Aging Doesn’t Have to Scare You! With Heather Boger, PhD

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[00:00:04] Loretta Lynch-Reichert: Hello everyone, and welcome to the Medical University of South Carolina’s Science Cafe podcast, Science Never Sleeps. Today, our guest is Dr. Heather Boger, associate professor of neuroscience, associate director of the Institute for Healthy Aging, which will house the Center on Aging, and director of the Senior Mentor Program, and host of the annual Center on Aging Senior Expo, and a much sought after speaker on the science of aging. Welcome, Dr. Boger.

[00:00:34] Heather Boger, PhD: Good morning, thanks for having me.

[00:00:36] Lynch-Reichert: Our pleasure. I mentioned that you direct the Center on Aging and host an annual expo, but of course in this year with COVID-19, there hasn’t been an opportunity for events. Before we get started on your research of the aging brain, tell us how the Institute for Healthy Aging and the Center on Aging came about at MUSC and explain the mission.[00:00:58] Boger: Sure, so the Center on Aging has existed for roughly 20 years at MUSC and it was initiated through a charge from the state as well as from the university to create a center related to aging and healthy aging and it’s with the intent that we increase not only the education but also research opportunities, as well as community outreach. So we do a lot in terms of going out into the community to talk about various things as it pertains to aging, such as the discussion we’ll have this morning about brain health, but other things such as resources that are actually available in the community to help individuals age in place, for example. But we also provide education for our MUSC students as well as community caregivers, so it is important that everybody has a good understanding of aging, what things change with aging and how can we best cope with these things and help individuals that are truly aging which actually is all of us.

[00:02:04] Lynch-Reichert: You’re absolutely right, in fact we recently had a guest at MUSC and his specialty is gerontology and he reminded us that every part of the body faces aging in some regard and so that all the research and all the clinical care at some point gets to where, you know, you’re looking at an aging body and so I think the work that you do in your center and the institute are incredibly important to everyone. At the time of this recording, Ruth Bader Ginsberg, a justice of the United States Supreme Court, passed away at the age of 87. We marvel at her strength, her towering intellect, and vibrancy up until the very end. How does one maintain such vitality and awareness, or is it just the luck of the draw?

[00:02:54] Boger: Yeah, so obviously there’s a lot of factors that play into the aging process, and as you mentioned, no body system is immune to the aging process and a lot of it has to do with how we take care of ourselves. There are genetics that play into this, there are environmental impacts, but you know, making sure we’re taking care of ourselves is important, such as exercising. I think one of the big things that helped her gain a lot of recognition in the last few years was her exercising. We were seeing how she was doing these planks for minutes, if not multiple minutes on end, and working with these physical trainers and you know, she really put a lot into her health, especially after all of her cancer diagnoses, and so you know, making sure that we take care of our bodies – exercising, eating appropriately – but also getting the appropriate amount of sleep which is hard for us to do, especially in these COVID times, but also mental health is very important – making sure that we try, if we can, to regulate stress, making sure that we’re doing things that make us happy, bring us pleasure, in addition to the everyday work that we all have to accomplish, so it’s a multitask practice, if you will, to help our bodies as we age to cope with things.

[00:04:27] Lynch-Reichert: I... yeah, her routine put me to shame. This 87-year-old woman and myself. So yeah, so I think I better get back on the treadmill. As a country, how well are we aging and what does our future as geriatric citizens look like? Take us through the latest statistics, and I’m curious if you know if we compare well or worse than other countries, at least western countries.

[00:04:58] Boger: Yeah, so I give lectures to our medical students on the physiology of aging and population health, and what’s impressive is because of our medical advancements, because of increases in sanitation procedures, we are living longer. We are educating ourselves a lot better on the aging process, but we’ve got all these other advancements that are helping and so you know, it’s estimated that by 2030, there’s going to be roughly - 20% of our population is going to be 65 years or older and it’s projected by the year 2100, which is of course awhile from now, but still, we will have in the U.S. over 1 million individuals to reach that 100 mark.

So it is quite impressive how we have been able to facilitate, help foster people to live longer. And I always – especially right now in these hard times of COVID – like to point that you know just recently, South Carolina, North Carolina can take credit for the oldest living U.S. citizen, I mean she just turned 115 or 16 - they’re not quite sure on that exact age because of birth records, but she lives in North Carolina, she was born in South Carolina and lives in North Carolina and so there’s tons of pictures of them doing a drive by, if you will, birthday celebration because this happened during COVID, but we as a society are doing really well to help people age.

