Aging Reimagined: A New View of Old Age
One day in 2012, a group of women and men ages 50 to 91 stood, awkward and shivering, on a pool deck at Monroe Community College in Rochester. For some, it was the first time in years they had worn a swimsuit in mixed company. It was also the first day they would train for a triathlon.
For eight weeks, they ran, cycled, and swam their way into race fitness. Two months later, more than 50 athletes lined up for the running leg of the race, and a vanguard of local Hell’s Angels’ riders, most in their late sixties or so, started them off with a roar.
Almost everybody finished the certified sprint course triathlon—with a 750-meter swim, 12-kilometer bike ride, and five-kilometer run—all on the same day.
“We were presenting them with a life option that they never would have thought possible, and within a week everybody was doing wonderful things. It was an enormous success,” says University of Rochester Medical Center Professor Emeritus William Hall, MD, who created the event with Carol Podgorski (MPH ’85, PhD ’90, MS ’05), professor of Psychiatry. At the time, Podgorski and Hall headed the Center for Lifetime Wellness, which supported the training. AARP provided funds to develop and host it, the first of its kind in New York state.
“What it did for me was solidify this idea that we often sell older people short in terms of what they can do,” Hall says. “That’s when things really got started. It was an amazing example of what is possible to do in Rochester.”
Off and Running
Training for the tri continued for several more summers. By the end of the program, the concept of conditioning and training for adults ages 50 and over had gained a solid footing.
It was the natural outgrowth of a University of Rochester tradition in geriatrics that began in the 1960s, long before a focus on healthy aging caught on elsewhere. Fifty years before Hall’s triathletes jumped into the pool at MCC, T. Franklin Williams, MD, was making waves with geriatrics care and research in Rochester. One of the founders of modern geriatrics medicine and a giant in the field (he directed the National Institute for Aging for eight years), Williams placed Rochester at the forefront of geriatrics before it was even a specialty.
Williams mentored countless geriatricians across the country, including Hall and others who remained on home ground and built on his success. Today, geriatricians and scientists in the University of Rochester Aging Institute (URAI) are known around the world for groundbreaking research and older-adult care models.
The volume of bench research, patient care, and community support related to aging in Rochester is staggering. From fracture centers to DNA research to community music programs for older adults, URAI integrates all such strengths across campuses. Many of these are replicated around the world. And experts here are sharing and collaborating more easily.
“Promoting vitality in aging through discovery, collaboration, and innovation is what this Institute is all about!” says Annette (Annie) Medina-Walpole, MD, chief of the Division of Geriatrics & Aging, who directs the Institute with a contagious enthusiasm. “The UR Aging Institute is committed to promoting health, independence, and engagement, enabling all of us to live our best lives.”
Geriatricians have heard all the stereotypes of old age, usually starting with “it’s tough growing old,” followed by a list of ailments and an inevitable downward spiral of loss and limitations.
However, scientists and clinicians in the URAI say the picture doesn’t fit everyone’s experience of aging, nor did it ever: They are blowing those stereotypes out of the water, proving older adults can be capable of far more—cognitively, physically, socially—than previously believed. Vital and healthy advanced age is not only possible; for a growing number, like Hall’s triathletes, it’s what everyone should strive for.
Hall and Susan Friedman, MD, MPH, professor of Medicine in the Division of Geriatrics & Aging, have continued the quest to promote healthy aging. A 2015 article they published in the Journal of the American Geriatrics Society notes that “collaborative efforts between geriatrics, communities, and individuals will set the stage for developing a healthier society for all to age well and successfully.” Friedman has gone on to publish additional papers on healthy aging and to launch the Lifestyle Medicine program at Highland Hospital.
“People often think that aging is this inevitable decline. Forget about a fountain of youth. But it seems that the process of aging is really malleable and can be influenced,” says Dirk Bohmann, PhD, senior associate dean for Basic Research and the Donald M. Foster, MD, Professor in Biomedical Genetics, who has studied aging for more than 20 years.
The need to study aging and to shift societal attitudes has never been more urgent. More than 10,000 people in the U.S. turn 65 every day, and the number of older adults will more than double to 88 million by 2050, according to the AARP. That’s more than 20 percent of the population. Not surprisingly, funding for aging research—from the National Institute on Aging and a growing roster of other sources—is on a steady rise.
Far from a bleak outpost of last-chance medicine, aging research and geriatrics medicine turn out to be an exciting place.
