TRANSFORMING AGING Aging Institute 2019 Annual Report Aging Institute 2019 Annual Report UPMC Senior Services & the University of Pittsburgh “Of molecules, mice, and men.”

This report chronicles the continued progress of the Aging Institute of UPMC Senior Services and the University of Pittsburgh as it adds a new dimension to its well-established excellence in geriatric care: a revolutionary scientific investigation of the very fundamentals of aging. Its quest is to literally transform the aging process. This interdependent circle of molecules, mice, and men holds the promise of discovery, testing, and life-changing applications that may help to conquer age-related diseases and enhance the very quality of life itself. TABLE OF CONTENTS 10 22

6 16

The Biology of Educational Aging Research Initiatives in Aging Services

Aging Institute Innovations Initiatives in Research

2 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh 38 50

30 40 Celebrating Administrative Senior Staff & Champions Leadership

Connecting to Centers of the Community Excellence

aging.pitt.edu • seniorservices.upmc.com 3 Dear Colleagues and Friends As a society, we often speak of the promise and potential of medical student, that passive plan of care had already youth — but the same holds true at the opposite end of the started changing. Thrombolytics came into use when I spectrum, as I can attest in our daily work at the Aging Institute was a cardiology intern, followed by increasingly greater of UPMC Senior Services and the University of Pittsburgh. interventions. The field of cardiology moved from an observational field to an interventional one. Whatever your life’s pursuit, aging is the essential, ultimate destination of the human lifespan. It remains a process we Today, geriatrics is at a similar point of inflection. It is no are far from understanding, and one from which scientists, longer necessary for us to merely watch people as they age — educators, and clinicians have so much to learn. The more I we can make rational and meaningful interventions in the study aging, the more I appreciate its implications and aging process. That is precisely what we are doing in our meaning for us as individuals, as a society — and as a species. research at the Aging Institute Laboratory as we try to influence the rate and process of aging in the hope of Through my research work in the biology of aging, I am extending health span, eliminating age-related disease, and constantly energized by the rapid changes that are improving the quality of life. Our emphasis is on leveraging happening worldwide on the aging landscape. We are on the basic science for direct translation and clinical application verge of seismic shifts in how we view aging and, in particular, as soon as possible. In short, we want to move beyond the our ability to intervene in the process to promote and theoretical to develop effective new medicines for human use. extend healthier lives. Here in Pittsburgh at the Aging Institute, we hope to be a leader among our many colleagues As you’ll read in later pages of this report, over the last who share our early interest in this revolutionary work. year, we’ve made great progress on our ambitious and accelerated plans to identify biochemical pathways that Simultaneously, we remain deeply committed to continuing directly target the aging process, develop new drugs the vital initiatives in education, training, and service that that will enhance our resilience to aging, and apply that are hallmarks of the Aging Institute. Its many programs knowledge through clinical interventions. In particular: and collaborations are valued for fostering best practices, developing innovative care models, and responding to our • We have filed five patents on different compounds and region’s great need for leadership in geriatric care. formed a company to commercialize two of them.

Many years ago, I recall hearing stories about President • We have two promising drugs now in development, Dwight Eisenhower’s first heart attack in 1955. The heavy designed to stimulate a process known as autophagy — smoker was advised to spend six weeks in bed: that was the system by which your body clears away damaged “best practice” therapy at the time. By the time I was a proteins. Our goal is to begin human testing by the end of 2020.

