Next ‘Innovative Design, Testing, and Implementation of Frailty Interventions’ Seminar, February 26 at 9am

We are excited to announce the next session of the Innovative Design, Testing, and Implementation of Frailty Interventions seminar series!

Date/Time: February 26, 2025, 9-10AM EST

Title: Strength on Wheels: A meal delivery and exercise intervention for homebound older adults.

Speaker: Jessica Lee, MD, MS, Associate Professor and Chair, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, McGovern Medical School, University of Texas Health Center at Houston

Location: Zoom (please contact Brian Buta for Zoom information)

This series aims to bring together leading experts from around the globe to share insights and advances in frailty intervention and related research and implementation methodologies within clinical and public health settings.  If you would like to nominate potential future presenters, including yourself, please use this Frailty Interventions Speaker Nomination Form.

The seminar series was developed as part of the Frailty & Multisystem Dysregulation Working Group, and it is being held in conjunction with the working group meetings. It is sponsored by the Johns Hopkins Older Americans Independence Center, and co-led by Dr. Qian-Li Xue, Associate Professor of Geriatric Medicine, and Dr. Susan Gearhart, Associate Professor of Surgery, at Johns Hopkins.

ICFSR 2025 Frailty Highlights in Toulouse, March 12–14

By Anthony L. Teano, MLA, and Peter Abadir, MD

The #FrailtyFighter series is back! As part of our ongoing effort to promote frailty science, we are once again collaborating with the International Conference on Frailty and Sarcopenia Research (ICFSR) to highlight key presentations and contributors.

Since 2023, our Frailty Science team (supported by the Johns Hopkins Older American Independence Center) has worked to elevate the voices of both established and emerging investigators in the field of frailty. This year, we are excited to showcase 25 #FrailtyFighters—dedicated researchers making impactful contributions to frailty research.

Honoring a Leader in Frailty Science

A special highlight of ICFSR 2025 is the Lifetime Achievement Award presentation to Dr. Jeremy Walston, a co-PI of the Frailty Science team and the Johns Hopkins Older Americans Independence Center. Dr. Walston’s groundbreaking contributions have shaped the field, and we are proud to celebrate this well-deserved recognition. His work continues to influence frailty research worldwide, and his legacy as a mentor, investigator, and leader in aging research remains a guiding force for many in the field.

The award presentation will take place on March 12 at 3:10 PM—a moment to recognize a career dedicated to advancing knowledge and improving care for older adults.

The Johns Hopkins #FrailtyFighters at ICFSR 2025

Johns Hopkins University is sending a strong team to Toulouse this year, with nine JHU #FrailtyFighters delivering impactful presentations:

📢 Dr. Michael Bene – Oral Communications (March 12, 4:30 PM)
📌 Multiomics Reveals Mechanisms of Rejuvenation in Aged Mice by Losartan

📢 Drs. Qian-Li Xue, Karen Bandeen-Roche, and Melissa deCardi Hladek – Symposium (March 13, 2:20 PM)
📌 Unraveling Physical Resilience: Psychosocial Determinants, Stress-Response Physiology, and the Mediating Role of Frailty in Shaping Clinical Phenotypes and Outcomes

📢 Dr. Jenny Peña Dias – Oral Communications (March 13, 3:10 PM)
📌 Sex Hormone Binding Globulin and Incident Frailty in Women with HIV

📢 Drs. Sean Leng, Reyhan Westbrook, Qinchuan Wang, and Thomas Laskow – Symposium (March 14, 8:45 AM)
📌 Molecular and Metabolomic Characteristics of Frailty and Sarcopenia and Frailty’s Impact on Immunity

Stay Connected and Celebrate Frailty Science

To see all 25 #FrailtyFighters featured at ICFSR 2025, check out our presentation slides or follow us on X (formerly Twitter). We invite you to like, share, and engage with the conference’s highlights as we celebrate the incredible work of these researchers.

We extend our best wishes to all attendees, presenters, and the ICFSR team for a successful and inspiring 15th annual conference. See you in Toulouse—virtually or in person!

Next ‘Innovative Design, Testing, and Implementation of Frailty Interventions’ Seminar, January 22 at 9am

We are excited to announce the next session of the Innovative Design, Testing, and Implementation of Frailty Interventions seminar series!

Date/Time: January 22, 2025, 9-10AM EST

Title: The EngAGE Randomized Controlled Trial: Study design, strategy, estimated cost and preliminary results of a trial exclusively recruiting frail, multimorbid, homebound, African-American older adults and their care partners.

Speaker: Megan Huisingh-Scheetz, MD, MPH, AGSF, FGSA, Associate Professor, Associate Director, Aging Research Program, Co-Director of the Successful Aging and Frailty Evaluation Clinic, Section of Geriatrics and Palliative Medicine, University of Chicago

Location: Zoom (please contact Brian Buta for Zoom information)

This series aims to bring together leading experts from around the globe to share insights and advances in frailty intervention and related research and implementation methodologies within clinical and public health settings.  If you would like to nominate potential future presenters, including yourself, please use this Frailty Interventions Speaker Nomination Form.

