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.

The 11^th annual celebration was held Sept. 30 at the Kentucky Center for African American Heritage, recognizing 35 older adults for 2022. The ceremony is an Optimal Aging Month signature event organized each year by the�� Trager Institute/Republic Bank Foundation Optimal Aging Clinic to create an age-friendly culture in our community.

“The whole day was so special, making me and the honorees feel like a celebrity with all the attention,” said honoree Abbie Creed, 91. “From the minute I stepped onto the property, receiving a nametag and the beautiful corsage, being escorted to my table, receiving the certificate and especially the beautiful Gold Medal and the kindness shown throughout the whole program, made me feel so special and pampered beyond measure.”

Read about the exceptional older adults listed below at the . To see more photos from the event, visit the .

Virginia Bell | Age: 100

Ann Carter | Age: 89

Julia Coulter | Age: 86

Abbie Creed | Age: 91

Denny Crum | Age: 85

Sister Julia Davis | Age: 85

Rita Durbin | Age: 91

Reverend Jerry Eifler | Age: 86

Marge Fore | Age: 93

Betty French | Age: 85

Sarah Gabler�� | Age: 96

Mary Grayson | Age: 95

Jess and Rilda Hendrix | Age: 89 & 86

Patricia Holtzapple | Age: 90

Roma Houchin | Age: 86

Delbert Keith | Age: 89

Charles Kenneth Kinberger | Age: 94

Marjorie “Margie” Manning | Age: 93

Maria Marquez | Age: 86

Bertha Mason | Age: 97

Connie Miceli | Age: 93

John Moore | Age: 89

Elaine Morgan | Age: 85

Arla Nesbit | Age: 87

Norma Niehaus | Age: 91

Eleanor Price | Age: 102

Sheldon Rifkin | Age: 87

William Schmitt | Age: 90

David Stewart | Age: 86

Betty Stotz | Age: 88

Robin Whitehouse | Age: 87

Willa Fae Williams | Age: 86

Jocille Wright | Age: 92

Bette Zeller | Age: 95

“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 interactive info session can be viewed on the Zoom platform at: . To learn how to access a Zoom meeting, .

“As most of us have heard by this point, older adults and individuals with serious chronic diseases such as respiratory conditions, heart disease and diabetes are at elevated risk for serious cases of COVID-19. Given the expertise of our leadership team in the areas of older adult health and chronic disease management, we want to provide practical advice and guidance for people who are scared and concerned for their safety and health,” said Anna Faul, PhD, executive director of the UofL Trager Institute.��������

This session addresses the following pressing questions:

• How best to protect yourself from getting the virus
• What to do if you think you have the virus
• How to prepare for quarantine
• How to address the anxiety that may arise because of the pandemic
• How to care for older adults who may be quarantined in nursing homes
• How to combat loneliness during quarantine and social distancing
• How to care for chronic illness during this pandemic
• How to maintain your weight and physical activity
• How to handle lost earnings
• How to prevent coronavirus-related scams

This session is recorded from the live March 17 event and available for distribution.��������������

“Even though older adults and persons with chronic diseases face greater risk relating to COVID-19, there are simple precautions all of us can take to keep ourselves, our families and our communities as healthy and resilient as possible. If you are high-risk it is important to take proactive steps now to try to prevent the disease – such as washing your hands, avoid touching your face, avoiding crowds and non-essential travel – as well as developing safety plans in the event of quarantine or illness,” said Christian Davis Furman, MD, medical director of the UofL Trager Institute.

Important COVID-19 resources:

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“As a��geriatrician, I routinely��check for signs of physical abuse, such as unusual weight loss, bruising or skin breakdown, but the form of elder abuse I encounter the most is financial abuse,” said Christian D. Furman, MD, MSPH, AGSF, interim chief, Division of General Internal Medicine, Palliative Medicine and Medical ����ֱ��, Margaret Dorward Smock Endowed Chair in Geriatric Medicine and medical director, UofL Trager Institute. “Older adults are vulnerable to financial exploitation, such as scams,��especially when they have��dementia. This population is��targeted as many��receive��monthly income (such as pensions or VA checks), have savings and may have a reduced ability to fend off scams.”

She encourages older adults and their family members to sign up for the����service to receive notice of how would-be criminals may try to steal money.

Furman urges older adults to plan ahead financially to prevent this type of abuse.

“I see too many individuals who lose their life savings in situations like this,” she said.

Elder abuse can take on different forms: physical abuse, sexual abuse, neglect and financial exploitation. Possible signs include:

• Physical abuse – frequent injuries; multiple bruises in various stages of healing; individual appears to be frightened
• Sexual abuse – fear of a particular person; upset when being changed or bathed; irritation or injuries of the mouth, genitals or anus
• Neglect – obvious malnutrition or dehydration; dirty and offensive body odor; absence of glasses, dentures or hearing aid
• Financial exploitation – unusual activity in bank account; lack of food, clothing and personal supplies; missing personal belongings such as jewelry, television or art.