4 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh These are remarkable milestones to achieve in just two years. Credit for deans of the University’s Schools of the Health Sciences: Bernard J. Costello, many of our early successes is due in large measure to funding from both MD, DMD, School of Dental Medicine; Anthony Delitto, PhD, PT, FAPTA, UPMC Enterprises and The Beckwith Institute, which is funding the RIGHT School of Health and Rehabilitation Sciences; Donald Burke, MD, Graduate (Reducing Inflammations forG reater Health Trial) study, our cornerstone School of Public Health; Jacqueline Dunbar-Jacob, PhD, RN, FAAN; School clinical trial. We are greatly indebted to both for their confidence and of Nursing; and Patricia Kroboth, PhD, School of Pharmacy. My thanks as well generous support. Additionally, our researchers continue to attract funding to Elizabeth M.Z. Farmer, PhD, dean of the School of Social Work, and Ann E. from the National Institutes of Health (NIH), providing valuable and credible Cudd, PhD, provost and senior vice chancellor, University of Pittsburgh. external validation of our work. With the support of many, we look forward to even greater accomplishments I am especially fortunate to be surrounded by colleagues who bring vision, in the coming year, with plans to expand our research energy, and passion to this work: Anne Newman, MD, MPH, the Institute’s portfolio with additional faculty recruits and clinical director; Daniel Forman, MD, director of emerging therapeutics; and the continued growth of external funding. In our lead team of investigators who made the leap of faith with me to begin tandem with this growth, the clinical care, this project, and assured its early momentum. educational and outreach programs of the Institute will move under the heading of Our work also reflects the confidence of many other individuals, offices, UPMC Senior Services where they will and organizations that have embraced our mission of discovery. I offer continue to expand their reach and provide particular thanks to the following people for their guidance, input, and key aging-related supports and services investment this past year: to a wide lay and professional audience. Steven D. Shapiro, MD, executive vice president, UPMC; Timothy Billiar, MD, There’s never been a more associate medical director, UPMC International and Commercial Services exciting time to be part of Division; Jeanne Cunicelli, executive vice president, UPMC Enterprises; the Aging Institute. Matthias Kleinz, DVM, PhD, senior director, UPMC Immune Transplant and Therapy Center; Mark T. Gladwin, MD, director of the Pittsburgh Heart, Lung, Sincerely, and Blood Vascular Medicine Institute, University of Pittsburgh; Christopher P. O’Donnell, PhD, executive vice chair of academic affairs, Department of Medicine, University of Pittsburgh; Deborah Brodine, president, UPMC Western Psychiatric Hospital & president, UPMC Senior Services; Jeffrey A. Toren Finkel, MD, PhD Director, Aging Institute of UPMC Romoff, president and chief executive officer of UPMC;Arthur S. Levine, MD, Senior Services and the University senior vice chancellor for the health sciences and dean of the School of of Pittsburgh Professor of Medicine, Division of Medicine, University of Pittsburgh; Bruce R. Pitt, PhD, chair of the Department Cardiology, School of Medicine, of Environmental and Occupational Health, University of Pittsburgh; Diane P. University of Pittsburgh G. Nicholas Beckwith III and Holder, executive vice president, UPMC, president, UPMC Insurance Services Dorothy B. Beckwith Inaugural Chair in Translational Medicine, Division, and president and chief executive officer, UPMC Health Plan; the University of Pittsburgh Collaboration is the bedrock of all Aging Institute initiatives. By bringing together gifted researchers, scientists, and administrators from the University of Pittsburgh and UPMC — and beyond — we have tapped into a wealth of knowledge and are generating exciting and innovative solutions. In 2019, our multi-year Healthy Brain Aging Initiative continued this collaborative and creative approach, yielding new scientific findings on brain health in older adults. Aging Institute Initiatives Exercise is Good for the Brain professor of psychiatry and director of the Pitt did stretching exercises three times a day. Using an approachable exercise regimen can Science Outreach program at the University of Remarkably, both groups experienced improved improve brain health Pittsburgh. “Our goal now is to do a much larger — but different — cognitive performance study to determine how useful an approachable during the six-month study. While the exercise A six-year pilot study with older adults by the — or less intense — exercise regimen can be in group got better at executive function tasks, Healthy Brain Aging Initiative has yielded improving brain health in older adults.” the stretching group got better at learning intriguing findings that show that exercise — and memory. “The stretching outcomes were even less intense, but mindful, exercise — is Initiative Milestones completely unexpected,” says Dr. Cameron. good for aging brains. The results are so • In 2013, the initiative led by John M. Jakicic, “We think it was due to mindful stretching; promising that the initiative feels it has the PhD, chair of the Department of Health and people were asked to actively think about initial evidence it needs to continue its research Physical Activity at the University of Pittsburgh, stretching multiple times a day, and it may and pursue external funding support in 2020. began looking into the health benefits of have helped memory.” regular exercise on brain health. Their reasoning: if exercise can be better integrated into a The persistent participation of the subjects person’s everyday life, they’d be more likely in completing the exercise program was to add it to their daily routine. “We looked at especially noteworthy for a pilot like this, animal models and saw that active monkeys notes Dr. Cameron. Only one person did not don’t just exercise once a day — they exercise complete the full study. “The study created all day long. They’re not running a marathon, an unexpected, but noticeable, level of social but they aren’t sedentary,” says Dr. Cameron. engagement that led participants to feel they • In 2015, 25 older adults aged 65–85 were were contributing to something important through their involvement.” “We think our colleagues in the scientific world recruited for a human study. The test group did will share our excitement about these findings,” 10 minutes of moderate exercise three times a • After seeing cognitive improvements in both day, five days a week. The only says Judy L. Cameron, PhD, initiative chair, and control group groups, the initiative turned to team members

8 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh Abbe de Vallejo, PhD, an immunologist at executive function — including a surprising link The next paper, which will come directly UPMC Children’s Hospital, and Panagiotis between lower levels in vascularity and improved out of their investigation, will report on the (Takis) Benos, PhD, professor of computational executive function. identification of biomarkers that appear to be and systems biology, in 2018 to look for linked to specific cognitive functions. “The real “These are exciting findings to come out of the possible biomarkers of the changes. Using question is whether there is something that can Healthy Brain Aging Initiative pilot study,” says blood samples taken from participants before be easily measured and tracked without being Dr. Cameron. and after the study, they identified 88 proteins invasive that can tell people if they are exercising in the blood that could be expected to show Next Steps enough to help their brain function,” says aging-related changes. In June 2018, the first paper to come out of the Dr. Cameron. group’s research — “Association of Hippocampal Over the next year, the initiative plans to continue In 2019, Vineet Raghu, a doctoral student working Substructure Resting-State Functional Connectivity working to identify biomarker pathways. New with Dr. Benos, performed a proteomic analysis, With Memory Performance in Older Adults” — grants will be used to conduct a larger study looking at proteins in the blood to identify was published in the American Journal of involving a control group that is sedentary in changes that correlated to the changes Geriatric Psychiatry. Stephen Smagula, PhD, addition to the exercise and stretching groups. in cognitive function. His analysis identified assistant professor of psychiatry at the University proteins belonging to molecular pathways whose of Pittsburgh, served as lead author. abundance was significantly different between Two additional papers are currently being written the exercise and stretching groups. He then to support grant requests in 2020. Dr. Jakicic conducted a graphical model analysis to identify and Meryl A. Butters, PhD, associate professor proteins directly linked to exercise or stretching of psychiatry and clinical and translational and changes in cognitive function. He found a science at the University of Pittsburgh, will biomarker associated with changes in memory report on the cognitive findings in the exercise plus several biomarkers linked to changes in and stretching groups.