The seminar series was developed as part of the Frailty & Multisystem Dysregulation Working Group, and it is being held in conjunction with the working group meetings. It is sponsored by the Johns Hopkins Older Americans Independence Center, and co-led by Dr. Qian-Li Xue, Associate Professor of Geriatric Medicine, and Dr. Susan Gearhart, Associate Professor of Surgery, at Johns Hopkins.

Announcing a New Seminar Series on Innovative Design, Testing & Implementation of Frailty Interventions

A new seminar series, “Innovative Design, Testing, and Implementation of Frailty Interventions,” sponsored by the Johns Hopkins Older Americans Independence Center, is being co-led by Dr. Qian-Li Xue, Associate Professor of Geriatric Medicine, and Dr. Susan Gearhart, Associate Professor of Surgery, at Johns Hopkins. Both Drs. Xue and Gearhart contribute to the multi-institutional, interdisciplinary Frailty Science team. 

This seminar series was developed as part of the Frailty & Multisystem Dysregulation Working Group, and it is being held in conjunction with the working group meetings.

This series, which will be held via zoom, aims to bring together leading experts from around the globe to share insights and advances in frailty intervention and related research and implementation methodologies within clinical and public health settings. 

The inaugural seminar has been slated:

Date/Time: October 23, 9-10AM EST

Title: The Surgical Pause: Update and Lessons Learned from a Randomized Trial

Speaker: Shipra Arya, MD, Stanford University


If you would like to nominate potential future presenters, including yourself, please use this Frailty Interventions Speaker Nomination Form.

To attend these seminars, please contact Brian Buta (bbuta@jhu.edu) for Zoom information.

If you have questions about the scientific plans for this series, please email: Dr. Xue.

ICFSR 2024: A Brief Review from a Growing International Conference 

Convening in Albuquerque March 20-22, the 14th Annual International Conference on Frailty and Sarcopenia Research (ICFSR) was the largest yet, with 441 participants (40% in person) from 29 countries, with 230 original research abstracts submitted on a wide range of topics. It is impossible to summarize such a diverse meeting, but a few highlights are below. We hope you will chime in the comments with what you learned!

The ICFSR Lifetime Achievement Award was presented to Dr. Anne Newman, who was honored for her science and mentorship over the years. Dr. Roger Fielding (Boston, USA) in his introduction noted that she is one of 10 siblings, perhaps leading her to an early understanding of the importance of collaboration.  In her keynote, Dr. Newman reviewed the history of thinking about frailty as an add-on in the Cardiovascular Health Study to the now in-depth focus in the Study of Muscle, Mobility and Aging (SOMMA).

An important recurring theme at the meeting focused on the ongoing debate on identifying sarcopenia and the challenges this presents for clinical research. In the first symposium, Dr. Peggy Cawthon (University of San Francisco, USA) gave a detailed review of the comparison between the performance of DXA, CT, MRI and D3Creatine for measuring muscle. Dr. William Evans (Berkeley, USA) pointed out that additional work is needed before a consensus can be established. Dr. Gustavo Duque (McGill University, Canada) gave an excellent keynote presentation on osteo-sarcopenia and the communication between muscle, bone and fat that we are just beginning to understand and has many implications for future sarcopenia research.

A number of large trials presented preliminary findings. The SPRING study, presented in a symposium by Dr. Qian-Li Xue, Dr. Thomas Laskow and Dr. Nicholas Schmedding from Johns Hopkins University, Baltimore, looked at the recovery after the stressor of knee surgery and reported that baseline predictors of resilience had the biggest impact on the short-term recovery, with less impact on the long endpoint. Results of RNA gene expression profiling in the SOMMA study were presented in the third symposium by Dr. Gregory Tranah (UCSF, USA), Dr. Russell Hepple (University of Florida, USA) and Dr. Paul Coen (AdventHealth Orlando Florida, USA). Markers of denervation were found to be associated with mitochondrial respiration as well as to a lesser extent with clinical endpoints. In addition, the oxidative stress response seemed to be differentially activated between mitochondrial and cytosolic mechanisms.

Several longitudinal studies are underway comparing human and mouse aging cohorts. This included the INSPIRE project presented by Dr. Angelo Parini (Toulouse University, France) and the Study of Longitudinal Aging in Mice (SLAM) presented by Dr. Rafael de Cabo for the National Institute on Aging (Baltimore, MD). These are both impressive large-scale projects aimed a collecting and correlating data across many functional modalities with detailed biochemical and exposure markers over time. Among the complementary points between the talks was the variety of ways there are of trying to integrate this extensive data to understand the biology of healthy aging. With the accumulation of large cohorts, the potential to pool data resources and increase our understanding with advanced statistical and AI assisted analytic techniques was also a topic of much conversation.