Age-Friendly Louisville, through the Social Participation, Respect and Inclusion Workgroup, is working to raise awareness of elder abuse in Louisville. In coordination with various social service agencies, the group seeks to improve community cohesion to guard against elder abuse through education.

“It can be hard to imagine that anyone would deliberately want to harm an elderly person, but unfortunately elder abuse does occur,” said Chris Clements, Louisville Metro Retired Senior Volunteer Program coordinator and facilitator for Age-Friendly Louisville. “Some instances of elder abuse are intended to exploit the person through things like scams, and in other cases, neglect can be unintentional like when an older adult’s caretaker does not provide them with basic necessities.”

The Age-Friendly Louisville Social Participation, Respect and Inclusion Workgroup meets the second Tuesday of every month from 2 to 4 p.m. at the Thrive Center, 204 E. Market Street.

UofL News: What was the primary focus of your lecture?

Christian Furman: I gave five of the eight lectures, and my topics were geared to practitioners new to the field of geriatrics. I discussed both practical skills for working with older adults, as well as general information about the aging process. Topics included geriatric assessments, cognitive assessments for dementia, how to break bad news, advance care planning and end-of-life discussions.

UofL News: Is this part of an ongoing effort?

Christian Furman:��This was my first trip to Belize; however, my leadership and mentorship role in developing the study of geriatrics in the country is part of a larger, ongoing effort. Belize does not have geriatricians, and there are only a couple facilities and programs that support older adults. Starting in 2014, through a three-year LIFE (Living Independently in Full Existence) grant with Catholic Health Initiatives Mission and Ministries Foundation and KentuckyOne Health, I began working with Dr. Omar Aviles, a primary care physician in Belize who works at Mercy Clinic, a clinic for older adults in Southside Belize City. I provided monthly telehealth consultations to Dr. Aviles through videoconferencing to discuss patient cases. In this way, I provide continuing mentorship and expertise on specific patients, and offer advice on how to develop an interdisciplinary geriatrics clinic and program. My goal in providing telecommunication consultations is to provide Dr. Aviles with instruction on geriatric medicine best practices that he can use in his practice and disseminate to his colleagues.

UofL News: What are the main challenges for older adults in Belize?

Christian Furman:��In Belize, more than 41 percent of the population lives below the poverty level and, as in many countries, the effects of this are often most severely felt by a nation’s older adult population. Many older adults in Belize struggle to meet their basic needs across the major areas of health: social, housing, food access, transportation and medical care. These challenges are exacerbated by a lack of geriatricians in the country. These obstacles make accessing quality health care a challenge for many older adults. Having access to a geriatrician when we are older is essential to aging optimally. Just as we need pediatricians when we are young who understand the nuances of our health needs, so, too, is it essential to have someone who understands the complexities of aging. Many of the health care professionals in Belize have not been taught geriatric syndromes such as dementia, delirium, polypharmacy and how to complete a comprehensive geriatric assessment.

UofL News: What is the future of geriatric care in Belize?

Christian Furman:��I am optimistic about the future of geriatric care in Belize. Even with just this one grant, we have been able to dramatically improve the skill set and awareness of geriatric issues among the Belizean health care workforce. Already many of the practice protocols at the Mercy Clinic have been updated to reflect the needs of their older adult population. Working with this practice has started a larger movement in the country to disseminate best practices more broadly – as seen by the first geriatrics symposium held in October. Dr. Aviles also has passed along many of our conversations to the National Health Insurance (NHI) of Belize, a branch of the Social Security Board of Belize. Due to this effort, NHI is even considering changes in the geriatric health care delivery throughout the country.

I have been honored to be part of this movement in Belize to improve the health and well-being of older adults. It has been deeply rewarding to help professionals integrate geriatric best-practice medicine into their practices. I am committed to doing all I can to increase the number of geriatricians – as illustrated by my work on this grant and in my efforts at UofL to add to our number of geriatric medicine fellows. I also am working to educate professionals through the institute’s Interprofessional Curriculum for the Care of Older Adults (iCCOA). The shortage of geriatricians is not only a challenge in Belize but also in the United States. According to the American Geriatrics Society, we need 30,000 more geriatricians by 2030 to meet the health care needs of the growing older adult population.

Nearly $2 million in funding from the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, will provide stipends each year throughout a four-year period to 13 master level social work students, five counseling psychology students, and four doctoral level psychiatric nursing students for a total of 88 students. These students will be part of the Rural Geriatric Integrated Behavioral Health�� and Primary Care Training Network and will complete behavioral health practicums in primary care settings throughout Bullitt, Henry, Oldham, Shelby, Spencer and Trimble counties. They also commit to seek employment in those areas upon graduation.

