Aging & Geriatrics
Research overview
As the world’s population is aging, scientists at Kaiser Permanente Washington Health Research Institute (KPWHRI) are at the forefront of research to help older adults lead healthier lives.
Among the questions KPWHRI scientists have examined include whether getting regular exercise may reduce the risk of dementia, whether widely used medications increase the risk of falls and fractures, how long-term use of opioid pain medications affects the brain, and what approaches can help frail older adults become more physically active. Our research includes studies looking at brain health, physical activity and behavior change, medication safety, cardiovascular health, and chronic disease management, among other research areas. Now, new funding for aging research — especially research on Alzheimer’s and related dementias — offers even greater opportunities for KPWHRI scientists and their colleagues who work in health care systems.
Studies spanning decades
The institute has hosted several long-running cohort studies, including the Adult Changes in Thought (ACT) Study, a collaboration with the University of Washington. For more than 30 years, ACT researchers have studied risk factors for dementia, with the goal of finding new ways to delay or prevent Alzheimer’s disease and cognitive decline.
In May 2021, the National Institute of Aging awarded ACT a new grant totaling $55.6 million. With this additional funding, ACT will further examine how various health factors across our life span can impact later-life heart and brain health. The funding will allow ACT to examine the health impacts of sleep, physical activity, socio-economic factors, and prescription medications, as well as to examine brain imaging. In addition, ACT will continue to collect and study participants’ brains after their deaths to better understand how brain physiology is impacted by lifestyle factors.
Under the 5-year grant, ACT partners are expanding the existing cohort of 2,000 Kaiser Permanente Washington members to 3,000 and implementing new strategies to recruit a more diverse population. Additionally, as part of the grant, the ACT team is making its data more accessible to researchers nationwide. You can find out more about the ACT Study and collaborate with the team at www.actagingresearch.org.
Wide-ranging research
Scientists at KPWHRI are advancing age-related research in many other areas as well. Some highlights:
- The institute’s research on medication safety is contributing to better understanding of how certain medications affect older adults’ well-being and how to avoid unsafe and unnecessary medications. Among other initiatives, KPWHRI researchers are developing a compendium of tools and resources to improve the management of opioids in older adults. Michael Parchman, MD, MPH, is also leading a pilot clinical trial to study the impact of training clinicians to become value champions to reduce inappropriate prescribing for people with dementia.
Additionally, Ben Balderson, PhD, is working with scientists at the University of Washington on 2 grants to test an approach to help older adults reduce or stop risky medications. The researchers are reaching out to primary care doctors and patients with information and education about medications such as opioids, benzodiazepines, and muscle relaxants that may increase the risk of falls, dementia, or other challenges. These studies are set within 18 primary care clinics at Kaiser Permanente Washington.
- In a pilot trial of 172 older adults with risk factors for dementia, researchers at KPWHRI and the University of California, San Francisco (UCSF) are examining whether health coaching to improve physical activity, sleep, and other modifiable risk factors for dementia is an effective way to prevent cognitive decline as people age.
- Dori Rosenberg, PhD, MPH, and colleagues are leading a randomized controlled trial examining whether reducing the amount of time older adults spend sitting can improve their health. In her pilot studies, she showed that helping older adults to sit less (by encouraging more standing and moving) fit into their daily lives more easily than focusing only on promoting structured bouts of exercise.
- Sascha Dublin, MD, MPH, is leading work to promote earlier recognition and diagnosis of dementia. Together with researchers at UCSF, she and her team developed the eRADAR risk score, which uses routine data from electronic health records to identify people at higher risk of having undiagnosed dementia. Now, with funding from the National Institute on Aging, they are conducting a randomized clinical trial to test the impact of applying this model and reaching out to high-risk patients in 8 primary care clinics at Kaiser Permanente Washington and UCSF.
- Robert Penfold, PhD, is leading a pragmatic randomized trial to develop and test STAR-VTF, a training program to support caregivers of people with dementia and reduce the use of antipsychotic medications among these patients. The program was originally created by colleagues at the University of Washington and has now been adapted to provide online training and virtual visits.
