UMN Medical School Aims to Address an Aging Population

Yesterday was the 100th Anniversary of Armistice Day. So often in medicine, great progress comes from the great tragedies like World War I: improvement of trauma surgery, common use of blood transfusions as therapy, chemotherapy born of the terrible poisonous gases used in the trenches. With World War II came the widespread use of antibiotics, and the survivors of that conflict, “The Greatest Generation,” would find life prolonged by medications to treat high blood pressure and cholesterol, diet to improve cardiovascular health and diabetes, lifesaving open-heart surgery, joint replacement, and a host of other new technologies.

We find that, with the success of medical research and clinical progress, we are faced with a juggernaut of our own making, one that touches every field of medicine, and the one medical condition we all share—aging. According to the US Census Bureau, the average life expectancy at the time of World War I was 47 years. By 1950, it was 68 years and by 1991, it had risen to 76 years. Between now and 2050, the number of “elderly” (defined as 65 and older) will double to roughly 20 percent of the U.S. population.

In the Medical School and in the Office of Academic Clinical Affairs, we are focusing on three aspects of improving the process of aging:

• What are the physical processes of aging?
• How do we medically and ethically treat an aging population?
• Can we reverse some of the damage that we have until now, assumed was irreversible?

We are building a comprehensive infrastructure to focus on and coordinate the work, including the Biology of Aging Medical Discovery Team (MDT), the Institute on the Biology of Aging and Metabolism (iBAM), and an Aging Task Force. A key part of our joint clinical enterprise comes from the vision of Dr. Jim Pacala, Head of Department of Family Medicine and Community Health; Dr. Peter Igarashi, Head of Department of Medicine; and Fairview Health Services to create a comprehensive program of academic clinical geriatrics that can be implemented through our family medicine clinics that are on the front lines of providing these services. Already, our programs for Excellence in Geriatric Scholarship, geriatric psychiatry, geriatric orthopaedics, and clinical residency are in place.

Universal to us all and yet highly individual, aging is the new conundrum. To quote a friend, “everyone wants a place, a part, or a pill” to help improve their quality of life into these years. Recent work on senescence, the normal cellular response to stress, has shown that as our immune systems age and decline, senescent cells accumulate and drive inflammation. The new directors of iBAM, Drs. Niedernhofer and Robbins have been asking the research question of how to help the aging body clear senescent cells. Their work in senolytics, published in Nature Medicine and elsewhere, has the potential for translation into clinical application, and ultimately, for extending the human health span.

On Veteran’s Day today, when we honor the commitment and sacrifice of so many, and thank those who have served in the past and serve in the present, it is fitting to think about how to improve the quality of life they have preserved for all of us.