Now what we’ve got to do is make sure that we are there for those individuals in these advanced ages so that they’re getting proper care, assistance what have you. You asked me about how we compared to other western societies, and you know I think we’re right there with everybody. You know, I looked at the recent statistics – I think the life expectancy in the U.S. for men and women is let’s say 87.6 and in the U.K. it’s 79.1 – so we’re sitting right there in terms of other countries, in terms of successful aging, if you will. I will say women still outlive the men, you know we still have that little bit of an edge up, so there we go.

[00:07:33] Lynch-Reichert: That’s nice to know [laughter]. Let’s move to the brain. As a neuroscientist are you optimistic on research of aging brains? Is there a new discovery on the horizon for Alzheimer’s - one of the most challenging of aging brain diseases.

[00:07:50] Boger: It is, and you know, we deal with Alzheimer’s, we have Parkinson’s, so we’ve got several different neurodegenerative diseases that age is the number on risk factor for. I will say that that’s not the only risk factor, there’s other things that are implicated in these diseases such as genetics, lifestyle, head traumas, previous exposures and environmental exposures, what have you. So as you can imagine, all of those risk factors combined kind of create a little bit of a conundrum for us in terms of being able to properly treat slash find a cure for these individuals.

But I will say that again, because of medicine, because of evolution, because of technologies such as imaging, we’re making great strides in the potential of being able to find a biomarker for these disorders which would be highly integral for early diagnosis of patients. Most times when a person with Alzheimer’s or Parkinson’s disease starts presenting with symptoms, you know, a good portion, a majority of the cells that are involved in that disease have already started to die off and so you know, we don’t have a way of bringing neurons, brain cells back to life and so if we can find biomarkers, good assays that can help us detect the disease early would be just phenomenal to our ability to potentially find a cure, find a disease altering treatment for these individuals.

And here at MUSC I’m very proud to say that, you know, on both sides, the movement as well as the memory disorder side, we’ve got great researchers doing just that - looking at imaging techniques that can be used for biomarkers, blood sampling for biomarkers - as well as therapeutic interventions that may be able to modify the disease progression. So we’re getting there, I mean it’s a time, it takes time and again with our continuing advancements and our ability to test, scan individuals, is going to be integral.

[00:10:20] Lynch-Reichert: I know that MUSC’s neuroscience department is actually one of the best in the country, if I’m not mistaken, at least from a research perspective, they were number eight in the last few years which is very impressive and I hope that people take note of that and understand that what we do in the research enterprise certainly carries over to the clinical enterprise. Do you feel comfortable offering any specifics on some very promising research in that area or is everything still a little bit too new to really give us any hope?

[00:10:56] Boger: Well, you know, it’s something to keep in mind is that research is an ever-evolving process that we’ll find potentially something that potentially may work in an animal model that may not have the same result in the patient population. And so, what we do at MUSC, and I think this is pretty fantastic, is our basic scientists - those that work with animal models looking for mechanisms - have a nice, intimate relationship with our clinical counterparts who are working with the patient population and administering the clinical trials that exist.

There are some drug therapies that are being looked at for Alzheimer's Disease. It is too earlier to indicate whether they’ll work or not, you know, obviously that will play out as they progress through their different phases of clinical trials but likewise on the Parkinson’s side, you know, we’re trying out some devices right now to look for a different type of nerve stimulation as a therapy for Parkinson’s and I’m doing those in my animal models and then my movement disorder counterpart, Dr. Hinson, is trying that in her patient population, so you know, we’ve got a unique setting here at MUSC where we’re working together, basic and clinical, to come up with these strategies.

And you know this as well, it’s not just within MUSC, you know we have collaborations outside of the university for Alzheimer’s disease, with Dr. Mintzer over at Roper, but also across the country, so it’s not just within our own enterprise but we’re really good about having these multi-site research projects to see if our findings, our results are spanning multiple populations and not just in house. There are a lot of exciting things, but it is, you know, something to be cautious about when you start hearing things in clinical trial because you never know what’s going to happen until the study is over.

[00:13:09] Lynch-Reichert: That... excuse me. That leads me to a question. We spoke earlier that aging affects every part of the body and you are teaching, you know, you are engaged with students about these processes, but if I understand correctly, the geriatric healthcare workers is a very small population. So how do we, as we age as a society and we grow as an aging society, how is the healthcare system supporting that if we just have a very small group of folks actually engaged in that kind of work?

[00:13:48] Boger: Yeah, as you mentioned of course geriatric medicine is small in terms of its discipline and you have pockets of geriatricians across the nation. MUSC a few years ago made it one of their initiatives to increase geriatric medicine here on campus, which I was very excited about. So we were able to bring in Dr. Newbrough, and Overstreet, and he’s been able to build a fellowship program in geriatrics, and that’s great because that’s the only one that exists in the state. So we’re trying to, in that regard, increase our presence here at MUSC.