- Marlaine Figueroa Gray, PhD, is collaborating with scientists at the University of Toronto and on the ACT Study to examine the lived experiences of older adults with cognitive subtypes of dementia and the perspectives of those who care for them. She has also partnered on projects to determine health outcomes of kinless elders living with dementia, to examine the experience of people living with advanced dementia who receive specialty palliative care, and to understand the perspectives of patients, families, and providers on a screening tool that would provide information on the risk of living with undiagnosed dementia.
- The cancer screening work by Karen Wernli, PhD, and Ellen O’Meara, PhD, has underscored the need for more research into when the benefits of screenings for breast and lung cancers are worth the risks for older adults, particularly people with other serious illnesses.
- The Chronic Care Model — developed at KPWHRI’s Center for Accelerating Care Transformation (formerly known as the MacColl Center for Health Care Innovation) — is widely recognized as the leading care-design model for everyone, including older people, with chronic disease.
- In addition to the institute’s work promoting healthier aging, KPWHRI scientists — through the ACT Study, its predecessors, and other research — have contributed to the growing movement to support and improve caregiving, especially for people living with dementia. Our investigators are also seeking ways to help older adults receive late-life care that best reflects their values and preferences.
Recent publications on Aging & Geriatrics
Heath L, Gray SL, Boudreau DM, Thummel K, Edwards KL, Fullerton SM, Crane PK, Larson EB. Cumulative antidepressant use and risk of dementia in a prospective cohort study. J Am Geriatr Soc. 2018 Sep 17. doi: 10.1111/jgs.15508. [Epub ahead of print]. PubMed
Lee CS, Larson EB, Gibbons LE, Lee AY, McCurry SM, Bowen JD, McCormick WC, Crane PK. Associations between recent and established ophthalmic conditions and risk of Alzheimer's disease. Alzheimers Dement. 2019 Jan;15(1):34-41. doi: 10.1016/j.jalz.2018.06.2856. Epub 2018 Aug 8. PubMed
Gray SL, Anderson ML, Hanlon JT, Dublin S, Walker RL, Hubbard RA, Yu O, Montine TJ, Crane PK, Sonne JA, Keene CD, Larson EB. Exposure to strong anticholinergic medications and dementia-related neuropathology in a community-based autopsy cohort. J Alzheimers Dis. 2018 Jul 21. pii: JAD171174. doi: 10.3233/JAD-171174. [Epub ahead of print]. PubMed
Deming Y, Dumitrescu L, Barnes LL, Thambisetty M, Kunkle B, Gifford KA, Bush WS, Chibnik LB, Mukherjee S, De Jager PL, Kukull W, Huentelman M, Crane PK, Resnick SM, Keene CD, Montine TJ, Schellenberg GD, Haines JL, Zetterberg H, Blennow K, Larson EB, Johnson SC, Albert M, Moghekar A, Del Aguila JL, Fernandez MV, Budde J, Hassenstab J, Fagan AM, Riemenschneider M, Petersen RC, Minthon L, Chao MJ, Van Deerlin VM, Lee VM, Shaw LM, Trojanowski JQ, Peskind ER, Li G, Davis LK, Sealock JM, Cox NJ; Alzheimer’s Disease Neuroimaging Initiative (ADNI), Alzheimer Disease Genetics Consortium (ADGC), Goate AM, Bennett DA, Schneider JA, Jefferson AL, Cruchaga C, Hohman TJ. Sex-specific genetic predictors of Alzheimer's disease biomarkers. Acta Neuropathol. 2018 Dec;136(6):857-872. doi: 10.1007/s00401-018-1881-4. Epub 2018 Jul 2. PubMed
