USC Health Now

As the baby boomer generation ages, they look to medical advances to keep them going in their golden years.

USC Health Magazine
Fall 2006
by Monika Guttman

The largest demographic, those people born in the years 1946 through 1964, is hitting its senior moment: the first baby boomer will be 65 in 2010. Statistics show that senior populations in states like South Carolina and Iowa will double by 2025. One out of every four households will be providing care for older persons. The older population at the quarter century mark, according to the U.S. Census, is projected to be double that of 2000, growing from 35 million to 72 million.

Older citizens, by their very nature, have more illness. If current incidence rates remain the same, by 2020 global cancer rates are expected to double. And by 2025, there will be a 49 percent increase in the number of people with Alzheimer’s disease.

Yet the boomers are expected to be among the healthiest generations of seniors and will live an average five years longer than their parents. Among the steps toward progress in life expectancy are advances in the prevention and treatment of heart disease, improved knowledge of the genetic links to cancer, and adoption of healthy lifestyles, such as engaging in physical activity, eating a balanced diet and maintaining a lean body weight.

Although women can expect to live longer than men, the gap is narrowing as death rates by gender have started to converge over the last couple of decades. Some researchers suggest that, rather than an improved outlook for men, this convergence reflects changes in women’s behavior, including increased cigarette smoking and the stresses related to multiple roles of housework, occupational activities, child care, parent care and social activities.

A bright future

The good news is that medicine—and the technology that goes with it—is already working toward the future. The seniors of 2025 will be supported by medical advances that will make their golden years glow more brightly. Among the possibilities on the horizon:

Replacement parts: Research on stem cells is illuminating a host of therapies, including the possibility of replacing worn out cells in the body’s joints. One of the most difficult challenges for seniors, notes Timothy Charlton, M.D., Keck School assistant professor of orthopaedic surgery, is osteoarthritis, a type of arthritis caused by inflammation, breakdown and eventual loss of cartilage in the joints. This can be caused not only by injury, he says, but also by aging.

“The glass ceiling in orthopaedics right now is looking for a way to regenerate cartilage. Cartilage regeneration is still in its infancy. The difficulty isn’t growing it—it’s placing it and keeping it in the degenerated areas. The delivery system is difficult.” Charlton fully expects a breakthrough to occur before 2025. “When we figure out how to deliver it, when we master the technology, then the field of orthopaedics will go in a whole new direction.”

Vision rehab: Reading glasses, distance glasses, magnifying glasses on neck chains, all long-associated with seniors, may be history by 2025, says David Huang, M.D., Ph.D., Keck School associate professor of ophthalmology and director of the Center for Refractive Surgery at the Doheny Eye Institute. “One of the biggest areas of research right now are ultra-thin lenses that can be inserted into the eye, making it possible to do corrective surgery on people who weren’t candidates before,” he says. “This will be one of the biggest growth areas in vision in the next 10 years.”

Gum vaccines: The 500-lb. gorilla of dentistry today is gum disease, says Charles M. Goldstein, D.D.S, M.P.H., USC School of Dentistry Endowed Professor in Community Dentistry. The search for a vaccine that would help subdue the bacteria that cause gum disease is the focus of intense research—and could prove possible by 2025. “Some patients who regularly see their dentists for care still have slow deterioration of the tissue that supports the teeth. Others with minimal care are very resistant to gum disease,” Goldstein says. “Hopefully a vaccine will eliminate gum disease for future generations. Our goal is that all people should retain an intact and healthy dentition throughout life.”

Heart implants: Implantable devices that monitor pressure in the heart then transmit the readings to a computer have already been tested by Uri Elkayam, M.D., and Leslie Saxon, M.D., both Keck School professors of cardiovascular medicine. The devices reduced hospitalizations by 41 percent for patients with heart failure, and that was just when information was sent to a physician and looked at during a clinical visit, says Elkayam. “This device is the future—and is likely to change the paradigm for treatment of heart failure,” he predicts. The implant is similar in size to a pacemaker and contains a sensor for recording pressure in the right ventricle where it is placed, and a coil antenna that is implanted under the skin. The patient places a small hand-held device over the antenna, which transmits the pressure readings. The readings are downloaded to a computer and sent to the physician via the Internet. “It turns out this pressure change is actually key to detecting problems before a patient needs to be hospitalized for worsening symptoms,” Elkayam says.

