The elderly accept may minor discomforts like stiffer muscles and getting tired more quickly, but they do want to go to their children's birthdays independently. Preventive elderly care helps people with that. The goal is to let people grow old while maintaining their self-reliance and independence for as long as possible. Researchers inside and outside hospitals are working together to tailor treatments to the unique situation of the elderly.
The elderly have their own needs, their own vulnerabilities. Their medical history, daily life, mental state and social environment are all factors to be considered. All these things are related, says internist and geriatric specialist Simon Mooijaart: “Geriatric medicine is a separate discipline. You can’t just say: someone has breast cancer, and in cases of breast cancer we always do this and that. A seventy-year-old does not have the same resilience as a forty-year-old. And one seventy-year-old may still be very fit, while another would no longer be able to cope with surgery.”
Which of these two options applies can be seen in someone's molecular profile. Molecular epidemiologists study blood, fat or muscle and make molecular profiles to chart what state the elderly are in. They do that by looking at certain metabolites, substances that are produced during metabolism. These substances indicate what the cells of certain organs are doing. Are the liver cells dividing? Are the cells in the kidneys cleaning up? Are the muscle cells still working well? With the aid of these metabolites, it is possible to see if an organ is still functioning properly, long before the person experiences physical complaints.
Leiden University researchers have chosen 220 metabolites to test for in all 70+ patients who enter the LUMC. This will yield a huge amount of data. The patient is then treated and the researchers analyse what happens to them, for example, how they respond to the medication. Afterwards, they see if the disease progression could be predicted based on the molecular profile.
Professor of Molecular Epidemiology Eline Slagboom: “In this way, a classification system is developed that allows patients to be divided into four groups, from very healthy to extremely vulnerable. Once we have this information, we can adjust their treatment and devote extra attention to the vulnerable patients.”
Dividing according to resilience
Internist-geriatric specialist Mooijaart is working on a classification system in a completely different way. He wants to avoid a situation where older people who come into the emergency room never again return to their former level despite successful treatment in the ER. Because of the pain, stress and strange environment, they can become confused and deteriorate mentally. They can also suffer side-effects from the medication, which is usually developed for healthy forty-year-old men and not for eighty-year-olds who often have multiple chronic conditions.
Mooijaart is developing a short questionnaire for older people entering the ER. With more information about the state of these patients’ memory, degree of dependency, drug intake, environment and medical history, doctors can adjust their treatment and avoid many problems.
Unraveling the secret of healthy old age together
The scale on which the research on geriatric studies is being conducted in Leiden is truly unique. Mooijaart tested his questionnaire on 3000 people, the largest study of its kind anywhere in the world. Slagboom is analysing data from 100,000 people who come from families that have been living to be over over 90 years old for multiple generations in the hopes of clarifying what lifestyle factors contribute to healthy ageing.
The close connection between fundamental researchers and the clinical environment is particularly beneficial. It has, for example, led to a study of indicators for renal failure based on a question administered by doctors.
Doctors and researchers work in parallel: doctors take blood samples while in the laboratories and Slagboom’s team analyse the indicators. Mooijaart and Slagboom like it this way: quick and efficient working, practice-oriented fundamental research and excellent cooperation. Mooijaart: "There may be institutions around the world that are better in fundamental research or clinical research, but the combination of expertise we have under one roof is unique. There is no island mentality here.”