Anttila V, Bulik-Sullivan B, Finucane HK, Walters R, Bras J, Duncan L, Escott-Price V, Falcome G, Gormley P, Malik R, Patsopoulos N, Ripke S, Wei Z, Yu D, Lee PH, Turley P, Grenier-Boley B, Chouraki V, Kamatani Y, Berr C, Letenneur L, Hannequin D, Amouyel P, Boland A, Deleuze J-F, Duron E, Vardarajan BN, Reitz C, Goate Am, Huentelman MJ, Kamhoh MI, Larson EB, Rogaeva E, St George-Hyslop P, Hadonarson H, Kukull WA, Farrer LA, Barnes LL, Beach TG, Demirci FY, Head E, Hulette CE, Jicha GA, Kauwe JSK, Kaye, Leverenz JB, Levey AI, Lieberman AP, Pankratz VS, Poon WW, Quinn JF, Saykin AJ, Schneider LS, Smith AG, Sonnen JA, Stern RA, Van Deerlin VM, Van Eldik LJ , Harold D, Russo G, Rubinsztein DC, Bayer A, Tsolaki M, Proitsi P, Fox NC, Hampel H, Owen MJ, Mead S, Passmore p, Morgan K, Rossor M, Lupton M, Hoffmann P, Kornhuber J, Lawlor B, McQuillin A, Al-Chalabi A, Bis JC, Ruiz A, Boada M, Seshadri S, Beiser A, Rice K, van der Lee S, De Jager PL, Geschwind DH, Riemenschneider M, Riedel-Heller S, Rotter JI, Ransmayr G, Hyman BT, Cruchaga C, Alegret M, Winsvold B, Palta P, Farh KH, Cuenca-Leon E, Furlotte N, Kurth T, Ligthart L, Terwindt G, Freilinger T, Ran C, Gordon S, Borck G, Adams H, Lehtimäki T, Wedenoja J, Buring J, Schürks M, Hrafnsdottir M, Hottenga J-J, Penninx B, Artto V, Kaunisto M, Vepsäläinen S, Martin N, Montgomery G, Kurki M, Hämäläinen E, Huang H, Huang J, Sandor C, Webber C, Muller-Myhsok B, Schreiber S, Salomaa V, Loehrer E, Göbel H, Macaya A, Pozo-Rosich P, Hansen T, Werge T, Kaprio J, Metspalu A, Ferrari M, Belin A, Maagdenberg A, Zwart JA, Boomsma D, Eriksson N, Olesen J, Chasman D, Nyholt D, Avbersek A, Baum L, Berkovic S, Bradfield J, Buono R, Catarino CB, Cossette P, Jonghe P, Depondt C, Dlugos D, Ferraro T, French J, Hjalgrim H, Jamnadas-Khoda J, Kälviäinen R, Kunz W, Lerche H, Leu C, Lindhout D, Lo W, Lowenstein D, McCormack M, Møller R, Molloy A, Ng P-W, Oliver K, Privitera M, Radtke R, Ruppert A-K, Sander T, Schachter S, Schankin C, Scheffer I, Schoch S, Sisodiya S, Smith P, Sperling M, Striano P, Surges R, Thomas NG, Visscher F, Whelan CD, Zara F, Heinzen E, Marson A, Becker F, Stroink H, Zimprich F, Gasser T, Gibbs R, Heutink P, Martinez M, Morris H, Sharma M, Ryten M, Mok B, Pulit S, Bevan S, Holliday E, Attia J, Battey T, Boncoraglio G, Thijs V, Chen WM, Mitchell B, Rothwell P, Sharma P, Sudlow C, Vicente A, Markus H, Kourkoulis C, Pera J, Raffeld M, Silliman S, Perica VB, Thornton LM, Huckins LM, Rayner NW, Lewis CM, Gratacos M, Rybakowski F, Keski-Rahkonen A, Raevuori A, Hudson JI, Reichborn-Kjennerud T, Monteleone P, Karwautz A, Mannik K, Baker JH, O'Toole JK, Trace SE, Davis OSP, Helder S, Ehrlich S, Herpertz-Dahlmann B, Danner UN, van Elburg AA, Clementi M, Forzan M, Docampo E, Lissowska J, Hauser J, Tortorella A, Gonidakis F, Tziouvas K, Papezova H, Yilmaz Z, Wagner G, Cohen-Woods S, Herms S, Julia A, Rabionet R, Dick DM, Ripatti S, Andreassen OA, Espeseth T, Lundervold A, Steen VM, Pinto D, Scherer SW, Aschauer H, Schosser A, Alfredsson L, Padyukov L, Halmi KA, Mitchell J, Strober M, Bergen AW, Kaye W, Szatkiewicz JP, Cormand B, Ramos-Quiroga JA, Sánchez-Mora C, Ribasé M, Casas M, Hervas