aging.pitt.edu • seniorservices.upmc.com 9 The Biology of Aging Research There’s a palpable, unmistakable energy when you walk the halls of Bridgeside Point 1, home to the Aging Institute Laboratory.

Just two years ago, the expansive two-story, 30,000-square-foot space was vacant. Now, it is filled with high-tech, state-of-the-art laboratories and offices, sunlit by floor-to-ceiling windows that offer spectacular glimpses of the Pittsburgh skyline.

But the view matters little. It’s the underlying sense of shared purpose and discovery that drives the research and physician scientists who work there. They are united by their exploration of why and how we age — with the ultimate goal of transforming the lives of everyone as we age. A Revolutionary New Look at Aging Faculty Additions The Aging Institute at Bridgeside Point brings Ten inaugural faculty were recruited in 2018, with together established world-class scientists and another three faculty joining their ranks in 2019: gifted early-career researchers who are working Stacey J. Sukoff Rizzo, PhD to uncover the basic mechanisms underlying The Jackson Laboratory in Maine human aging and develop novel therapeutic An expert in behavioral phenotyping of mouse strategies to slow or reverse the aging process. models of disease, Dr. Rizzo’s research interests As the research arm of the Aging Institute, the include neurodegenerative conditions of Laboratory is focused on: aging, including Alzheimer’s, Parkinson’s, The Aging Institute • Basic science and Huntington’s diseases. • Drug development Matt Steinhauser, MD Laboratory’s Harvard’s Brigham and Women’s Hospital • Clinical interventions Research Agenda Dr. Steinhauser’s research interests include the Bridgeside Point’s labs include the recent • Explore the metabolism and biology of study of metabolism and adipocyte biology, addition of an impressive, multimillion-dollar, aging, using sophisticated molecular including the characterization of what happens on-site high-throughput drug discovery facility techniques. when people go long periods without eating and that enables experimental samples to be the resulting metabolic changes that occur in • Identify novel small molecules — simultaneously tested at unfathomable speeds. the body. drugs — to combat the aging process. Institute researchers can daily screen and compare • Test new therapies in actual human roughly 25,000–30,000 compounds a day. Andrey A. Parkhitko, PhD Fellow in Genetics, Harvard Medical School patients that will leverage its discoveries “We have made remarkable progress in our in the biology of aging. Dr. Parkhitko’s research focuses on the fruit second year of operation,” notes Toren Finkel, fly (Drosophila) as a model to study aging MD, PhD, director of the Aging Institute. “The and age-related disease, including metabolic productivity of our core faculty has resulted in alterations and their potential retargeting funding for numerous basic research projects during aging. from sources like the National Institutes of Health. Their research also has provided the critical momentum needed to launch our major clinical research projects.”

12 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh Faculty Publications • Molecular Carcinogenesis • An Aging Institute research retreat Over the last two years, the work and collaborations • Molecular Metabolism • Translational aging forums with the of the faculty of the Aging Institute have been Pittsburgh Claude D. Pepper Older published in 24 peer-reviewed journals, professional • Nature Cell Biology American’s Independence Center and publications, and mainstream press, including: • Nature Genetics the University of Pittsburgh Schools of • Aging Cell • Nature Magazine Medicine and Public Health • American Journal of Respiratory & • PLOS One 2019 Clinical Studies Critical Care Medicine • Redox Biology The Aging Institute’s two major clinical initiatives • Cardiovascular Research • Stem Cell Research & Therapy in 2019 both focused on the cause and impact • Cell Death Discovery • Science Magazine of chronic inflammation in older adults. “The • Diabetes bold idea we are testing in our clinical studies is An Expanded Teaching Role whether we can find medicines that target the • European Respiratory Journal In addition to its research focus, teaching is pathways of inflammation — and in doing so, • Expert Review of Cardiovascular Therapy a fundamental part of the Aging Institute slow or reverse the rate at which we age to Laboratory’s mission. “We’re very committed to prevent or even eliminate age-related diseases,” • FASEB Journal (Federation of American providing innovative research opportunities and a says Dr. Finkel. Societies for Experimental Biology) rich environment for training a new generation of Spearheading the clinical efforts isAnne B. • Free Radical Biology and Medicine investigators in the field of aging,” says Dr. Finkel. Newman, MD, MPH, now in her second year as He notes that beyond individual mentorship, • JAMA Internal Medicine clinical director of the Aging Institute of UPMC the Institute will be providing support in career Senior Services and the University of Pittsburgh. • JCI Insight development, presentation skills, and grant • Journal of the American College of Cardiology writing, as well as networking opportunities “Dr. Newman — internationally known for her within and outside of the University of Pittsburgh. leadership role in the study of human aging — is • Journal of Clinical Investigation now overseeing the Aging Institute’s efforts to Other Institute activities now include: • Journal of Molecular & Cellular Cardiology test its geroscience hypothesis, which posits that • Journals of Gerontology Series A • A research conference series offered monthly therapies targeting the basic biology of aging can slow — or possibly reverse — human aging,” says • Molecular Cell • Monthly “Research in Progress” presentations during the academic year Dr. Finkel.

