• $2.4 million from the National Institute on Aging will support work by Bradford Hill to investigate how aging leads to reduced blood flow to the heart in older individuals. Hill will study these changes and how this dysfunction could be prevented or corrected. The work may lead to opportunities to prevent age-dependent decline in exercise capacity and promote healthy aging.
• $3.4 million from the National Heart Blood and Lung Institute was awarded for a clinical trial to test whether treatment with the nutritional supplement carnosine improves symptoms and progression in peripheral artery disease in which narrowing of arteries reduces blood flow to arms or legs. Aruni Bhatnagar, Shahid Baba and Amit Dwivedi will conduct the trial.
• $4.67 million from the National Institute of Environmental Health Sciences will support the Green Heart Louisville Project, which studies how an increase in the number of trees and shrubs affects heart health. The team, led by Bhatnagar, recently reported results from their work that began in 2018 in South Louisville. The new award will allow the team to continue to gather data on community health for the next five years as the planted trees continue to grow.
• $ 0.8 million from the Department of Defense was awarded to Daniel Conklin for a two-year project to investigate the role of inhaled agents in Gulf War Illness (GWI), a chronic condition affecting 25-32% of Gulf War veterans. GWI involves chronic pain, muscle fatigue, cognitive impairment, migraines and stroke. Conklin will investigate whether inhalation of volatile organic compounds and particulate matter from burning oil wells, burn pits, contaminated sand and chemical and biological weapons may have led to repeated local and systemic inflammation, causing the condition.

This most recent funding adds to the $11.6 in grants awarded to institute researchers announced earlier this year.

“Aging is not inevitable; it is an opportunity. Not everyone has the chance to grow old,” said Robert Friedland, professor of neurology at the University of Louisville and an expert on aging. “How well we age depends on what we do.”

Inspired by his grandfather’s struggle with dementia, Friedland has spent nearly five decades as a neurologist and researcher, studying the causes of neurological diseases and seeking new ways to treat and prevent them. In addition to seeing patients with a focus on cognitive, behavioral and geriatric neurology, his ongoing research investigates the connection between microbes in the gut and mouth and the development of Alzheimer’s and Parkinson’s disease and other neurodegenerative conditions.

Based on this work, Friedland says it is possible for people to preserve health into later years by stockpiling reserves in cognitive, physical, psychological and social health.

Although Friedland admits that certain physical declines are inevitable with age and that genetics can predispose a person to certain diseases, he believes in many cases these reserves can prevent diseases or lessen their effects, delay age-related declines and allow an older person to recover from accidents and illness.

“Genetics do have a role in our health but they are not the whole story. Choices we make throughout life affect whether diseases develop and how much they reduce our health when they do,” Friedland said. “We can do things that delay or mitigate heart disease, diabetes and cognitive and neurological diseases and allow us to recover from life events that otherwise may cause permanent declines in health.”

Each of Friedland’s four factors, described below, is dependent on the others. Friedland provides tips on increasing reserves of each area. By developing habits that add to these reserves, you can maximize your opportunity to remain active and healthy as you get older.

Cognitive reserve – The ability of the brain to work effectively, solve problems and make decisions.

Since the brain controls every system in the body, it makes sense that a healthy brain will support other reserve factors (physical, psychological, social).

Keep the brain healthy by seeking opportunities to learn new things and challenge your ways of thinking throughout life. Learn a new language or a new skill, such as playing a musical instrument or crochet. Play chess or other games. Any activity that involves learning and strategy will strengthen your brain.

“Watching television is not a good activity since it is completely passive and does not require participation. Reading is a better choice as it demands involvement,” Friedland said. “Telling stories is good for your memory and attention skills.”

Physical reserve��– The health of the body’s cardiovascular, neurological, musculoskeletal and other systems.

These reserves depend on eating the right food, engaging in physical activity every day and receiving regular health care.

A diverse diet of healthy foods supports both your body and your microbiota, the microorganisms that live in and on the body and are essential to your overall health. Friedland recommends a diet that is mostly plants, high in fiber and low in sugar, salt and saturated fat. When you improve your diet, you also can improve the health of your microbes which aids your own health.

“I call it gene therapy in the kitchen,” Friedland said. “By making the best choices in your food, you can alter the genetic makeup of your microbiota and improve your overall health in as little as two weeks.”