A, Arranz MJ, Haavik J, Zayats T, Johansson S, Williams N, Dempfle A, Rothenberger A, Kuntsi J, Oades RD, Banaschewski T, Franke B, Buitelaar JK, Vasquez AA, Doyle AE, Reif A, Lesch KP, Freitag C, Rivero O, Palmason H, Romanos M, Langley K, Rietschel M, Witt SH, Dalsgaard S, Børglum A, Waldman I, Wilmot B, Molly N, Bau C, Crosbie J, Schachar R, Loo SK, McGough JJ, Grevet E, Medland SE, Robinson E, Weiss L, Bacchelli E, Bailey A, Bal V, Battaglia A, Betancur C, Bolton P, Cantor R, Celestino-Soper P, Dawson G, De Rubeis S, Duque F, Green a, Klauck SM, Leboyer M, Levitt P, Maestrini E, Mane S, Moreno-De-Luca D, Parr J, Regan R, Reichenberg A, Sandin S, Vorstman J, Wassink T, Wijsman E, Cook E, Santangelo S, Richard Delorme, Rogé B, Magalhaes T, Arking D, Schulze TG, Thompson RC, Strohmaier J, Matthews K, Melle I, Morris D, Blackwood D, McIntosh A, Bergen SE, Schalling M, Jamain S, Maaser A, Fischer SB, Reinbold CS, Fullerton JM, Guzman-Parra JG, Mayoral F, Schofield PR, Cichon S, Mühleisen TW, Degenhardt F, Schumacher J, Bauer M, Mitchell PB, Gershon ES, Rice J, Potash JB, Zandi PP, Craddock N, Ferrier IN, Alda M, Rouleau GA, Turecki G, Ophoff R, Pato C, Anjorin A, Stahl E, Leber M, Czerski PM, Cruceanu C, Jones IR, Posthuma D, Andlauer T, Forstner AJ, Streit F, Baune BT, Tracy Air T, Sinnamon G, Wray N, MacIntyre D, Porteous D, Homuth G, Rivera M, Grove J, Middeldorp C, Hickie I, Pergadia M, Mehta D, Smit JH, Jansen R, de Geus E, Dunn E, Li Q, Nauck M, Schoevers RA, Beekman ATF, Knowles JA, Viktorin A, Arnold P, Barr C, Bedoya-Berrio G, Bienvenu O, Brentani H, Burton C, Camarena B, Cappi C, Cath D, Cavallini M, Cusi DDarrow S, Denys D, Derks E, Dietrich A, Fernandez T, Figee M, Freimer N, Gerber G, Grados M, Greenberg E, Hartmann A, Hirschtritt M, Hoekstra P, Huang A, Huyser C, Illmann C, Jenike M, Kuperman S, Leventhal B, Lochner C, Lyon G, Macciardi F, Madruga-Garrido M, Malaty IA, Maras A, McGrath L, Miguel E, Pablo Mir P, Nicolini H, Okun MS, Pakstis A, Piacentini J, Pittenger C, Plessen K, Ramensky V, Ramos EM, Reus V, Richter M, Riddle M, Robertson M, Roessner V, Rosário M, Sandor P, Stein D, Tsetsos F, Van Nieuwerburgh F, Weatherall S, Wendland J, Wolanczyk T, Worbe Y, Goes F, McLaughlin N, Nestadt PS, Grabe H-J, Depienne C, Konkashbaev A, Lanzagorta N, Valencia-Duarte A, Bramon E, Buccola N, Cahn W, Cairns M, Chong S, Cohen D, Crespo-Facorro B, Crowley J, Davidson M, DeLisi L, Dinan T, Donohoe G, Drapeau E, Duan J, Haan L, Hougaard D, Karachanak-Yankova S, Khrunin A, Klovins J, Kucinskas V, Keong JLC, Limborska S, Loughland C, Nnqvist JL, Maher B, Mattheisen M, McDonald C, Murphy K, Nenadic I, Os J, Pantelis C, Pato M, Petryshen T, Quested D, Roussos P, Sanders A, Schall U, Schwab S, Sim K, So H-C, Stögmann E, Subramaniam M, Toncheva D, Waddington J, James Walters J, Cheng W, Cloninger R, Curtis D, Frans Henskens F, Mattingsdal M, Oh S-Y, Scott R, Webb B, Churchhouse C, Breen G, Bulik C, Mark Daly M, Dichgans M, Faraone SV, Guerreiro R, Holmans P, Kenneth Kendler, Koeleman B, Mathews CA, Price A, Scharf J, Sklar P, Williams J, Wood N, Cotsapas C, Palotie A, Smoller J, Sullivan P, Rosand J, Corvin A, Neale BM, on behalf of the Brainstorm consortium. The analysis of shared heritability in common disorders of the brain. Science. 2018 Jun 22;360(6395). pii: eaap8757. doi: 10.1126/science.aap8757. PubMed