aging.pitt.edu • seniorservices.upmc.com 13 Joining her is Daniel E. Forman, MD, associate ability. Participants took Losartan (a high blood have looked at drugs that successfully modify director for clinical translation and director of pressure medication) and/or omega-3 fatty acids inflammation for disease, we believe we are the emerging therapeutics. “Dually trained and (fish oil). The now-published study found that first to look at modifying inflammation as a way board certified in both geriatrics and cardiology, while there was an initial lowering of IL-6 levels, of improving frailty.” Dr. Forman brings impressive research credentials those results were not sustained over a period During the course of taking the drug over a year’s that have attracted national attention,” says of months. time, participants will be measured for elements Dr. Finkel. “He’ll be helping to direct a series of “While the study may not have supported the of fatigue, strength, and body composition. innovative clinical trials that launched in late hypothesis, it did allow us to build a platform for 2019. The first of these — dubbed the RIGHT “Our innovation is that this is one of the few times future studies,” says Dr. Newman. “It affirmed study — will test whether immunomodulation people will be given a drug for aging. We believe that we have the ability to recruit the right study can alter the course of human frailty.” the Aging Institute is uniquely positioned to look participants as well as line up the statistical team at the changes that occur on a systemic level with ENRGISE and physicians who know how to conduct and this drug,” says Dr. Newman. “If that happens — Markers of inflammation like Interleukin-6 (IL-6) analyze the research.” and we’re able to prove the concept that the drug play an important role in predicting decline as we RIGHT works and how it works — that will lead to a much age. ENRGISE — Enabling Reduction of Low- RIGHT (Reducing Inflammations forG reater larger clinical trial.” Grade Inflammation in Seniors — was a randomized Health Trial) is the Institute’s major research clinical trial led by Dr. Newman that focused on initiative to jump-start its program of innovative adults age 70 and older with elevated IL-6 levels. therapies. Funding the initiative is The Beckwith “We know that IL-6 levels correlate with frailty Institute, an endowed fund of UPMC. in older adults,” says Dr. Newman. “Chronic RIGHT is a small pilot trial launched in fall 2019, inflammation is associated with most age-related targeting 50 participants. This randomized, diseases — from cardiovascular and neuro- double-blind clinical trial involves the participation degenerative diseases to metabolic disorders, of a pharmaceutical partner that is supplying cancer, and musculoskeletal disorders.” participants with a drug intervention identified The trial tested the potential of anti-inflammatory to lower IL-6 levels. interventions for preventing major mobility “We know that chronic inflammation increases disability by improving or preserving walking as we age,” says Dr. Forman. “While researchers

14 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh A Sampling of Faculty Research at the Aging Institute Laboratories

• Unraveling the age-related mechanisms involved in the susceptibility to lung disease • The study of molecular mechanisms that control cell proliferation and inflammation • Small molecule drug discovery • Age-related amyloid diseases, such as Alzheimer’s • Mitochondrial function, cellular metabolism, oxidative stress, and aging • Impact of exercise on skeletal muscle gene transcription • DNA damage in aging and age-related diseases • Construction of a disease-associated risk gene transcriptional regulation network • Bacterial protein toxins to develop therapeutics • Mitochondrial dysfunction and metabolic adaptations to stress • Therapeutic targets to mitochondria dysfunction- related diseases by manipulating stress signaling • Molecular mechanisms behind the sensing, repairing, and clearance of damaged organelles in mammalian cells • Regulation and function of the mammalian 12-hour clock as related to metabolic disease and aging