Interventions are underway in many contexts, including nutritional analogues, exercise, even stem cells, and these dominated the oral abstract presentations. Dr. Francesco Landi (Catholic University of Rome, Italy) inspired all of us to be more personally active with mentions of the Longevity Run project. One randomized trial of an intervention presented underway is not to prevent frailty however, but to prevent frail patients from undergoing surgical procedures for which they were at high risk of complications. Presented by Dr. Shipra Arya at Stanford University, The Surgical Pause study at the VA in Palo Alto is in the final stages and has some interesting findings about how willing different specialties were to adopt the practice, how easy it was to use and how successful as a result. These findings were reinforced by the single center experience of Dr. Bradley Schmit at the University of Florida where high levels of institutional support have led to significant reductions in harm.  The abstracts are published in the Journal of Frailty and Aging for anyone who missed the meeting as there are too many to review. 

A special focus of this meeting was on providing care for older persons with frailty in diverse communities. Dr. Debra Waters, hosting the meeting from the University of New Mexico, acknowledged the history of the First Nations in and around Albuquerque on whose former land the meeting was taking place. A roundtable on Thursday afternoon discussed the work of several panelists, Dr. Nitin Budhwar, Dr. Alex DeRadke, Dr. Raj Shah and Dr. Waters, from UNM who have been working with diverse and indigenous communities in the United States and New Zealand to understand what frailty and aging means in this context. Developing culturally congruent care is critical for improving the health across diverse communities around the world, and is an especially important point for an international meeting, that seeks to bring researchers together across multiple communities.

#FrailtyFighters 3.0—Frailty Highlights Coming Up at ICFSR 2024: March 20-22

slide displaying Fraity Science logo, ICFSR logo, and #FrailtyFighters

You may have noticed the buzz on social media that we have teamed up with the 14th International Conference on Frailty & Sarcopenia Research to call your attention to frailty highlights you don’t want to miss at their annual meeting in Albuquerque, New Mexico, from March 20-22.  Below you will find a curated listing of frailty-related presentations in chronological order; bold indicates speakers from JHU:

Wednesday, March 20th

  • 3pm—Lifetime Achievement Award: Dr. Anne Newman, University of Pittsburgh (USA)
  • 3:20pm—Keynote 1: Health ABC to SOMMA: Leaning into aging biology to understand frailty and sarcopenia” with Dr. Anne Newman, University of Pittsburgh (USA)
  • 5:40pm—Symposium 2: “Characterizing Resiliencies to Physical Stressors in Older Adults: Phenotype Development & Validation” with Drs. Qian-Li Xue, Thomas Laskow, and Nicholas Schmedding, Johns Hopkins University (USA)

Thursday, March 21st

  • 8:10am—Oral Communication 11: “Hormone Replacement Therapy and Muscle Loss in Post-Menopausal Women: Analysis from the Baltimore Longitudinal Study of Aging using Repeated Dual-Energy X-Ray Absorptiometry” with Dr. Jenna Mammen, Johns Hopkins University (USA)
  • 9:00am—Symposium 3: “Gene Expression Profiling in Muscle Identifies Pathway Associations with Mitochondrial Respiration, Physical Performance, and Muscle Mass in Older Individuals from SOMMA” with Drs. Steven Cummings, S.F. Coordinating Center, CPMC Research Institute (USA); Gregory Tranah, CPMC Research Institute (USA); Russell Hepple, University of Florida (USA); and Paul Coen, AdventHealth (USA)
  • 10:30am—Keynote 3: “Current and investigational medications for the treatment of sarcopenia” with Dr. Yves Rolland, IHU HealthAge, University Paul Sabatier (France)
  • 11:30am—Keynote 4: “Osteosarcopenia and the crossroad between muscle, bone and fat” with Dr. Gustavo Duque, McGill University Health Centre (Canada)
  • 1:50pm—Roundtable 1: “Culturally Congruent Frailty Care With Diverse Communities” with Drs. Nitin Budhwar, Alex DeRadke, Raj Shah, and Debra Waters, University of New Mexico (USA)
  • 2:50pm—Oral Communication 19: “Higher Thyroid Hormone Levels are Associated with Lower Muscle Quality: Results from MROS” with Dr. Jenna Mammen, Johns Hopkins University (USA)

Friday, March 22nd

  • 9:00am—Symposium 7:Skeletal Muscle Mitochondrial Energetics in the Study of Muscle, Mobility and Aging (SOMMA)” with Drs. Peggy Cawthon, California Pacific Medical Center (USA); Steven Cummings, S.F. Coordinating Center & CPMC Research Institute (USA); Russell Hepple, University of Florida (USA); and Paul Coen, AdventHealth (USA)
  • 9:40am—Keynote 6: “Patient-reported and performance outcomes relevant to sarcopenia” with Dr. David Cella, Northwestern University (USA)
  • 1:20pm—Keynote 7: “The New Challenges of Healthy Longevity: From the Sprint-t Study to the Longevity Run Project” with Dr. Francesco Landi, Catholic University of Rome (Italy)

Want to figure out who these folks are when you see them at ICFSR24? Our #FrailtyFighter 3.0 campaign on X (the platform formerly known as Twitter) has been highlighting their presentations, which includes images of presenters.  For your convenience, you may find a compilation of this Tweet content here.

