Advancing the Science

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February 6, 2020

Improving the quality of life for the aging population in Rochester and beyond

By Advancing the Science contributor
an elderly or senior man and woman driving in a car with a couple of friends in the back seat, laughing and smiling

By Adolfo Espitia Jr., public affairs intern

Diagnosed with pulmonary hypertension some years ago, Elizabeth, now 65, was left with a debilitating condition that prevented her from even light activities. She had to rely on her husband to take care of their home. Finally, the medications she had taken for 10 years stopped working, forcing her to undergo a heart-double lung transplant in late 2013.

Post-transplant was a rough experience, as Elizabeth described it. After being hospitalized numerous times it eventually left her so weak she had to use a wheelchair. Elizabeth started cardio-pulmonary rehabilitation for 16 weeks to regain her walking ability. Now a widow, she no longer lives in her house.

Her Mayo Clinic physician suggested continuing exercise after her rehabilitation finished, referring her to the senior center in Rochester, Minnesota (125 Live, now rebranded as a center for active adults of all ages). With her untiring determination, Elizabeth was finally able to stand with the support of a cane.

In ideal situations, it’s geriatricians that serve aging adults like Elizabeth. These medical specialists focus on the needs and conditions that face aging patients.

Geriatrics – an expanding need with few providers

By 2050, 20% of the U.S. population will be considered “elderly.” With a rising aging population, the demand for geriatricians is increasing. The American Geriatrics Society predicts a 45% increase in demand for geriatricians from 2013-2025.

However, as of 2017, there were only 7,000 certified geriatricians in the U.S. In Minnesota, there were only a total of 144.

Geriatricians are trained in age-related illnesses like osteoporosis, heart disease and neurological disorders like Alzheimer’s and dementia, in contrast to general or family practitioners whose training is much broader.

To bolster the capabilities of existing geriatricians, the Mayo Clinic Robert and Arlene Kogod Center on Aging conducts innovative research focused on improving the quality of life for seniors. Groundbreaking research marks new hope to alleviate age-related diseases. Meanwhile, community centers like 125 Live provide resources and encourage activity for more fulfillment in life’s final phase.

Lilia Ponton, M.D., a geriatrician at Olmsted Medical Center, just down the road from Mayo Clinic, is among those 144 Minnesota geriatricians. Her concerns involve all the unique challenges on treating elderly patients. For example, older adults experiencing delirium can lose independence, forcing them to rely on a caregiver. It could become dangerous for the patient, or the caregiver, if the caregiver isn’t aware of the older adult’s medical history.

Other illnesses and health conditions also pose unique health and safety risks for older adults, the most common being falls.  The U.S. Centers for Disease Control and Prevention says that falls are the leading cause of fatal injury among older adults. Non-fatal falls cost more than $50 billion dollars each year, and those costs continue to rise.

Dr. Ponton says that improving quality of life for older people could decrease falls and hospitalizations, potentially improving health care costs.

However, there still is a concerning shortage of geriatric care providers across the nation, she says.

Mayo Clinic hopes to change that, and is launching a plan to inspire a new generation of geriatricians and gerontology researchers.

A new geroscience training program to spark interest in elder care

Robert Pignolo, M.D., Ph.D., is a geriatrician at Mayo Clinic. He agrees that languishing class sizes in geriatric medicine could potentially cause a real problem. That’s why the Mayo Clinic Kogod Center on Aging, in collaboration with the Mayo Clinic Center for Clinical and Translational Science launched a new geroscience training program in mid-2019. (Read more.)

The program focuses on the areas of expertise needed to conduct clinical trials: standard clinical research, geriatric medicine, geriatric clinical research and geroscience. Research in this area could ultimately benefit individuals by finding ways to slow or reverse the cellular causes of aging as opposed to treating specific age-related diseases.

Currently Mayo Clinic’s geroscience program is advancing current research on cellular senescence. Senescent cells are believed to be the cause of aging-related illnesses like Alzheimer’s and osteoporosis. By removing these senescent cells, the quality of life may be improved for older adults.

Dr. Pignolo says by 2050, 20% of the U.S. population will be considered elderly, urgently calling for renewed interest in geroscience.