aging.pitt.edu • seniorservices.upmc.com 15 A core mission of the Aging Institute is to “sow seeds” of innovative and cross-disciplinary age-related research. Through the Seed Grant program and other initiatives, the Aging Institute is fostering original research aimed at improving the health, care, and independence of older adults. As intended, many of our seed projects provide the critical “proof of concept” investigators need to go on and secure additional outside funding for expanded research. Innovations in Research UPMC’s RAVEN Grant RAVEN’s first four years showed promising results, The telemedicine initiative was spearheaded by Marking seven years of innovation and progress prompting CMS to award a second $20 million geriatrician Steven Handler, MD, PhD, CMD, an for skilled nursing facility residents award in 2016 that expanded RAVEN’s outreach associate professor of geriatric medicine at the to 35 skilled nursing facilities statewide. The University of Pittsburgh, and now director of In 2012, the Centers for Medicare and Medicaid Phase II grant, scheduled to conclude in October Geriatric Telemedicine Programs. Its early impact Services (CMS) awarded UPMC Senior Services 2020, also introduced a new payment incentive and growing technical needs led UPMC Enterprises and the Aging Institute the first of two four-year model based on a facility’s ability to proactively to establish Curavi Health in 2016, appointing Dr. Innovation Awards known as RAVEN (Reduce manage six health conditions that historically Handler as its chief medical and innovation officer. Avoidable Hospitalizations Using Evidence-based result in hospitalization for older adults. It also led to the CuraviCart, a state-of-the-art Interventions for Nursing Facilities in Pennsylvania). telemedicine cart used to examine skilled nursing In making the awards, CMS was seeking to pilot, “As we commence our final year in the project, facility residents, and CuraviCare, a HIPAA- test, and evaluate new approaches with the we’re evaluating the cumulative impact of the compliant video platform that links the facility potential of improving and reducing the cost of RAVEN project in collaboration with CMS and with expert medical help specific to the condition. care for skilled nursing facility residents enrolled other Innovation Award recipients nationwide,” in Medicare and Medicaid. says RAVEN co-director April Kane, MSW, LSW. “After hours, facilities traditionally rely on “This experience has offered us deep insights telephone consults when a resident experiences To achieve that goal, the $19 million Phase I RAVEN into the culture, needs, and challenges of care a change in condition,” says Dr. Handler. “These demonstration project focused on implementing providers in a nursing home setting, and allowed phone consults are generally done by a doctor a comprehensive, multi-pronged approach us a unique opportunity to create new ways to unfamiliar with the resident and without benefit of targeted at reducing avoidable hospitalizations at better support them and the residents they serve.” a physical exam. The result is residents are usually 19 skilled nursing facilities in western Pennsylvania. transferred to the hospital. Its initiatives included facility-based nurse Telepresenters: A Promising New practitioners and enhanced nursing staff; the Model for Sustainability “Not only are these transfers time intensive for implementation of staff education tools and Approaching its final year, RAVEN is piloting a staff, they’re also highly disruptive for these older training; evidence-based communication tools new direction to expand use of telemedicine adults and sometimes harmful to their health,” to improve clinical assessment for earlier adds Dr. Handler. “What’s more, these avoidable Among RAVEN’s many groundbreaking initiatives identification of changes in a resident’s condition; hospitalizations are costing Medicare, private in its early years was its pioneering use of enhanced medical review and pharmacy insurers, and taxpayers billions a year and resulting telemedicine for skilled nursing facilities. engagement to reduce potential medication- in financial loss for skilled nursing facilities and Telemedicine holds the promise of enhancing related problems; and the use of telemedicine potential penalties for the hospital.” resident access to expert care — regardless of and information technology to expand access time of day — while reducing unnecessary In the summer of 2019, RAVEN and Curavi began to care. emergency admissions. exploring a new telemedicine model designed to

18 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh address some of the obstacles identified over the facility, they also are able to take orders and could be measured to directly determine how a the span of the project. complete the necessary clinical charting and body is functioning and aging? She zeroed in on documentation. In addition, they are able to ATG7, or autophagy related 7, a protein found In the original telemedicine model, nursing examine other residents while on-site and instruct circulating in human blood that plays an essential staff were trained to use the special carts at the staff about a resident’s changing medical condition. role in cell recycling. Without it, autophagy patient’s bedside to communicate remotely with doesn’t occur. a doctor. “Despite the support and enthusiasm “We believe this new model will translate to for telemedicine at facilities, there were barriers better care and higher satisfaction for patients Dr. Kuipers, assistant professor of epidemiology to its use due to limited resources and staffing,” and staff — and hopefully provide a sustainable in the Graduate School of Public Health at the says Dr. Handler. “That led us to consider piloting model to continue,” says Dr. Handler. University of Pittsburgh, received a seed grant an alternative approach in RAVEN’s final year.” from the Aging Institute in 2018 to research 2018 Seed Grant Update: Circulating Autophagy Related 7 (ATG7) Protein as Telemedicine’s goal remained the same: to break Circulating Autophagy as a a Biomarker of Aging. Her one-year study aimed the cycle of unnecessary, high-cost readmissions Biomarker of Aging to establish a protocol for measuring circulating and improve access to quality care. But the Autophagy is an important natural process that ATG7 and determine the correlation of the protein telemedicine delivery model has been “flipped” “cleans and recycles” the body’s cells to maintain with aging. An easily measurable marker of human from an internal to external one — bringing in the right balance at critical times in development aging could lead to improved risk estimation and specially trained staff to carry out the service, or in response to nutrient stress. When autophagy new autophagy-based therapies. explains Dr. Handler. doesn’t function properly, it has been linked to “In epidemiology, that’s the holy grail of aging Under the new model, a medical consultant, or diseases of aging such as heart disease. research,” says Dr. Kuipers. “We’re trying to find registered nurse, acts as a “telepresenter” — Epidemiologist Allison Kuipers, PhD, had an idea: a biomarker that more clearly distinguishes a bringing the telemedicine cart to the nursing What if there was a biomarker, or indicator, that person’s age than merely chronologic age.” home, setting it up at the resident’s bedside, and performing an examination under the guidance In keeping with the 2018 Seed Grant Program of a nurse practitioner, doctor, or specialist at a theme “Collaboration in Aging,” she assembled a remote location. team from across the University of Pittsburgh and the Aging Institute — experts in aging, population In this pilot program funded by an additional health, medicine, and lab sciences. They examined supplement from CMS, the telepresenters/nurse 81 adults between the ages of 70 and 91. In addition practitioners are on call after-hours and respond to taking blood samples for ATG7 measurements, within an hour. There are added bonuses: Because they conducted an assessment of their vascular they are registered nurses and are licensed at stiffness and cognitive and physical function.

aging.pitt.edu • seniorservices.upmc.com 19 Study results were mixed. According to Dr. Kuipers, her team succeeded in finding a way to measure ATG7 and determined that levels do vary. But they were unable to find a strong indicator of aging or cardiovascular disease. Surprisingly, they did see a correlation with body mass index (BMI).

