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Convening in Albuquerque March 20-22, the 14^th Annual International Conference on Frailty and Sarcopenia Research (ICFSR) was the largest yet, with 441 participants (40% in person) from 29 countries, with 230 original research abstracts submitted on a wide range of topics. It is impossible to summarize such a diverse meeting, but a few highlights are below. We hope you will chime in the comments with what you learned!

The ICFSR Lifetime Achievement Award was presented to Dr. Anne Newman, who was honored for her science and mentorship over the years. Dr. Roger Fielding (Boston, USA) in his introduction noted that she is one of 10 siblings, perhaps leading her to an early understanding of the importance of collaboration.  In her keynote, Dr. Newman reviewed the history of thinking about frailty as an add-on in the Cardiovascular Health Study to the now in-depth focus in the Study of Muscle, Mobility and Aging (SOMMA).

An important recurring theme at the meeting focused on the ongoing debate on identifying sarcopenia and the challenges this presents for clinical research. In the first symposium, Dr. Peggy Cawthon (University of San Francisco, USA) gave a detailed review of the comparison between the performance of DXA, CT, MRI and D₃Creatine for measuring muscle. Dr. William Evans (Berkeley, USA) pointed out that additional work is needed before a consensus can be established. Dr. Gustavo Duque (McGill University, Canada) gave an excellent keynote presentation on osteo-sarcopenia and the communication between muscle, bone and fat that we are just beginning to understand and has many implications for future sarcopenia research.

A number of large trials presented preliminary findings. The SPRING study, presented in a symposium by Dr. Qian-Li Xue, Dr. Thomas Laskow and Dr. Nicholas Schmedding from Johns Hopkins University, Baltimore, looked at the recovery after the stressor of knee surgery and reported that baseline predictors of resilience had the biggest impact on the short-term recovery, with less impact on the long endpoint. Results of RNA gene expression profiling in the SOMMA study were presented in the third symposium by Dr. Gregory Tranah (UCSF, USA), Dr. Russell Hepple (University of Florida, USA) and Dr. Paul Coen (AdventHealth Orlando Florida, USA). Markers of denervation were found to be associated with mitochondrial respiration as well as to a lesser extent with clinical endpoints. In addition, the oxidative stress response seemed to be differentially activated between mitochondrial and cytosolic mechanisms.

Several longitudinal studies are underway comparing human and mouse aging cohorts. This included the INSPIRE project presented by Dr. Angelo Parini (Toulouse University, France) and the Study of Longitudinal Aging in Mice (SLAM) presented by Dr. Rafael de Cabo for the National Institute on Aging (Baltimore, MD). These are both impressive large-scale projects aimed a collecting and correlating data across many functional modalities with detailed biochemical and exposure markers over time. Among the complementary points between the talks was the variety of ways there are of trying to integrate this extensive data to understand the biology of healthy aging. With the accumulation of large cohorts, the potential to pool data resources and increase our understanding with advanced statistical and AI assisted analytic techniques was also a topic of much conversation.

Interventions are underway in many contexts, including nutritional analogues, exercise, even stem cells, and these dominated the oral abstract presentations. Dr. Francesco Landi (Catholic University of Rome, Italy) inspired all of us to be more personally active with mentions of the Longevity Run project. One randomized trial of an intervention presented underway is not to prevent frailty however, but to prevent frail patients from undergoing surgical procedures for which they were at high risk of complications. Presented by Dr. Shipra Arya at Stanford University, The Surgical Pause study at the VA in Palo Alto is in the final stages and has some interesting findings about how willing different specialties were to adopt the practice, how easy it was to use and how successful as a result. These findings were reinforced by the single center experience of Dr. Bradley Schmit at the University of Florida where high levels of institutional support have led to significant reductions in harm.  The abstracts are published in the Journal of Frailty and Aging for anyone who missed the meeting as there are too many to review. 

A special focus of this meeting was on providing care for older persons with frailty in diverse communities. Dr. Debra Waters, hosting the meeting from the University of New Mexico, acknowledged the history of the First Nations in and around Albuquerque on whose former land the meeting was taking place. A roundtable on Thursday afternoon discussed the work of several panelists, Dr. Nitin Budhwar, Dr. Alex DeRadke, Dr. Raj Shah and Dr. Waters, from UNM who have been working with diverse and indigenous communities in the United States and New Zealand to understand what frailty and aging means in this context. Developing culturally congruent care is critical for improving the health across diverse communities around the world, and is an especially important point for an international meeting, that seeks to bring researchers together across multiple communities.

 

The sudden passing of Dr. Judy Kasper, a prominent expert in the study of disability in later life and its implications for older adults, their loved ones, and health care policies, struck all who knew her with feelings of sadness and shock.  To celebrate Dr. Kasper as both a stellar scientist and a wonderful colleague and friend, we asked some of her collaborators to reflect on their work with her and the impact she had on their careers and lives.  We have also summarized Dr. Kasper’s important role in facilitating frailty research in the National Health and Aging Trends Study.

 

 

Tributes to Dr. Kasper

 

I met Judy in 1992 when she took over as co-PI for the Women’s Health and Aging Study (WHAS). I was at the beginning of my career and the only other social scientist in the research group. Ten years my senior, Judy (unbeknownst to her I suspect) quickly became a role model for me in how to successfully navigate the medical research environment and keep personhood, social structure and environment on the table. Judy was my sounding board and reality check. Two of my earliest first-authored papers were executed under Judy’s support and guidance. Social scientists think differently, I won’t say better, but work touched by Judy was and is indeed better. Judy was creative and accomplished – for example, co-writing much of the WHAS “purple book” monograph and expanding the WHAS footprint by establishing the Caregiving Study focused on the care receivers, a novelty at the time. Our collegial relationship continued well beyond the active collaborations, developing into a cherished friendship. I will forever miss our annual extended lunches and summer gourmet potluck dinners at the Bolton Hill Tennis and Swim Club, where all the people and surroundings would fade into the background as we caught up on our academic lives and the life events and accomplishments of our children.