Researchers in Aging & Geriatrics
 Sascha Dublin, MD, PhDSenior Investigator |
 Dori E. Rosenberg, PhD, MPHSenior Investigator |
 Erin J. Bowles, MPHDirector, Collaborative Science |
 Ellen O'Meara, PhDPrincipal Collaborative Scientist |
 Melissa L. Anderson, MSPrincipal Collaborative Biostatistician |
 Rod L. Walker, MSPrincipal Collaborative Biostatistician |
 Laura Harrington, PhD, MPHAssociate Scientific Investigator |
 Katie Coleman, MSPHDirector, ACT Center |
 Robert Penfold, PhDSenior Investigator |
 Marlaine Figueroa Gray, PhDAssistant Investigator |
 Ben Balderson, PhDSenior Collaborative Scientist |
 Jennifer C. Nelson, PhDDirector, Biostatistics; Senior Investigator |
 Onchee Yu, MSPrincipal Collaborative Biostatistician |
 Jessica Chubak, PhDSenior Investigator |
 Yu-Ru Su, PhDAssociate Biostatistics Investigator |
 Chloe Krakauer, PhDCollaborative Biostatistician |
 Karen Wernli, PhDSenior Investigator |
 Mikael Anne Greenwood-Hickman, MPHSenior Collaborative Scientist |
 Brian D. Williamson, PhDAssistant Biostatistics Investigator |
 Pamela A. Shaw, PhD, MSSenior Biostatistics Investigator |
 Nicole M. Gatto, PhD, MPHPrincipal Collaborative Scientist |
 Linda K. McEvoy, PhDSenior Investigator |
 Lily N. Shapiro, PhDCollaborative Scientist |
Affiliate researchers
James Bowen, MD
Neurologist
Swedish Medical Center
Paul Crane, MD, MPH
Professor, Internal Medicine
University of Washington
David R. Crosslin, PhD
Assistant Professor
Biomedical Informatics and Medical Education
Adjunct Faculty
Genome Sciences, Division of Medical Genetics
University of Washington
Kristen Dams-O'Connor, PhD
Associate Professor
Department of Rehabilitation Medicine
Icahn School of Medicine at Mt. Sinai
James Floyd, MD, MS
Assistant Professor, Department of Medicine
Shelly Gray, PharmD, MS, AGSF
Professor, Department of Pharmacy
University of Washington
Gail Jarvik, MD, PhD
Professor, Medical Genetics, Genome Sciences, Department of Medicine
University of Washington
Dirk Keene, MD, PhD
Department of Pathology
Harborview Medical Center
Zachary A. Marcum, PhD, PharmD
Assistant Professor, School of Pharmacy
University of Washington
Wayne McCormick, MD, MPH
Head of Gerontology and Geriatric Medicine
UW Medicine
Sue McCurry, PhD
Research Professor, Psychosocial and Community Health
University of Washington
Elizabeth Phelan, MD, MS
Associate Professor, Medicine/Gerontology and Geriatric Medicine
Harborview Medical Center
Adjunct Associate Professor, Health Services
University of Washington
Janelle S. Taylor, PhD
Professor, Department of Anthropology
University of Toronto
Linda Teri, PhD
Professor, Psychosocial & Community Health
Director, Northwest Research Group on Aging, Psychosocial and Community Health
University of Washington
Oleg Zaslavsky, PhD, MHA, RN
Assistant Professor Biobehavioral Nursing and Health Systems Department
Associate Director of Research, de Tornyay Center for Health Aging
School of Nursing, University of Washington
Healthy findings blog
Reframing how we speak about dying
In a recently published blog based on her legacy research, Marlaine Figueroa Gray describes how to talk about death.