“ATG7 may not be the best biomarker of aging, but it still appears to be associated with health status in people over age 70,” she says. The Aging Institute reprised its role in support of the 2019 conference, along with the Magee- Perhaps the most important outcome was the Womens Research Institute and UPMC Centers collaborative nature of the study, she adds. for Rehab Services.

“Collaboration is critical. That’s how we take The daylong conference looked at the pathways findings from animal-based lab studies and that lead to aging, focusing on epigenetics and the explore how an experimental model or design impact of environmental and physical factors on the presentations on biology and diseases, from applies to humans,” says Dr. Kuipers. “We need genome while also encouraging new collaborations embryonic development to aging.” collaborative research to actually move the in science. Presenters included regional and science forward from lab studies to human national experts in public health, women’s health, “We already know that environment affects studies and improved patient care.” genetics, cell biology, and pediatrics. health across the lifespan. Epigenetics sheds far greater light on that process,” says Daniel J. The Epigenome Across the “We want the conference to serve as an exciting Buysse, MD, professor of psychiatry and clinical Lifespan Conference opportunity for researchers from across multiple and translational science at the University of Looking at the pathways that lead to aging disciplines and areas of study to focus on the Pittsburgh School of Medicine. “What is clear in human lifespan,” says Yoel Sadovsky, MD, In May 2019, the University of Pittsburgh’s Clinical lifespan research is that it requires the contributions executive director of Magee-Womens Research and Translational Science Institute (CTSI) held its of diverse perspectives and disciplines. Many of Institute and associate dean, women’s health “The Epigenome Across the Lifespan” conference, the presenters are sharing exciting and emerging research and reproductive sciences at the bringing together basic and clinical researchers, research on a variety of topics, giving our University of Pittsburgh. “Our point of focus was health professionals, educators, and students participants an early look at the newest thinking not only aging, but the epigenomic pathways from throughout the tristate region to examine on topics. It’s truly a celebration of collaboration across life’s course, which were explored through the trajectories shaping development and and diverse perspectives.” transitions across life’s course.

20 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh Plans are currently underway for a 2020 Proposals pairing basic science research with Epigenetic Regulation of Human Memory Lifespan Conference. clinical/translational teams were strongly CD8 T cell Effector Function During Editor’s Note: CTSI is part of an NIH-funded nationwide encouraged, as were proposals involving Immune Senescence network which provides the support necessary to bridge the interprofessional collaborations between at least Hossam A. Abdelsamed, PhD gap between innovative approaches to research and effective clinical and public health practice, health policy, two different schools within the University of Research Assistant Professor and community engagement in research. Magee-Womens Research Institute is the largest research institute in the United Pittsburgh or UPMC. Department of Surgery States dedicated exclusively to women’s health research. Thomas E. Starzl Transplantation Institute 2019 Pilot Seed Grant Recipients University of Pittsburgh School of Medicine Seed Grant Program 2019: Focusing The Aging Institute awarded the following seed on Cancer and Aging grants in 2019 in support of these projects: Geographic Access to Oncology and Its Cancer is among the leading age-related diseases, Impact on Cancer-Related Health Outcomes Angiotensin II: novel pleiotropic regulator of prompting a focus by the 2019 Pilot Seed Grant Coleman Drake, PhD senescence and transformation in the lung program on Aging and Cancer. Now in its 12th year, Assistant Professor Ferruccio Galbiati, PhD the Institute’s seed grant program encourages Department of Health Policy & Management Professor and Vice Chair of Research junior faculty to collaborate in exploring new Graduate School of Public Health Department of Pharmacology & Chemical Biology areas of research in aging that have the potential University of Pittsburgh University of Pittsburgh School of Medicine for further funding from outside sources. Lindsay Sabik, PhD Characterizing age-related variations in Supported by the Aging Institute of UPMC Senior Associate Professor persistent neuropathy-related balance/gait Services and the University of Pittsburgh, this Department of Health Policy & Management changes, functional impairments, and social year’s program received additional funding from Graduate School of Public Health role disability after chemotherapy for the UPMC Hillman Cancer Center. Five grantees University of Pittsburgh gynecologic cancer were selected as this year’s winners. Grace B. Campbell, PhD, MSW, RN, CNL, CRRN Immune inhibitor receptor LILRB2 in mediating Open to junior faculty researchers across the Assistant Professor aging-induced inflammatory state and promoting spectrum of disciplines at the University of School of Nursing, Department of Acute & immune suppressive microenvironment of acute Pittsburgh and UPMC — from basic biology, Tertiary Care myeloid leukemia clinical and translational approaches, and School of Health & Rehabilitation Sciences, Binfeng Lu, PhD epidemiological, to psychosocial, health sciences, Department of Occupational Therapy Associate Professor health policy, and health services — the program University of Pittsburgh Department of Immunology sought innovative proposals demonstrating University of Pittsburgh research collaborations focusing on the intersection between cancer and aging.