Exercising for 30 minutes each day, regardless of weather or circumstance, is enough to improve physical health, Friedland says. More is better, of course, and when you combine physical activity with social interactions and cognitive activity by playing a sport such as golf or tennis, the benefits multiply.

Taking steps to protect yourself from injury or illness also is important. Wear a helmet when you are riding a bike, wash your hands and avoid exposure to toxins.

It also is important to get enough quality sleep each night, practice good dental hygiene, avoid excess alcohol and have regular medical checkups.

Polypharmacy is another problem to avoid. Friedland said that as people age, they may accumulate prescriptions for multiple health concerns that can interact or alter the effectiveness of each other. If you are taking several prescriptions, regularly evaluate all of them with your health care provider.

Psychological reserve��– A healthy mental state that is free of agitation, anxiety and depression.

Poor mental health can affect your ability to interact with others or maintain your physical health. Practice a positive mental attitude, engage in activities that are meaningful to you and manage stress with meditation or other measures.

“Depression is common in older people, and that can lead to memory problems,” Friedland said. “Physical factors can contribute to depression, such as poor sleep or vitamin deficiency. A lack of social interactions and physical activity also can cause or aggravate depression.”

Social reserve��– Personal relationships and the ability to function in society.

The company of others can motivate people to take care of themselves and encourage them to maintain healthful behaviors. Positive relationships can be with a spouse, a group of friends or professional colleagues.

“Studies indicate that dementia is more common among people whose social activity declines later in life,” Friedland said. “Humans need relationships with others in order to maintain good health.”����

Social engagement can go hand in hand with the other types of activity by including friends in physical exercise, games, a craft or work. Involvement in community or religious activities also can increase a sense of belonging and a desire to stay active.

Ideally, you will begin developing habits that contribute to these reserves early in life, but Friedland says it is possible to add to reserves and improve your health at any age – even once you reach an age when you experience the effects of deficits.

“Aging is not inevitable,” Friedland said. “The chance to be alive should be recognized as an opportunity – an opportunity to manage our lifestyle factors to maximize survival, health, fitness and meaning as we age.”

More detailed advice from Friedland that may help people live longer, healthier lives and a deeper discussion of the reasons he makes these recommendations are available in his book, “.” Published in October by Cambridge University Press, the book was cited by the Wall Street Journal as one of the five best books on aging and retirement published in 2022.

HAPF is a year-long program designed to prepare leaders who will work to improve health and aging policy relative to health care for older adults. Applicants to the program must demonstrate a commitment to the health and aging issues of older Americans, as well as the potential to be health policy leaders.��

According to Trager Institute Executive Director Anna Faul, the fellowship will allow Furman to introduce the institute and its mission to people who have the power to change the field of geriatrics, not only to address the needs of older adults but to redefine the aging experience.

UofL News asked Furman about what drew her to the fellowship and what she expects to gain and learn during her year in D.C.

UofL News: How did you hear about this fellowship and what interested you about applying for it?

Christian D. Furman: I first heard about the Health and Aging Policy Fellowship when I was an innovation advisor for the Center for Medicare and Medicaid Innovation (CMMI) about ten years ago. While I was a CMMI innovation advisor, they encouraged us to apply for the fellowship. As I teach geriatrics, I always discuss policy issues that need to be corrected. I thought now was the time to change these policies. Instead of just talking about it, now was the time to do something.��

ULN: What are your expectations going into the fellowship?

Furman: I expect to learn how state and federal policies are made. I expect to learn who makes these policies. I expect to make a network of professionals who I can work with in the future to advocate for policy changes to improve the lives of older adults.

ULN: What excites you the most about being part of this fellowship?��

Furman:��I chose the residential track and will be relocating to Washington during this one-year fellowship. I am excited to be in an environment where I will meet people daily who can change policies to improve the lives of older adults!

ULN: Do you have any specific goals you want to accomplish while in Washington?��

Furman: My goal during the fellowship is to change the Hospice Medicare Benefit to include room and board at the nursing home. When I was chief of hospice and palliative care at the VA, I would discharge dying patients to the nursing home with Hospice so they could have a peaceful death in a home-like setting. A few weeks later, they would arrive back at the VA emergency room (ER) actively dying. The ER is not the best environment to die.

