New issue of JAGS highlights award-winning research

Advancing care for older people across health specialties, the American Geriatrics Society (AGS) and the AGS Health in Aging Foundation today announced that two expert researchers–Kavita Dharmarajan, MD, MSc, an assistant professor in the Department of Radiation Oncology and the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in N.Y.; and Nazema Siddiqui, MD, MHSc, an associate professor of obstetrics and gynecology at Duke University Medical Center in Durham, N.C.–will receive the 2020 Jeffrey H. Silverstein Memorial Award for Emerging Investigators in the Surgical and Related Medical Specialties. Originally slated for presentation at the AGS 2020 Annual Scientific Meeting–now cancelled due to the COVID-19 pandemic–the awards will be presented to Dr. Dharmarajan and Dr. Siddiqui at the AGS 2021 Annual Scientific Meeting (#AGS21) in Chicago, Ill. (May 12-15, 2021).

“As we work to advance geriatrics expertise, we need to break down silos and build professional collaboration across specialties,” notes Sunny Linnebur, PharmD, FCCP, FASCP, BCPS, BCGP, AGS board chair. “Working at the crossroads of geriatrics and other important specialties, Dr. Dharmarajan and Dr. Siddiqui are modeling the way not only to better collaboration but also to better care.”

“Palliative Radiation Treatment in Older Adults with Brain Metastases: Benefit or Burden?” (Kavita Dharmarajan, MD, MSc)

For her work originally slated for presentation at #AGS20 and now profiled in a special supplement from the Journal of the American Geriatrics Society (JAGS), Dr. Dharmarajan and colleagues from across the Icahn School of Medicine at Mount Sinai looked at whether a certain form of palliative radiation therapy (a form of cancer treatment intended to reduce symptoms and improve quality of life) was associated with more benefits or burdens for older adults with certain types of cancer. For their work, the team looked at data from more than 28,000 patients with breast, lung, or gastrointestinal cancer and a diagnosis of brain metastases (which means that cancer has spread, or metastasized, to the brain from its original location). Of those patients, 20 percent were 75 years old or older, and more than 52 percent received a form of palliative radiation treatment known as “whole brain radiation therapy” (WBRT). More than 80 percent of patients receiving WBRT completed treatment.

Compared with younger patients, those 75-years-old and older were less likely to be offered palliative WBRT and more likely to stop WBRT prematurely. People over age 75 also experienced a higher rate of mortality within six months of completing radiation therapy. According to Dr. Dharmarajan and her colleagues, results suggest that WBRT as a palliative option frequently goes unfinished and can be associated with worse outcomes in older adults with cancer that has spread to the brain. More research is needed to identify patients likely to benefit from this type of a palliative option.

“Urinary Microbiome in Menopausal Women with Recurrent Urinary Tract Infections” (Nazema Siddiqui, MD, MHSc)

In her research also featured in the JAGS supplement, Dr. Siddiqui and colleagues from Duke, Oregon Health and Science University, and the University of Virginia turned a critical eye to one of healthcare’s most pervasive concerns for older women: Recurrent urinary tract infections (UTIs).

Specifically, Dr. Siddiqui and her team looked at the role different treatment options might play in the “urinary microbiome,” the medical term for the bacterial environment found in our urinary system (including normal/healthy levels of bacteria, as well as bacteria that can contribute to recurrent UTIs). These options include topical vaginal estrogen (a cream or ointment applied to the vagina to improve levels of estrogen, a hormone that declines during menopause and which many believe impacts levels of urinary-tract bacteria) and antibiotics (the standard treatment option for most bacterial infections, including UTIs).

Analyzing sterile urine samples from 65 women, the research team found that a specific type of bacteria known as Lactobacilli was found in the urinary microbiome of all women, but there were higher amounts in women without UTIs. For example:

35 percent of women with recurrent UTIs had moderate to large amounts of Lactobacillaceae when they were treated with topical vaginal estrogen and daily antibiotics.

44 percent of women with recurrent UTIs had moderate to large amounts of Lactobacillaceae when they were treated with topical vaginal estrogen but without daily antibiotics.

By comparison, 56 percent of women without recurrent UTIs (also known as the “control group”) had moderate to large amounts of Lactobacillaceae.

There were also trends towards different species of Lactobacilli recovered in women taking daily antibiotics. Interestingly, the team was also able to use a new research technique known as Bayesian graphical compositional regression to identify smaller clusters of microbiome differences in women from the three groups above. These results point to subtle but important differences in bacteria, which may change our thinking about how and why UTIs recur, and our approaches to treatment by extension. Those differences are important, since UTIs remain among the most common bacterial infections for women, accounting for nearly 25 percent of all infections and ranking high among those infections most likely to reoccur.

The Silverstein Memorial Award is one of several honors conferred by the AGS at its Annual Scientific Meeting. The 2020 award recipients–all of whom will be honored at #AGS21–include more than 20 healthcare leaders representing the depth and breadth of disciplines championing care for older adults. For more information, visit Meeting.AmericanGeriatrics.org.

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Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has–for more than 75 years–worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.

The Health in Aging Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation’s work, visit HealthinAgingFoundation.org.

The Silverstein Memorial Award for Emerging Investigators in the Surgical and Related Medical Specialties recognizes emerging researchers across health care committed to careers in aging. Their geriatrics-focused work in surgical and other medical specialties helps to advance the unique care we all need as we age.

The AGS Annual Scientific Meeting is the premier educational event in geriatrics, providing the latest information on clinical care, research on aging, and innovative models of care delivery. Following the cancellation of the 2020 gathering due to the COVID-19 pandemic, nearly 3,000 nurses, pharmacists, physicians, physician assistants, social workers, long-term care and managed care providers, healthcare administrators, and others will convene next year from May 13-15 (pre-conference program on May 12), in Chicago, Ill., to advance geriatrics knowledge and skills through state-of-the-art educational sessions and research presentations. For more information, visit Meeting.AmericanGeriatrics.org.