aging.pitt.edu • seniorservices.upmc.com 21 Educational Initiatives in Aging Services From in-home caregivers to hospital clinicians and front-line staff, the Aging Institute continues to educate audiences on the immense physical, mental, and social challenges faced by older adults. As one of the region’s leading resources for geriatric education, the Aging Institute offers extensive educational training programs, community outreach, literature, videos, and simulations aimed at increasing awareness and improving the direct care and treatment of aging adults — today and tomorrow.

The following educational programs and initiatives will continue to engage both professional and lay audiences and will move under the heading of UPMC Senior Services. The Aging Institute at UPMC educator for the Aging Institute. “Both groups work McKeesport: Expanding Outreach on a daily basis with seniors who need assistance. Providing information, education, and support for Our goal through this outreach is to build awareness healthier, more informed lives of how the services and staff at the Resource Center can connect them to the help they need.” Providing underserved older adults — as well as their families and community members — with The Aging Institute played a key role in helping information, education, and support to help them UPMC McKeesport become the first hospital live healthier and more informed lives has been the in western Pennsylvania to receive prestigious mission of the Aging Institute at UPMC McKeesport NICHE (Nurses Improving Care for Healthsystem Resource Center since it first opened in 2014 with Elders) designation in 2012. “Today, we remain residents have great needs and there are many the support of the McKeesport Hospital Foundation. committed to supporting the educational needs opportunities to provide both clinical and social of the staff,” says Ms. Jones. Its regular program The Resource Center features a robust program service supports.. Having the on-site Aging offerings include: staffed by trained health care professionals and Institute Resource Center provides an invaluable central hub for us to help these individuals right includes community outreach, a community-based • Quarterly geriatric training opportunities for here at the hospital. And we also have access help and referral line, educational programs, and nurses, patient care technicians, and nursing to the Aging Institute’s broader expertise and lifestyle programs to encourage healthy living. assistants through the Institute’s Geriatric educational and training resources.” Resource Nurse and Geriatric Nursing Assistant/ “In 2019, we continued to focus our energy on Patient Care Technician programs. Programs in increasing our connections and partnerships with For example, in 2019, the Resource Center began 2019 were attended by nearly 70 staff members. both primary care providers (PCPs) and members offering a monthlyCaregiver Support Group of the faith-based community in McKeesport,” • Ageless Wisdom, the Institute’s geriatric meeting to help caregivers cope with challenges says Melissa Jones, MSN, RN, geriatric nurse sensitivity program, has been integrated in the they face. “It’s an opportunity for these individuals orientation curriculum for all new employees, to share their insights, struggles, and ideas in a from housekeeping to senior administrators. safe and understanding space,” says Ronnie Edwards, MSW, LSW, aging and disability Tracy Petras, manager of community outreach at coordinator for the Aging Institute, who serves UPMC McKeesport, praises the Aging Institute for as one of the facilitators for the on-site support its vital role with older residents in the community. group. “Many of our current members are caring “The association between UPMC McKeesport for spouses with dementia or Alzheimer’s and the Aging Institute is very important to us,” disease, so part of what we do is educate says Ms. Petras. This is a community whose older participants on the disease process — why

24 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh we let people know they’re not alone – and that others care and want to help them.”

Helping seniors lead healthier lives through diet and exercise is the goal of UPMC McKeesport’s MOVE UP, The Mobility and Vitality Lifestyle Program. “Weight reduction can have many positive effects on health, particularly on both mobility and chronic conditions such as high blood pressure and diabetes.” says Holly Sloan, their family members act like they do, how to MS, lead volunteer coordinator for the Aging healthy eating habits, behavior modification, and help — and what to possibly expect in the future.” Institute Resource Center at UPMC McKeesport self-directed, moderate-intensity physical activity and instructor for the hospital’s MOVE UP program. such as walking. “Our MOVE UP studies have been In 2019, the Institute moved from monthly to very well received,” says Ms. Sloan. “So many twice-a-month workshops and community Last year, UPMC McKeesport became the first study participants want to continue to meet after events at the Aging Institute Resource Center, hospital-based site of MOVE UP — an ongoing the study portion of the program ends that we covering a wide range of topics presented by national community-based lifestyle research offered them the opportunity to do so at the established guest experts — from advance study led locally by the University of Pittsburgh’s Resource Center.” directives and elder law to financial planning and Prevention Research Center at the Center for Aging senior nutrition. “We often look at the questions and Population Health under the direction of Anne The Resource Center has also served as a site we get on the Aging Institute’s Call and Referral B. Newman, MD, MPH, clinical director of the Aging for the Matter of Balance program, a national Line for topic suggestions,” says Ms. Edwards. Institute. Not a weight loss program, MOVE UP evidence-based falls management program for “Elder law is a great example. Attendance at targets both mobility and weight loss through older adults. The free program meets for eight that Resource Center event was one of our most weeks; its two-hour-long classes focus on reducing well attended programs in 2019.” the fear of falling and increasing activity levels among community-dwelling older adults, with In her role as community social service coordinator the goal of breaking the cycle of repeated falls of the UPMC McKeesport Aging Institute, Ashlee frequently seen after a first accident. Stone fields a wide range of calls for the Resource Center’s help and referral line. “We’ve helped “It’s our hope that the model we’re building people connect to a variety of services — from to serve older adults with the Aging Institute health care to home repair and home modifications Resource Center at UPMC McKeesport is one that like ramps and handrails,” she says. “Most of all, we can share with other UPMC facilities,” adds

