“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.

N-AGE is a non-profit membership organization representing geriatric education centers and other organizations that provide education and training to health professionals.��The organization seeks to improve the quality of health care for older adults, including underserved and minority groups. N-AGE is a leading national voice for building a robust pipeline at every level of education to increase the size and skill set of students and professionals in the aging-related workforce.

“I am honored to be selected for this national leadership position. As a long-time educator in the field of gerontology, I am deeply passionate about increasing the workforce size and improving the skills of the aging-related workforce,” Faul said. “Workforce development is one of the UofL Trager Institute’s strategic initiatives and we have received several HRSA-funded grants to support this goal. I look forward to taking what we have learned from these programs to a national level.”

“We are thrilled that Dr. Faul has joined the N-AGE Board of Directors. She is an experienced leader in the field who brings a wealth of knowledge about aging services and geriatrics,” said Catherine P. Carrico, PhD, president of the N-AGE board.

As a new board member, Faul will serve as chair of the ����ֱ�� and Training Committee. In this role, she will further the committee’s goal of enhancing nationwide opportunities for the education of health care practitioners in geriatrics and gerontology. Specifically, Faul will work to increase the visibility of HRSA s and . This builds on her experience as principal investigator for both the UofL Trager Institute’s HRSA Geriatric Workforce Enhancement Program and HRSA Behavioral Health Workforce Enhancement Program. She also has served as mentor for Samantha Cotton, PhD, program manager at the UofL Trager Institute and 2019 Geriatrics Academic Career Award recipient.

Faul learned of her board selection during the 2019 Gerontological Society of America’s 2019 Annual Scientific Meeting in Austin, Texas. She begins her 3-year term on the N-AGE board in January 2020.

“I am grateful and excited to begin this new role on the National Association for Geriatric ����ֱ�� Board. This is an incredible opportunity to elevate the leadership of the UofL Trager Institute, and the University of Louisville in shaping the future of geriatric education in our country,” Faul said.

The conference will be held June 11-13, 2017, at the Galt House Hotel, 140 N. Fourth St.

The Optimal Aging Conference brings together academics, professionals and older adults across a variety of disciplines who are united by a view that aging is an opportunity, not a disease. Institute Executive Director Anna Faul, PhD said, “This conference is unique in that it emphasizes the potential when diverse individuals come together united in a common commitment to transforming our current aging paradigm, including participation and input from older adults and caregivers.”

Abstract submissions for the conference close Friday, Dec. 16 at 11:59 p.m. Practitioners and academicians in any field related to aging care can submit an abstract as the conference will examine service delivery complexities and burdens through both academic and professional workforce perspectives.

Abstracts can be submitted . More detailed information can be accessed The opening of the abstract submissions is the finale of the Institute’s observance.

The Optimal Aging Conference supports the dissemination of biopsychosocial aging research, age-friendly��product innovation, and evidence-based practice and education models and social service delivery. The theme of the conference this year is “Approaching Aging as a Life-Long Journey.”��

“For optimal aging to be realized, we must infuse a lifespan approach into our work, practice, and research,” said Barbara Gordon, past president of KAG.��

Early bird registration for the conference will open Feb. 15, 2017. The early bird registration fee for students, medical residents and senior citizens (age 65 and older) is $100; $240 for KAG Members; and $260 for all other academics and professionals. After Feb. 15, registration will be an additional $10 per category.

More information about the conference is .��

UofL News: What does it mean to ‘age optimally’?��

Dr. Christian Davis Furman: Aging optimally means that the person is staying active physically, intellectually, emotionally and spiritually. The person may not be perfect in all these areas, but he or she makes the most of their condition. We want our older adults to flourish.

UofL News: What is the single biggest contributor to staying as healthy as possible as we age?��

Dr. Christian Davis Furman:��The single best predictor of staying healthy as we age is to stay active – physically, mentally and socially.�� As people age, they should develop routines of exercise, mental engagement and social engagement, such as doing activities with friends, joining book clubs, playing cards and the like. The main thing is to stay active.��

UofL News: How should adult children address the needs of their parents and other loved ones as they age?

Dr. Christian Davis Furman:��As parents age, adult children should encourage them to visit their health care provider on a regular basis to monitor their health and catch any problems as early as possible. They should also encourage the older adult to complete Advance Directive, Living Will and Medical Orders for Scope of Treatment, or MOST, forms.�� Most people know what Advance Directives and Living Wills are; the MOST form is a newer directive that expresses the wishes of a patient who has a life-limiting condition.

UofL News: What is palliative medicine and why is it important in the aging continuum?��

Dr. Christian Davis Furman:��Palliative medicine is a specialty in medicine that addresses pain and symptom management and ensures a patient’s wishes are honored when they have a life-limiting condition. Is it important to have access to palliative medicine to ensure patients don’t suffer at the end-of-life. The Palliative Care approach is interdisciplinary, so physicians, nurses, social workers, chaplains and others work together to ensure the patient and the family have the care they need.

UofL News: What inspired you to go into the specialty of geriatrics?��

Dr. Christian Davis Furman:��My love of my grandparents and older adults inspired me to go into geriatrics. My grandparents treated me as an equal when I was young and had the patience to teach me to play a card game called Rook. I loved playing Rook with my grandparents and their friends. In medical school, I realized I was unique in my love of older adults and was excited to learn that the specialty of Geriatric Medicine existed! I became interested in Palliative Medicine when I was a Geriatric Medicine Fellow. I liked the ethical issues and patient care issues at the end-of-life. Caring for patients as they age and go through the dying process is both an honor and a life-affirming activity.

In January, Furman also was named the Smock Endowed Chair for Geriatric Medicine, supported by the Margaret Dorward Smock Charitable Trust, established in 1981 to support geriatric medicine faculty members to study and teach geriatric medicine to students at the UofL School of Medicine.��