What I like also is that they go out into the community, so they serve several of the senior communities as their resident geriatricians. But with that being said, obviously increasing student’s knowledge, physician’s knowledge of geriatric medicine is important because it is important to remember that things do change as we get older, that there are things physicians need to be on the lookout for. We know that nutritional needs change as we get older, we know that as we get older the incidence of individuals having multiple medications can actually cause problems, so making sure physicians and pharmacists are working together for the appropriate medicinal therapies because we know that many can cause severe side effects if they’re interacting in senior patients.

So it’s really trying to expand the knowledge base even down to pediatric physicians because as we tell our students, even in pediatrics, you’re going to potentially be dealing with someone over the age of 65 mainly because a lot of grandparents take their grandchildren to the doctors, you know, to help parents out. So you know no matter what discipline of medicine you’re going into, you’re going to be working with a senior and so making sure you have the appropriate knowledge, the appropriate understanding – helping to break down stereotypes associated of aging is one of my big missions – is important because you know seniors are just as vital to this society as anybody else and they’ve got a lot to teach. They have a lot of life experience that is valuable and should be fostered as well and not be pushed to the side, if you will. So building that appreciation for our seniors is crucial as well.

[00:16:35] Lynch-Reichert: So I have a personal interest in this because I have a mother who is 91 years old, almost 92, actually and I hope I follow in her footsteps. So moving just a little bit outside of the realm of research though, when you are advising audiences, say at the Center on Aging Expo that’s done every year – beautifully done every year by the way – what would you tell somebody like me when I’m the caregiver for my mother and how do we approach the healthcare system, you know, when I’m taking her to the doctor. I take her to MUSC doctors so I know they’re always in good hands, but those people in rural areas or just don’t have the resources that we have here in Charleston, how would you advise those caregivers in managing the health of their elderly parents or relationships?

[00:17:33] Boger: Yeah, so there’s obviously a very fine line that you know people should be walking with that because one, you’ve got to keep in mind, seniors are adults still, you know. We want to make sure that we’re not belittling, or downgrading, or dismissing any symptoms or signs or whatever that they may be having, but as a family member, as a caregiver, I strongly encourage that, if possible, if the parent allows, to have an active role in their medical care. And obviously to do that, the parent, the senior would have to allow permission. You know, it’s being there asking the questions that may not be asked or thought about by the patients themselves, that's, you know, with any generation dealing with a potential diagnosis that’s uncomfortable.

But being there, being supportive, making sure you’re asking the correct questions, making sure that a family member also knows about all the medications that that individual is taking. I know we went through something like that in our family where, you know, something happened to my mother and we didn't know all her medications and now that she’s gone, me as a child of my dad, we make sure that we know now everything he takes, in the event of an emergency. So being cognizant of the parent or the senior’s health is important because that helps you be able to help that person out with asking the right questions, being there, providing the right support, getting the right resources necessary for the treatment of that individual. But being careful not to overstep bounds in that this is still an adult, you know? They should be treated with respect and dignity just like anybody else would.

[00:19:39] Lynch-Reichert: Those are great words, and my mother tries to remind me of that every time I try to tell her what to do, so you’re absolutely right, we would all want to be treated that way. With regard to the aging process, and in particular brain aging, how can we protect ourselves now in our 30’s, 40’s, 50’s, 60’s?

[00:20:06] Boger: Yeah, so I... you know, it’s funny because we talk about this a lot, especially with the younger generation is, you know, what’s vital to your brain in reducing the risk, if you will, of neurodegeneration is keeping that brain active, keeping it engaged. And you do these things by staying involved in social activities. You know I play... I used to play a lot of sports, I run now. I do things that I know help me, one relieve stress and focus on something else at that time. I do a lot of painting. Of course this is just audio but behind me I have paintings that I’ve done. Doing things that I enjoy but yet keeps my brain active.

Obviously doing those fine motor skills, you know, having a higher being that you believe in, no matter what your religious beliefs are, having that connection with something is important. Making sure that you are exercising, that you are eating appropriately, not McDonald's every day, three times a day, but eating the appropriate amounts of fruits and vegetables and healthy meats and reducing sugar intake. Even doing mind games, you know there’s... while I don’t play a lot of video games and I don’t necessarily promote video game playing, there are mind... brain... let’s see, this is my lack of knowledge at technology – brain games that are available that can be played on small devices. Even doing crossword puzzles, sudoku, Tetris – see again my age showing through here – helps with activity because that’s making you think about processes and how to pair things and memory recall, that kind of stuff – it's really keeping it active for sure.

