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Healthy Aging and Genetics. Jenny Johnson Utah Department of Health, Chronic Disease Genomics Program www.health.utah.gov/genomics. Overview. Healthy aging includes genetics Family health history (FHH) – what is it and why is it important? Why older adults and FHH?

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Healthy aging and genetics

Healthy Aging and Genetics

Jenny JohnsonUtah Department of Health, Chronic Disease Genomics Program

www.health.utah.gov/genomics


Overview
Overview

  • Healthy aging includes genetics

  • Family health history (FHH) – what is it and why is it important?

  • Why older adults and FHH?

  • “Make Family Health History a Tradition”

  • Next steps

  • Resources


Healthy aging includes genetics
Healthy aging includes genetics

  • Environment?

  • Humor?

  • Social supports?

  • Personal behaviors?

  • Luck?

  • Staying active?

  • Religion?

  • Genetics?

  • Ice cream?


Longevity genes
Longevity genes

  • While genetics does impact aging, there are many other factors

    • Heritability 20-30%

    • Environment 70%

    • Genetic influences are greatest on the “oldest old”

  • Centenarians are rare because complex environment and genetic factors must be present

    • Understand disease process and susceptibility

    • Drugs to maximize years in good health

Perls T, et al. Understanding the determinants of exceptional longevity. Ann Int Med 2003; 139(5):445-450.

Perls T, et al. The genetics of aging. Curr Opin Gene Develop 2002; 12:362-369.

Barzilai N, et al. Searching for human longevity genes: The future history of gerontology in the post-genomic era. J Gerontology 2001; 56A(2):M83-M87.


Genetics across the lifespan
Genetics across the lifespan

Alzheimer’smacular degenerationosteoporosis

diabetesdepression

birth defects

heart diseasecancer

asthmaautism


What is a family health history
What is a family health history?

  • A family’s combination of shared genes, environment, behaviors, and culture


Why is it important
Why is it important?

  • Health problems run in families

  • Helps you know what your risk may be

    • Guides screening tests and behavior change

  • Family history may be a risk factor in all stages of life

    • Environment

    • Behaviors and lifestyle

    • Genetics


Why is it important1
Why is it important?

Genetics

Family health history

Behaviors

Environment


We all have a family history of something
We all have a family history of something!

high blood pressure

diabetes

allergies

blue eyes

autism

leanness

high cholesterol

osteoporosis

pre-term birth

red hair

macular degeneration

obesity

birth defects

stroke

Alzheimer’s

asthma

cancer

arthritis

kidney disease

longevity

emphysema


Why is it important2
Why is it important?

“Knowing your family history can save your life. The earlier you know which health conditions run in your family, the easier it is to develop prevention plans with your doctor.”

  • Dr. Richard H. Carmona, former U.S. Surgeon General


Case study
Case study

  • Marian

    • 67 year old mother of 9

    • Oldest of 10 children

      • Both sets of grandparents died of heart attacks by age 70 (some as early as 43)

      • Dad died heart attack age 63

      • Several siblings have died or had heart attacks or open heart surgery in 30’s and 40’s

    • Diagnosed with diabetes and high cholesterol

    • Possible FH (familial hypercholesterolemia or inherited high cholesterol)?


Case study1
Case study

  • How does Marian’s FHH impact her behaviors? Her children? Grandchildren?

  • What prevention messages or strategies would you recommend?

    • Prioritize!

  • How would FHH change above for family members in their 40’s, 50’s, 60’s, or 70’s?


Still not convinced
Still not convinced?

  • 14% of UT families had a family history of CHD but accounted for 72% of early CHD and 48% of all CHD

  • 11% of UT families had a family history of stroke but accounted for 86% of early strokes and 68% of all strokes

  • Those with a family history have the most to gain from prevention messages and interventions

Williams RR, et al. Usefulness of cardiovascular family history data for population-based preventive medicine and medial research (The Health Family Tree Study and the NHLBI Family Heart Study). Am J Cardio 2001; 87:129-135.


Personalized prevention recommendations & referral for further evaluation

High Risk

Family

Health

History

Moderate

Risk

Personalized prevention recommendations

Reinforce standard prevention recommendations

Average Risk

Scheuner, et al. Am J Med Genet (1997), 71:315-324


“Elderly patients represent an untapped resource for family history.”

Acheson LS, et al. Family history-taking in community family practice: Implications for genetic screening. Genet Med 2000; 2(3):180-185.


Untapped resource
Untapped resource… family history.”

  • Studies show:

    • Elderly patients are less likely to be asked about their family histories

    • Those with Medicare are less likely to be involved in family history-taking

    • Patients and physicians perceive family history as less important or less predictive in older age

    • Having a family member present decreases the likelihood that family history is discussed

Acheson LS, et al. Family history-taking in community family practice: Implications for genetic screening. Genet Med 2000; 2(3):180-185.


Why fhh and older adults
Why FHH and older adults? family history.”

  • Genealogy is the fastest growing hobby in the U.S.

    • 60% are interested in family history research

    • Websites are very popular

  • “Wired Seniors”

    • 62% adults age 50-58 and 49% age 59-68 use Internet

    • 66% have searched for health information and 36% to do genealogy research

Maritz Research Inc. Sixty percent of Americans intrigued by their family roots. (Accessed July 30, 2006)

Pew Internet and American Life Project. Older Americans and the Internet. March 25, 2004. Washington DC. (Accessed July 30, 2006)


Why fhh and older adults1
Why FHH and older adults? family history.”

  • Utah is the place!

    • Utah: A gold mine for genetic research (learn.genetics.utah.edu)

    • Utahns themselves

  • National interest

    • U.S. Surgeon General Family History Initiative

    • CDC

    • And more!