For more information about registering for ICFSR24 either in person or virtually, or to see the full program of all presentations and speakers, visit their website.

We send best wishes to ICFSR24 organizers and presenters that it will be yet another fabulous international gathering of some of the greatest minds in frailty research!

Frailty Science Presentations at ICFSR 2023

The 2023 International Conference on Frailty and Sarcopenia Research is coming up soon! This annual conference, which showcases state-of-the-art research on frailty and sarcopenia, will be held in Toulouse, France from March 22nd -24th.  There is also a virtual attendance option. 

We are excited to announce that members of our Frailty Science team will be attending to present talks at symposia and paper sessions during the conference.  Some featured sessions are highlighted here:

  • Dr. Jeremy Walston will moderate the lead symposium, A Road Map for the Development of High Priority Physical Frailty Research.  Dr. Walston will present a talk on Biological Research Priorities; Dr. Qian-Li Xue will present Future Implementation Research Priorities; and Dr. Karen Bandeen-Roche will present Public Health Research Priorities.
  • Dr. Qian-Li Xue will moderate a symposium on Disentangling Relationships among Resilience, Frailty, and Self-Reported Health: Longitudinal Evidence from Community and Clinical Studies of Older Adults. For this session, Brian Buta, MHS, will present Frailty and Self-Reported Health as Surrogate Markers of Physiological Resilience: Findings from the SPRING-RESTORE Study; Dr. Xue will present Physical Frailty, Self-Reported Health and All-Cause Mortality: Implications for Resilience; and Dr. Amal Wanigatunga will present Interactions between Self-Reported Health and Free-Living Movement Patterns on Frailty Incidence.
  •  Dr. Karen Bandeen-Roche will moderate a symposium on the Conceptualization, Ascertainment and Implications of Prefrailty as a Public Health Priority. As part of this session, she will present on Next-generation Prefrailty Assessment in the Physical Frailty Phenotype.
  • Dr. Jenna Mammen will lead a presentation on the Association Between Thyroid Function and Lower Limb Composition in Older Adults: Analysis from the Baltimore Longitudinal Study of Aging.
  • Dr. Megan Huisingh-Scheetz will present on Design, methods and preliminary findings for the EngAGE trial: An exercise and social engagement intervention for multimorbid, homebound African American older adult-care partner dyads delivered over voice-activated technology.

The full conference program is now online, including keynote presentations and poster sessions

We hope those who are interested are able to attend this exciting conference!  Registration is still open, including an option for virtual attendance. 

Please also take a look at our ongoing Frailty Fighters campaign that highlights many of the presenters at this year’s conference. 

Wishing all a great 2023 ICFSR, in person and online! 

#FrailtyFighter 2.0: International Edition–Especially for the ICFSR Congress 2023

We are bringing back our celebrated #FrailtyFighter social media campaign on Twitter!  And we are proud to partner with the International Conference on Frailty and Sarcopenia Research (ICFSR) Congress to highlight global researchers in this space leading up to the ICFSR 2023 Conference in Toulouse, France, from March 22-24 as a key part of this effort. These Tweets will include a visual brief biography about these giants in frailty, sarcopenia, and resiliency research, as well as links to selected publications, and point out when their ICFSR presentation will take place.

“#FrailtyFighter 2.0: International Edition” launched on Monday, February 20, 2023 with content about the conference, to which Johns Hopkins University is sending six researchers to present: Drs. Karen Bandeen-Roche; Jeremy Walston; Jenna Mammen; Amal Wanigatunga; Qian-Li Xue; and Mr. Brian Buta. Also, Dr. Megan Huisingh-Scheetz from the University of Chicago will be presenting at the ICFSR conference; she contributed to Frailty Science’s Clinical Topic: Primary Care content. That brings up the number of Frailty Science team members presenting at ICFSR 2023 to seven!

Over the coming weeks leading up to the conference, we will Tweet about each member of our team presenting at ICFSR 2023 and their research, as well as promote ICFSR 2023 content about leading international frailty researchers, such as Dr. Leocadio Rodríguez Mañas (whom ICFSR will recognize with a Lifetime Achievement Award), and more keynote speakers and presenters.

#FrailtyFighter Prof. Leocadio Rodríguez Mañas, MD, PhD

The #FrailtyFighter social media campaign is a fabulous way to celebrate frailty scientists and their research, and we may continue the series after the ICFSR conference is over to raise awareness of more significant contributions in frailty science, and to recognize up-and-coming junior researchers in the field.

You are invited to participate!

To be considered for this effort, here’s what we need from you:

  •  Name and academic degrees
  •  Brief biography (36 words or fewer)
  • Affiliated institutional logo
  • Current head shot (vertical orientation)

Additionally, it is very nice to have meaningful content to generate more interest in the #FrailtyFighter Tweet about you, such as links to:

  • Recent frailty research
  • Future presentation that includes you
  • Award or honor received
  • News about you on frailty
  • Anything else to related to frailty with which you are involved

We can help draft text for the Tweet itself to accompany the visual art if you like, and you are welcome to prepare draft text (up to 280 characters including links, etc.) if there is a particular angle you would like to promote in messaging.

