UofL News: Please describe some of the health disparities that directly impact the older adult population.��

Harrington: Ageism is a collective result of stereotypes, prejudice and discrimination based solely on age. This is a relevant barrier to health care equity and patient safety. Our mindset of ageism must change. Human life means growing older across the life span without self-exclusion. The burden of preventable disease, mistreatment and inequity in access to and the provision of quality health care impedes opportunities to achieve optimal health. Optimal aging begins in early life and continues across the lifespan.

UofL News: What are some ways to overcome these challenges?��

Harrington: We must take a collaborative all-hands-on-deck approach. There is a strong body of research showing patient outcomes are best when inter-professional teams work together. Our patients are begging for access to high-quality health care.

UofL News: Louisville is home to multiple aging care businesses and city leaders hope we can be innovators for improving quality of life for the growing population of older adults throughout the United States. How do you see your work (both in research and teaching) contributing to this effort?��

Harrington: Ensuring that all our primary care nurse practitioner graduates acquire the knowledge and skill to care for our older adults in the community and long-term care settings is my highest priority as a nursing educator. Disseminating content for student and practicing nurse practitioners on the most complex medical conditions will hopefully help them improve their patients’ outcomes.

I and my medical and computer science and engineering colleagues also are working to change the most confounding social problems affecting older adults with Alzheimer’s disease and their caregivers using artificial intelligence and innovative product design. This exciting research has substantial social and policy implications.

UofL News: As someone with decades of geriatric nursing experience, explain how your research has helped improve the health and well-being of family caregivers of those with��Alzheimer’s disease/Alzheimer’s disease-related dementias (ADRD).��

Harrington: From the 30,000-foot perspective, the gaps are vast in every area of aging. Fifteen million family caregivers of those with ADRD and 12 million ADRD care recipients are potentially impacted by research and innovative practice models adopted by health care professionals. It is difficult to separate research in aging into disease-based categories because they are all interconnected. My defined program of nursing scholarship and creative activity focuses on older adults’ and their caregivers’ health disparities and power inequity in the context of heart failure, Alzheimer’s disease and Alzheimer’s disease related dementias, and ageism.

UofL News: What are some of your significant areas of geriatric research?����Describe for us some of the outcomes.

Harrington: Yes, in the context of the fellowship with the academy, there are several:

• 5 million individuals who reside in long-term care have heart failure. My innovative heart failure evidence-based guideline remains the only nurse-driven practice guideline of its kind since 2006, and has received national and international recognition through citations and inclusion of content. I created the ACE (Assess, Collaborate, Engage) Delirium Superimposed on Dementia practice model to improve how we approach delirium superimposed on dementia that impacts 20 million hospitalized older adults with ADRD yearly. That research recently published in .
• I believe education for quality health care for older adults requires a multi-prong approach that reaches health science students, health science professionals and families in the community. The possibilities for nursing innovation are infinite with inter-professional collaboration and begin with identifying the problems in care provision or care delivery. Redesigning the Medicare Annual Visit process for a 45 office Federally Qualified Health Centers (FQHC), prompted leading an inter-professional team in the development and production of an innovative desktop application for comprehensive geriatric assessment with custom reporting capabilities for FQHCs.
• The outcome of the first population-based study of 1,500 older adults in eastern North Carolina identified family caregivers’ need and desire for the knowledge and skill to be optimal caregivers for those with Alzheimer’s disease. We also realized how unrealistic it is to expect farmers to lose critical daylight hours to seek preventive health care, so we connected them to AgriSafe nursing services who visited them on their farms. The population-based community research led to delivering person-in-context dementia simulation to caregivers as an educational method to improve their understanding of dementia and their family members’ daily challenges and multiple educational workshops in collaboration with area agencies on aging.
• Between 2015 and 2017, I conducted two research studies that successfully eliminated academic silos in inter-professional geriatric education. The outcomes were an innovative and sustained Two-As-One Preceptor Model and the Troika InterProfessional (TIP) Gerontology ����ֱ�� Model impacting over 300 third-year medical, primary care nurse practitioner and physician assistant students. The TIP outcome model was designed for a student team of three primary care professionals who learn and apply gerontology knowledge in a virtual clinic environment. All faculty reported students maintained proficiency in the content over time. These skills impact approximately 8 million older adults these individuals will serve when extrapolated over a 20-year career.

UofL News: What is the future of geriatric health care?��

Harrington: We currently have approximately 680,000 adults over the age of 65 in Kentucky. The majority of the state’s counties, 81 of 120, are medically underserved. This void is compounded by many primary care physicians who are approaching retirement. Nurse practitioners are critical to the care quality of our older adult population and will remain critical for at least the next 30 years. Enacting legislation to remove the practice barriers and allowing nurse practitioner to practice collaboratively at the full scope of our educations, experience and training is growing more so each year. This is imperative to our ability to impact the wide-range of health disparities our older adults experience.

“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.