the cancer cell is different, then you will know what therapy to put in. Immunotherapy is much more subtle and easier on the body,” he added. Several basic facts about cancer and aging put the importance of the Geriatric Oncology Program’s work into perspective. “Cancer incidence increases with age. It is so much more frequent that cancer is a disease of the elderly. Why does it increase with age? Certain defense systems protect your body. Aging is a slow, gradual accumulation of damage to these systems,” he said. Mortality from cancer also increases with age until 85 years when the risk goes down, Dr. Vijg said. “If a person has reached 85 without having cancer, he has very strong defense systems thanks to genetics.” With this knowledge in mind, the researchers can determine drug treatments to help those who do not have strong DNA, he said. While the researchers continue to work daily to find answers to these daunting questions, Dr. Vijg offered this advice: Caloric restriction, which is the only intervention that retards aging, also retards or reduces the incidence of most types of cancer. |
