Rochester Medicine

Aging Reimagined: Vital Living

Nov. 1, 2022

Martha Hope isn’t one to sit at home all day with nothing to do. Well-occupied from a young age, she had a long career in human services and foster children to raise.

But one day, some time after her husband had passed away, she sat in her bedroom and started to weep. Until that moment, it hadn’t dawned on her that she was lonely.

Martha Hope
Martha Hope

“I realized what was happening, so I started talking to people. I said, ‘We need to talk about this isolation and being lonely.’ I’m concerned about mature adults. We can’t assume that everybody is happy by themselves,” Hope says.

Hope, who is nearly 80, found her way back by following her interest: connecting people. She and Charles White, whose own struggle with loneliness and depression during the pandemic spurred him to get involved, organized social events for older adults last year—an Erie Canal cruise, a trip to Onondaga Lake to see the holiday lights—and the nonprofit Senior Expressions was born.

“We try to address isolation, mental health challenges, depression, and anxiety that we see in our seniors, especially single seniors that may not have that outside connection,” White says.

When the organization held a semiformal ball at Harro East last year to bring everyone together, the UR Aging Institute stepped up to assist and was invited to participate. In addition to dinner and dancing, the ball featured tables staffed by University specialists who provided information about resources—at the University and in the community—for older adults. The ball was a hit by all accounts, and a second this year was equally successful.

“When I think of aging with vitality, the first person who comes to mind is Martha Hope. She, along with Charles White, has been an inspiration to me personally and a driving force behind the Institute’s engagement with the Rochester community,” says Annie Medina-Walpole, MD, chief of the Division of Geriatrics & Aging and director of the UR Aging Institute (URAI). “Partnering with Senior Expressions has allowed us to connect with older people to promote education, health, and safety. We look forward to many more years of collaboration, and I am excited to see where this new partnership takes us.”

Supporting the Experts

Being involved in the ball was part of URAI’s Vital Living pillar, which steers its research, education, and patient care outward to help create an age-friendly community in Rochester. It starts with a simple question: What does it mean to age with vitality? It finds the answers through the wisdom of older adults and the expertise of area organizations.

Rochester has rich resources for older people. The Monroe County Aging Alliance illustrates this well. More than 20 member organizations—from aging providers to businesses—advocate on issues facing older adults, including poverty, ageism, and livable community initiatives. They recently created and published an action plan for an Age-Friendly Rochester and Monroe County.

It’s a relatively small city—210,000, with 1 million in the six-county region—but large enough to be an innovative model for an age-friendly community. People 65 and older make up 17 percent of the county population, a number expected to rise.

There’s a lot of work ahead. Income disparities force a wide gulf between the highest average life expectancy in the county (81.1 in Pittsford) and the lowest (72.4 in the city’s southwest quadrant). A 2021 report by the Alliance, Poverty in Later Life, showed that one in five city residents age 65 and older lives below 100 percent of the poverty level ($12,490 per year). The number of poor adults in the city is growing.

Yeates Conwell, MD
Yeates Conwell, MD

And while the University has a strong history in geriatrics and many partners in the community, work remains “to make the University and Medical Center truly collaborative and trusted by the community,” says geriatric psychiatrist Yeates Conwell, MD.

In 2003, Conwell and psychiatry faculty colleague Carol Podgorski, PhD, started exploring ways to improve mental health services for local older adults. With a five-year grant from the National Institutes of Health, they created SHARE—the Senior Health and Research Alliance—together with Lifespan of Greater Rochester, an advocacy and aging services organization for older people and caregivers, and Catholic Family Center.

“We turn to those agencies to really learn what is important to older adults. Lifespan is working out there on the streets every day. They’re the real experts in that. And in turn we can show them how to study the effects of the programs they offer,” Conwell says.

Their research showed that older adults with mental health issues rarely sought those services. Through SHARE, the agencies started focusing on data and evidence-based practices, which gave them the information they needed to build an infrastructure that better meets the mental health needs of their constituents, Podgorski says.

Other programs have multiplied since SHARE began, and faculty are surveying the current mental health landscape for an update. The institute is keen on avoiding duplication.

“We either want to add value or fill in gaps or find ways to enhance those services with things universities do best,” Podgorski says.

A sampling of other programs includes:

  • HOPE (Helping Older People Engage) Lab is working with Lifespan and other partners to ease the loneliness of people and their family caregivers. Led by Kim Van Orden, PhD, and with funding from the National Institutes of Health and other sources, the lab is developing a portfolio of interventions that agencies can use to help boost social connectedness in later life. For example, peer-support programs, like the Retired Senior Volunteer Program, help reduce isolation and improve quality of life for lonely older people.
  • FLCEAD (Finger Lakes Center of Excellence for Alzheimer’s Disease), led by Podgorski, works to expand the reach of services for people with cognitive impairment. A big part of this is outreach to rural and minority communities. The number of referrals for dementia screenings the center receives outstrips capacity, so FLCEAD is working with other UR partners to educate primary care doctors to screen in their practices. URMC’s Memory Care Program is the clinical hub for FLCEAD.

Showing Up for All

Nurse Practitioner Ida Earner Ida Earner (BS ‘99, MS ‘09), was named a University DEI champion in the Division of Geriatrics & Aging last October and, in June, received the division’s inaugural Community Engagement Award. Born and raised in Rochester and the daughter of Mexican immigrants, she focuses her efforts on equitable health care in the community where she grew up. Latinx adults age 65 and older have the highest poverty rate in Rochester (39 percent)—nearly twice that of Black adults of the same age.

