The designation recognizes emergency departments with specialized expertise, staffing and resources for patients 65 and older, who represent about one-third of all patients treated in Cedars-Sinai’s Emergency Department each year.

“This recognition reflects our commitment to delivering exceptional, patient-centered emergency care for the older adults of our community,” said Claude Stang, RN, executive director of the Cedars-Sinai Emergency Department. “As the No. 1 Medicare provider in California, we care for thousands of older adults every year, and we are dedicated to keeping them safe and healthy.”

Accreditation reviewers cited several programs and features that distinguish Cedars-Sinai’s approach to geriatric emergency care, including the Barry and Rena Plost Senior Emergency Center within the Emergency Department.

“We try to place patients who would benefit from a quieter environment in our senior care unit, where private rooms, dim lighting and reduced noise can help minimize delirium for patients who are susceptible,” Stang said. “Those seemingly small changes can make a meaningful difference for older adults in the Emergency Department.”

Other components highlighted by reviewers included:

• A specialized geriatric nurse assessment team, trained to identify delirium, dementia, fall risk and social determinants of health.
• Integrated physical therapy and pharmacy services, including prescription medication screening, review and reconciliation.
• Senior-friendly amenities, including reserved reclining chairs in the waiting area, improved signage and lighting, handrails, and accessible bathrooms.
• Tender Loving Care volunteers, who are specially trained to provide companionship and comfort for older adult patients.
• A physician who leads ongoing education on geriatric emergency care for physicians and physician assistants.

Level 1 accreditation builds on Cedars-Sinai’s broader commitment to age-friendly care. The health system also has been named an Age-Friendly Health System Committed to Care Excellence, a recognition from The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.

“Older adults often have unique medical and social needs that require a different approach to emergency care, that centers around the 4M’s (What Matters Most, Mobility, Medications and Mentation) of age-friendly care,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai. “As an Age-Friendly Health System, every member of our team plays an important role in ensuring patients receive compassionate, specialized attention from the moment they arrive through a seamless transition to the next stage of their recovery.”

The Emergency Department’s research team also has been active in advancing geriatrics research, publishing on sepsis, brain injury, cardiac biomarkers and observation care. The work helps to inform evidence-based practices that further strengthen care for older adults.

Emergency Department Expansion Underway

The accreditation comes as Cedars-Sinai continues a major expansion of its Emergency Department, an investment designed to increase capacity while supporting the specialized care needs of a growing patient population.

The project will add 16,550 square feet to the department and increase the number of care spaces from 60 to 100.

Sam Torbati, MD, chair and medical director of the Emergency Department, said the project is expected to be completed by the end of 2028.

“Smaller improvements, such as a new laboratory, are expected to open this fall,” Torbati said. “Patients will begin to see more significant changes next summer.”

The first major phase will add 15 acute care beds, eight behavioral health beds to treat patients with mental health needs, six critical care and trauma beds, and a dedicated room designed to care for critically ill children. The expansion also will include new waiting areas, an updated triage space and a redesigned patient entrance to improve capacity and the overall care experience.

“Demand for emergency care continues to grow, and we’re committed to finding new ways to improve the experience and quality of care for our patients,” Torbati said. “The expansion is a significant investment in meeting those needs.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The May 3 panel discussion, “Informing Innovation: Emerging Medicine and Jewish Ethics,” begins at 9 a.m. and features experts focusing on the latest advancements in genetic and genomic testing, as well as gerotherapeutics—drugs that target the biological processes of aging.

“What was once considered science fiction is now real, and as scientific and medical innovation accelerate, the question is no longer just what’s possible—but what’s responsible,” said Rabbi Jason Weiner, PhD, senior rabbi and director of the Spiritual Care Department at Cedars-Sinai. “As a faith-based institution, we believe it’s essential to explore the science and its ethical, moral and theological implications. This event creates space for those conversations so people can make more informed decisions about their health.”

Topics Include:

• What research shows about emerging “anti-aging” therapies

• Clinical trials targeting the root causes of aging—and the potential impact on cancer, dementia, heart disease and other conditions

• The difference between evidence-based medicine and widely marketed but unproven products

• What genetic testing can and cannot reveal

“Advancements in genomic technologies have bolstered the promise of solving medical mysteries, predicting future health risks, and advancing personalized medicine,” said Joyce So, MD, PhD, chief genomics officer at Cedars-Sinai and a speaker at the event. “But that promise also raises ethical and theological questions. Asking those questions now helps ensure we use these powerful tools wisely.”

So’s presentation will explore direct-to-consumer genetic testing, genetic discrimination, privacy and confidentiality concerns, predictive testing without clear treatment options, and disparities in access to—and understanding of—genetic information.

James Kirkland, MD, PhD, director of the Center for Advanced Gerotherapeutics at Cedars-Sinai, will address common misconceptions about longevity science, including the gap between promising research and proven therapies. He also will discuss lifestyle interventions being studied now and how emerging gerotherapeutic approaches could reshape clinical care in the next decade.

“If scientists can safely slow the fundamental processes of aging, the impact could extend across many diseases at once,” Kirkland said. “Early clinical trials are already exploring how conditions linked to aging, such as Alzheimer’s disease and other forms of dementia, begin developing long before symptoms appear. If these approaches prove safe, the next step could be preventing disease in people at high risk.”

Kirkland also will share his team’s research into removing damaged “aging” cells or preventing them from releasing harmful substances that contribute to disease and decline later in life.

Other event speakers include Rabbi Elan Segelman, U.S. rabbinic director of PUAH; and internationally known Torah scholar Rav Asher Weiss Shlit”a, who will give the keynote address.

“Informing Innovation: Emerging Medicine and Jewish Ethics” will take place from 9 a.m. to 1 p.m. at Harvey Morse Auditorium, 8701 Gracie Allen Drive, Los Angeles, CA 90048.

Attendees are encouraged to register at csethicssymposium.com.

Media

To arrange an interview, contact Kristin Reynolds at 424-241-8108 or marykristin.reynolds@cshs.org.

Elam, 91, has been retired for 23 years from her job at United Food and Commercial Workers Local 770. And she is thriving, says Elam’s physician, Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai, because Elam is doing retirement the right way.

“Carrie’s doing many of the things we encourage our patients to do as they age— keeping herself physically healthy and having a full social calendar,” Rosen said.

Statistics from the U.S. Bureau of Labor Statistics show nearly 20% of today’s workforce are 65 or older, up from 10% in the mid-1980s. And many older adults stay in the workforce for health—not financial—reasons. One analysis suggests that retiring earlier is associated with higher mortality, finding an 11% reduction in risk of death for each additional year of work.

So how can today’s older adults slow down or leave their careers without losing their health?

“Retirement from work is not retirement from life,” said Zaldy Tan, MD, MPH, medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai. “It’s not like there is a universal, specific age at which our bodies shut down or our brains slow down to a halt. That is not physiological. This idea of retirement is man-made.”

The key factor, Tan said, is not retirement itself—but what people do after they stop working. Retirees who remain socially and cognitively engaged often experience better physical health, slower biological aging and improved mental wellbeing than those who do not, Tan said.

Elam is a perfect example. Her days still have structure and purpose: volunteering on her church’s fundraising committee, walking in Fox Hills Park, attending the opera and sharing Sunday dinners with family.

“I like to get dressed, give back to my community and make sure I have a full day,” Elam said.

Rosen said that sense of routine and purpose can make a big difference in how people experience retirement.

How to Prepare for a Healthy Retirement  

For many, a job gives more than income—it provides routine, purpose and daily social interaction. When the job disappears, the transition can be challenging, particularly for people whose relationships and activities revolve around the workplace.

“Work is sometimes seen as negative,” Tan said. “But we shouldn’t look at work as evil and vacation or retirement as good. It’s really what you make of both situations.”

Retirement can even improve the health of some—especially those leaving physically demanding or high-stress careers. Rosen said that some of her retired patients find they have more time to focus on exercise, cook healthier meals, spend time outdoors or explore new interests.

But Tan said the transition works best when people prepare for it.

“People spend years preparing to enter the workforce, but retirement requires discipline, too,” he said. “If your friendships and routines are centered on work, you need to start building activities, social connections and interests outside the workplace before you retire so you don’t end up isolated.”

Rosen recommends that people who are considering retiring take stock of where they find meaning in their lives—whether that purpose comes primarily from work or from activities, hobbies and relationships outside the workplace.

“What matters most are a patient’s individual goals and preferences,” Rosen said. “It really depends on the individual and what they find most meaningful in their life.”

For those who do retire, Rosen said maintaining structure and healthy habits is essential. She recommends aiming for at least 150 minutes of cardio each week and strength training twice a week. She also advises retirees to build social activities into their routines, such as volunteering or scheduling regular get-togethers with friends, to stay socially connected.

Mental stimulation is another important piece. Work often provides daily intellectual challenges, and Rosen said retirees benefit from replacing that engagement with activities such as continuing education, mentoring or doing memory exercises.