“In the future, patients will be able to transmit the information if they’re not feeling well, and based on the hemodynamic information, the physician will be able to make changes to the medications even without an office visit.”

The biggest change, he adds, is that “right now implantable devices are used for treatment. What this device shows is that in the near future we will also be able to use implanted devices for diagnosis, which will enable physicians to recognize worsening heart failure at the onset and prevent hospitalizations.”

Deterring disease

Cancer vaccines: For the first time ever, there is a vaccine against cancer—the three-shot series that protects against human papillomavirus (HPV), a sexually transmitted virus that causes cervical cancer. It is highly effective against two strains of HPV, which are responsible for 70 percent of cervical cancer cases. When the vaccine was announced last year, government officials called it “historic.”

Indeed, vaccines against cancer—and cancer recurrence—will be much more available, says Jeffrey S. Weber, M.D. Ph.D., the Berle and Lucy Adams Chair in Cancer Research, Keck School associate professor of medicine, molecular microbiology and immunology and chief of oncology. Weber recently presented promising data from an adjuvant study in melanoma of high-risk patients who received a vaccine with CTLA-4 antibody with extended dosing. CTLA-4 is a molecule on T cells that is responsible for suppressing the immune response and thought to be pivotal in melanoma metastases. “These were 25 patients with Stage 4 disease who were resected and rendered free of disease,” says Weber. “In 12 months there have been only six relapses, and most had good levels of immunity to the vaccine.”

The future will mean such cancer vaccines “will be in common use and that they would at least be used to treat patients with resected cancer at high risk of relapse, and that they would need to be repetitively used, chronically over time,” he predicts.

Targeted drugs: Tobias Ulmer, Ph.D., assistant professor of biochemistry and molecular biology at the Keck School, calls this “the golden age” of the life sciences. “It’s where physics was 100 years ago; biologic science is where the major breakthroughs will be in the next 25 years.”

The German-born scientist uses nuclear magnetic resonance spectroscopy to illuminate the three-dimensional structures of proteins and their dynamics at atomic resolution to unravel some of the cellular mysteries of neurodegenerative diseases like Parkinson’s and Alzheimer’s. Ulmer tries to understand how degraded protein aggregates are formed inside the cell and the specific interactions that stabilize the total disease state versus the healthy state. “If we understand the formation of the first type of aggregates, we’ll be able to understand how to stop the formation of the entire range of disease-causing aggregates with drugs.”

Personalized care

House calls: For homebound senior citizens, the need to obtain medical care may be strong—yet the ability to get to a doctor may be an insurmountable challenge. A growing cadre of doctors will return to the time-honored practice of house calls, thanks to financial incentives and such benefits as eliminating the need for an office with overhead costs. Wayne Chen, M.D., assistant professor of medicine at the Keck School, is leading this future trend as director of the USC Home Visit Program. Chen and a nurse treat homebound seniors three afternoons a week, providing care to those ages 65 years and older who have difficulty leaving their homes to attend medical appointments. “We bring the clinic to their homes for routine medical care and much more,” says Chen. “USC physicians are on the cutting edge of health care, and the growing trend in geriatric medicine is a return to traditional home visits by physicians.”

Wellness first: Experts on aging agree that, as the elderly population increases, there will be many new programs that attempt to keep them well. In a study developed by Florence Clark, Ph.D., professor and associate dean of the USC School of Dentistry division of occupational science and occupational therapy, researchers found that occupational therapy delayed age-related declines in the health, physical function and psychosocial well-being of culturally diverse elderly men and women. The widely cited “Well Elderly” study spotlighted the key role of occupational lifestyle redesign, in which an occupational therapist helps a client develop and adopt a routine of beneficial daily activities based on the client’s individual needs. The study “proved that lifestyle-oriented treatment for the elderly, a rapidly growing population greatly in need of preventive services, could work,” Clark says.

Preventive occupational therapy programs, implantable heart devices, drug treatments targeted to specific diseases, and more; all of these may delay reliance on expensive nursing home care, chronic hospitalizations and the consequent loss of independence greatly feared by many of the baby boom generation. And this improved quality of life for everyone is the goal for medical researchers as they continue to light the path toward a healthier future.