Submissions are accepted on a rolling basis. 

Please send all content in one email to our communications specialist: tony.teano@jhu.edu

We hope you enjoy the #FrailtyFighter series and consider joining the cause to bring more attention on social media to this critical subspecialty in geriatric research and healthy aging, and your leadership to that purpose.

#FrailtyFighter content requirements

Johns Hopkins Frailty Science Researchers Contribute to a Global Frailty Seminar Series

Dr. Jeremy Walston and Dr. Karen Bandeen-Roche, Frailty Science’s co-PIs, are participating in a novel Frailty Seminar Series along with other influential aging and frailty researchers from around the world over the coming several months. The highly-informative Frailty Seminar Series is an 11-month program aimed at promoting scientific exchanging and sharing evidence-based practices and research advances about all aspects of frailty around the globe. Continue Reading

Dr. Jeremy Walston and Dr. Karen Bandeen-Roche, Frailty Science’s co-PIs, are participating in a novel Frailty Seminar Series along with other influential aging and frailty researchers from around the world over the coming several months.  The highly-informative Frailty Seminar Series is an 11-month program aimed at promoting scientific exchanging and sharing evidence-based practices and research advances about all aspects of frailty around the globe.

On October 13th, Dr. Jeremy Walston joined Drs. Matteo Cesari (University of Milan, Italy) and Kenneth Rockwood (Dalhousie University, Canada) to present “Frailty as an Outcome of Clinical Trials” as part of this series.   Dr. Cesari spoke to the clinical relevance and scientific relevance of health outcomes pertaining to frailty within the context of aging, and to the importance of frailty definitions and assessment tools.  Dr. Rockwood addressed the complexity of measuring frailty in clinical trials, a summary of mortality risks observed by cardiologists, and characteristics of qualify frailty measures demonstrated through clinical trials. Finally, Dr. Walston discussed the physical frailty phenotype, its biological underpinnings, and the use of both the physical frailty phenotype and the frailty index in clinical trials.  Recommendations were made to target pre-frail groups in clinical study development, and using frailty as a secondary outcome given present FDA targets of primary outcomes in older adult related to physical and cognitive primary outcomes.  

These seminars are recorded.  For your convenience, here are links to the Frailty Seminar Series recordings to date:

All seminars held at Noon ET on the second Wednesday of each month through July, 2022.  The next seminar will be held on December 8th: “Frailty and Vaccine Effectiveness and Response to Infections” with Dr. Melissa Andrew from Dalhousie University, Canada. 

You may be interested to know that Dr. Karen Bandeen-Roche will present “Progression of Physical Frailty and The Risk of All-Cause Mortality” at the session on February 9, 2022.  Without a doubt, her presentation will be thoughtful, insightful, and compelling.  Don’t miss it!

Certificates of attendance are provided.  AMA CMEs are available for those eligible.  You may register for one Frailty seminar or all of them here.  The series is sponsored by the Geriatric Research Education and Clinical Center, and its organizing committee includes scientific leaders from four continents.

Finally, if you are a seeking a postdoc opportunity that explores some of these ideas, take a look at the fabulous T32-funded Translational Aging Research fellowship (PI: Dr. Jeremy Walston) and the Epidemiology and Biostatistics of Aging training program (PI: Dr. Karen Bandeen-Roche) here.

Details about the series, the organizing committee, and the full Frailty Seminar Series presentation schedule appear below:

FSS ScheduleFSS Details & Org Cmte

For World AIDS Day, December 1st: How does one face aging when they never planned to survive? 

Screen Shot 2021-11-23 at 4

The average age of people living with HIV in most care settings in the United States is 50 years of age or older. For many in this group, a diagnosis of HIV may have occurred decades ago and was accompanied, at the time, with the almost certain fate of disability and eventual death.

This led to people living for the day with no ability to contemplate tomorrow, much less, aging with the virus for decades. Living with the clinical consequences of HIV mono therapy and the subsequent resistance to antiretroviral therapy as well as the significant toxicities associated with these older therapies is a double-edged sword.  On the one hand, their lives were saved, and on the other, quality of life and wellness during the aging process were often sacrificed.

This past week, I had the opportunity at the Association of Nurses and AIDS Care Conference to listen to our elders from across the US who are living and aging with HIV. They wanted us to know that while they’re so happy to be alive they often feel that we as a clinical community have been slow to respond to their voices. Not only do many continue to feel isolated because they’ve lost their formative friend group, but some also reported struggling to make new friends as they continued to live.  Social isolation and loneliness heighten the negative impacts of aging through both biological and psychosocial mechanisms. These conditions enhance frailty (see: HIV and Frailty) and likely contribute to earlier transition to long-term care facilities.

