university of rochester aging institute
TRANSCRIPT
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The Matthew E. Fairbank Lecture
University of Rochester Aging InstitutePromoting Vitality in Aging through
Discovery, Collaboration, & Innovation
Yeates Conwell, MDVera Gorbunova, PhD
F. Vankee Lin, PhD, RNAnnette Medina-Walpole MD
June 10, 2021
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UR_Aging
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T. Franklin WilliamsCarter Catlett Williams
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COMMUNITY
UNIVERSITY OF ROCHESTER
University of Rochester Aging Institute (URAI)
Promoting Vitality in Aging through Collaboration, Discovery and Innovation
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“Knowing is not enough;
we must apply.
Willing is not enough;
we must do.”
Johann Wolfgang
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COMMUNITY
UNIVERSITY OF ROCHESTER
Office for Aging Research & Health Services (OARHS)https://www.urmc.rochester.edu/aging-research-health-services.aspx
Rochester Aging Research Center (RoAR)https://www.urmc.rochester.edu/roar-center.aspx
UR Aging InstitutePromoting Vitality in Aging through
Collaboration, Discovery and Innovation
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VisionWith vitality and resilience,
aging adults have the power to thrive
MissionPromote vitality in aging by transforming care
and communities through collaboration, discovery and innovation
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COMMUNITY
UNIVERSITY OF ROCHESTER
UR Aging InstituteVital Discovery Vital Care
Vital Living
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Monroe County Office of the Aging
COMMUNITY
UNIVERSITY OF ROCHESTER
Older Adults & Families
School of Medicine
School of Nursing
UR Medicine
InvestigatorsClinicians
UR Aging Institute
River CampusArts & Sciences Data Science
Engineering
Education
Business
Music
Accountable Health Partners
UR Medical Faculty Group
Educators
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Aging with Vitality
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Why Rochester? Why Now?We (UR & URMC) have broad strengths across the
spectrum of aging research, education and clinical geriatrics on which to draw
URAI can impact strategic planning for other URMC Priorities (National Cancer Institute Designation for Wilmot Cancer Institute)
The Rochester region is aging rapidly and is of a size & configuration to serve as a laboratory for aging well
COVID-19 pandemic issues unveiled & lessons learned
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Monroe County Aging Stats17% of population is age 65+Average life expectancy at birth: 78.2 years
https://rochealthdata.org/2021/05/24/may-is-older-americans-month-poverty-in-later-life/
https://media.cmsmax.com/ravk3pgz5ktlujs1r08ci/134-3-cgh-monroe20countyhealthprofile-81317-r9-20170913051412.pdf
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URMC is also Aging…HH and SMH 2020 Encounters
Visit Type Total Encounters
EncountersAge ≥ 65 years
Number
Encounters Age ≥ 65 years
Percent
Highland HospitalInpatient 20,179 7,489 37%Outpatient 167,717 49,978 29%
Strong Memorial HospitalInpatient 41,057 13,179 32%Outpatient 930,180 282,405 30%
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Birth Death
Aging Across the Lifespan
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Birth Death
How and why do we age?• What factors determine longevity, life span, health span?• What interventions optimize health, well-being & vitality?
Population Health Promotion & Management
Can we control aging to slow down the process? Ultimate Preventive Medicine
VITAL DISCOVERYResearch
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https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/age#heading-Zero
Cancer and Aging
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AGING
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Emotional Wellbeing and Aging: Implications for Addressing
Neuropsychiatric Symptoms in Old Age
F. Vankee Lin, PhD, RN
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Neuropsychiatric Symptoms (NPS) in Old Age
Jang, et al. Journal of Alzheimer’s Disease 2020
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Emotional Wellbeing (EWB): Changes with Age
Steptoe, et al. Lancet 2015
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Examples of Appraisal and Adaptation Strategies: Reactivity
Behavior Physiology Brain Circuit
• Affective arousal ↓• Positive valence ↑• Gaze or attention to
negative stimuli ↓
• ANS reactivity to negative stimuli ↓
• Salience network to positive stimuli ↑
• DMN to negative stimuli ↓
• DMN to positive stimuli ↑
• Amygdala to positive stimuli ↑
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Emotional Wellbeing (EWB) and Aging
Red: Positive appraisal & adaptationBlue: Negative appraisal & adaptation
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Study of Emotional Wellbeing (EWB) and Aging Using a Cross-Species Model
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The Fountain of Youth (1546) Lucas Cranach
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Mammals Differ up to 100-Fold in their Lifespan
32 years
3 years
211 years
2 years
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Naked Mole RatVertebrate of the Year 2013 (Science magazine)
Prince Hitachi Prize in Comparative Oncology
• Lifespan 35 years
• Resistant to Cancer
• Resistant to Osteoarthritis
• Resistant to ischemia reperfusion
• Do not develop neurodegeneration
Tian et al. 2013, Nature
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Hyaluronan Produced by Naked Mole Rat Cells
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- HA =
CancerResistantLong-lived
CancerProne
Short-lived
=+ HA ?