The reason this occurred is when the patient arrived at the nursing home, the nursing home said that if the patient wanted to use their Hospice Medicare Benefit, they needed to pay room and board (about $250/day) or they could stay at the nursing home at no-charge and use their Skilled Medicare Benefit. Most patients choose free services, so they used their Skilled Medicare Benefit and not their Hospice Medicare Benefit. Therefore, when they start to actively die, there is no specialized care team that knows what to do (Hospice), so the patient is sent back to the ER. While these dying patients are receiving Skilled Medicare Services, they are forced to do physical therapy and walk up and down the halls when they are very weak and would rather stay in bed. I have seen this same scenario play out again and again over my past 22 years as a geriatrician. Now is the time for me to try to change this policy. This fellowship will give me the skills necessary to advocate for this change.��

ULN: You’ll continue your role as the medical director at the Trager Institute/Republic Bank Foundation Optimal Aging Clinic while you’re doing this fellowship. How do you plan to stay connected with the Trager Institute during your absence?��

Furman: I am very grateful for the support from Toni Ganzel, dean of the UofL School of Medicine and Anna Faul, executive director of Trager Institute, in allowing me to pursue this fellowship. I will retain the Smock Endowed Chair and be able teach advocacy and policy to our learners at Trager during the fellowship. I will join Trager meetings and conferences virtually and speak daily to our practice manager. The other geriatricians and our nurse practitioner will care for my patients during this time. I am extremely blessed that we have a wonderful team!

Interview by Samantha Adams.

“Being a model of optimal aging means continuing to evolve and flourish as we age to the best of our ability. It is a state of being and mind that one grows toward over a lifetime,” said Anna Faul, executive director of the Trager Institute. “It is choosing not to passively accept society’s ideas of what aging means but rather to find what matters most to you and pursuing it.”

Adults who achieve the age of 85 by Sept. 1 and who live according to the physical, social, creative and spiritual principles of optimal aging are eligible for the Gold Standard of Optimal Aging Award. Anyone may nominate an older adult at the until July 15. Sponsorship information for the award ceremony also is available at the site.

“This award is one of the cornerstone events of Optimal Aging Month, a time dedicated to promoting the view that aging is an opportunity, not a disease,” said Christian Davis Furman, medical director of the institute. “We are so excited to share with the community all of our older adults who are optimally aging.”

Honorees will receive their awards during a luncheon on Sept. 30 at the Kentucky Center for African American Heritage as part of UofL’s Optimal Aging Month. Each honoree and one guest may attend the event for free and may either join in person or virtually. Additional tickets at $40 per person may be purchased at the later this summer. The event benefits the and its efforts to empower older adults to flourish.

For more information, call 502-588-0433 or email tragerinstitute@louisville.edu.

This year’s conference, hosted by the and the Kentucky Association of Gerontology, follows the theme “Aging Inspired. Aging Reinvigorated,” and emphasizes an interdisciplinary approach to the aging experience that includes advances in medical research, lifestyle and culinary medicine, trauma-informed care and more.

“Participants in this year’s Optimal Aging Conference will have the opportunity to hear from esteemed experts in various fields, including octogenarians, speaking to the many opportunities we all have to age well,” said Anna Faul, executive director of the Trager Institute. “Although the pandemic has been challenging, those working in the field of aging and older adults themselves are inspired to continue to create opportunities for change, innovation and implementation of models of care that will reinvigorate the aging field.”

This multi-day event will feature two preconference speakers, five keynote speakers, more than 30 breakout and poster sessions and opportunities to network and earn continuing education credits.

2022 Optimal Aging Conference keynote addresses:

• Aging inspired. Aging reinvigorated: Panel honoring octogenarians; facilitated by Sandy Markwood, MUP, CEO, USAging.��Honorees: Mattie Jones, Marie Clay, Marie Vessels, State Representative Tom Burch, Father Jim Flynn
• Alzheimer’s update;��Gregory Jicha, MD, PhD, director, UK Sanders-Brown Center on Aging
• Culinary medicine: Hungry for change;��Robert Graham, MD, MPH, ABOIM, FACP, chef and co-founder, FRESH Medicine
• Aging as an opportunity;��Robert Friedland, MD, professor, UofL Department of Neurology
• Integrating lifestyle medicine into standard medical practice,��Dexter Shurney, MD, vice president. and chief medical officer of Adventist Health and Blue Zones Institute

In addition to the keynote presentations, experts in breakout and poster sessions will discuss such topics as creative interventions for social isolation, trauma-informed care, acupuncture as an evidence-based therapy for addressing stress and burnout, age-friendly cities and communities and coding for seniors.