Elam, for example, reads every day and keeps her mind active with small mental exercises. If she can’t remember the name of something, she runs through the alphabet until a letter triggers her memory.

When Retirement Isn’t the Right Fit

For Christine Maclin, retirement simply wasn’t a good match.

Maclin, now 79, originally retired from her job as a cook at age 69, planning to rest and enjoy her free time. But after six months, she realized she missed the learning and sense of purpose that work provided.

“I mean, how many movies can you go to? How many coffee shops can you go to?” Maclin said. “I love hanging out with my friends, but ultimately I felt like retirement was time wasted.”

She returned to the workforce through a staffing company, first working as a cook for the Magic Castle and the University of Southern California—and later as an associate on the sales floor at Nordstrom. In January 2025, she decided to try something new and took a 10-week course in professional caregiving.

“What Christine has done—finding work and continuing to learn—shows that some patients fare better when they work,” Tan, Maclin’s physician, said.

Now Maclin works twice a week as a personal caregiver—cooking for her client, socializing and helping with errands—while continuing to learn something new every day.

“I like having somewhere to go and having something to do,” Maclin said.

Keeping a Positive Mindset, Retired or Working

Elam and Maclin each attribute their good health to a resilient, positive mindset.

Maclin says occasionally forgetting things is a normal part of life and not something worth getting upset about. Instead of becoming frustrated, she focuses on solving the problem, as she recently did one morning when she couldn’t recall if she had taken her medication.

“Instead of getting angry because you forgot something, solve the problem,” Maclin said. “I decided that after I take my medication, I just turn the container upside down, so I know.”

Elam says she tries to approach the aging process with as much style and grace as possible and avoids worrying prematurely.

Retired or not, she believes the key to staying healthy is simple: “Find activities you enjoy, and always be grateful,” Elam said.

Read more from Stories and Insights: Why Exercise Is Important as You Age

Following a joyful holiday season spent with loved ones, many people start the new year feeling sluggish—often from indulging in rich food and drinks or falling out of their workout routines.

Time for a change, said Sara Espinoza, MD, medical director of the Cedars-Sinai Healthspan Clinic, which emphasizes maintaining a good quality of life while aging. 

“If people are feeling guilty because they overindulged, my advice is, don’t wallow in it,” Espinoza said. “Every day is a new day, and it’s never too late to turn over a new leaf—especially in the new year.”

Although many earnestly make healthy resolutions, a 2023 Forbes Health/OnePoll showed that the average resolution lasts less than four months. Espinoza sat down with the Cedars-Sinai Newsroom to explain how resolving to practice healthy habits today—such as regular exercise and healthy eating—can affect long-term health.   

For people who are not feeling their best after the holidays, what are some healthy resolutions they can make to start feeling better?

When people feel sluggish after the holidays, I usually start with recommending sleep. Sleep hygiene is critical for restoring energy, and one of the simplest steps is going to bed at the same time every night.

After sleep, consistent physical activity is one of the most effective ways to improve energy levels. If someone continues to feel fatigued despite improving sleep and exercise habits, that can be a signal of depression, and I recommend being screened.

What New Year's resolutions would you say have the biggest impact on longevity?

I almost always point to physical activity as having the greatest impact on long-term health.

I encourage people to aim for at least 150 minutes of cardiovascular exercise per week, along with resistance training two days a week. That resistance training does not have to be complicated and can include body-weight exercises.

If that amount of exercise feels out of reach, I don’t want people to get discouraged. Even starting with a resolution to walk more each day is beneficial, especially because there is evidence showing regular walking reduces the risk of heart disease and stroke.

My main message is any time working out is better than no time.

How do healthy daily habits support healthy aging and help prevent age-related diseases?

I talk frequently with patients about maintaining a healthy body weight because of its strong link to long-term health. Even modest weight loss—about 5% to 10% of body weight—can significantly reduce the risk of developing diabetes, sometimes by as much as 60%.

Research also shows that reducing calorie intake over several years can improve cardiovascular health, cholesterol levels and insulin sensitivity in young to middle-aged adults who are overweight or obese.

When discussing diet, I often reference Harvard’s Healthy Eating Plate. About half the plate should be fruits and vegetables, a quarter should be whole grains such as brown rice or whole-wheat bread, and the remaining quarter should be healthy protein sources like fish, poultry, beans or nuts.

That said, dietary changes do not need to be extreme to be effective. If the guideline feels too strict, I suggest small, realistic adjustments, such as sharing a side of fries or choosing a salad instead.

People do not need to overhaul their entire diet overnight. Even one vegetable-focused meal a day as a resolution is a step in the right direction. Moderation is key.

Why is it so hard to stick to New Year’s resolutions, and what evidence-based strategies help people follow through?

One of the biggest reasons people struggle to stick with New Year’s resolutions is a lack of accountability. I often recommend working out with a friend, joining a class or having someone regularly check in.

Research on fitness trackers and wearables is mixed, but for many people, tracking progress is motivating. Simply monitoring daily steps on a phone or pedometer can help maintain consistency or reinforce habits.

I also encourage SMART goal setting, meaning goals that are specific, measurable, achievable, relevant and time bound. Starting with small, incremental steps is far more sustainable than setting unrealistic resolutions.

What are some underrated or often overlooked habits that can improve long-term health and aging?

One habit that often is overlooked is oral health. Poor dental health has been linked to cardiovascular disease and dementia.

To support oral health, I recommend brushing at least twice a day, flossing daily and limiting sugary foods and drinks. Again, if that is too rigid, even brushing teeth twice a day is a great resolution.

Are there any extra resolutions that promote healthy aging?

Although general guidelines are a helpful starting point, my medical recommendations to support healthy aging resolutions for the greatest impact are tailored to an individual’s health status.

For older adults, for example, weight loss requires careful consideration because it can lead to loss of both fat and muscle. In those cases, weight loss combined with resistance training can help preserve muscle mass and maintain strength.

For patients with cardiovascular disease, I often recommend not smoking, limiting alcohol, taking prescribed blood pressure medications and following a low-sodium diet.

To make an appointment with the Healthspan Clinic, call 310-423-3870 and select option 1 and ask to schedule an appointment with Espinoza.

Read more from Cedars-Sinai Stories and Insights: How to Think About Your Biological Age

Obesity increases the accumulation of senescent cells, aged cells that have stopped dividing but have not died, in several organs and tissues.

“Senescent cells differ depending on the originating cell types, diseases and other factors. Some senescent cells help with wound healing, but others cause harm and are known contributors to age-related diseases,” said Masayoshi Suda, MD, PhD, assistant professor of Medicine at Cedars-Sinai and lead author of the study. “Our goal is to identify and target these harmful types of senescent cells while sparing helpful cells.”

Previous research by the investigators showed that eliminating senescent cells with drugs called senolytics improved metabolic function, the body’s method for turning food and drink into energy.

In the current study, investigators focused on senescent blood vessel cells. They selectively removed these cells from obese laboratory mice and found that the animals’ inflammation and fat mass were reduced—and blood sugar levels improved.

When the investigators transplanted senescent blood vessel cells into lean laboratory mice, those mice developed inflammation in fat tissue and metabolic dysfunction.

Suda said this occurred because senescent blood vessel cells release high levels of inflammatory molecules.

The investigators next treated both groups of mice with fisetin, a naturally occurring senolytic compound, and found that the mice had fewer senescent blood vessel cells and improved diabetic symptoms. Investigators saw a similar decline in senescent blood vessel cells when they treated tissue samples from obese human patients with fisetin.

“Preliminary findings like these are crucial to translating aging research into clinical care,” said James Kirkland, MD, PhD, director of the Center for Advanced Gerotherapeutics and senior author of the study. “While more research is needed, we aim to eventually treat multiple age-related diseases simultaneously by using fisetin and related senolytics for aging and metabolic health.”

Suda said his team will next work to test this approach in clinical trials.

“If we can target senescent cells safely in humans, it could help address not just diabetes but a range of age-related conditions,” he said.

Additional Cedars-Sinai authors include Selim Chaib, Larissa Langhi Prata, Tamar Pirtskhalava, Nino Giorgadze, Sara Espinoza, Nicolas Musi, and Tamar Tchkonia.

Additional authors include Yi Zhu, Utkarsh Tripathi, Karl Paul, Allyson Palmer, Vagisha Kulshreshtha, Christina Inman, Kurt Johnson, Runqing Huang, Carolyn Roos, Luisa Leon-Sanchez, Jordan Miller, Thomas White, Linshan Laux, Laura Niedernhofer, Paul Robbins, Sundeep Khosla and Stefan G. Tullius.

Disclosures: Tamar Tchkonia, Allyson Palmer, Yi Zhu and James L. Kirkland have a financial interest related to this research, including patents and pending patents covering senolytic drugs and their uses held by Mayo Clinic.

Funding: This work was supported by the US National Institutes of Health (NIH) grants R37AG013925, R33AG061456, P01AG062413 (J.L.K., S.K., L.J.N., P.D.R.), U54 AG079754 (P.D.R., S.K., L.J.N), P01AG43376 (P.D.R., L.J.N.), R01AG086085 (S.K.), R01AG087387 (Y.Z.), and R01 AG063543 (L.J.N.). 