 

                    — Eleanor Simonsick, PhD, Intramural Research Program, National Institute on Aging

 

 

Like Eleanor, I met Judy in 1992 as a fellow member of the WHAS team. I have been privileged to collaborate with her ever since, including in WHAS but also extending to the National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC). We were finalizing an NSOC paper when Judy passed away so sadly and far too soon last summer.

 

Judy’s advancement of scholarship on disability, long-term and end-of-life care, and caregiving was truly monumental. Her leadership of the NHATS and NSOC leaves a particularly enduring legacy of this. Anyone visiting the websites for these studies will quickly see: These studies achieve the highest standard of rigorous design and implementation, thorough documentation, and effectiveness of data sharing. They will advance science—and commensurately, health and functioning of older adults and their caregivers—for years to come. In her own work Judy was the model of a public health scientist—her research thoughtfully grounded in theory as befits the social scientist she was, but always addressing matters of practical import for both individuals and populations. It addressed the identification and forestallment of disability before it becomes severely disabling, documented the caregiver experience so that policies to maximize their efforts may be developed, and identified disparities and other major factors determining access to health services. I’ll remember Judy, most of all, as an ideal colleague—one unblinking in her appraisal of a work’s scientific method and practical import but also fiercely and generously supportive of her trainees, ready with a laugh, and open to ideas contrasting with her own. She provided me with a role model of female leadership that was strong but also comfortable in one’s skin: This affected me more than she likely knew. I dearly miss her.

 

                     — Karen Bandeen-Roche, PhD, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health

 

 

I had the tremendous fortune to meet Judy in 1999 as 1st year doctoral student during a “meet and greet” doctoral seminar at which she talked about her career and research in aging and disability. Judy was involved at that time in a variety of survey-based projects, including a Commonwealth-Fund supported survey to understand the experiences of older adults with disabilities living in 6 states who were dually enrolled in both Medicare and Medicaid.  She was also wrapping up her work in co-leading the Women’s Health and Aging Study and its ancillary survey of family and other unpaid caregivers. 

 

Hearing Judy talk about her work was transformative for me. I had up to that point only worked with administrative claims data and the business side of health care. Judy’s talk revealed for me the importance of understanding what matters to people in their experience of health care. In particular I was struck by the need to understand the impact of living with disability as well as the consequences of disability and care delivery for their family members. Judy revealed the power of survey-based research as a way to understand individuals’ lived experiences. Hearing about Judy’s work led me to switch directions and she became my dissertation advisor. Judy’s commitment to strong social science and survey methods and her respect for the research process influenced my decision to pursue a career in academics. We went on to be close collaborators on a host of NIH and foundation-funded initiatives and over time in jointly mentoring doctoral students and junior investigators. Losing Judy has been tremendously difficult not only because of our strong collaboration and her professional mentorship but her friendship and wisdom. Her legacy will live on through the strength of the National Health and Aging Trends platform and her numerous mentees who are leading research, policy, and practice initiatives in aging and disability.

 

                    — Jennifer Wolff, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

 

 

I first encountered Judy when I was a doctoral student at the Johns Hopkins Bloomberg School of Public health over a decade ago. She gave a talk at the Center on Aging and Health on her plans for NHATS, specifically its design and development. As someone who was studying late life mobility as a contributing factor to disability, I was very interested in, and motivated by, her talk. Several years later after I returned to JHSPH as faculty, Judy approached me about implementing objective physical activity assessment (accelerometry) into NHATS to better understand how physical activity contributes to the disablement process. I was honored and excited to become an NHATS co-investigator and contribute to its mission of improving life for older adults. Throughout the design and implementation process, I enjoyed working with Judy and learned a lot from her mentorship. She was intelligent, kind, and fun and becoming Co-PI of NHATS and Judy’s colleague has been a highlight in my career. Taking over for Judy has been bittersweet, but I am committed to continuing her vision for NHATS, and to looking for ways to expand and advance our understanding of disability in late life.

 

                    — Jennifer Schrack, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health

 

 

A Brief Summary of Dr. Kasper’s Impact on Frailty Research

 

Among the many accomplishments in her renowned scientific career, Dr. Kasper served as Principal Investigator for both the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC). Over the past decade, hundreds of publications have resulted from the comprehensive and rigorously collected data in these studies. Led by Dr. Karen Bandeen-Roche, members of our Frailty Science team had the privilege to closely collaborate with Dr. Kasper to operationalize a measure of physical frailty in NHATS. This work led to the highly cited paper, “Frailty in Older Adults: A Nationally Representative Profile in the United States”, published in the Journal of Gerontology: Medical Sciences in 2015; Dr. Kasper was the senior author. This publication established a nationally representative prevalence for physical frailty in the US and also highlighted the notable race and income disparities, and regional differences, in frailty prevalence among the older non-nursing home population.  It also laid the ground work for numerous frailty-related studies that have followed in recent years, including research on the associations of frailty and mortality, cognitive impairment, psychosocial factors, and health disparities, among others. A full list of publications to date is available on the NHATS website using the keyword, Frailty: https://www.nhats.org/publications/search.  We are deeply grateful for our partnership with Dr. Kasper, for her scientific excellence and collegiality, and for the legacy of research on frailty and aging that endures from her vision and leadership.

 

Virtual Event: Honoring the Life & Legacy of Judy Kasper

 

The Johns Hopkins Bloomberg School of Public Health will hold a virtual event to honor the life and legacy of Dr. Kasper on Tuesday, January 18, 2022 from 12-1pm ET; details here.