Participants who attend the preconference on Sunday, April 24 may attend a full-day session from Anthony Watkins on assessing and managing suicide or a half-day session with Claude Drouet on addressing the complexities in social work ethics. Participants can also register for a free webinar by Teepa Snow, an occupational therapist who specializes in dementia care and dementia education, on April 24 from 4:30 to 6:30 p.m. The discussion will focus on how to cope when one is the sole caregiver.

“The Optimal Aging Conference has its origins more than four decades ago in the Kentucky Association for Gerontology Conference, an event for everyone who cared about issues related to aging in our communities including professionals from all disciplines as well as students, older adults and caregivers,” said Barbara Gordon, Trager Institute’s director of community engagement. “The Trager Institute continues that tradition with its conference this year making sure that a diverse and inclusive group of individuals are not only participating but also presenting at the conference.”��

Last year, the conference moved to a virtual platform in response to the COVID-19 pandemic and will again be held virtually this year. Register .

“It is so exciting that the Republic Bank Foundation Optimal Aging Clinic received the Age-Friendly recognition so shortly after celebrating our one-year anniversary,” said Anna Faul, executive director of the UofL Trager Institute and the Optimal Aging Clinic. “This recognition serves as a testament to . We strive to be on the forefront of patient care for older adults and we look forward to continuing to provide every older adult with the best care possible as part of the Age-Friendly Health Systems initiative.”

As part of the�� initiative,��The John A. Hartford Foundation and the��Institute��for Healthcare Improvement, in partnership with the American Hospital Association and the��Catholic��Health Association of the United States, are helping hospitals, clinics and other care settings��implement evidence-based interventions��specifically designed to improve care for older adults.��

The interventions are tested and adapted through participation in Age-Friendly Health��Systems Action Communities. These collaborative entities are comprised of health care teams from across the country that are committed to sharing data and learning together. The teams work��to��implement best��practices across emergency departments, intensive care units, medical-surgical��units, general wards and primary and specialty care settings.

The Optimal Aging Clinic now joins more than 450 health systems working to make care for older��adults even more��tailored to patients’ goals and preferences and consistently of high-quality as part of the initiative, which is based on a series of practices focused on addressing four��essential elements��of care for��older patients known as the 4Ms:

• What Matters: Know and align care with each older adult’s specific health outcome goals and care��preferences including, but not limited to, end-of-life care, and across settings of care.
• Medication: If medication is necessary, use age-friendly medications that do not interfere with What��Matters to the older adult, Mobility, or Mentation across settings of care.
• Mentation: Prevent, identify, treat and manage dementia, depression and delirium across settings��of care.
• Mobility: Ensure that older adults move safely every day in order to maintain function and do What��Matters.

Joe D’Ambrosio, director of behavioral health at the UofL Trager Institute and Republic Bank Foundation Optimal Aging Clinic, says the Age-Friendly initiative also is infused in the organization’s Behavioral Health Services Organization.

“We are so happy to include this initiative in the work we do with our therapy patients,” D’Ambrosio said. “The 4Ms of the initiative align perfectly with the behavioral health interventions we share with patients in their efforts to age optimally and we are excited to build upon the progress we have made in our first year to continue to help older adults thrive as they age.”

Learn more about the Republic Bank Optimal Aging Clinic in a .

“Our strong line-up of speakers, breakout sessions and poster sessions is not to be missed for anyone working in the aging field or who has interest in inspiring our understanding of aging,” said Anna Faul,�� executive director of the Trager Institute. “After having to cancel last year’s event, we are excited to bring back the Optimal Aging Conference this year on a virtual platform that allows for an incredibly rich and engaging experience.”

The 2021 conference, scheduled for April 18-20, will feature experts in aging, dementia and Alzheimer’s research, innovation and public health and will be held virtually.

“The 2021 Optimal Aging Conference will provide outstanding resources, inspiring ideas and continuing education for Kentucky’s aging service professionals,” said Anne Wildman of the Kentucky Association of Gerontology. “The conference is a great opportunity for networking and professional development.”