[00:22:06] Lynch-Reichert: One of the things that strikes me, as you’re speaking is, these are incredible resources and I’m going to ask you in a moment to talk about how the institute engages the public on this, but it also brings to mind, there are a lot of folks who don’t have access to any of this and for those folks who live in, you know, even food deserts where the only thing they have access to is cheaper food, they don’t have family connections, you know, they don’t even really have good medical care in rural areas, how do we help them? What is it that the institute is doing or that the center is doing to help these types of folks?

[00:22:48] Boger: Yeah so we do a lot of outreach and we have a lot of connections into the community that serve that particular population, those more rural individuals that don’t have access, and obviously a lot of that issue is because of a lack of transportation. We have poor transportation, especially for our seniors, but we work with agencies in the community such as the... Area Agency on Aging, so it’s a tongue twister, that receives funds through the state, but also donations, that go out and do meal delivery services.

Obviously when COVID hit, this was a large population that got affected, and so we helped collect food that could be taken to the Agency on Aging for distribution to their patrons, and so we help promote those events. We work with the Lowcountry Senior Network that, this past weekend actually, did kind of a drive by farmer’s market type thing, where they handed out food and obviously, you know, families helped with that. But really for, as a society as a matter of reaching out to those communities, you know, realizing that we do have these rural areas – and South Carolina is, I mean South Carolina is farm land, it was, and we still have very large pockets of rural communities and there’s nothing wrong with it, I think it’s part of the charm, but if we know it and we recognize it, it’s important for us to reach out to those communities and help, and so we do that through the center through our community ties.

We help with Meals on Wheels, which obviously reaches out a lot to seniors that don’t have access. We help facilitate cooking demonstrations for low budget individuals, you know, we all don’t want to go out and spend twenty dollars every time at the grocery store for one meal, you know, we want to be economic as well, and so there are ways to cook healthy with resources that you have. And you know, it’s making sure that we utilize those resources, so it’s different ways that we are reaching out to the community, either with our physical presence, our virtual presence, or you know, providing guidance on seeking the appropriate resources.

[00:25:26] Lynch-Reichert: I really can’t think of a more important institute than the Institiute on Health Aging and the Center on Aging. I’m not kidding, I think everyone should know about it. Dr. Boger, thank you so much for invaluable information, and for all the work you do, both in neuroscience research of aging and in outreach to our public. We are grateful for your commitment and determination in finding the solution to these very difficult issues. So tell us more about how we can engage with the center and where we can learn more information. I’m sure there’s a website that folks would love to tab into.

[00:26:04] Boger: Sure! So people can go to musc.edu and enter in ‘Center on Aging’ and it will take you directly to that page. We also have a Facebook that Kelly Franklin is very in tune with and keeps up to date. We also have a Twitter, so she tweets to help the community stay informed of not only things happening at MUSC, because that’s obviously important, but also to let people know what’s going on in the community and resources that they can tap into, such as the National Institute for Health when they give seminars on Alzheimer’s Disease or exercise benefits for the brain, so it’s not just a local resource, but she’s very good about tapping in and letting people know about national seminars or resources that are available.

[00:26:59] Lynch-Reichert: That is... I’m sorry go ahead.

[00:27:02] Boger: I said even clinical trials that are going on.

[00:27:07] Lynch-Reichert: That is really wonderful. A true treasure and asset for our community. Do you expect with the COVID-19 virus continuing, do you expect to have a Center on Aging Expo next year or are you looking to do something virtual?

[00:27:26] Boger: Yeah, we’re obviously exploring all options. Currently, you know, I can’t say that we’re going to have an in-person one, while I would love to. We very much have to take into consideration that it’s the senior population that is one of the most vulnerable populations and trying to bring a bunch of seniors together in an environment like that would be not wise. So we’re exploring some options for virtual resource fairs, if you will. Maybe even as the summer months come, hopefully within a year’s time we’ll have a little bit better grasp and understanding of COVID, and potentially, you know, vaccine’s out to help but we are playing around with different ways of providing the resources, just potentially not in that in-person setting that we’ve been able to do the last few years, so it’s an evolving process and definitely something that we’re still open to, just figuring out or having modified versions, plans available if needed.

[00:28:40] Lynch-Reichert: All the more reason for us to stay tuned and to check in with you and the Center on Aging and the Institiute for Healthy Aging. Thanks again to our guest, Dr. Heather Boger, associate professor of neuroscience, associate director of the Institute for Healthy Aging, director of the Senior Mentor Program and the host of the annual Center on Aging Expo and a much sought after, wise speaker on the science of aging. Join us next time when we speak to Dr. Mark Semler, CEO of the Zucker Institiute for Applied Neurosciences. Thank you everyone and stay well.