Why fhh and older adults2
Why FHH and older adults? family history.”

  • 96% of Americans felt family health history was important but…

  • Only 30% have collected it! (CDC MMWR 2004)

  • Older adults are interested in and understand the importance of genetics

Walter FM, Emery J. Coming down the line – Patient’s understanding of their family history of common chronic disease. Ann Fam Med 2005; 3(5):4-5-414.

Skirton H, et al. A legacy for the children – attitudes of older adults in the United Kingdom to genetic testing. J Clinical Nursing 2006; 15:565-573.


Gift for future generations
Gift for future generations family history.”

  • Many older adults express interest in FHH because it offers “an opportunity to invest in the family’s future…”

  • Example: “I mean, I’ve got four little grandchildren and if there was anything in my genes and I could help them by saying, make sure you get this checked, it is a possibility that you are helping them, I mean it is possible to do that, even at my advanced age.”

Skirton H, et al. A legacy for the children – attitudes of older adults in the United Kingdom to genetic testing. J Clinical Nursing 2006; 15:565-573.


Why fhh and older adults3
Why FHH and older adults? family history.”

  • Gatekeepers to family history

  • Mental exercise and evaluation

  • Something to talk about

  • Reminiscence may be therapeutic

  • Social support systems may be revealed

  • Family dynamics

Acheson LS, et al. Family history-taking in community family practice: Implications for genetic screening. Genet Med 2000; 2(3):180-185.

Bannerman C. The genogram and elderly patients. J Fam Pract 1985; 23(5):421, 428.


You can t change your genes
You can’t change your genes… family history.”

  • But you can change your behaviors!

  • FHH presents an opportunity to engage entire family in understanding genetic risks

  • Older adults can serve as role models to the family


Does fhh increase motivation
Does FHH increase motivation? family history.”

  • Few studies have been done w/ mixed results

    • Mainly focus on genetic testing

    • Smokers who got genetic risk feedback made greater progress in cessation rates at 6 months but not 12

    • Those at risk for CVD had higher aspirin use and cholesterol management but not lifestyle modifications

    • Obese women’s (over 50 yrs) confidence to lose weight or control eating not affected by + obesity gene status

    • Non-obese however had lower perceived behavioral control

McBrdie CM, et al. Incorporating genetic susceptibility feedback into a smoking cessation program for African-American smokers with low income. Cancer Epidemiol Biomarkers Prev 2002; 11:521-528.

McCusker ME, et al. Family history of heart disease and cardiovascular disease risk-reducing behaviors. Genet Med 2004; 6(3):153-158.

Harvey-Berino J, et al. Does genetic testing for obesity influence confidence in the ability to lose weight? A pilot investigation. J Am Dietetic Assoc 2001; 101(11):1351-1353.

Frosch DL, et al. Behavioral consequences of testing for obesity risk. Cancer Epidemiol Biomarkers Prev 2005; 14(6):1485-1489.


Does fhh increase motivation1
Does FHH increase motivation? family history.”

  • Utah Family High Risk Program

    • 10 year follow up with high and average risk families

    • High risk families maintained behavior changes (exercise, weight loss, some screenings behaviors)

Johnson J, et al. Utah’s Family High Risk Program: bridging the gap between genomics and public health. Prev Chronic Dis [serial online] 2005 Apr.


Make family health history a tradition project
“Make Family Health History a Tradition” project family history.”

  • Goal: Increase awareness of the importance of family health history in Utah

    • Talk about it

    • Write it down

    • Share it

  • November 2005


Make family health history a tradition project1
“Make Family Health History a Tradition” project family history.”

  • Partners:

    • Media (TV, print, radio, Internet)

    • Salt Lake County Aging Services and 18 senior centers

    • Genealogists

    • Family History Library

    • Genetic counselors and other health professionals


Make family health history a tradition project2
“Make Family Health History a Tradition” project family history.”

  • 26 classes, 407 participants

  • Seniors were as likely to report that they would collect and share their FHH as younger participants

  • All but one felt a FHH was important


Make family health history a tradition project3
“Make Family Health History a Tradition” project family history.”

  • Family Health History Toolkit

    • 6,700 + distributed to date

    • To order: Visit www.health.utah.gov/genomics or call the Health Resource Line at 1-888-222-2542


Next steps
Next steps family history.”

  • Tell Us Your Story! (ongoing)

  • Salt Lake County Aging Services revising the Toolkit based on focus groups in senior centers (completion June 2007)

  • Conduct surveys w/ seniors about perception of disease based on genetics, environment, and personal behaviors (completion June 2007)

  • Promotion to AARP


Take home messages
Take home messages family history.”

  • Healthy aging includes genetics

  • Family health history most applicable genomic tool today

  • Include FHH as part of genealogy

  • Focus on sharing

  • Family dynamics are crucial


Resources websites
Resources (websites) family history.”

  • Chronic Disease Genomics Programwww.health.utah.gov/genomics

  • CDC Family Historywww.cdc.gov/genomics/public/famhistMain.htm

  • U.S. Surgeon General Family History Initiativewww.hhs.gov/familyhistory/

  • Genetic Alliancewww.geneticalliance.org


Resources books
Resources (books) family history.”

  • Shawker, Thomas H. Unlocking your genetic history: A step-by-step guide to discovering your family’s medical and genetic heritage. Rutledge Hill Press, 2004.

  • Daus, Carol. Past Imperfect: How tracing your family medical history can save your life. Santa Monica Press, 1999.

  • Bennett, Robin L. The practical guide to the genetic family history. Wiley-Liss, Inc., 1999.

  • Milunsky, Aubrey. Your genetic destiny. Perseys Publishing, 2001.


Contact us
Contact Us family history.”

  • Chronic Disease Genomics Program


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