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Investigators at the Los Angeles Pepper Center will focus on extending older adults’ healthspan—which means aging with reduced burden of chronic diseases and conditions that lead to loss of independence—by studying interventions that target the biological processes of aging. Investigators then will translate those findings into clinical care.

“This prestigious grant provides Cedars-Sinai the opportunity to expand its geroscience research within our institution, across Los Angeles, and beyond, with the long-term goal of offering evidence-based healthy aging guidance for older adults,” said Sara Espinoza, MD, director of the Cedars-Sinai Center for Translational Geroscience.

For the next five years, Espinoza will lead the Los Angeles Pepper Center in collaboration with colleagues at USC and UCLA who say the combined expertise and resources of the three prominent institutions is a strong advantage.

“This partnership allows us to accelerate breakthroughs that can directly improve quality of life for older adults,” said Pinchas Cohen, MD, dean of the USC Leonard Davis School of Gerontology and co-director of the new center.

The Centers for Disease Control and Prevention projects that nearly one-quarter of the U.S. population will be 65 or older by 2060. Researchers say this creates a critical need to address the onset of multiple chronic diseases linked to aging. By intervening in the aging process at the biological level, scientists aim to prevent, delay and treat multiple medical conditions simultaneously.

“This designation strengthens our commitment to addressing the health challenges of aging—not only for today’s older adults, but for future generations as well,” said Jonathan Wanagat, MD, PHD, a geriatrician at UCLA and co-director of the Pepper Center.

The Claude D. Pepper Older Americans Independence Center in Los Angeles has four aims: to further develop gerotherapeutics—drugs that target the underlying cellular aging processes—and increase the number of researchers, expand clinical trials, and share the latest findings in translational geroscience.

“The robust resources, network and infrastructure made possible by the NIH solidifies Los Angeles’ leading position in aging research and geriatric clinical care,” Espinoza said. 

Read more in Cedars-Sinai Discoveries Magazine: The Future of Aging Research

Healthcare professionals in the Healthspan Clinic concentrate on the prevention and treatment of age-related illnesses and disabilities like cognitive decline and impaired mobility. The clinic is open to patients 18 and older.

“Aging is the leading risk factor for developing multiple chronic conditions that diminish quality of life,” said Sara Espinoza, MD, medical director of the Cedars-Sinai Healthspan Clinic and a Gerontological Society of America fellow. “This unique clinic offers scientifically backed science with clinically proven treatment and lifestyle recommendations that can improve health and wellbeing—now—and as individuals age.”

While advancements in medicine like antibiotics, vaccines and childbirth care have increased the average U.S. lifespan, physician-scientists at Cedars-Sinai are more concerned with keeping patients healthy—not merely alive. The medical term is “healthspan,” and the clinic’s experts say their goal is to help adults stay healthy and independent as long as possible.

“To do so, it is important that our approach is guided by scientifically proven, evidence-based findings about the fundamental aging processes that are root-cause contributors to multiple disorders and diseases—in other words, the new field of geroscience,” said James Kirkland, MD, PhD, director of the Center for Advanced Gerotherapeutics at Cedars-Sinai.

Patients seeking care at Cedars-Sinai’s Healthspan Clinic participate in at least one in-person visit. Experts assess patients for physical and cognitive function, lifestyle factors such as diet and exercise, and overall health status.

Espinoza said these consultations are an opportunity to discuss healthy-aging goals and habits. Patients are provided guidance on lifestyle, such as diet, exercise and sleep quality. Patients in the Healthspan Clinic also can opt to participate in a biorepository that analyzes patients’ blood and other data to track biomarkers linked to the onset of diseases.

“This clinic is an opportunity to change the trajectory of a patient’s health before they have complex medical issues,” said Espinoza, also the director of the Center for Translational Geroscience at Cedars-Sinai, where investigators conduct clinical trials for medicines and lifestyle advances aimed at healthy aging.

Nicolas Musi, MD, director of Cedars-Sinai’s Diabetes and Aging Center and the Division of Endocrinology, Diabetes and Metabolism, and Kirkland are also part of the clinic and provide treatment recommendations for metabolism, endocrinology concerns, and questions regarding interventions that potentially affect fundamental aging processes.

Espinoza said Healthspan physicians can refer interested patients to geroscience clinical trials at Cedars-Sinai or through the Translational Geroscience Network—an international consortium studying the biology of aging to prevent, delay or treat age-related diseases.

The network comprises 90 clinical trials across the U.S. and northern Europe and is led by Kirkland. The National Institutes of Health recently renewed the Translational Geroscience Network grant, awarding nearly $3 million over the next four years.

“The NIH renewal allows the network to keep studying a range of conditions that accelerate aging, including long COVID, obesity and Alzheimer’s disease, to ultimately find new ways to help people age in better health,” Kirkland said.

As the Healthspan Clinic grows, Espinoza also plans to hire physical trainers and dietitians to help curate personalized diet and exercise plans for patients.

To make an appointment with the Healthspan Clinic, call 310-423-3870 and select option 1.

Read more from Discoveries: The Future of Aging Research

“Previous studies have shown that transfusions of blood or plasma from young mice improved cognitive decline in older mice, but that is difficult to translate into a therapy,” said Clive Svendsen, PhD, executive director of the Board of Governors Regenerative Medicine Institute and senior author of the study. “Our approach was to use young immune cells that we can manufacture in the lab—and we found that they have beneficial effects in both aging mice and mouse models of Alzheimer’s disease.”

The immune cells, called mononuclear phagocytes, circulate throughout the body disposing of harmful substances, but become less effective as we age.

The investigators used human induced pluripotent stem cells, which are adult cells that have been taken “back in time” to an early embryonic state, to generate young mononuclear phagocytes. When the young cells were infused into aging mice or a mouse model of Alzheimer’s disease, investigators noted several important changes.

First, the mice receiving the young cells performed better on memory tests than mice without cell treatment. These mice were also found to have more “mossy cells” in the hippocampus, a brain region critical for learning and memory.

“The numbers of mossy cells decline with aging and Alzheimer’s disease,” said Alexendra Moser, PhD, a project scientist in the Svendsen Lab and lead author of the study. “We did not see that decline in mice receiving young mononuclear phagocytes, and we believe this may be responsible for some of the memory improvements that we observed.”

Mice receiving the young mononuclear phagocytes also had healthier immune cells, called microglia, in their brains. These microglia use long thin branches to detect and clear debris and damaged cells. The branches shrink and retract due to aging and Alzheimer’s disease, but they remained long and healthy in mice receiving the therapy.

The mechanism behind the effects in the brain remain to be established. As the young mononuclear phagocytes did not appear to enter the brain, investigators believe the cells may have worked indirectly.

The cells could have released antiaging proteins or even tiny particles called extracellular vesicles, which are small enough to enter the brain. Or they could have absorbed pro-aging factors from the blood to keep them out of the brain. The mechanism of protection is the focus of ongoing studies to determine the most effective way to turn these findings into a therapy that could be used in a clinical trial in patients. 

“Because these young immune cells are created from stem cells, they could be used as personalized therapy with unlimited availability,” said Jeffrey A. Golden, MD, executive vice dean for Education and Research. “These findings show that short-term treatment improved cognition and brain health, making them a promising candidate to address age- and Alzheimer’s disease-related cognitive decline.”

Additional authors include Luz Jovita Dimas-Harms, Rachel M. Lipman, Jake Inzalaco, Shaughn Bell, Michelle Alcantara, Erikha Valenzuela, George Lawless, Simion Kreimer, Sarah J. Parker, and Helen S. Goodridge.

Funding: This work was supported by the Universal Sunlight Foundation, the Cedars-Sinai Center for Translational Geroscience, and the Cedars-Sinai Board of Governors Regenerative Medicine Institute.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“It’s not just sniffles or cold-like symptoms. It can turn into pneumonia or an even more severe illness for older adults that can lead to hospitalization and, unfortunately, sometimes their demise,” said Leslie Ramirez, MD, a physician with Cedars-Sinai’s Senior Advantage program, which specializes in caring for medically complex Medicare Advantage patients 65 and older.

Because the body’s immune system weakens with age, Ramirez said, viruses like influenza can cause more serious illness in older adults. Once hospitalized, they’re at even higher risk for developing bedsores and skin infections from lack of movement. And unlike younger people whose condition rapidly improves once an illness passes, it can take weeks for older adults to regain their strength.

“If they’ve been in the hospital for a while, when they return home, they can struggle getting in and out of bed, getting to the bathroom or sitting down and standing up,” Ramirez said. “It complicates their care and increases the burden on the family members trying to help them.”

The Cedars-Sinai Newsroom talked with Ramirez about the most effective ways to help older adults avoid a hospital stay altogether.

What can cause an older adult with the flu to need hospital care?

