Ongoing Rancho Bernardo Study Seeks to Unveil Mystery of Aging

If anyone knows Rancho Bernardo’s secrets, it is Dr. Elizabeth Barrett-Connor. She has been poking and prodding its residents for information since 1972.

Barrett-Connor, chairwoman of the department of community and family medicine at the UC San Diego School of Medicine, and other researchers associated with a long-running study use questionnaires, telephone interviews and physical examinations to monitor the diet, life style and health of 4,000 Rancho Bernardo residents. Researchers have used reams of data gathered over the years to help unlock some of the secrets of aging.

In November, for example, UCSD researchers used data from the study to determine that women increased their risk of developing Type II, or adult-onset diabetes, with each pregnancy.

Several years ago, researchers were among the first to suggest that estrogen replacement therapies helped improve the overall health of women after menopause. Researchers also were among the first to identify a relationship between potassium levels in the blood and the risk of stroke.

They now are studying the Rancho Bernardo population to determine the role of diet, life style and heredity in the development of osteoporosis, a bone disorder that occurs in old age. They have also taken early steps toward a better understanding of memory loss and are seeking links between body fat--how much and where it is located--and heart disease.

By design, the Rancho Bernardo study focuses on “the problems of people who are past 50 . . . (such as) heart disease, high blood pressure, diabetes and osteoporosis,” Barrett-Connor said. Data from the study also suggests that people over 50 must continue to pay attention to cholesterol levels.

The Rancho Bernardo study is “one of the great pioneers” in the rapidly expanding research on how people age, said Edward Schneider, dean of the Andrus Gerontology Center at the University of Southern California.

During the early 1970s, “the country was trying to ignore aging,” Schneider said. “The ‘Pepsi Generation’ was going rampant.”

But as the average age of Americans increases, people are paying more attention to aging. “Congressmen and policy makers are finally understanding that they, too, are aging, and if there’s research on aging, they may benefit from it,” Schneider said. “The only way to be immune from aging is to die. Everybody’s concerned about it.”

Longitudinal studies, such as the Rancho Bernardo study, are important because they “look at people over a long period of time,” Schneider said. “We need more studies like this. We can use them in Boston, Baltimore, Iowa, anywhere you can, to get a better picture” of how people age.

“My lifetime goal is to explain why women live longer than men,” Barrett-Connor said during a recent speech. “I want men to live longer so I’m not the only woman on my block with no man to talk to.”

Barrett-Connor, 54, who describes herself as “on the wrong side of 50,” gave little thought to aging when she began the study. “In all honesty, at age 35 I never thought about being 55,” said Barrett-Connor. “I was interested, though, in what happened to older people. I’m interested in healthy aging.”

So too, it turned out, were the thousands of Rancho Bernardo residents who answer questionnaires and take occasional physical examinations. Participants are not paid. However, the extensive medical examinations have alerted a few volunteers to life-threatening diseases that might otherwise have gone undetected.

Most volunteer time and information because “they are motivated, because they want to be helpful and make a contribution” that might benefit their children and grandchildren, Barrett-Connor said. “We’ve enjoyed an astounding level of support.”

Volunteers do not expect to benefit from the study, said Lillian Summers, a participant since 1972.

“If you live long enough, you’re going to get old,” said Summers, who views her involvement as a way “to help out with research. This is a wonderful project.”

“In order to have research you have to have the ‘researchee,’ ” quipped Winston Bowen, 75, who is taking part in the osteoporosis study. “This is as close as I can come to helping out. It’s done for the research, because I have no personal gain from it.”

The study was initially supposed to be a one-shot deal, because Barrett-Connor only had funding for short-term heart disease research.

But Barrett-Connor decided that it would be “boring” to simply study heart disease and simply disassemble the study. She found more funding to continue monitoring the population as it aged.

That decision was “a combination of planning and good luck,” Barrett-Connor said. “We had the good fortune to (be able to) pick any kind of population we wanted to study, and we had the foresight to pick one that was older.”

But as is the case with most population studies, the UCSD clinic is constantly seeking new funding. “There’s no ongoing source of easy money,” Barrett-Connor said. “Every five years or so we spend three months looking for another grant.” It’s an agonizing period, she said.

The Rancho Bernardo study provides an interesting counterpoint to the Framingham Heart Study, a Massachusetts-based study that is perhaps the nation’s best-known long-running population study. The Framingham, which celebrated its 40th anniversary in 1988, and Rancho Bernardo projects were both created to study heart diseases, but the populations are remarkably dissimilar.

When the Framingham study began in 1948, many of its participants were walking time bombs; a high percentage regularly ate rich foods, smoked cigarettes, avoided exercise, and, in many cases, were overweight. At the outset, elevated blood pressure and high cholesterol and blood sugar levels were commonplace.

In contrast, the Rancho Bernardo population, which was relatively healthy when the study began in 1972, has remained surprisingly free of ailments that afflict many older people.

In keeping with the general Rancho Bernardo population, study members are overwhelmingly white, financially secure, well educated and decidedly healthy. Many residents moved to the community in the 1960s, when “there was no hospital in the area,” Barrett-Connor said. “So they’d damn well better have been healthy.”

The population was so full of pep and vigor that, during the 1970s, a developer used a photograph of study participants to advertise a new Rancho Bernardo residential development. Move to Rancho Bernardo, the advertisement suggested, and you, too, can be healthy.

Researchers initiated the study by “driving around and knocking on doors” to attract interested residents. UCSD researchers interviewed and tested participants “in a mobile-home trailer in a dirt lot that is now a Vons grocery store,” Barrett-Connor said.

UCSD had purchased “a trailer with a bathroom. . . . (but) there was not any place to hook the bathroom into,” Barrett-Connor said. “So we dug a sump, and ended up with a system I don’t care to describe.”

Researchers now examine participants at a small clinic in a Rancho Bernardo medical arts building. Most information is gleaned from annual questionnaires and occasional telephone surveys.

Every few years--the timetable is largely governed by how much funding is available--different study groups make lengthy visits to the clinic. As is the case with most population studies, researchers “don’t manipulate people and we don’t do experiments,” Barrett-Connor said. “We just observe.”

Research is now focused on osteoporosis, and several hundred participants are spending four hours at the clinic for an examination. Blood is drawn, memory and lung capacity are tested, and bone density is checked with a pair of state-of-the-art machines. Participants also provide information about diet, exercise, alcohol and tobacco use, sexual habits and self-image.

“We know things about you that you might now prefer not to have told us,” Barrett-Connor quipped during a recent speech in Poway. “We know about life styles, what you eat, whether you smoke, drink alcohol . . . your social support systems, whether you exercise (and) what new medical diagnoses you’ve had.”

Researchers have also begun to ask questions about memory loss, a common ailment among older people.

“We’re trying to find out how it works,” Barrett-Connor said. “We’re interested in finding out if it’s related to hormones, or maybe exercise or medication.”

Information from questionnaires and memory tests could help researchers to understand how and why memory fails, Barrett-Connor said.

“We have all the antecedent behavior . . . about drinking smoking, diet and exercise,” she said. “Maybe we can (eventually) pinpoint whether the behaviors are related to memory loss, maybe people are more forgetful if they drank more as kids, or smoked more as kids.”

And, the data might one day help researchers learn more about Alzheimer’s disease. But, at present, “we’re not prepared to make advances at that level,” Barrett-Connor said. “We’re trying to get more money, but we’ll begin by studying normal memory loss, like not being able to recognize someone, or having trouble thinking of people’s names and telephone numbers.”