Research
ACT Study contributes to understanding Alzheimer’s disease in brain cells
Mapping the disease at the cellular level identifies possible new treatment targets.
Research
Alzheimer’s vision study improved with home testing
The research builds on the ongoing Adult Changes in Thought (ACT) Study, started in 1994.
News
Researchers connect for ACT Symposium, advancing science on dementia, aging
The long-running ACT Study is now in its 30th year.
Research
Changing sitting habits shows meaningful impact
A new trial highlights a promising intervention to improve blood pressure in older adults.
Research
Can preventing hearing loss reduce dementia risk?
New research from Linda McEvoy, PhD, helps explain how hearing loss affects the brain.
2023 ACT Symposium
Researchers gather to address critical topics in aging and dementia
The ACT Research Symposium returns with an in-person scientific forum.
Research
Traumatic brain injury raises risk of brain atrophy
Study suggests pathology of brain cell loss after traumatic head injury is distinct from Alzheimer’s disease.
New findings
Using long-term data to understand a vulnerable population
Studies offer insights into the lives of older adults with dementia who lack family.
News
New open data to help understand Alzheimer’s
Cell by cell, scientists are building a high-resolution map of brain changes in Alzheimer’s disease.
ACT Study news
Healthy aging: New tool for research and collaboration
Adult Changes in Thought (ACT) Study launches a new website to advance our understanding of brain aging.
Research
Cataract surgery linked with lessened dementia risk
JAMA Internal Medicine study finds cataract surgery associated with 30% lower risk of dementia in aging population.
ACT Study
Roundup of 3 recent studies on dementia risk
Researchers explore links between hearing loss, military service, and cognitive decline — and look at timeliness of diagnosis.
Live Healthy
How to lower your risk of dementia
It’s never too late (or too soon) to take preventive steps.
Research
Helping older adults improve health by sitting less
Dr. Dori Rosenberg discusses her work on a new Cochrane review looking at ways to help older adults be less sedentary.
Prescription overload
Deprescribing: Less may be more
Dr. Sascha Dublin explains why sometimes not taking medications may be a safer and healthier choice.
New funding
Grant of over $55M to boost Alzheimer’s, dementia study
Kaiser Permanente Washington will co-lead an expanded ACT Program to better understand the aging brain.
KPWHRI in the media
Understanding Alzheimer’s disease in brain cells
Alzheimer's study in Seattle makes new findings for future therapies
FOX-13, Oct. 22, 2024
Research
Study evaluates biomarker criteria for Alzheimer’s risk
One-third of people classified as ‘highest risk’ may not develop Alzheimer’s disease, study suggests
KPWHRI in the media
Evidence shows benefits of activity for healthy aging
Inspiring Seattle rowers: ‘boys in the boat,’ and now, women age 70 and up
Seattle Times, April 5, 2024
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