The flu can trigger a huge inflammatory response in the lungs of older adults who may not be able to continue breathing on their own. They might need supplemental oxygen and fluids because we tend to eat and drink less when we’re ill. Dehydration can be very harmful in older patients, causing their blood pressure to drop, as well as respiratory distress.

Older adults also are more likely to have multiple chronic health issues—heart, lung and kidney conditions—and an influenza infection can make all of those worse.

If an older adult gets the flu, how can they avoid a severe illness?

They should contact their provider as soon as they experience flu-like symptoms—fever, chills, body aches, maybe a sore throat or diarrhea—or get tested for the flu at a nearby urgent care. With a confirmed diagnosis, patients might be eligible for Tamiflu, an antiviral treatment that can help shorten the length of illness and decrease severity. But the medication must be started within five days of symptom onset.

It's also important to rest and drink plenty of water. Chicken noodle soup or broth also can help with hydration. Acetaminophen can help reduce a fever, ibuprofen can ease body aches and over-the-counter cough suppressants can help ease a cough. But always check with a provider before taking a new drug to ensure it won’t interact with your current medications or chronic conditions.

Do you have any advice for caregivers or loved ones of older adults?

It’s important to identify flu symptoms early—a fever above 100.4 degrees, chills, fatigue, body aches, an itchy throat. If you notice that an older loved one with the flu is starting to become more lethargic, very weak or confused—they don’t know where they are or who they are, and they’re usually very aware of their surroundings—those are big flags that the severity of their illness is increasing. Take them to the emergency department or call their provider immediately.

If they start complaining that they haven’t gone to the restroom as much as they normally do, that could be a sign they’re not drinking enough, or their kidneys aren’t functioning well. If their cough worsens and they’re having difficulty breathing or they’re short of breath or they can’t walk to the bathroom—those are all red flags.

How can older adults avoid the flu?

Wash your hands, especially if you’re going to be eating or you’ve been in an environment that might not be clean. You might want to avoid crowded places like giant sporting events during flu season. I’m not advocating that people skip important life events like a wedding or gathering with family, but take precautions, such as masking or keeping your distance. Some people still choose not to shake hands.

And, of course, get the flu shot. The flu vaccine is available at local pharmacies and in our clinic at Cedars-Sinai. For those 65 and older, there is a high-dose flu shot because their immune system isn’t as reactive as it used to be, and they need a stronger dose to mount a successful immune response. Younger family members also should consider getting vaccinated to reduce their risk of contracting influenza and passing it on to their older relatives. But remember, it takes two weeks to become fully protected. Keep that in mind if you want to time your flu shot ahead of Thanksgiving, the holidays or major travel.

Read more on the Cedars-Sinai Blog: Care Coordination for the Sandwich Generation

The plan, published in the peer-reviewed journal Neurology® Clinical Practice, covers all aspects of the complicated medication regimen, from guidelines for emergency management of patients on lecanemab, and biweekly patient assessments, to a comprehensive informed consent process, including a provision for an authorized surrogate for adult patients who may lack the cognitive ability to manage their own care.

Lecanemab, recently approved by the Food and Drug Administration (FDA), is a complex therapy requiring biweekly infusions, periodic imaging and laboratory tests, clinical patient assessment, and drug interaction screening. Rita Shane, PharmD, vice president and chief pharmacy officer at Cedars-Sinai, said the guidelines will help guide the management of future complex therapies.

“With an increasing number of FDA approvals of these types of high-cost, innovative therapies, a comprehensive, multidisciplinary planning process not only supports access, but also safety for patients,” Shane said. “The process design we implemented for lecanemab can serve as a blueprint to support safe and effective management of these new, complex neurologic therapies at institutions across the country.”

Additional authors: Sarah Kremen, MD; Zaldy S. Tan, MD, MPH; Hai Tran, PharmD; Thanh G. Tu, PharmD; Nancy L. Sicotte, MD.

Funding: The authors report no targeted funding.

Conflict of interest: S. Kremen was a consultant for Eli Lilly and Company relating to donanemab.

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That’s why Gregory Jones, RN, injury prevention and outreach coordinator for the hospital’s Trauma Program, is on a mission to help older adults avoid risk factors and prevent falls. Jones has been giving talks at community centers across Los Angeles County leading up to Falls Prevention Awareness Week Sept. 23-27.

“Prevention is the best cure for the disease of trauma,” Jones tells audiences. “Many falls are preventable, and knowledge is power, so the more everyone is aware of the ways to prevent a fall, the better.”

The National Council on Aging reports that every 11 seconds, an older adult is treated in a hospital emergency department for a fall-related injury. According to the U.S. Centers for Disease Control and Prevention, at least 300,000 people 65 and older visit a hospital every year for a hip fracture from falling.

Jones said most people will be able to get up if they fall. Still, for some, a fall can lead to lost independence, disability or even death.

“People who have fallen once have a greater risk of falling again,” Jones said. “Another risk factor is feeling unsteady or off balance, needing support to walk, or holding onto furniture when walking around the house.”

Other fall risk factors include:

• Taking medicines that can cause lightheadedness or drowsiness
• Home hazards, such as slippery surfaces, lack of railings, clutter or inadequate lighting
• Numbness in the feet
• Weak leg muscles
• Vision problems

Jones tells older people that simply knowing whether they’re at greater risk of falling is just part of the equation.

“You also must correct what could cause you to fall or has already caused a fall,” he said.

Cedars-Sinai’s outpatient Geriatrics Program offers consultations for falls and fall prevention.

Its outpatient Bone Health Coaching Program, part of the Geriatric Fracture Program in the Department of Orthopaedics, provides bone health and fall risk evaluations and counsels patients on how to reduce the risk of fragility fractures—typically in the hip, spine or wrist—which can occur when a person falls from a standing position.

“The risk of falling and breaking a bone is much greater for people with poor bone quality from osteoporosis or osteopenia,” said nurse practitioner Kathleen Breda, associate director of Orthopaedic Clinical Programs. “Because poor bone quality isn’t usually obvious, many people don’t know they have a problem with their bones until they fall and break one. Proactive care to protect bones is crucial to long-term quality of life. Our Bone Health Coaching Program helps people at risk for a fall before they break a bone or helps them avoid another fracture if they fall again.”

The Cedars-Sinai Geriatrics Program and Bone Health Coaching Program have received Age-Friendly Health System Committed to Care Excellence recognition, which means they work to improve bone fracture outcomes through the “4Ms” model of care: learning what matters most to each patient, optimizing medications, helping them maintain mobility and monitoring mental state.

One important way to take action to prevent a fall, Jones and Breda said, is by building balance, strength and flexibility through an exercise program. Cedars-Sinai offers Forever Fit classes for older adults, led by its Community Health Improvement professionals.

Other ways to prevent a fall include regularly reviewing medications with a physician or pharmacist to make sure side effects don’t increase fall risk, getting an annual vision and hearing checkup, and keeping the home environment uncluttered.

Jones encourages taking small steps—no pun intended—on the path to fall prevention.

“Start by taking a look around the house—that throw rug in the hallway may be pretty but is it a fall hazard?” he said. “I also recommend a night light or flashlight for the bathroom or bedroom. Use a cane if your doctor says you should. Be sure you’re wearing the right shoes.

“But at the same time, don’t get overwhelmed. You don’t have to do all these things all at once. Start small.”

Jones will discuss fall prevention on Wednesday, Sept. 18, at 10 a.m. at West Hollywood Comprehensive Service Center, 7377 Santa Monica Blvd., and on Friday, Sept. 20, at 11 a.m. at Jewish Family Service, 11338 Santa Monica Blvd.

Read more on the Cedars-Sinai Blog: Bone Health Breakdown—How to Prevent Fractures

“In older adults, higher levels of amyloid beta and tau have been associated with poorer memory and cognition," said Mitzi Gonzales, PhD, director of Translational Research in the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai and lead author of the study. “Our study found that this was also true in adults age 55 and younger—a period thought to be important for prevention. We also found higher levels in individuals with a higher genetic risk for Alzheimer's disease. Future studies should examine memory and cognitive changes over time and look at why some individuals remain mentally sharp despite having high levels of these proteins, to provide important clues about maintaining cognitive health over the lifespan.”

The findings highlight the importance of understanding the effects of amyloid beta and tau proteins on memory and thinking abilities at earlier ages. The work could also help focus dementia-prevention efforts in younger at-risk populations.

Additional authors: Adrienne O’Donnell, Saptaparni Ghosh, Emma Thibault, Georges El Fakhri, Sudha Seshadri, Jeremy Tanner, Claudia L. Satizabal, Charles S. Decarli, Keith A. Johnson, Alexa S. Beiser, Matthew Pase.

Funding: National Institutes of Health, Grant/Award Numbers: N01-HC-25195, HHSN268201500001I, 75N92019D00031; National Institute on Aging, Grant/Award Numbers: RF1AG059421, R01AG054076, R01AG049607, R01AG033090, R01AG066524, R01NS017950, R01AG077472, P30AG066546; National Health and Medical Research Council of Australia Investigator, Grant/Award Number: GTN2009264. 