2021 Optimal Aging Conference topics and speakers:

Aging Inspired in Kentucky: Directions in Aging Policy (Panel Discussion)

• Sandy Markwood, CEO, National Association of Area Agencies on Aging
• Eric Friedlander, acting secretary, Kentucky Cabinet for Health & Family Services
• Lindsey Hix, deputy director, Office of Senior Protection & Mediation, Office of the Kentucky Attorney General
• Victoria Elridge, commissioner, Department for Aging and Independent Living

A Community Network Approach to Health

• Eric Feigl-Ding, chief health economist, MicroClinic International; faculty member, Harvard Medical School and Brigham and Women’s Hospital, Boston

Ending the Alzheimer’s Pandemic

• Dale Bredesen, professor, UCLA; founding president and professor emeritus, Buck Institute for Research on Aging; author of New York Times bestseller, The End of Alzheimer’s

AARP Keynote: Examining the 50-plus Experience During COVID-19

• David Wolf, professor and chair, Department of Health and Aging Services Leadership, Bellarmine University

Alzheimer’s Update

• Gregory Jicha, professor of neurology and director, Sanders-Brown Center on Aging at the University of Kentucky

Guided by the theme “Aging Inspired,” conference attendees also will hear from experts on how to prevent financial elder abuse, national programs and arts activism counteracting ageism, programs for caregivers of persons with Alzheimer’s disease and related dementias, the future impacts of artificial intelligence and robotics in senior care, trauma-informed care of older adults, international evidence-based falls programs, lifestyle medicine nutrition and more.

through April 16.��

“It would be impossible for us to fulfill our mission of innovating the aging experience without first ensuring the safety and health of our older adult patients and staff during the pandemic,” said Anna Faul, executive director of the Trager Institute. “This partnership with LoDI has been beneficial for us to understand what we need to do to return to normal capacity when the positivity rates are at a level that would be absolutely safe for our patients and staff.”

Through the collaboration, LoDI and Trager Institute leaders established capacity and utilization estimates to allow Trager staff to transition from telehealth and work-from-home policies to hybrid policies allowing a return to in-clinic visits for patients and location-based work for Trager students, faculty and staff.

LoDI, housed at the , is dedicated to developing innovative delivery processes for industries including manufacturing, service and health care. Students and faculty at LoDI recently worked with businesses in the oil and refinery field, a public utility and the .

For the project at the Trager Institute, a team led by Lihui Bai, co-director of LoDI, used a simulation model to determine a safe volume of traffic that allows proper social distancing at the Optimal Aging Clinic. In particular, the study team, which included Monica Gentili, Arsalan Paleshi and LoDI Fellow Shahab Sadri, simulated operations at the clinic to determine the maximum number of clinical staff, patients, faculty and students, as well as Trager faculty and staff, that safely could be present in the building.

The results of the study will serve as a guide for Trager Institute leadership in determining the percentage of clinic appointments that must be kept virtual and the number of learners and institute staff and faculty who safely could resume on-site activities. The clinic will implement the guidelines provided by the study once coronavirus infection rates in the community reach an acceptable level to resume in-person visits.

“Our study found that patient and staff movements at key common areas throughout the facility are within the safety measures of a COVID-19 environment,” Bai said. “We were happy to be a part of this collaboration by applying our simulation model to study the traffic patterns at the Optimal Aging Clinic. We look forward to extending this study to evaluate other operations measures such as utilization and possible improvements in a joint future research with the team at the Trager Institute.”

“We are grateful to the LoDI team for their expertise in helping us determine safe and efficient operating procedures at the clinic,” Faul said.

“We are thrilled to be able to honor this year’s Gold Standard of Optimal Aging cohort through such a special recognition,” said Anna Faul, executive director of the . “It is our tradition to invite the honorees to a luncheon to celebrate their inspirational and vital role in our community. Instead of an in-person event this year, we are celebrating with a creative social-distancing video tribute as well as a variety of other media recognitions. We are thrilled to have so many leaders recognize the incredible strength of our state’s older adults during this difficult year.”

The ninth celebration of UofL Trager Institute’s Gold Standard of Optimal Aging honors individuals age 85 or older who are outstanding models of optimal aging and exhibit inspirational involvement in various aspects of their lives, despite any challenges they may face.