“Outside of geriatrics it will get people interested, whatever their field is to look at aging in older patients in a different way,” Dr. Pignolo says. “Just because someone is very old it doesn’t mean they’re automatically excluded from possibly getting better.”

Even though the program is still in its infancy, Dr. Pignolo is optimistic and hopes that new opportunities within the program will attract geriatricians and non-geriatricians alike.

Healthy aging, from within

Mayo Clinic makes scientific breakthroughs with cellular senescence

As humans age, there is a greater likelihood of being diagnosed with an age-related illness. James Kirkland, M.D., Ph.D., director of the Mayo Clinic Kogod Center on Aging found that senescent cells prevent the creation of new cells, causing a build-up of old, damaged cells.

“The fundamental aging process is the root cause and contributor of diseases and disabilities that accumulate with aging,” he says.

Based on Mayo Clinic research from 2015 and 2016 studying mice with osteoporosis, Mayo Clinic partnered with the Wake Forest School of Medicine, Winston-Salem, North Carolina, and the University of Texas Health Sciences Center at San Antonio, to conduct the first human clinical trial, publishing their findings in early 2019.

The study treated patients with pulmonary fibrosis and sought to determine whether senolytic drugs — agents that remove senescent cells — could delay fundamental aging processes.

Dr. Kirkland says the study concluded that the drugs alleviated some physical dysfunction and improved other physical performances. After additional research, Dr. Kirkland hopes to perform a larger clinical trial with patients who have several chronic conditions.

For Dr. Kirkland, the goal of the research is not to extend the lifespan, but to improve one’s health span.

“We want to improve health later in life, we don’t want to prescribe better wheelchairs or walkers,” Dr. Kirkland says. “It would be ideal if we had people who were 80 or 90 feel like they were 40.”

One example he cites is cardiovascular disease. Although fewer individuals are dying from heart attacks, survivors may not completely recover. This, Dr. Kirkland says, is where senolytic drugs could improve physical recovery and could also give back a sense of dignity for older adults who otherwise couldn’t perform daily tasks like standing or getting dressed.

Meanwhile, on a community level, older adults are beginning to take their quality of life into their own hands. They beg for terms like “senior” and “senile” to be tossed.

The aging population no longer accepts the traditional aging lifestyle.

Which brings us back to Elizabeth, one of those aging community members.

Beyond graduating from a wheelchair to standing with a cane, Elizabeth’s devotion to exercise and improving strength paid off. She was finally able to stand, exercise and swim independently. Her physicians praise her for her devotion to physical activity.

Community centers like 125 Live have given older adults like Elizabeth a second chance.

At 125 Live, the mission is to place activity back in control of the older adult. Sylwia Bujak-Oliver, 125 Live’s executive director, emphasizes that age should not determine one’s capabilities.

“People are generally going away from the word ‘senior’ because there’s a conception that the individual is senile, or needs help,” Bujak says. “You are an independent individual and you have your own free will. We will modify and adjust to your abilities, but we will not be telling you that you can’t do something.”

Older adults visit 125 Live for other resources in addition to physical activity. Part of aging is the loss of friends and family and declining health. To lessen isolation, Bujak-Oliver says 125 Live offers support groups on topics ranging from grief to neurogenerative disorders.

One of these groups helped Dan, 71, who sought companionship and social interaction after his wife passed away in 2012.

Bujak says members regularly approach her to relay how 125 Live has improved their health and quality of life.

Lucinda, 78, is another example how activity could benefit older adults.

After being diagnosed in late 2018 with ovarian cancer, Lucinda’s prognosis was “not good.” Because of her age, many surgeons would have hesitated, unsure if she would be able to tolerate abdominal surgery. However, because of Lucinda’s diligence in staying active, her doctors felt safe to operate. The surgery was successful and now Lucinda continues physical activity.

“I believe joining this center and participating in activities they have here is what really got me through it (ovarian cancer),” Lucinda says. “They (doctors) keep telling me it really is a miracle that I am as strong as I am and able to do what I do with that terrible phrase, ‘at your age.’

“I’m proud of my age,” she says.

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Tags: About, aging, Center for Clinical and Translational Science, geriatrics, Kogod Center on Aging, population health, Robert Pignolo

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