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The Centers for Medicare & Medicaid Services (CMS) recently selected the Cedars-Sinai CARES (Care Management/Alzheimer’s Expertise/Resources/Education/Social Support) Program for dementia patients and their caregivers as a Guiding an Improved Dementia Experience (GUIDE) Model site. The Cedars-Sinai CARES Program is among 14 established programs in California, and it is one of only two in Los Angeles selected by CMS for the established program track. 

Additionally, the medical center’s comprehensive outpatient Geriatrics Program for people 65 and older, along with its Bone Health Coaching Program, recently received Age-Friendly Health System Committed to Care Excellence recognition from The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States. Cedars-Sinai also is among just 30 hospitals nationwide recently selected to join the new Age-Friendly System-Wide Spread Collaborative, which aims to accelerate adoption of evidence-based, high-quality care for older adults across all the medical center’s sites and care settings.

“Cedars-Sinai cares for more patients over 80 than any other academic medical center in the country, so operating under an age-friendly healthcare model is critical to our continued ability to serve our growing community of older adults,” said Bryan Croft, the hospital’s executive vice president and chief operating officer. “In just over a decade, the U.S. will have more people over age 65 than children, for the first time in history. An aging population has unique care needs, and these recognitions further demonstrate that Cedars-Sinai is the premier institution to provide this level of outstanding care.”

Cedars-Sinai Medical Center first received the Age-Friendly Health System Committed to Care Excellence designation in 2020.

Age-Friendly Health Systems integrate the “4Ms” of care: what matters most to each patient, medication safety, mobility and mentation, or mental functioning.

“Integrating the ‘4Ms’ framework into models of care for older people is about providing optimal care and measures of safety while addressing what’s most important to each individual patient,” said Sonja Rosen, MD, chief of Geriatric Medicine. “You can’t assume that everyone’s goals and preferences are the same. At Cedars-Sinai, we strive to help people live as healthy and high-functioning as possible for as long as possible and at the same time, achieve their goals.”

Cedars-Sinai’s outpatient Geriatrics Program has geriatricians who treat patients throughout the community for geriatric syndromes and primary care needs. This includes conducting consultations for falls, osteoporosis, polypharmacy—which is taking five or more medications—dementia, social isolation, loneliness, and other topics of importance for many older adults.

The hospital’s outpatient Bone Health Coaching Program, part of the Geriatric Fracture Program in the Department of Orthopaedics, provides bone health assessments and counsels patients on how to reduce the risk of fragility fractures, often caused by poor bone quality associated with older age, reduced mobility and some medications. Poor bone quality is often a surprise to older adults – unless they are screened, they may not be aware. According to the U.S. Centers for Disease Control and Prevention, falls that cause fragility fractures are a primary cause of injury in people 65 and older and often lead to hospitalization, loss of independence and even death. 

“We aim to help preserve good quality of life and independence for our patients," said nurse practitioner Kathleen Breda, MSN, associate director of orthopaedic Clinical Programs. “We’re proud that our Bone Health Coaching Program has connected more than four times the national average of patients with bone health care and is an important element of our age-friendly model of care." 

The CARES Program at Cedars-Sinai provides comprehensive dementia care management for patients with Alzheimer’s disease and other dementias as well as support and training for their family caregivers.

With the CMS selection of the CARES Program as a GUIDE Model site, eligible Medicare patients in the program can access $2,500 annually for adult day care, in-home care and facility care expenses when they need additional help—for example, after a hospital stay or during times of decreased caregiver availability.

Patients in the moderate to late stages of dementia also will receive a CARES Program home visit to help evaluate their needs, ensure safety and promote sustainability of in-home care. Educational offerings for caregivers are also provided.

“The selection of our CARES Program as one of the CMS GUIDE established care sites is a testament to the high quality of care that we provide to patients with memory impairments and the support we provide to family caregivers of dementia patients,” said Zaldy Tan, MD, MPH, director of the CARES Program and the Jona Goldrich Center for Alzheimer’s and Memory Disorders. “We continue to see improved health outcomes in vulnerable patients who are enrolled in the program, and as a GUIDE Model site, we expect this to be further enhanced.”

Read more from the Cedars-Sinai Blog: Anxiety in the Golden Years: What You Should Know

“After several decades of research, we understand that Alzheimer’s disease is not going to be easy to conquer,” said Zaldy Tan, MD, MPH, director of The Maxine and Bernard Platzer Lynn Family Memory and Healthy Aging Program. “There is no magic infusion, injection or pill that will cure it, but there are tactics to prevent or reduce one’s risk for it. While we continue to search for a viable path for stopping this disease in its entirety, prevention is of the utmost importance.”

An estimated 6.7 million Americans are living with Alzheimer’s disease, according to the National Institutes of Health. As advances in medicine and disease prevention are helping more people live longer and reach the age—65 and older—at risk for developing Alzheimer’s disease and dementia, Cedars-Sinai’s healthy aging program focuses on personalized risk profiling using clinically validated tools.

Risk factors for developing Alzheimer’s disease or dementia include family history of the disease, a gene called APOE4, diabetes, high blood pressure, sleep apnea, unhealthy weight, history of traumatic brain injury or head trauma, and social isolation.

The Cedars-Sinai program is open to anyone 40 to 60 years old with at least two of these risk factors, and anyone 60 or older who doesn’t have signs of Alzheimer’s disease or dementia but wants to protect their brain health.

Prior to their first clinic visit, patients complete a questionnaire that delves into their physical activity, diet, social networking, history of physical and emotional trauma, and level of education, among other things.

During the clinic visit, Tan and colleagues perform a detailed physical and neurological exam and cognitive tests. They also assess each patient’s grip strength, how many times they can sit in a chair and stand up again unsupported in 30 seconds, their level of frailty and risk of falling. Some patients are sent home with digital devices to continuously measure blood pressure, sleep patterns and oxygenation during sleep.

“These are things that are not necessarily asked about in primary care, or even in general neurology clinics,” said Tan, who is also medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders and the Carmen and Louis Warschaw Endowed Chair in Neurology at Cedars-Sinai. “We use clinically validated tools to evaluate each individual’s risk and resilience factors. And based on that information, we teach them strategies to reduce their risk and maintain brain health.”

The team includes a dietitian to help participants improve their eating habits, a health psychologist who assists with behavior change issues such as smoking cessation, sleep specialists, and an occupational therapist who helps participants understand how their brains work and offers cognitive training to improve memory habits. Patients also can be referred to other specialists, including those from the Smidt Heart Institute at Cedars-Sinai, as brain and heart health are closely linked, Tan said.

“Studies show that as many as 40% of cases of Alzheimer’s disease and related dementias can be prevented or delayed with the right clinical guidance,” said Nancy L. Sicotte, MD, chair of the Department of Neurology and the Women’s Guild Distinguished Chair in Neurology at Cedars-Sinai. “We launched this program to help our patients optimize their brain health throughout life, and also to push the science forward through continued translational research.”  

Tan noted that recommendations and referrals are personalized and specific to each patient. He said that everyone is different, and while some people have more areas to improve on and others have fewer, everyone has something.

“We want to help people take preventive action as early as possible,” Tan said. “Delaying the onset of Alzheimer’s disease for even five to eight years is tantamount to a cure for many people, because the greatest risk is in those ages 80 and up. Those who delay onset until their late 80s might avoid it altogether.”

Read more on the Cedars-Sinai Blog: When Should I Be Concerned About Memory Loss?

“Mrs. Berg,” he said, “how did you get to be 107 years old?”

She looked up from her seat and with a twinkle in her eye, she answered.

“Well … first, you have to be 106.”

That was seven years ago, said Robert Berg after his mother’s recent death at 114. When she passed away, Pearl Berg was the third oldest person in the U.S., the ninth oldest person in the world, and the world’s oldest Jewish person, according to the Gerontology Research Group. She also was Cedars-Sinai’s oldest patient.

Although the medical center’s health professionals treat more people 80 and older than any other U.S. academic medical center, Berg was one of a kind, physicians say.

“Living as long as Pearl did, with good quality of life, is a blessing,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine and a professor of Medicine at Cedars-Sinai. “We celebrate that because it’s both amazing and unusual.”

But how did she do it? In observing his mother’s lifestyle over the years, Robert Berg said she had “uncommon common sense.”

“She never smoked, only had a sip of wine once a week at most, drank freshly squeezed OJ every morning, ate very few fatty foods and had only a modest amount of dessert,” he said. “Although, when she was 102, some of those constraints lifted—she wanted dessert every day—and by 106, she was asking for candy every morning and afternoon.”

Robert Berg learned much from his mother—how to take life less seriously and maintain a sense of humor are at the top of the list. He admired other qualities, too, like how she continued to make new generations of friends.

“As she aged, she lost many friends and family,” he said. “But she wasn’t stuck in the mourning phase—she mourned, remembered and then moved on. She did not live in the past.”

Pearl Berg was 80 when she lost her husband. She had been his caregiver for nearly a decade, and Robert Berg and his brother worried about what would become of her life.