Recipients of the Gold Standard of Optimal Aging are recognized each year in September, the Trager Institute’s Optimal Aging Month, as part of the institute’s effort to foster a more age-inclusive community.

“What makes this award so special is that it is a recognition of the active and ongoing contribution older adults make in our families and communities,” said Christian Davis Furman, medical director of the UofL Trager Institute. “This year, more than ever, we have been inspired by the example of the older adults in our lives as we navigate the current pandemic. The whole Trager Institute team is deeply humbled by their inspiring stories and grateful to be able to celebrate them, even from a distance.”

Furman was one of the original creators of the Gold Standard of Optimal Aging in 2011.

The 2020 Gold Standard of Optimal Aging honorees:

This year’s honorees include writers, avid bowlers, musicians, artists, immigrants, activists and educators. Many are active participants in the . These individuals volunteer all across the Louisville community in hospitals, homeless shelters, meals on wheels, assisted living communities, veterans’ services, the Red Cross and more. Members of this year’s cohort also are long-time advocates for social and racial justice and environmental protection. Several honorees have been active in their community’s COVID-19 response by helping to make masks for health care providers.

Profiles of the 2020 honorees are now and the video tribute will be added to the page Friday, Sept. 11.

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“The UofL Trager Institute is thrilled to offer this new acupuncture set of services to our community,” said Anna Faul, executive director of the UofL Trager Institute. “These new services available at our Republic Bank Foundation Optimal Aging Clinic are part of a broader effort to provide a one-stop shop of comprehensive services that support long-term wellbeing.”

Acupuncture is the anchor of traditional Chinese medicine that involves the placement of fine, sterile needles into specific points on the body to heal disease, restore balance and promote health. AcuBalance providers say the services offered at the UofL Trager Institute can help address a wide range of both neuromusculoskeletal and internal/mental-emotional including:

• acute and chronic pain
• arthritis
• fibromyalgia
• addiction and recovery
• autoimmune issues
• cardiovascular health
• indigestion and digestive health
• cognition and brain health
• reproductive and sexual health
• hormone and thyroid health

These services are known as integrative treatments because they are to be used in conjunction with a primary care physician.

Colby Helton and Andrea Helton, offering services at the UofL Trager Institute, are fully licensed to practice acupuncture and traditional Chinese medicine in Kentucky, having passed four National Board Exams through the . The providers have completed a four-year master’s degree in acupuncture and TCM that included over 3,000 hours of didactic education as well as 1,000-hour clinical residency programs. Colby Helton holds a doctorate in TCM, which required an additional 1,200 hours of didactic education, including additional training in gerontological acupuncture, clinical experience and a doctoral capstone project.

“We are elated to offer acupuncture services in partnership with the UofL Trager Institute at the Republic Bank Foundation Optimal Aging Clinic,” Helton said. “We bring a unique approach to our acupuncture and body therapies as we have extensive training specifically in providing acupuncture to older adults. Our services also will be a great resource for individuals needing pain management support and those looking for anxiety and stress relief. Utilizing an integrative approach and in collaboration with primary care, we can help patients with nearly any condition, from chronic pain and inflammatory conditions to hormonal and emotional imbalances.”

In addition to offering integrative services designed to help individuals achieve optimal health as they age, the new acupuncture services at the UofL Trager Institute may provide anxiety and stress relief specifically related to COVID-19.

“Over the past few months, we’ve seen a dramatic increase in anxiety, depression and stress among health care providers and caregivers, especially our frontline and long-term care workers. Without proper self-care, health care workers face a burnout like we’ve never seen before, which can turn into varying degrees of psychological crises and PTSD,” Helton said. “Integrative therapies like acupuncture help offer significant relief and reprieve by addressing the biological, mental and emotional components of stress and burnout. Specifically, we work to increase parasympathetic tone and reduce stress reactivity, which can balance the mood, sleep cycles, energy, cognition, digestion, cardiovascular health and even immunity. Essentially, we can help our fellow health care workers navigate the COVID landscape with a bit more ease and grace.”

Acupuncture services are available to any member of the community, with appointments available Tuesdays and Thursdays from 1to 6 p.m. To make an appointment, visit the , or call 502-588-4340. Services are provided on a private payment structure.