“Isolation and transportation are big issues for older adults. Often there are limited behavioral health clinicians in rural areas, and it is the perfect marriage to incorporate behavioral health services within the primary care offices where older adults are already seeking care,” said Anna Faul, PhD, executive director of ISHOA and associate dean of academic affairs at the��.

Christian Furman, MD, the institute’s medical director and a professor of geriatric and palliative medicine, said the combination of multiple health conditions like diabetes, high blood pressure, heart failure and hearing or vision loss can be overwhelming for older adults.

“The mind-body connection is so important,” Furman said. “Physicians can write prescriptions but unless a person understands why they have a disease and receives the proper training on how to be resilient, people can feel helpless in their situation. We see a lot of alcohol and drug-abuse, and now the opioid epidemic.”

As the result of a for the creation of the Kentucky Rural & Underserved Geriatric Interprofessional Program, older adults in rural areas are already seeing the benefits of coordinated care.

Former Henry County resident Lynn Retzlaff, 66, has been living with a degenerative bone disease most of his life, resulting in a number of health complications leading to such factors as poor nutrition, reliance on opioids, isolation and despair.

Through meeting with one of the institute’s community health organizers, Retzlaff was able to get connected with multiple services for older adults, including a nutritionist, a student counselor and transportation services. He also learned new techniques for managing pain.

“I am no longer on opioids,” Retzlaff said. “I now use meditation tapes and have found they help me more than the pain medication. Before, I would cycle between relief and suffering.”

Retzlaff says he now eats more balanced meals and is in an overall better mental state.

“Many older people feel they can’t cope – they feel helpless. Without the help of the institute and community health organizers I would have deteriorated and life would be very gray.”

The newest HRSA grant also aims to bring enhanced training to both students and primary care providers. Utilizing the institute’s already established , along with development of a curriculum for the Professional Certificate in Rural Geriatric Interdisciplinary Integrated BH-PC and continuing education courses for health care professionals, the initiative hopes to build capacity for the mind-body approach to care for seniors.

“We are thrilled to receive this grant award,” Faul said. “With this funding, we will improve the health outcomes of vulnerable older adults in our rural counties. We also will dramatically increase the interdisciplinary approach to health care education and service delivery, infuse behavioral health into rural primary care, and provide students with increased employment possibilities.”

Furman, who practices geriatric medicine with , says both older adults and their care-givers stand to benefit from the grant.

“When you look at a disease like dementia, patients deal with many behavioral disorders like paranoia or agitation, and there can be a lot of anxiety on how to problem-solve around those factors,” she said. “This grant is important in not only getting behavioral health specialists into rural areas but also in opening up opportunities for physicians and nurse practitioners to coordinate with behavioral specialists to improve patient outcomes from a social support stand-point.”

Check out footage from today’s announcement:��

“This distinction celebrates not only lifetime achievements but also the continuing contribution of older adults,” said Christian Furman, MD, medical director of the institute. “This award is one of the cornerstone events of Optimal Aging Month in September, a time dedicated to promoting the view that aging is an opportunity, not a disease.”

Now in its seventh year, the award recognizes adults 85 years or older who are outstanding models of optimal aging in the physical, social, spiritual and creative aspects of life.

“Optimal aging is the ability to flourish throughout one’s lifespan. It is not a specific level of achievement but rather a state in which a person is able to continue living life to its fullest,” said Anna Faul, PhD, executive director of the institute.

The public may an older adult for the Gold Standard Award for Optimal Aging through April 15. Multiple award winners will be announced during a luncheon September 7 at the Crowne Plaza, 830 Phillips Lane. Former radio personality Wayne Perkey will serve as master of ceremonies. Tickets are $35 per person. The event benefits the Institute for Sustainable Health & Optimal Aging and its efforts to empower older adults to flourish.

Along with the nomination form, sponsorship and registration information also is .��

This award program celebrates older adults who embody the institute’s vision for a world where older adults flourish. This award recognizes adults 85 years or older who are outstanding models of optimal aging in the following four categories: physical, social, spiritual and creative. Multiple award winners will be named at a luncheon on Sept. 8.

“The Gold Standard Award for Optimal Aging is a special event that demonstrates the importance of appreciating the contribution of persons of all ages in our community,” said Christian Furman, MD, medical director of the institute. “The Gold Standard Award for Optimal Aging celebrates not only the lifetime achievements but also the continuing contribution of older adults. Furthermore, this award is one of the cornerstone events of Optimal Aging Month – a month dedicated to promoting the view that aging is an opportunity, not a disease.”

Nominees and awardees demonstrate that while aging optimally looks different for every person, the spirit of optimal aging is something everyone can strive for, said Anna Faul, PhD, executive director of the institute.

“Optimal aging is the ability to flourish throughout one’s lifespan. It is not a specific level of achievement but rather a state in which a person is able to continue living life to its fullest,” she said.

Nominations are now being .��