The UPMC Aging Institute: Keeping Up With a Growing Population
by Imaz Athar
Fever. Cough. Runny nose. In the early 1900s, these symptoms were considered a death sentence. As the United States underwent industrial growth during this time period, lack of sanitation and overcrowding allowed communicable diseases such as the flu and pneumonia to infect and kill thousands each year. Fortunately, the nation’s population has become significantly healthier since the 1910s. Due to the introduction of vaccines and improved living conditions, a fever, cough and runny nose are now a small part of life, rather than an abrupt end.
To be precise, advancements in healthcare have contributed to a 54 percent decline in deaths since 1900. In addition, they have allowed individuals to live longer lives. In the early 1900s, the 65+ age group, known as the aging population, was almost nonexistent. Today, this cohort constitutes 13.1 percent of our total population. Looking to 2030, the aging population is expected to double in size to 71.5 million, making it the fastest growing age group in the United States.
The growth of the aging population has had quite unforeseen consequences. In the past, our healthcare system focused on providing treatment for acute illnesses – ailments such as the cold or flu, which were prevalent throughout the early and mid 1900s. On the other hand, today’s elderly face a number of chronic health problems, such as heart disease and arthritis. The rise of such illnesses has sparked a debate over healthcare delivery, as many believe that a system encouraging treatment for acute conditions is outdated. Many advocate for a shift to a holistic, patient-centered approach. The rapid growth of the elderly further complicates the issue of healthcare delivery and raises an important question: do we even have the resources available to provide care to a rapidly growing population that was much smaller in size only 50 years ago?
It seems that hospitals in the United States have asked themselves this very question and are striving to find answers. About ten years ago, the University of Pittsburgh Medical Center (UPMC) Senior Services found their answer when they established the Aging Institute. Dr. Charles Reynolds, a geriatric psychiatrist, has been the Director of the Aging Institute for the past five years. He describes their mission as a “three-legged stool”: in order to improve clinical services for the elderly, the Aging Institute 1) develops and tests new models of care delivery, 2) educates the clinical workforce to better care for older adults and 3) conducts research relevant to the older population.
Reynolds realizes that the proportion of older adults is getting larger and that people are living longer. With a prolonged lifespan, many older adults face long-lasting medical conditions, such as hypertension, diabetes and chronic lung disease. Cancer and neurodegenerative diseases are also becoming more common with aging. According to Reynolds, older patients may even be receiving treatment for up to six medical issues at a time. Living with a number of persisting illnesses can be difficult and taxing both physically and mentally. The Aging Institute strives to ease these burdens by providing patients with information on ways to prevent illness and maintain optimal health.
“The major challenge comes to how to age in a healthy way,” Reynolds said. “Things like physical activity, social connectivity, not smoking, moderate use of alcohol, appropriate immunizations, screenings and checks for cancer are all part of important primary care and important lifestyle choices at this point that enable people to maximize what we think of as health span.”
Besides illness, aging patients may have other issues that need to be addressed, including access to legal, financial and community services. Reynolds calls the Aging Institute “one-stop shopping,” as the Institute’s help-line aids patients in accessing a variety of these services. The help-line receives over a hundred callers each month and, according to Reynolds, it “helps callers navigate through what in reality is a very complicated system of benefits to get to the resources that they need.”
In addition to providing patients with the resources to live a healthy life as they age, the Aging Institute also endeavors to impart healthcare professionals with the knowledge required to effectively treat older adults. Currently, most healthcare professions have relatively small portions of their members that are focused specifically on the geriatric population. Reynolds believes that it is necessary to concentrate on the older population, as the issues they deal with are much different from those of other age groups.
“We can’t necessarily generalize the science from what we know about caring for young adults or mid life adults to caring for older adults because of the complexity involved with caring for older adults,” Reynolds said.
Proper training of healthcare professionals is especially important, as there is currently a shift from aggressive care to palliative and supportive care. According to Reynolds, part of the conversation with patients is “to get an understanding of what they think are the goals of care.” In line with this thinking, Reynolds believes that it is important for clinicians to understand the values of the patient and their family and what types of medical care are acceptable depending on the patient’s expectations. The Aging Institute has developed a certificate program for nurses and nurse aides to instill these very principles. Both the nurse aid and nursing tracks of the program emphasize the critical thinking and problem solving skills necessary to handle geriatric health concerns. The Aging Institute also provides seminars and educational programs for nurses and other healthcare professionals that address social and ethical issues unique to elderly patients, such as ageism and social support.
In addition to educating healthcare professionals, the Aging Institute equips home caregivers with resources to care for their aging family members. According to Reynolds, assisting home caregivers is vital because, often times, geriatric patients who “can’t or won’t come into clinic are some of the neediest people in the aging spectrum.” In many ways, the Aging Institute reduces the stress of what can be an exhausting role by connecting caregivers with nursing services as well as aging agencies that provide home assessments for safety. As the role of the caregiver evolves with the changing health of their family member, the Aging Institute may also connect caregivers with respite care services, as well as supportive mental and medical services.
Beyond providing resources for patients, caregivers and healthcare professionals, the Aging Institute sponsors research that focuses on ways to improve the trajectories of aging over a long period of time. The investigational studies involve collaborations across the entire Pitt campus, including the School of Medicine, the School of Education, the Psychology Department and more.
“Part of what we try to do in the Aging Institute is to fertilize conversation across these centers of excellence,” Reynolds said. “And we’re having good success in doing that.”
Dr. Judy Cameron, Professor of Psychiatry, has conducted research that has focused on the relationship between physical activity and brain health. According to Reynolds, Cameron’s study has taught us that physical activity may be protective against neurodegeneration, particularly the kind we see in Parkinson’s disease. More recently, Dr. John Jakicic of the School of Education is leading a study to determine whether or not three ten-minute bouts of physical activity a day has as much of a benefit for brain health as more sustained bouts of activity. These types of research studies provide significant and much-needed insight into improving geriatric patients’ health. Reynolds also believes they serve to persuade older adults to participate in practices that prevent chronic illnesses. “An important question is how do we persuade older adults to engage in physical activity to the benefit of their heart and the benefit of their brain,” Reynolds said. “We think that social reinforcement is a very important part of the stimulus to engage in physical activity.”
Each year, the Aging Institute hosts a Research Day that showcases aging research conducted by clinicians and researchers throughout the University of Pittsburgh and UPMC systems. This year, researchers and clinicians from various backgrounds, such as the Department of Chemistry, Epidemiology, Cardiology, Social Work and the Palliative and Supportive Institute presented their findings. Studies on the physical activity in arthritis patients and the longitudinal relationship between sensorimotor peripheral nerve functioning and endurance walking were among the award winners.
The Aging Institute does a commendable job of aiding patients and healthcare professionals in Pittsburgh as the increased lifespan gives rise to new obstacles. As the aging population continues to grow, Reynolds believes the success of the Aging Institute can inform the rest of the nation on how to meet these challenges.
“If we can get it right in Pittsburgh then what we learn here has broad public health and clinical relevance for the rest of the nation,” Reynolds said.