“Health equity is essential to improving the aging journey for everyone in our community. We must view health holistically, accounting for the social determinants that impact one’s health and working to address each of them with patients so they can flourish,” said Anna Faul, executive director of the . “It felt necessary for health equity to be our theme this year, especially with the growing aging population in the U.S. and the recent challenges to DEI initiatives.”��

The Trager Institute/Optimal Aging Clinic and the Kentucky Association of Gerontology hosted the conference, held in person for the first time since 2019.

As the opening keynote speaker, Kentucky State Director of Faith-Based and Community Initiatives Charles Booker set the tone and mission of the conference, emphasizing the need to listen to the voices of those directly impacted by services and policies and the importance of strengthening community relationships.

Other keynote sessions included an update on Alzheimer’s and dementia research from Gregory Jicha, professor of neurology at the University of Kentucky; a call to action for women’s caregiver roles and health disparities from Sam Cotton, associate professor at the UofL Department of Family and Geriatric Medicine; a panel on health equity and aging policy with Bob Blancato, executive director of the National Association of Nutrition and Aging Services Programs and Sandy Markwood, CEO of the National Association of Area Agencies on Aging; and a panel of six octogenarians and nonagenarians who shared insights on aging optimally.

The nearly 300 attendees also had the opportunity to participate in sessions on animal-assisted therapy, the benefits of adult day care, lifestyle medicine for preventing dementia, ageism, expansion of senior center services, mental health challenges in older adults and other topics.

“The Optimal Aging Conference was an enlightening and rewarding experience. Participants were able to journey through the landscapes of aging and health equity with every keynote and workshop presentation they attended. This conference reinforced my belief that, by embracing inclusivity and understanding, we can make every year of life a rich and fulfilling adventure for everyone,” said Barbara Gordon, director of community engagement for the Trager Institute/Optimal Aging Clinic.�� ��

The annual conference aims to transform preconceptions about aging, hoping to ignite conversations in which aging is viewed as an opportunity rather than a disease. For more details and information about the 2025 event, visit the .

By Samantha Adams, UofL Trager Institute

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.

The Commission on Accreditation of Rehabilitation Facilities (CARF) has accredited the Behavioral Health Service Organization at Trager for three years for outpatient treatment of adults and older adults. Trager is one of only 10 organizations around the globe accredited by CARF for mental health services for older adults.

“Accreditation is a public statement that our organization strives to ensure that our services are of the highest possible quality,” said Joe D’Ambrosio, the Trager Institute’s director of behavioral health. “At Trager, we are committed to reducing risk, addressing health and safety concerns, respecting cultural and individual preferences and providing the best possible quality of care.”

Mental health is an important aspect of overall health and well-being. Losses that can occur with aging – social activity,��identity and physical health – put individuals at higher risk for developing behavioral health issues. However, signs of mental illness in older adults often are overlooked or dismissed as normal symptoms of aging. Without treatment, conditions such as depression and anxiety can lead to further physical decline. Behavioral health services are provided as part of the clinic’s comprehensive care to help individuals maintain health as they age.��

In order to be CARF-accredited, programs and services must demonstrate that they conform to internationally recognized standards for service delivery and are committed to continuous quality improvement and a consumer-driven focus. CARF International is an independent, nonprofit accreditor of health and human services providers in aging services, behavioral health, child and youth services, durable medical equipment, employment and community services, medical rehabilitation, opioid treatment programs and vision rehabilitation services.

“For our Trager team, accreditation demonstrates our belief that all people have the right to be treated with dignity and respect, have access to needed services that achieve optimum outcomes and are empowered to exercise informed choice,” D’Ambrosio said.

D’Ambrosio said that during Trager’s accreditation survey, the CARF surveyor commended the institute’s FlourishCare^TM service, an integrated lifelong wellness care approach focused on lifestyle and preventative medicine for adults of all ages, as well as the use of student interns and telehealth, increasing accessibility to services.

Trager’s aging services include the FlourishCare^TM assessment, care coordination, family support, medication management and education, organized education programs, end-of-life care and grief support, all available in a nationally recognized, age-friendly clinic.

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

“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.