Leaving one’s home and transitioning to long-term care is stressful for anyone.  The fear and anxiety of losing autonomy is coupled with concerns of losing dignity from receiving care, meals, and baths from strangers.  This already challenging situation is made worse when living with HIV.  First, the concern of needing to hide your HIV status and the potential for stigma and discrimination by both healthcare workers and other seniors is very real.  Second, long term care facilities are often ill equipped to manage HIV treatment.  Finally, members of the LGBTQ+ community with HIV suffer the potential need to go back into the closet to avoid further discrimination associated with sexual orientation.

There is hope for change, however.  The community aging with HIV is an active group of seniors who are advocating for change around the world.  Here in Baltimore, “Older Women Embracing Life” was founded in 2005 by women living and aging with HIV out of a premise that emotional support enhances quality of life and reduces psychological stress for people with HIV.  Another group called, “Let’s KickASS,” which stands for AIDS Survivor Syndrome, was founded in 2013 by long-term HIV survivors in San Francisco. Both not-for-profit agencies are pillars of the HIV and aging community.  They support members, patients, care givers, long-term care facilities, and others by increasing awareness of the complex nature of HIV and aging.  Their advocacy is essential to highlighting the community’s voice and we must listen.

Researchers focused on aging also have the opportunity to consider people with HIV in their programs.  For example, a program known as Community Aging in Place or CAPABLE, developed by the Johns Hopkins School of Nursing Professor and now Dean of the School of Nursing, Dr. Sarah Szanton, is transforming aging successfully at home. CAPABLE was designed for low-income seniors to improve safe aging in place.  The approach includes a nurse, an occupational therapist, and a handy worker to address both the home environment and uses the strengths of the older adult to improve safety and independence.  This program is now endorsed by the Center for Medicare.  The original work included only a handful of people with HIV and now collaborations are underway to consider the development of CAPABLE-HIV.  This work will focus on how to adapt CAPABLE for people with HIV and determine the unique needs for safe aging in place for this community.  While in the formative stages, we believe this effort will contribute to national efforts to improve aging in place for people with HIV.  The newly formed Center for Infectious Disease and Nursing Innovation (CIDNI) and the long-standing Center for Innovative Care in Aging are partnering to move this effort forward.  Keep watching this space for opportunities to participate in community advisory board discussions.

November 14th is World Diabetes Day

Getty image African American Older Man With Glucometer Kit

Diabetes is extremely common in the older adult population, affecting more than one-quarter of Americans aged 65 and older. In addition, approximately half of older adults have prediabetes; these are individuals are more likely to develop diabetes in the next few years in the absence of appropriate lifestyle interventions. Thus, three-quarters of the older adult population is either at high-risk for diabetes or already has diabetes.

As people with diabetes live longer, there are many geriatric conditions that occur more frequently in people with diabetes compared to those without diabetes, including cognitive impairment, incontinence, falls, and polypharmacy. Our research in the Women’s Health and Aging Studies has found that diabetes is also linked to frailty (Kalyani et al., 2012;  Kalyani et al., 2012). Persons with frailty are much more likely to have diabetes than those who are non-frail or prefrail and they also have dysregulation in hormones of energy metabolism. Previous research has suggested that this relationship is potentially bidirectional: persons with diabetes are more likely to develop frailty, and those who are frail are more likely to develop diabetes. Our studies have also found that higher levels of blood glucose are related to the development of frailty over time, which provides additional insights into potential underlying pathways linking diabetes and frailty.

Physical frailty is defined by unintentional weight loss, low physical activity, exhaustion, slowness, and decreased strength. Emerging data suggest that an accelerated loss of muscle mass, called sarcopenia, may be the key link between diabetes and frailty. Persons with type 2 diabetes (which comprises vast majority of diabetes in older adults) are vulnerable to excessive age-related muscle loss. Although muscle loss can begin in persons with diabetes at younger ages, it occurs more rapidly in older ages, compared to those without diabetes. The loss of skeletal muscle can significantly impact quality of life for people with diabetes and also increase the risk for falls, hospitalization, and mortality.

While diabetes accelerates the process of muscle loss, the mechanisms aren’t fully understood. There are probably multiple mechanisms linking type 2 diabetes and sarcopenia (Kalyani et al., 2014). For example, one of the key roles of insulin is to move glucose from the blood into skeletal muscle tissue where it is necessary for cell function and stimulates protein synthesis. In type 2 diabetes insulin signaling is impaired and insulin is not able to effectively drive glucose into the muscle tissue. This insulin resistance is associated with decreased protein synthesis in the muscle, leading to loss of muscle mass and decreased strength. Insulin resistance is also associated with mitochondrial dysfunction, which results in a decline in skeletal muscle function.

As we celebrate World Diabetes Day this year, we need to recognize that the rapidly increasing number of older adults, and therefore older adults with diabetes, poses a unique challenge to clinicians and researchers. In particular, considerations of the consequences of diabetes beyond the traditional complications such as heart disease and on other morbid conditions such as sarcopenia and frailty, need to be urgently addressed in order to preserve quality of life and reduce mortality for this population.

World AIDS Day 2020 Reflection–Frailty, Resilience, and Impact.