As Earner and her colleagues give presentations on health topics in the community, one event hit especially close to home. The Division of Geriatrics & Aging and URAI were invited to present at the monthly meeting of Centro de Oro, a 60-and-older Spanish-language social group affiliated with Ibero-American Action League. The event was held at Jackson Recreation Center, adjacent to School No. 9, the school Earner attended. Earner, Medina-Walpole, and Marie Bell (EdD, RN ’94, GNP-BC), a nurse at Strong Memorial Hospital and nurse practitioner with the UR Medicine Geriatrics Group who previously worked with Centro de Oro, shared home safety tips for preventing falls, taking medication, and handling scam phone calls. Then someone mentioned Earner had been a local student. That brought the house down.

“Oh my goodness! It was a great feeling to be back,” she says, laughing. “It was really awesome to come full circle.”

It’s important to walk the walk, adds Earner, who recalls translating her father’s Spanish during his hospital stays. “We talk so much about addressing these disparities in access to care. It’s not until they see us physically out there, going into these communities, that they’re going to understand this is a mission, not just a checkbox.”

During her fellowship for movement disorders, neurologist Blanca Valdovinos (MD ’15, Res ’19, Flw ’20), assistant professor of Neurology and Geriatric Faculty Scholar, noticed that only two Spanish-speaking patients came through the clinic over the course of a year. Latinx make up 20 percent of Rochester’s population. With such a discrepancy, she knew it had to be an access issue.

That spurred Valdovinos, a second generation Mexican-American, to start a neurology clinic for geriatric Spanish speakers. She mostly sees patients with Parkinson’s disease, but also treats more common neurologic illnesses, like headaches and migraines. She thought it would take a while to catch on but, by the end of the first month, she was booking out four months. That has since expanded to a six-month wait.

“There’s a huge, huge need that we’re trying to meet but haven’t yet,” she says.

Valdovinos has found that her older-adult patients whose first language is other than English can feel isolated. They may be uncomfortable talking about their concerns with a doctor, feeling rushed or misunderstood.

About a year into the clinic, Valdovinos applied for and received a Geriatric Faculty Scholar award from the Division of Geriatrics & Aging, funded by the Geriatric Workforce Enhancement Program grant. A main goal is to educate nurse practitioners, nurses, residents, and fellows who rotate through the clinic. Hour-long sessions based on the AFHS 4Ms equip them with ways to get around language, mistrust, and cultural barriers. And her Spanish-only patients use a special diagram to convey what matters most to them.

Preliminary findings show that patient trust has improved, along with how well patients feel their doctors know them. “I know we are making changes little by little, by being more mindful about ‘how do I take care of a geriatric patient? How do I approach them?’” Valdovinos says. “I also think it’s made me a better doctor.”

Learning Loop

In a learning feedback loop with the University, older adults become advocates, teachers, and researchers themselves.

“We want to learn from older adults,” says Podgorski. “We want them to engage across our University. We want to find what they might have to teach us, what matters to them, whether through knowledge, program development, or shaping health promotion programs.”

Engaging Older Adult Learners as Health Researchers (ENGOAL) was a great example of this in action. It is a year-long certification program in health research skills, through the Warner School of Education, for older adults from underserved communities. They learned about chronic illnesses so they could advocate for themselves, as well as convey the perspective of their communities’ values and priorities more effectively to health professionals. They also partnered on projects with geriatrics researchers at UR. Silvia Sörensen, PhD, a gerontologist and associate professor of human development at the Warner School, was project lead.

Annie Medina-Walpole, MD, and Charles White.
Annie Medina-Walpole, MD, and Charles White

Charles White was diagnosed with multiple sclerosis in 2016 and earned ENGOAL certification in 2019. The road to that day was a long struggle made worse by racial bias in the health care system.

Before his diagnosis, White spent years confused and in pain, trying to find help. With no insurance, he’d seek relief in hospital emergency departments, where he was often assumed to be under the influence of drugs or alcohol and left alone. Even after his diagnosis, he didn’t understand how to manage his condition, and he had no idea how to navigate the health care system to find out.

White shares his story today with third-year medical students to drive home lessons in bias toward people of color in medical care. And he is a liaison between the Department of Neurology and community members—many of whom do not trust the medical establishment—to improve engagement, education, patient care, and wellness. For example, he is collaborating with researchers to present community workshops on ways to boost brain health through a nutritious diet—and how to overcome barriers to access to healthy food.

This kind of paradigm shift is possible in an age-friendly university, says Medina-Walpole.

“We need to encourage older adults to participate in education and research, and promote personal and career development in the second half of life. The possibilities here are truly endless,” she says.

Ryan Gilmartin, MHA, program administrator for URAI, the Division of Geriatrics & Aging, and UR Medicine Geriatrics Group, and a member of the URAI executive committee, says the work comes from a place of genuine intention.

“I couldn’t be more proud to work where I work,” says Gilmartin. “Our institution wants to be the best it can be, not only for UR but really for the Rochester community, which gives me a great deal of pride, being a community member myself,” he says. “As the health system has evolved and expanded farther out, it’s really cool that this mission I see and feel in here every day is brought into every community we work in.”

Many of URAI’s leaders are baby boomers who “decided a long time ago they were not going to age like their parents aged. They were going to transform things,” Podgorski adds. “We all have this idea of how we want to age. That’s the exciting thing. Aging doesn’t just mean illness. There’s so much life and creativity in later years. We just have to help people tap into it.”