In 2005, with help from the Milton & Shirley F. Levy Family Chair in Alzheimer's Disease, the Institute for Aging Research established the Aging Brain Center. "We have long felt that research into crippling cognitive disorders such as Alzheimer's disease is a compelling endeavor. We look forward to the possibility that some day, these illnesses can be eradicated, allowing our seniors to continue to live with their dignity and memories intact," says Steven Levy. "Endowment of the first-ever chair of this kind in a long-term care facility represents our commitment to Hebrew SeniorLife as the undisputed national and international leader in the care and treatment of seniors."
As testament to its leadership in the area of aging research, IFAR attracted Sharon K. Inouye, M.D., M.P.H., one of the nation's leading gerontological scientists, to head the Aging Brain Center. In addition to the Milton & Shirley F. Levy Family Chair in Alzheimer's Disease, she also holds positions at Harvard Medical School and Beth Israel Deaconess Medical Center.
"The Aging Brain Center focuses on examining risk factors, pathophysiology, and broader societal implications, including costs, policy, and caregiver issues, of the many conditions that contribute to chronic cognitive impairment in older persons," explains Dr. Inouye. "My goal is to build the leading clinical research center in aging and the brain, and to bring together scientists representing multiple disciplines from throughout the Harvard community to address this area."
Shedding New Light on an Age-Old Problem
Before joining the Institute, Dr. Inouye was co-director of the Claude D. Pepper Older Americans Independence Center and Yale Program on Aging and director of the Yale Mentored Clinical Research Scholars Program. She is well known for her groundbreaking work on a prevalent and vexing condition known as delirium.
Although Dr. Inouye became aware early on in her medical career that delirium represented a serious threat to seniors, it still remains under-appreciated by some clinicians. As a medical resident, she observed symptoms of confusion and disorientation in many of the older patients that she treated during her hospital rounds. She also noticed that the condition was generally shrugged off as just something that sometimes happens to old people and little, if anything, was done to treat or prevent it despite its devastating effects. Dr. Inouye suspected this attitude stemmed from a basic lack of research into the prevalence, cause and consequences of the condition. As a fellow in the Robert Wood Johnson Clinical Scholars Program, she decided to investigate further and searched the available literature on the syndrome. She found that, indeed, delirium represented an area of study ripe for discovery.
Delirium is described as an acute decline in cognitive functioning and attention and is the most frequent complication of hospitalization in older patients. According to Dr. Inouye, occurrence rates range from 14 percent to 56 percent and mortality rates as a result from 25 percent to 33 percent. In addition, the dollar costs associated with delirium are substantial. According to several reports, inpatient costs alone are estimated at $4 billion in the United States; add on post-acute care in rehabilitation hospitals, nursing homes, and home health care and the financial burden rises. Then there is the human toll. From the patient's perspective, delirium seems to foster functional decline that can lead to the need for nursing home care and in the worst cases, death. The individuals who care for these patients are also profoundly affected. "There is a tremendous degree of caregiver burden associated with the care of delirious patients when they are discharged home from the hospital and over the ensuing months and years," says Dr. Inouye.
Through her research, Dr. Inouye has made progress toward finding ways to predict, treat or prevent delirium. Dr. Inouye's accomplishments include development of a new instrument for identifying delirium -- the Confusion Assessment Method -- that is now a widely used standard in the field. She also helped develop a model for predicting delirium that takes into consideration multiple factors that promote the syndrome. This model allowed her to develop an intervention strategy to prevent delirium that reduced it by 40 percent in a study population, demonstrating for the first time that a substantial proportion of delirium among seniors is preventable. Her recent work has included a study indicating the cost-effectiveness of the delirium prevention model and studies examining the pathophysiology and long-term outcomes of delirium.
The Future of Research at the Aging Brain Center
Despite Dr. Inouye's considerable progress, there is still more work to be done. She lists several issues on which her continuing research on delirium and dementia within the Aging Brain Center will focus, including clarifying the relationship between delirium and dementia; addressing the problem of under-recognition of the condition; developing better treatments; and finding ways to decrease caregiver burden.
IFAR faculty have focused on the conditions that greatly impact adults as they age, and until their studies, had largely been ignored by the research community. The problem of cognitive decline has been woven into many of their projects. The Aging Brain Center will greatly enrich their ability to explore this area of research further, complementing existing programs and ensuring progress toward better understanding of the aging process. With addition of studies within this new center, Hebrew SeniorLife looks forward to building on the Institute's past success and a future of robust discovery and innovation that will continue to improve the lives of seniors everywhere.