On December 1st 1988, the first World AIDS Day was observed to support people living with HIV (PLWH) and remember those who died during the initial phase of the AIDS epidemic.  Now, 32 years later, HIV has been transformed into a chronic disease with the widespread use of effective combination antiretroviral therapy. The goal of ending the HIV epidemic, while aspirational, is increasingly achievable with the widespread test and treat efforts and very effective prevention strategies.

 With survival of PLWH approaching that of peers without HIV, the HIV population is aging and the majority of PLWH in the US are now over 50 years old. Over the past 10 years, we have seen many reports documenting that aging-related comorbidities occur at an earlier age in PLWH and some have posited that HIV may represent an accelerated aging phenotype, which is driven by chronic immune activation.  There is much work to be done to understand the pathogenesis of comorbid diseases in PLWH and determine the extent to which this is the same or different than people without HIV.  We also need to understand the drivers and manifestations of physical frailty in this vulnerable population.  Here’s a link to an introduction to this area of HIV and Frailty

 While potentially vulnerable to the impact of aging-related conditions, older PLWH are also extremely resilient.  They know exactly the devastation that this disease caused and how to face its challenges.  As we face another viral epidemic, I am struck by the perspective of PLWH and their strength in the face of adversity and uncertainty.   The theme for World AIDS Day 2020 is “Ending the HIV/AIDS Epidemic: Resilience and Impact.”   For older PLWH, improving health span is essential, and their resilience forged from their lived experience in the early days of the HIV epidemic will be instrumental to achieve this goal.

#WorldAIDSDay2020

Safer Holiday Plans for Older and Vulnerable People

It should come as no surprise that observing the holidays will be different this year.  Here we outline important considerations about holiday gatherings during COVID-19 times, with special consideration to the health of older and more vulnerable relatives and friends.

First, leaders from Johns Hopkins Medicine are urging caution this holiday season.  In a recent memo to faculty, staff, and fellows, they provided the following guidance:

“As you consider participation in various forms of holiday gatherings, please be thoughtful and exercise great care to protect yourself and your loved ones, especially those who are elderly, have underlying medical conditions, or are otherwise more vulnerable to severe consequences from the infection.”

As we approach the Thanksgiving holiday, COVID-19 cases and deaths continue to increase dramatically in the US, and throughout many places worldwide. With winter upon us, everyone is spending more time inside with poor ventilation and dry air—ripe conditions for viral community spread.  At the same time, many people find themselves suffering from Pandemic Fatigue (or COVID-19 Caution Fatigue), and yearning for connection with family and friends.  Though we long to return to normal holiday rituals, it is so important for the health and wellbeing of our older friends and family members that we redouble our resolve to keep ourselves and our loved-ones safe.   Indeed, the Centers for Disease Control (CDC) warns that “small household gatherings are an important contributor to the rise of COVID-19 cases.”  By finding alternative ways to celebrate and reconnect with those dearest to us, we may be able to have safer holiday plans for frail, older, and vulnerable populations.  Below are the CDC’s assessment of lower to higher risk holiday activities:   

Lower Risk: 

  • A small dinner with the people in your household
  • A virtual dinner with family and friends
  • Preparing food for family and neighbors (especially those at higher risk of severe illness from COVID-19 who are physically distancing), and delivering it to them without person-to-person contact
  • Shopping online rather than in person on Black Friday and Cyber Monday
  • Watching sports events, parades and movies at home

Moderate Risk Activities: 

  • A small outdoor dinner with family and friends who live in your community
  • Visiting pumpkin patches or orchards where people are taking COVID-19 safety precautions like using hand sanitizer, wearing masks and maintaining physical distance
  • Small outdoor sports events with safety precautions in place

Higher Risk Activities: 

  • Going shopping in crowded stores just before, on or after Thanksgiving
  • Participating or being a spectator at a crowded race
  • Attending crowded parades
  • Using alcohol or drugs
  • Attending large indoor gatherings with people from outside of your household

As difficult as it may be, there are some individuals whose health conditions should preclude them any gatherings. The CDC advises the following people should not host or attend in-person holiday gatherings outside of their household; including anyone who:

Please see CDC guidelines here to help celebrate Thanksgiving more safely.

Safer Alternative Holiday Planning:

The reality is that socializing during Thanksgiving is likely going to be very limited in real life and may only include those in your household, but the potential for virtual or telephone connection is abundant for almost everyone. This social connection is especially important for our frail and isolated relatives and friends. If you would like to get ideas for hosting a virtual Thanksgiving, you will be pleased to know that the AARP has put together excellent suggestions, which you can find here as well as a “how to” guide, which you can find here.  As noted in a recent NIH Director’s blog, breaking the traditional way we observe Thanksgiving allows the opportunity for something new to emerge and blend in with time-honored traditions.  Here are some ideas to consider:

  • Don’t like Turkey?  Make a dish you love instead! 
  • Love cooking?  Ask for signature dish recipes from you family and friends and share yours! (Here’s a pecan pie recipe my grandmother made every Thanksgiving.)
  • Have you put on your COVID 19lbs?  Mask up and take a Thanksgiving walk and be mindful of nature, and maybe stroll with your pod maintaining physical distance
  • Missing family and friends?  Call them over the weekend on the phone or a video chat service, or write them a note.
  • Need to be more thankful this Thanksgiving?  Start a gratitude journal—it is really good for your outlook and mental health.
  • Want to go somewhere?  Visit a place virtually.  Plenty of venues and museums offer virtual tours these days.  Some of them have programs for children, such as the Baltimore Museum of Art’s opportunity to meet Matisse’s dog, Raoudi, and learn about Matisse’s art.
  • Feeling nostalgic for Thanksgiving pass times?  Fortunately, some aspects of Thanksgiving were pretty much virtual all along.  Here’s the Thanksgiving NFL schedule.  The Macy’s Thanksgiving Day Parade is still happening—which you have probably already virtually attended in the past from the comfort of your own home! In my household, watching “It’s a Wonderful Life” was a given, as well as playing board games.

Perhaps the one thing we can all be grateful for this Thanksgiving is how swiftly coronavirus vaccine research has been progressing, and the hope that this may be the only COVID-19 Thanksgiving we must endure.  We must be grateful for our good health.  And protect it, and the health of those most vulnerable.  Know that we are in solidarity with each other this holiday season in this regard, and that we are in good company in that sense; click here for a message from Dr. Anthony Fauci, world-renowned infections disease expert:  “My Thanksgiving is going to look very different this year.”

Healthy Voting is a Sacred Right

 

Voting is a sacred rightEveryone in our clinician and researcher community is invited to share vote-by-mail information with their patients and families.  This blog offers a summary of ways to help older people get out their votes as safely as possible in 2020, and it provides a voter’s personal experience on the ease of using a vote-by-mail ballot at a community-based official election ballot drop box.

 

Requesting an absentee ballot and mailing it well before election day, or placing a ballot in a designated drop box offer safe ways to minimize COVID-19 exposure based on guidance from leading experts:

 

 

  • The Bipartisan Policy Center says, “One of the best ways to vote safely is by using a mail ballot. If voting by mail or by absentee is an option for you in your state, doing so may be the best way to keep you and your community safe from COVID-19.” 

 

 

You may also opt to take advantage of voting in person at early voting places or per normal on election day in your state. Although experts believe these methods may carry greater risk for exposure to COVID-19 than voting by mail, there are important ways to decrease that risk if you choose to vote in person.  Please see the Center for Disease Control’s Recommendations for Voters.  

 

Additional information for older adults relevant to voting processes in your area can be found below:

 

  • American Association of Retired People: Resources on all the ways to cast your ballot in the 50 states, Puerto Rico and the District of Columbia; their site is linked to additional AARP information about how to protect your health and vote during the pandemic, as well as additional resources on ballot initiatives that may be of interest to older adults. 

 

  • National Council on Aging: Voting safely and healthy voting are top-of-mind in their nonpartisan resources for the 50 states, the District of Columbia and all U.S. protectorates/territories. 

 

 

PERSONAL EXPERIENCE WITH VOTING BY MAIL OPTIONS IN MARYLAND

 

I tested the sites mentioned above for Maryland’s process, and they were accurate.  Here is the process for Maryland.  At the time of this writing, the voter registration deadline has unfortunately passed—it was October 13th.  But if you are already a registered voter in Maryland, and you want to vote by mail or use a community-based official election ballot drop box, there is still time to do so.  In Maryland, you must request your mail-in ballot by October 20th. 

 

Here’s my personal experience with the process. In September, I requested a mail-in ballot online at the Maryland Board of Elections website.  After I received my mail-in ballot, I looked up all the local issues on my ballot, I carefully followed instructions and filled it out.  Mailing it back is free—it doesn’t require a stamp. But rather than mail it in, I opted to use a community-based official drop box that I found out about at the Maryland Board of Elections website.  I arrived by car at the drop box located at a local high school.  I put on my face mask.  I got out of my car.  I walked to the drop box, and I inserted my ballot.  To make sure it went all the way in, I placed my hand against the ballot box, and I heard my ballot land with a thud.  I looked up and I noticed the security cameras towering above. I felt secure that my ballot would be safe.  Because I touched the box, I used hand sanitizing lotion that I had in my pocket before touching my car door handle. When I arrived home, I washed my hands with soap and water.  The next day, I received an email from the Board of Elections that my ballot was received.  It was that safe and easy!

 

The cumulative effects of this year—civil unrest, economic strife, and the worst pandemic in a century—can make us feel powerless and small and disconnected from our loved-ones, our freedoms, our liberties, and our beloved pursuits of happiness.  Despite the circumstances, now can be a time of empowerment, dignity, and respect for older Americans’ right to vote.  There are very few events that bring us together as Americans: President’s Day; the Fourth of July; Thanksgiving; and Election Day.  I, for one, am glad to have voted and joined the millions of Americans who voted safely—with health in mind.  As they say in these times, “We’re in this together” and “Together apart.”