Jewish Home of San Francisco Center for Research on Aging

Our vision is for a better health span – not just a longer lifespan

To respond to the future challenges of our older adults’ changing healthcare needs, the Jewish Home has launched a $5 million Campaign for Research on Aging. Our goal is to have a world-class research center that will develop and coordinate clinical research devoted to diseases and conditions associated with very old age.

The Jewish Home of San Francisco Center for Research on Aging shares the common goal with other departments and programs of improving the care and quality of life for seniors.

Research enables us to evaluate approaches to care, to assess current therapies and environments, and to design and evaluate new therapies and programs. Through the creation of a center composed of multidisciplinary researchers, we are hoping to minimize the adverse consequences of aging.

The Jewish Home’s Long-Term Care Research Center was formed in 1997 in collaboration with the (Goldman) Institute on Aging. Janice B. Schwartz, M.D., was recruited in September 2001 as director of Research at the Jewish Home. In 2005, the Jewish Home’s research activities became independent under the direction of the Research department, culminating in the creation of our current Center for Research on Aging.

The goal of our research center is to discover and disseminate information that will result in improved care of older people, especially for the frail elderly. We hope to improve both the use of existing medical therapies and to develop new therapeutic approaches. We focus our research on common disorders occurring in older people, as well as on problems unique to aging populations. Our role is to bridge the gap between scientific discovery and the translation of our and others’ discoveries to beneficial use in older people.

Ongoing research projects
at the Jewish Home

Older Persons and Drugs:
Race, Gender, and Age Effects

—Janice B. Schwartz, M.D.

The goal of this project is to determine how age, gender, or ethnicity can affect the removal of medications from the body. Among the highlights of Dr. Schwartz’s findings are that women metabolize some, but not all, drugs faster than men; women and men require different doses of medicine; and hormone replacement therapy in women does not affect drug metabolism or responses.

Genetic Determinants of Drug Responses

—Janice B. Schwartz, M.D.

The overall hypothesis is that use of genetic information in combination with demographic and concomitant medication administration information will provide better estimates of drug dosing requirements than consideration of demographic and concomitant medication administration information alone in very old patients. Warfarin is the first medication to be studied. It is hoped that this would allow improved dosing during initiation of warfarin to older patients and decrease unwanted bleeding complications and that the time to reach a desired anticoagulation level will be reduced.

Maintaining Relationships and Quality of Life After Institutionalization for Dementia

—Theresa A. Allison, M.D. and Kenneth Covinsky, M.D.

This project seeks to identify moments of meaningful connection between caregivers and nursing home residents and to explore the underlying processes that foster relationships and social connections. An understanding of these processes may contribute to the development of clinical care models that enhance the quality of life of institutionalized adults with dementia.

Effects of Vitamin D on CYP3A Substrate Clearance

—Janice B. Schwartz, M.D.

This study will determine the effects of vitamin D supplements on how quickly the body clears a commonly prescribed cholesterol medication, Lipitor (atorvastatin). Levels of Lipitor will be measured in the blood, and the levels of blood lipids will also be evaluated. Identification of agents that may alter drug metabolism is important for optimizing drug therapy, especially in individuals who take multiple medications and supplements.

Effects of Vitamin D on Lipids

—Janice B. Schwartz, M.D.

Preliminary research data suggest that vitamin D supplements lower blood LDL-cholesterol and total cholesterol levels. If further investigation supports its effectiveness in lowering blood cholesterol levels, vitamin D administration could serve as a valuable addition or alternative to existing treatments for hyperlipidemia. The aim of this research is to detail the effects of vitamin D supplementation on blood lipid levels.

Etiological Roles of the Functional Anti-T Cell Auto-Antibodies and Th17 Cell Cytokine Abnormalities in Immunosenescence

—Edward Goetzl, M.D.

The overall hypothesis is that two critical causes of immunosenescence (aging-associated changes in immunity) are dysregulated generation of inflammatory interleukins (immune proteins) by T lymphocytes and production of anti-lymphocyte autoantibodies; that both are susceptible to correction by existing forms of therapy. This investigation is designed to study in the laboratory T lymphocytes from the blood of healthy aged patients in comparison to those of healthy young matched controls. The numbers of different types of T lymphocytes will be quantified and their functions assessed in vitro, including generation of a range of interleukins. Subject plasma will be studied for the presence and characteristics of anti-lymphocyte autoantibodies.

Proxy Decision-Making for Alzheimer’s Disease Research

—Laura Dunn, M.D.

Hopes for developing effective treatments for Alzheimer disease (AD) rest on clinical research, that will need to enroll AD patients, many of whom lack capacity to consent to research. This project will study how responsible parties or agents make decisions about entering Alzheimer disease patients into research projects. It will present protocols of varying risk and benefit levels (1) to determine influences on proxies’ research decisions and perceptions of research and (2) to examine potential influences on the decision making abilities of the proxies themselves.

Etiological Roles of Functional Anti-T Cell auto-Antibodies and Th17 Cell Cytokine Abnormalities in Immunosenescence

—Edward J. Goetzl, MD

The purpose of this study is to better understand the effects of aging on human white blood cells of different types. Investigations of the responses of the white blood cells from older individuals compared to younger subjects in the laboratory may shed light on differences in the ability of these cells to protect humans from various challenges in the environment, including infections and toxins as a function of age.

Improving Medication Therapy for Older Patients with Common Co-morbidities

—Janice B. Schwartz, MD and Michael Steinman, MD

The overall goal is to improve the use of medications for older people with multiple medical disorders. Our first step will be to identify the prevalence, type, and severity of prescribing problems in older people with defined patterns of multiple co-morbidities (“morbidotypes”) from databases of representative large groups of older men and women (Veterans Administration databases for older men and Nursing Home database(s) for older and very old women and men). The next step will be to develop “potentially optimized prescribing (POP)” algorithms that would be predicted to result in fewer medications prescribed, fewer unwanted effects, and be appropriate and efficacious for the older patient. The development process will consider clinical practice guidelines for each disorder, pharmacologic properties and interactions of medications used for the disorders (pharmacokinetic and pharmacodynamic), and geriatric conditions (function, projected length of life, care for vulnerable elderly) that would modify the approach to treatment of the disorder. The proposed optimized therapeutic combinations will then be evaluated and modified by experts from medical disciplines of the practice guidelines, clinical pharmacology and pharmacy, geriatrics, and health care utilization. The potentially optimized regimens identified will be used to design a subsequent comparative effectiveness study of the optimized combinations and “usual” therapy.

Effects of Low Dose Lenalidomide on T Cells in B Cell Chronic Lymphocyctic Leukemia

—Edward J. Goetzl, M.D.

This study will investigate a novel approach to improving the function of a subset of white blood cells (T cells) that have decreased function in older people. We have shown in the laboratory that the medication lenalidomide can improve the function of older T cells and T cells from patients with infections. We now want to investigate the effect of low doses of this medication in people with cancers of white blood cells to determine the right doses to produce beneficial effects without unwanted effects in order to design future studies in people with age-related or disease related changes in T cell function.

Research Application Procedures

It is our goal to facilitate research projects at the Jewish Home, while meeting the highest ethical standards and compliance with government regulations and Jewish Home policies and procedures.

Applications for research at the Jewish Home are welcomed. Researchers considering projects at the Jewish Home are encouraged to before completing the application for research at the Jewish Home.

Applications undergo review by the Jewish Home Research Committee but must have a licensed Institutional Review Board approval or Committee on Human Research Approval before they can be considered.