They needn’t have.

“She joined a book club, bought season tickets for the theater and concerts, intensified her participation with her bridge groups, remained active in charities, volunteered, and got even more involved with her synagogue,” Robert Berg said. “She made a new life for herself.”

That new life was perhaps extended even further when Walter Kerwin, MD, a cardiac electrophysiologist in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, replaced Pearl Berg’s pacemaker when she was 112. She had received her first pacemaker at 101.

“When Pearl needed a replacement pacemaker, there was much discussion with her family and careful consideration, taking into account that her advanced age invoked higher risks,” Kerwin said. “But Pearl’s condition and quality of life were the same as when the first pacemaker was installed, and she was lucid and had no evidence of dementia or disease. I undertook the procedure with a great deal of preparation.”

The procedure went flawlessly, and she was able to go home the following day.

“Good luck and good genetics obviously play a role in longevity,” Kerwin said. “Quality of life as we age is often self-determined, and people with disciplined habits and good attitudes often enjoy their senior lives. On the flip side, a lot of people succumb to degenerative diseases and other maladies, which is frustrating for them and their caregivers. We have a long way to go to better understand these diseases and better prevent and treat them.”

The Gerontology Research Group notes only nine “validated” supercentenarians—people who are 110 or older—in the world today, though other estimates place that number much higher, in the hundreds. Meanwhile, the number of Americans who are 100 or older is projected to more than quadruple over the next three decades, according to U.S. Census Bureau data reported by the Pew Research Center. The current average life expectancy is 77.5.

Cedars-Sinai has been designated an Age-Friendly Health System Committed to Care Excellence—a national movement representing health systems that integrate the “4Ms” of care: what matters most to each patient, medication safety, mobility and mentation (mental functioning).

Cedars-Sinai offers multiple age-friendly programs, including a Geriatric Fracture Program; an accredited Geriatric Emergency Department to care for patients 65 and older in private areas optimized for their wellbeing; the Jona Goldrich Center for Alzheimer’s and Memory Disorders; an outpatient geriatrics program within the Cedars-Sinai Medical Network; and other healthy aging initiatives.

The medical center also is focused on improving health and wellness for older adults through innovative research, education and clinical care in its Center for Translational Geroscience, which identifies and tests novel therapies for older adults.

Rosen said that Cedars-Sinai’s age-friendly programs are all the more significant because by 2035, there will be more people over 65 than there are children—a first in the U.S.

She emphasized that being committed to age-friendly care takes into account that honoring what matters most to patients depends on the person.

“Some people might have a goal to live to 100, but not everyone does,” Rosen said. “Our greatest privilege is helping people live as healthy and high-functioning as possible for as long as possible, in keeping with their personal goals.”

Hematologist-oncologist Jeremy Lorber, MD, assistant professor in the Department of Medicine at Cedars-Sinai Cancer and a member of Pearl Berg’s care team, offered his own takeaways.

“What we can learn from Pearl is that successful aging depends not only on healthy habits and good medical care,” Lorber said, “but on discovery and fulfillment of purpose, no matter one’s stage in life.”

Regarding how Pearl Berg got to be 114, perhaps she was not being coy with the reporter all those years ago, as experts are still seeking to better understand the components of longevity.

As for the Berg family, although they are feeling the deep loss of their matriarch, they are grateful for her quality of life.  

“And of course, just amazed at the quantity,” Robert Berg said.

Read more on the Cedars-Sinai Blog: How to Live a Longer, More Fulfilling Life

Called Forever Fit, the evidence-based, comprehensive fitness program is organized and taught by Cedars-Sinai’s Community Health Improvement professionals.

“The classes not only decrease falls and increase muscle strength, but are also proven to lessen social isolation, anxiety and depression,” said Jonathan Vickburg, LMFT, associate director of Community Health Improvement. “There is a physical benefit, of course, and surprisingly, many of our participants say there is an emotional impact as well.”

Participants in the class, held at the Culver City Community Center, agree.

Ron Cohen, 76, attends religiously. “I love the class,” he said. “I wish we would do it every day instead of three days a week. I really enjoy it.”

Bobbi Flusser, 79, said the class has improved her shoulder and back pain as well as her quality of life.

“It’s helpful both socially and physically,” Flusser said. “Exercise is important for your total health—balance, cardio, stretching, walking. It just covers everything. I would recommend this class to everyone.”

Data on the importance of exercise for older adults comes from a Cedars-Sinai study led by geriatrician Allison Moser Mays, MD.  As part of the research study, investigators followed older adults who participated in group exercise classes for six months.

“What we found is that older adults who participate in group exercise classes not only have physical benefits for their health and decreased risk of falling, but they also have increased social connectedness and decreased levels of loneliness,” Moser Mays said. 

Cedars-Sinai is looking to expand Forever Fit to other community centers, a win for both mental and physical wellbeing, according to Moser Mays.  “There is tremendous benefit from attending these classes,” she said. “By attending a group exercise class, you can also ultimately impact multiple facets of your life and health.” 

Forever Fit classes meet every Monday, Wednesday and Friday at 3 p.m. and 4 p.m. at the Culver City Senior Center.

Read more on the Cedars-Sinai Blog: Anxiety in the Golden Years: What You Should Know 

The findings are published in JAMA Network Open.

The development and use of medications to treat acute and chronic health conditions has improved longevity and quality of life. But for some older adults, taking multiple medications can do more harm than good. Polypharmacy—the use of five or more medications—is associated with a higher risk for falls, fractures, hospitalizations, along with functional and cognitive decline for some aging patients.

“Polypharmacy, especially harmful or inappropriate polypharmacy, is bad. But the research community hasn’t figured out how to consistently move the needle on hospitalizations, quality of life, mortality and other adverse outcomes associated with being on several medications at once,” said corresponding author Michelle Keller, PhD, a health services scientist in the Department of Medicine at Cedars-Sinai.

Investigators analyzed 14 studies that systematically evaluated various tactics used to address the risks of taking five or more medications. They could not find a clear set of practices that consistently helped polypharmacy patients, but some approaches showed promise.

“Intensive, face-to-face interventions were effective in some studies. In those cases, having a healthcare provider review the patient’s medical record, go over the drugs with them to discuss medication adherence or whether a drug was still appropriate, and providing patient education all appeared to reduce hospitalizations,” said senior author Joshua Pevnick, MD, co-director, Division of Informatics at Cedars-Sinai.

Adults 65 and older tend to take more medications. According to a report by the Centers for Disease Control and Prevention, about a third of adults in the U.S. who are in their 60s and 70s take five or more prescription drugs. Medications to control cholesterol, high blood pressure and diabetes are the most common.

“We must weigh the benefit of prescribing a new medication against the possible risk it may present. Can it interact with other medications the patient is taking or impact the disease course in the older adult? For example, a new medication may effectively treat a specific condition but make the person drowsy, putting them at higher risk for a fall or impair their cognitive abilities. The more tools we develop to help us assess the risk-benefit of medications for our patients, the better care we can give them,” said  Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai.

While time spent discussing medication use with a healthcare provider, in person, did reduce some negative polypharmacy consequences in a few studies, a simple consult with a pharmacist also proved protective in some cases.

“Older adults often develop a good rapport with their pharmacists, and in some of the studies we reviewed, relatively short consults with them were very helpful to polypharmacy patients—especially those who may be at risk for falls or cognitive decline. I think a lot of health systems are recognizing the important role a pharmacist can play in the overall healthcare of their patients,” Keller said.

Identifying who is at higher risk for adverse polypharmacy outcomes is critical in order to develop effective interventions and is the focus of a pilot program in development at Cedars-Sinai.

“We want to create a risk-prediction model using data from the electronic health records of patients seeing primary care physicians. For the polypharmacy patients we identify as being at high risk for health problems associated with their medication regimen. As a first step, we can flag the record and send a message to their physician recommending a consult with a pharmacist, as a first step,” Keller said.

The Cedars-Sinai pilot program is expected to begin this spring.

Funding: This work was supported by National Institutes of Health grant numbers K01AG076865 and K24AG047899.

Follow Cedars-Sinai Academic Medicine on X (Twitter) for more on the latest basic science and clinical research from Cedars-Sinai.

Read more on the Cedars-Sinai Blog: The Balancing Act of Fall Prevention

“This season can be particularly difficult for older adults who don't have as many social connections, or are hindered by physical limitations, because of all the messaging around us that emphasizes activity and connectedness,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai.

The Surgeon General of the United States has described loneliness and isolation as an epidemic affecting 50% of the population and associated with a higher risk for cardiovascular disease, dementia, stroke, depression, anxiety and death.

“Loneliness and isolation, part of what we call ‘social determinants of health,’ are established risks for poor health and early death, especially for aging adults. The health risks are equivalent to smoking  up to 15 cigarettes a day,” said Cedars-Sinai geriatrician Allison Moser Mays, MD, MAS.  “But we also know that being more socially connected can actually decrease the risk of mortality by as much as 50%.”

