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  1. Healthy Aging and Genetics Jenny JohnsonUtah Department of Health, Chronic Disease Genomics Program www.health.utah.gov/genomics

  2. 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

  3. Healthy aging includes genetics • Environment? • Humor? • Social supports? • Personal behaviors? • Luck? • Staying active? • Religion? • Genetics? • Ice cream?

  4. 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.

  5. Genetics across the lifespan Alzheimer’smacular degenerationosteoporosis diabetesdepression birth defects heart diseasecancer asthmaautism

  6. What is a family health history? • A family’s combination of shared genes, environment, behaviors, and culture

  7. 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

  8. Why is it important? Genetics Family health history Behaviors Environment

  9. 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

  10. 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

  11. 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)?

  12. 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?

  13. 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.

  14. 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

  15. “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.

  16. Untapped resource… • 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.

  17. Why FHH and older adults? • 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)

  18. Why FHH and older adults? • 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!

  19. Why FHH and older adults? • 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.

  20. Gift for future generations • 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.

  21. Why FHH and older adults? • 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.

  22. You can’t change your genes… • 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

  23. Does FHH increase motivation? • 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.

  24. Does FHH increase motivation? • 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.

  25. “Make Family Health History a Tradition” project • Goal: Increase awareness of the importance of family health history in Utah • Talk about it • Write it down • Share it • November 2005

  26. “Make Family Health History a Tradition” project • 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

  27. “Make Family Health History a Tradition” project • 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

  28. “Make Family Health History a Tradition” project • 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

  29. Next steps • 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

  30. Take home messages • 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

  31. Resources (websites) • 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

  32. Resources (books) • 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.

  33. Contact Us • Chronic Disease Genomics Program • Email: genomics@utah.gov • Phone: 801-538-9416 • Website: www.health.utah.gov/genomics