The RoAR and OARHS of Research
Basic aging research began in earnest at the University many years ago. Bohmann and University professors of Biology and Medicine Vera Gorbunova, PhD, and Andrei Seluanov, PhD, formed RoAR, Rochester Aging Research Center, bringing together investigators in basic and translational research at the Medical Center and River Campus through seminars, an Aging Research Day, pilot grants to advance the work, and ways to collaborate.
Podgorski and Professor and Vice Chair of Psychiatry Yeates Conwell, MD, started OARHS, the Office of Aging Research and Health Services, to gather clinicians, researchers, and educators in clinical care and population health. As a complement to basic research, it was a first step in linking basic scientists, clinicians, caregivers, and policy experts around the University.
While the two efforts weren’t officially siloed, neither were they connected in any real, change-making way. Collaboration between lab scientists and geriatricians wasn’t natural at first, Bohmann recalls.
“RoAR did basic research on the fundamentals of aging, the science behind it, whereas OARHS and geriatrics work on the actual state of being old. These are two different cultures. Still, we figured it would be very useful to support communication between them,” he says.
They came together in the newly formed URAI in 2019, spurring a whole new level of excitement and potential for the study of aging and the care of older adults in our health system and community.
An Age-Friendly Focus
From a clinical point of view, creating an institute that addresses an increasing need is important, says Mark Taubman, MD, URMC CEO and dean of the School of Medicine and Dentistry. The UR Aging Institute plays a huge part in the University’s strategic plan and mission: to improve the health of the region’s population and enhance UR’s reputation as a research-oriented university and medical center.
To that end, in May 2022, Strong Memorial and Highland hospitals received the highest level of certification as an Age-Friendly Health System (AFHS), an initiative of the Institute for Healthcare Improvement and the John A. Hartford Foundation with the American Hospital Association and the Catholic Health Association of the United States.
As the name suggests, AFHS certification is the best in evidence-based health care for older adults. It’s a focus on what matters to patients receiving care and on improving health outcomes for them—and a perfect fit with the URAI’s mission.
“Right now we have a region that’s not growing in population—it’s aging. More and more of the people we take care of are an aging population, and the diseases are age-related,” Taubman says. “We have an opportunity—because of who we are and what we already do with aging—to make a national mark. And we’re ripe to do it.”
Promoting Vitality in Aging
In the Institute’s three main areas—research, care, and community—University of Rochester experts are pushing against traditional boundaries of what aging looks like. They’re questioning long-held, limiting assumptions about the physical, mental, emotional, and social abilities of older adults. And they’re doing things quite differently in their clinical studies and scientific investigations.
Aging research is a wide-open field with a lot of exciting perspectives. But with abundant opportunities come challenges. For the Institute, this means being selective.
“We started by building on our existing strengths—and there are many—and now we are moving forward by creating new, unprecedented partnerships and collaboration across our institution that align with our mission and vision,” Medina-Walpole says.
“We’re not going to do this all at once,” adds Conwell, a member of the URAI executive committee. “Why did we take on a mission for the Institute that is as broad as this is, to include research and education and clinical care and population health? It has to do with the notion of the biopsychosocial model.”
The BPS model, the foundation of medical training and care at the University of Rochester, insists on treating not only the physical but the emotional, mental, and social aspects of health. It was conceived by URMC doctors George Engel and John Romano in the 1970s and is now in wide use around the world.
“It is inherently in the air we breathe here, and we want to disseminate that and make that an important part of how we work,” Conwell says.
Rochester is the perfect living laboratory to re-envision older age, says Hall, noting that he and colleagues who came up under Williams had support not only from the University but from the community.
“There are so many resources to help people age gracefully in Rochester,” he says. “That is probably not as well known here as it is nationally. Somehow this community saw the tea leaves and really tried to develop collaborative programs, so Rochester is well-recognized throughout the country for that form of leadership.
“If you’re going to have to age anyway, you might as well do it here in Rochester.”
Pictured at top: Martha Hope is a driving force behind URAI's community engagement and Vital Living pillar. Read more about her here.
Research ranges from basic science in the lab to data science and multidisciplinary aging studies. Scientific discoveries will be translated into creative approaches to increase longevity and health span as well as improve patient care and clinical outcomes.
The primary aim is to increase access to high-quality geriatrics care—driven by technology and data—in the region. URAI makes sure best practices and care models are shared across the system. A big focus is on workforce education, including training providers of all disciplines and disseminating the principles of the AFHS.
This pillar focuses on older adults in the Rochester community. It creates a loop of learning that goes both ways between the University and community nonprofits and individuals. URMC specialists and aging organizations offer evidence-based evaluations and lifestyle interventions that promote vitality in aging. And older adults become advocates, teachers, and researchers themselves, enlivening the university community with the spirit of aging.