Hearing loss, memory impairment, the inability to drive safely and other functional changes that can come with age impact the desire or ability to attend holiday gatherings and can exacerbate feelings of loneliness and anxiety.

“We see a lot of our patients not want to go out as much because they are unable to communicate well. Large gatherings of family or friends or just going out to a restaurant with others can be very stressful if they are straining to hear or have difficulty following conversations. They may prefer to stay at home and isolate rather than feel out of place or anxious,” said Mays, an assistant professor of Medicine.

Grief and loss can also be significant drivers of social isolation and loneliness as people age.

“This can be a particularly difficult time of the year for anyone who has experienced loss or who doesn't have that sense of community they wish they had. And that really is what defines loneliness—not having the social connections that you want,” Mays said.

Geriatricians at Cedars-Sinai routinely discuss loss and grief during patient visits and can provide referrals to social workers or grief support groups.

“If you know that an individual is feeling lonely, if they've shared that they wish they weren’t so alone and want help, then see if there are hurdles that are keeping them isolated, such as lacking transportation or feelings of grief and loss. Find out what you can do to help them,” said Rosen, a professor of Medicine.

Ways to Support Older People During the Holiday Season

1. Initiate: Check in more often with older family members and friends and gently ask how they are doing and offer support. A phone call can go a long way in nurturing connectedness.
2. Invite: Consider inviting them to smaller, more intimate, gatherings if functional limitations are an issue. Welcome them without pressuring them to fit into your plans.
3. Listen: Actively listen when they want to talk, even if it is a difficult conversation.
4. Accommodate: Discuss an activity or simple pleasure they would enjoy rather than insisting they participate in planned events.
5. Grieve: Loss is felt deeply during the holidays. Pay attention and let them know you are there to listen. Meet them where they are and do not force activities they may be anxious about.

Cedars-Sinai’s Leveraging Exercise to Age in Place (LEAP) is an evidence-based exercise program proven to decrease loneliness, social isolation and the fear of falling in older adults.

“We’ve found that purpose-driven activity is a good way to form community. In our LEAP program exercise classes, some of the participants were only coming 40% of the time, but they still felt they had a sense of community and connection to the class,” Mays said.

Loneliness and social isolation do not have to be the theme of this holiday season.

“A lot of people are embarrassed to ask for help. They’re embarrassed to be alone. But they need to know that most of us struggle with the same things at one time or another. We are all part of the same community. There is help and comfort, and we can be there for one another,” Rosen said.

Read more on the Cedars-Sinai Blog: Anxiety in the Golden Years: What You Should Know

Flu season started early in the Southern Hemisphere, which typically gives experts some clues as to what we’ll experience here in the U.S. To avoid getting caught off guard, it’s important to get the flu shot in September or October, said infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai.

“Even a typical flu season can be deadly and can cause significant hospitalization,” Gandhi said, pointing to 58,000 deaths in the U.S. and more than half a million hospitalizations—all caused by last year’s flu. “We should do what we can to protect ourselves—and others—with the best tool we have: the flu vaccine.”

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during regularly scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment online through My CS-Link at clinics in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

In addition to the flu, COVID-19 and the respiratory syncytial virus (RSV) could again spike at the same time, triggering a “tripledemic,” Gandhi said. Last year, that same triple punch filled emergency departments across the country and strained children’s hospitals with young patients, who are vulnerable to RSV—a virus that can be serious, if not deadly, for infants and older adults.

But there’s a silver lining this year. In addition to the flu vaccine, new RSV shots are available for babies and adults over 60, and a new COVID-19 booster is coming this fall.

“These new shots and vaccines could really help protect us and our community during the upcoming season,” Gandhi said. “We need to preserve capacity in hospitals for those patients who really need that care.”

Help for Youngest and Oldest

RSV causes mild cold-like symptoms in most people, but it’s the leading cause for hospitalization among infants in the U.S. In babies, the virus can cause mild illness or it can cause dangerous inflammation in a child’s tiny airways.

“There's really no way to predict how your child would do even if they're completely healthy,” said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s. “If they do end up having a horrible course with RSV, they will likely need to be hospitalized for oxygen support, fluids and other supportive measures.”

Most children in the U.S. will be infected with RSV within the first year of their life, and almost all infants will have been exposed to the virus by the time they're 2 years old.

But parents of infants have a new way to protect their children. The U.S. Food and Drug Administration (FDA) recently approved an immunization—a monoclonal antibody treatment called nirsevimab-alip (Beyfortus)—that can be given as a single-dose shot to newborns and infants during their first RSV season. Children up to 19 months old who remain vulnerable to severe disease in their second RSV season also can get the shot.

Soni said she “100%” recommends the immunization because of strong clinical trials that yielded positive results.

The FDA also recently approved a Pfizer RSV vaccine for women who are 32-36 weeks pregnant to protect their infants at birth. The same vaccine also was approved for adults 60 and older, as was another vaccine from pharmaceutical company GSK.

For older adults, the Centers for Disease Control and Prevention (CDC) recommended these new vaccines only for those who are at highest risk of severe RSV, such as patients with asthma, diabetes or heart failure. Although both vaccines are considered safe, a very small number of cases of Guillain-Barre syndrome—a condition in which a person’s immune system attacks their peripheral nerves—were reported after vaccination.

More data is needed to determine whether these episodes may have been unrelated to the vaccine, according to the CDC. But the significant risk RSV poses to some older adults could outweigh the very low risk of developing potential side effects.

Sonja Rosen, MD, section chief of Geriatric Medicine at Cedars-Sinai, said that for now,  she recommends the RSV vaccine for older patients with lung disease, or for those who are otherwise immunosuppressed and therefore at higher risk for severe illness. “Patients should speak with their physician and make an informed decision about whether this shot is right for them,” Rosen said.

New Twist on the COVID-19 Booster

The new COVID-19 booster has been updated to include a sub-variant of Omicron called XBB, which was the predominant strain at the time the shot was approved by the FDA this summer.  The vaccine should provide protection from all the strains circulating in the U.S. right now, Gandhi said.

Thanks to the new booster, antiviral medications like Paxlovid and at-home tests, Gandhi is grateful that “we're in a very different position in 2023.” She encouraged the public to take advantage of the booster when it becomes available this fall, to keep themselves and their loved ones safe, especially when gathering throughout the fall and winter holidays.

“We know immunity wanes after the administration of the booster and that many individuals may not have had a booster for quite some time,” Gandhi said. “I think it will be incredibly important, particularly in those populations that are vulnerable to COVID illness, hospitalization and potentially even death, to ensure that they get the updated booster in a timely fashion.”

She said it’s safe to get the COVID-19 and flu vaccines together. For older adults who determine with their physician that the RSV shot is right for them, they should get that immunization alone and two weeks apart from the other vaccines, if possible, Gandhi said. 

Read more on the Cedars-Sinai Blog: Flu—When to Go to the ER

In July, the first direct-to-consumer blood test designed to assess a user’s risk for developing Alzheimer’s disease hit the market. The test, which has not undergone Food and Drug Administration (FDA) review, measures the level of a protein called beta amyloid, a key component of plaques that form in the brains of Alzheimer’s disease patients, disrupting brain function.

Zaldy Tan, MD, MPH, medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders and the Carmen and Louis Warschaw Endowed Chair in Neurology at Cedars-Sinai, sat down with the Cedars-Sinai Newsroom to answer questions about the test, as well as similar blood tests that are in development.

What do these new blood tests measure?

Blood tests for Alzheimer's disease provide a convenient way for patients to see whether they might be developing Alzheimer's-type changes or pathology in their brain years before memory issues even begin. The challenge here is that these brain changes do not necessarily mean that they have Alzheimer's disease, which is a clinical diagnosis. What blood tests do is to look at traces of certain proteins that are known to develop in patients with Alzheimer's disease.

Who should take this type of blood test?

First, it is important to remember that the test currently on the market has not been evaluated or approved by the FDA. Neither have any of the other, similar tests that are in development. And these blood tests should really be reserved for people who are at risk or are having early symptoms of memory issues. These types of blood tests do not have a place for people who do not have significant risk factors for developing memory problems, or are not having any functional or social issues related to cognitive change.

Does a blood test alone provide enough information to diagnose potential memory issues?

A blood test will not answer that question. Only a trained clinician can. So, for people who are interested in these kinds of blood tests, I would suggest that patients first speak with their healthcare professional to see if these tests are right for them.

Alternatives to these newer-on-the-market tests are things like cognitive testing, a neurologic examination, or consultation with memory specialists. These blood tests provide just one data point or piece of information among many that need to be collected to know if someone is having early signs of Alzheimer's disease.

Do these blood tests help patients qualify for some of the new Alzheimer’s disease treatments such as lecanemab?

Currently, we confirm the presence of amyloid beta in the brain and qualify patients for these treatments through a PET scan of the brain or a lumbar puncture to test cerebrospinal fluid. These blood tests will need to be tested further and will need to be cleared by the FDA to make sure that they are reliable before they can be used to qualify patients for these new treatments. 