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nmrHAS2 vs Control Mice(25 months old)
• Shinier fuller fur• Less grey hair
• Improved skin wound healing
• Generally younger appearance
nmrHAS2
nmrHAS2
Control
Control
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nmrHAS2 vs Control Mice(2 years old)
nmrHAS2
Control
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Cancer resistanceLongevity
+ HA = ?
HMW-HA
HAase inhibitors
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Aging
DNA Repair
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Tian et al, Cell 2019
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Bowhead Whale, the Largest and the Longest-Lived Mammal
• Maximum lifespan 211 years, Body mass up to 200,000 lbs
• Unique mechanisms to maintain stable genome and epigenome
• Discovered two proteins enhanced in whale for accurate DNA repair
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Human Centenarian SIRT6 Allele
100
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CentenariansExtreme health in old age
Sarah Knauss at age 100Lived to 119
Alex Imich at age 111
• Live independently• Remain active• Free from dementia, cardiovascular disease, diabetes
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Chromatin Organization Unravels during Aging
Young Cell Old Cell
SIRT6, Yamanaka FactorsEpigenetic Rejuvenation
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From Comparative Biology to the Clinic
Seluanov, Gladyshev, Vijg, Gorbunova, Nature Reviews Cancer, 2018
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115
70
46
9224
Sarah Knauss and her Family (Five Generations)
0
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OVERALL GOAL:• To define the mechanisms by which brain aging influences EWB
and how EWB may impact risk for and progression of ADRD
OBJECTIVES:• Form a national collaborative of researchers to: coalesce best research practice resources for brain aging
and EWB research; form workgroups to establish priorities for the field conduct pilot studies to address them.
COLLABORATORS• Stanford University UC Santa Cruz• Johns Hopkins University Duke University
NETWORK FOR EMOTIONAL WELLBEING AND BRAIN AGING
“NEW Brain Aging” (U24 AG0782701)
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Needn’t end at 65… or 75
…or 85!
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VITAL DISCOVERYResearch Opportunities Research Centers & Grants
• Roybal Center for Social Ties & Aging• Epigenetic Aging and Rejuvenation• NEW Brain Aging Center• Future Opportunities
• Nathan Shock Center of Excellence• Claude D. Pepper Older Americans Independence Center
Collaboration• Wilmot Cancer Institute National Cancer Institute Designation• Delmonte Neuroscience Institute, Neurorestoration Institute,
Musculoskeletal Research Center• URMC Health Lab – Aging Research Core• Empire Discovery Institute
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VITAL CAREPatient Care & Education
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VITAL CAREPatient Care & Education
Access to high quality geriatrics care across region
Preferred provider of older adult care
Lead nation in geriatric workforce development • $3.5 million Geriatric Workforce Enhancement Program grant
Age-Friendly Health System
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An Age-Friendly Health System…
• Provide older adults with the best care possible
• Follow an essential set of evidence-based practices
• Cause no harm
• Align with ‘What Matters’ to the older adult & family / caregivers
• Optimize value for allReproduced with permission from the Institute for Healthcare Improvementhttp://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-ystems/Pages/default.aspx
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The Age-Friendly Health System4 Ms Framework
Reproduced with permission from the Institute for Healthcare Improvementhttp://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-ystems/Pages/default.aspx
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VITAL LIVINGCommunity Outreach
Lifestyle interventions that promote vitality in aging
New community partnerships that optimize quality of life, engagement and health
Make Rochester the ideal place to age well
Age-Friendly University & Community
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UR Aging Institute – The Future National and international renown as leader in aging
Interventions that promote Health Span and Rejuvenation
Growth and sustainability with funding & philanthropy
Greater market share for UR Medicine as our region’s destination of choice for older adult care and a geriatrics-trained healthcare workforce
Success in managing an aging population and its impact on individuals, families & society
New community & UR/URMC collaborations and partnerships that optimize quality of life, engagement and health
An Age-Friendly Health System, University & Community
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A Geriatrics Wish…
• Na ta ekatostisis (May you live to be 100). (Greek)
• May you live to be 100 years, with one extra year to repent. (Irish)
• May you live to be 100 and may the last voice you hear be mine. (Frank Sinatra)
• Sto lat, sto lat, niech zyje zyje nam (Good luck, good cheer, may
you live a hundred years). (Polish)
May you Age with Vitality…and if needed, may your care be from a UR Geriatrics Trained
Health Professional in an Age-Friendly Health System!
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URAI Website
https://www.urmc.rochester.edu/university-of-rochester-aging-institute.aspx