What are the risk factors for Alzheimer’s disease?

Age is one of the main risk factors for developing dementia later in life. Others include family history, especially having dementia diagnosed in a first-degree relative. People who have had traumatic brain injury or have had a stroke or have Parkinson's disease or other neurologic conditions may also be at increased risk of developing dementia.

What can people do to reduce their risk of Alzheimer’s disease?

So, what we need to do is to make sure that our brains get the blood supply that they need, and that is best assured by a healthy lifestyle: good diet, good sleep, exercise, increased socialization to make sure those connections between brain cells are nice and healthy. And of course, protecting your brain from trauma by wearing a helmet when you cycle or skate, wearing a seatbelt when you're driving, is important. So, it's really a combination of things in order to reduce the overall risk. Just like we do for our hearts and our bodies, we need to have a multimodal approach to risk reduction of brain disease, including Alzheimer's disease.

Read more on the Cedars-Sinai Blog: Am I at Risk for Dementia? What You Need to Know

About 5.8 million people in the U.S. have Alzheimer’s disease, according to the Centers for Disease Control and Prevention. That number is expected to triple to nearly 14 million by 2060. Tan told ABC 7’s Denise Dador that nationally, Los Angeles County has a high percentage of residents with Alzheimer’s disease (13.2% of residents). 

California has the seventh highest rate of older adults with Alzheimer’s in the country, which could be related to environmental factors that can increase an individual’s risk of developing the disease.

“Pollution has been related to the risk of Alzheimer’s disease, and we know that sometimes our air quality is not the best,” said Tan, who holds the Carmen and Louis Warschaw Chair in Neurology at Cedars-Sinai. He added that car-bound Angelenos don’t walk as much as residents of other cities.

Tan, who attended the Alzheimer’s Association International Conference in Amsterdam in July, told Dador that research presented at the conference on donanemab, an experimental immunotherapy drug, showed promise in slowing the progression of the disease. A study presented at the international conference showed donanemab reduced the progression of Alzheimer’s by 35%. Studies of lecanemab, the Alzheimer’s medication recently approved by the U.S. Food and Drug Administration, showed it reduced disease progression by 27%.

While there may be more new treatments in the future, Tan said it’s important to prioritize Alzheimer’s prevention. “It’s really about a healthy lifestyle and getting good sleep, lowering stress, preventing head trauma and eating a healthy diet,” Tan told Dador.  

Click here to watch the complete segment from ABC 7.

By 2030, there will be more than 70 million people over the age of 65 in the U.S., according to the U.S. Census Bureau. Because of a shortage in geriatricians, most of the healthcare for older adults in the U.S. will be provided by physicians in other specialties.

To address that gap, Cedars-Sinai and other age-friendly health systems create programs that focus on the “4Ms”: what matters most to older patients, patient mentation (mental functioning), patient mobility and medication safety. "By doing so, really in any program, we're going to help ensure that we're providing optimal care for our older patient population without necessarily having a geriatric provider directly providing that service,” Rosen told Ansari.

A good example, Rosen said, is Cedars-Sinai’s Geriatric Fracture Program, a collaboration of the Department of Orthopaedics and the Geriatric Section of Cedars-Sinai’s Department of Medicine. This program focuses on decreasing time to surgery for older adults who come to the hospital after experiencing a significant fracture, and ultimately decreasing their length of stay, Rosen told Ansari. When enrolled patients leave the hospital, clinicians follow up to assess the patient's bone health and develop strategies for future fall prevention.

In a recent study of the program, authors examined the health records of patients 65 and older with non-spine traumatic fractures who were cared for by physicians at Cedars-Sinai Medical Center. Investigators compared data from 746 patients who participated in the Geriatric Fracture Program with data from 852 patients who were not enrolled in the program.

The findings, published in a Health Services Research special issue on aging, showed that patients enrolled in the Geriatric Fracture Program experienced 2.12 fewer days in the hospital, a significant difference. Hospitalization also cost an average of about $5,000 less for program participants compared with patients not in the program. 

“We really focused on how to make sure that when patients leave the hospital, they still have their bone health … and strategies for future fall prevention have been addressed so that these things don’t happen again,” Rosen said.

Click here to listen to the complete “Advancing Health Podcast” episode.

Lecanemab, which must be given through an intravenous (IV) infusion, has been shown to slow disease progression in patients with early-stage Alzheimer’s who have elevated levels of beta-amyloid proteins in their brain. The drug removes these proteins, which are thought to cause Alzheimer’s.

While the medication holds promise for more than 1 million people with early-stage Alzheimer’s, it comes with caveats, Tan told NPR host Jon Hamilton. The treatment takes 18 months to work and only slows memory loss by about six months.

“’So, what does that six months mean to them?’ is my question,” Tan told Hamilton, “and whether that is worth showing up for an infusion every two weeks and risking brain bleeding and swelling.”

Tan, who also holds the Carmen and Louis Warschaw Chair in Neurology at Cedars-Sinai, explained that one of the obstacles to offering the treatment is meeting the guidelines imposed by private insurers. Patients will be required to undergo an evaluation and diagnostic testing—not fully covered by insurance—to determine whether they can be treated.  

“If that requirement becomes very restrictive, then only specialized centers will really be able to do this,” Tan told Hamilton. “And because of the limited capacity, I anticipate there will be a wait to get this medication.”

Though lecanemab is not a cure, Tan said it’s a step in the right direction. “It is a positive thing, because if we are going to get eventually to an effective and safe therapy, we need to start somewhere,” he told Hamilton.

Click here to read and listen to the complete segment on NPR.

Older women are among the most susceptible to developing UTIs, an infection of the bladder and urethra that causes urinary urgency and pain. UTIs also can cause delirium in older people, resulting in a sharp decline in mental abilities that triggers disoriented thinking.

“Up to one-third of elderly patients hospitalized with UTIs can experience some degree of confusion and reduced awareness of their surroundings,” said Shouri Lahiri, MD, director of the Neurosciences Critical Care Unit and Neurocritical Care Research at Cedars-Sinai and senior author of the study. “Delirium affects millions of patients a year in the U.S., contributing to longer hospital stays, long-term cognitive problems and increased mortality. Delirium can be a tipping point from which patients never fully recover. This is well established. What is less well established is why this is happening.”

To better understand the specific biological mechanisms behind UTI-associated delirium, Lahiri and colleagues observed laboratory mice with and without UTIs in specially designed mazes. In an arena where the animals could move about freely, uninfected mice spent more time in the center of the chamber. Those with UTIs huddled in the periphery, suggesting they had higher levels of anxiety, a common symptom of delirium.

In a Y-shaped maze with three arms to explore, uninfected mice tended to explore all three arms, while mice with UTIs kept returning to the same one, suggesting a lapse in short-term memory, another feature of delirium.

The investigators also observed structural changes in the brains of mice with UTIs.

In a previous study led by Lahiri, published in February in the American Journal of Respiratory Cell and Molecular Biology, investigators found a connection between ventilator-induced lung injury and delirium. Lahiri and colleagues theorized that in both cases this was because of the reaction of IL-6, which helps regulate immune response, to the lung injury or the UTI.

“Occasionally, when the response of IL-6 is excessive, our research indicates that there can be brain injury,” Lahiri said. “IL-6 induces changes within the neurons that our studies connected with delirium-like behavior. This is the first time this type of structural and functional change has been demonstrated. We’ve now shown two distinct models of this connection, one non-infectious and one infectious.”

In the current study, when investigators treated some of the infected mice with antibodies that blocked the effects of IL-6, the delirium-like behavior of those animals resolved. “Treatment with anti-IL-6 antibody in the UTI group normalized all the brain changes, both structural and functional,” Lahiri said. “A wealth of studies have shown a link between IL-6 and delirium, but only this study and our previous study have shown that IL-6 may play a direct pathological role in delirium.”

If symptoms are treated early, he added, full recovery is possible, and the next step is to design clinical trials with anti-IL-6 antibodies as a treatment for patients with UTI-induced delirium.

“Dr. Lahiri and his team have built a research framework with implications far beyond this study,” said Nancy Sicotte, MD, chair of the Department of Neurology who holds the Women’s Guild Distinguished Chair in Neurology at Cedars-Sinai. “Building on these efforts could improve outcomes for many of our patients.”

Lahiri believes the model he and co-investigators created could be used to study delirium in other conditions associated with increased incidence of UTI. These include those with pre-existing neurologic disorders like Alzheimer’s disease, Parkinson’s disease, stroke and multiple sclerosis where delirium can be hard to distinguish from the underlying disease but is important to treat.

“A huge population stands to benefit from these investigations,” he said. “We’re looking to apply this model to these other systemic disease conditions and states where the brain dysfunction caused is potentially reversible.”

Funding: This study was supported by National Institutes of Health/National Institute on Aging Grant R03AG064106, the American Academy of Neurology Institute and the F. Widjaja Foundation.

Read more on the Cedars-Sinai Blog: Alzheimer’s and Dementia FAQs