aging.pitt.edu • seniorservices.upmc.com 25 Ms. Jones. “Working together, we have the “We’ve relied heavily on their insights and staff member will play a role in providing potential to make a real difference for older experience, helping us identify areas of opportunity, excellence in geriatric care to our patients,” adults in the community.” establish milestones, build awareness, and provide says Ms. McKibben. Toward that end, in 2019 specific staff training on how we can better serve the following relationships and recognitions Pursuing Excellence in Geriatrics our older adult patients.” were secured with key organizations that UPMC Mercy is partnering with the Aging promote innovative geriatric care, including: For example, in May 2019 the Aging Institute hosted Institute on its path to becoming a hospital-level a program for more than 30 nurses, patient care • Designation as a “National Center of Excellence geriatric center technicians, and nursing assistants on topics such in Geriatric Medicine” by the John A. Hartford The Aging Institute has long been committed as dementia, recognizing and managing delirium, Foundation, a driving force nationwide in to ensuring that older adults receive quality, and medication management for older adults. supporting hospitals and health systems age-appropriate care. This past year, the Institute in improving their care for older adults. had the opportunity to join with UPMC Mercy It could be said that UPMC Mercy has been • Recognition as a NICHE (Nurses Improving to raise that commitment to a new level as the preparing for years for this new role, traditionally Care for Healthsystem Elders) membership hospital works to achieve designation as a serving a significantly older population. It holds program partner, a nurse-driven program to Geriatric Center of Excellence. Once achieved, prestigious designation as a Comprehensive help hospitals improve the care of older adults. UPMC Mercy will be the first hospital-level Stroke Center and is the hub of the renowned geriatric center in the UPMC system. UPMC Rehabilitation Institute. UPMC Mercy’s • Achievement of Bronze Level 3 Geriatric ability to offer a “one-stop” continuum of care is Emergency Department Accreditation by the especially important in treating more complex American College of Emergency Physicians, conditions in older adults — and the new UPMC which focuses on integrating best practices for Vision and Rehabilitation Tower currently under older adults into the emergency department. construction only adds to that potential. Additionally, members of the UPMC Mercy “Identifying ways to improve the quality of care Pharmacy are currently pursuing Board Certified for older adults is a perfect example of UPMC Geriatric Pharmacist (BCGP) designation, the Mercy’s mission as the only Catholic hospital in credential for individual pharmacists who meet the area — to serve the frailest and neediest in our the criteria for providing pharmaceutical care to community,” says Ms. McKibben. “Throughout the the elderly. “The executive leadership and staff of the Aging hospital, there is incredible energy and enthusiasm “With the Aging Institute’s help, we’re working to Institute have been invaluable partners with us about this initiative, at every level of care.” create a new model of geriatric care for the entire on this journey,” says Leeanna McKibben, MSN, Geriatric care requires a multidisciplinary approach. UPMC system,” says Ms. McKibben. , chief nursing officer and vice president RN, CENP “Every clinician, nurse, technician, and support of patient care services.

26 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh 2019 Aging Institute Scholarship Winners Each year, the Aging Institute awards $2,500 scholarships to UPMC employees seeking to advance their professional credentials in geriatrics. The scholarship helps to support their pursuit of the Graduate Gerontology Certificate at the University of Pittsburgh, led by the University of Pittsburgh Center for Social and Urban Research and the College of General Studies. Students can choose from online or on-campus course delivery options.

As evidenced by this year’s scholarship recipients, participants in the program represent a wide range of career paths — but they are united by a common commitment to providing better care and support for older adults.

Abigail Steele, PharmD As a clinical pharmacist at UPMC Mercy for the Heather Miller Clinical Pharmacist past four years, Abigail Steele has worked with Community Relations Coordinator UPMC Mercy medical teams caring for patients recovering from UPMC for Life-Northwest Pennsylvania brain and spinal cord injuries, stroke, and other serious injuries requiring inpatient rehabilitation. Many of those patients have been older adults. “I have experienced first-hand how much age can affect patients in this setting,” she says.

That daily interaction with geriatric patients inspired her to apply for the Aging Institute’s scholarship — especially now that UPMC Mercy is becoming a UPMC Center of Excellence in “I hope to take an active role in optimizing “I’m passionate about my work with older Geriatrics, caring for more geriatric orthopaedic patient care and medication safety as UPMC adults. I plan to use this knowledge to expand trauma and geriatric stroke patients. “Geriatric Mercy works to become a UPMC Center of health and wellness services for seniors in patients need specialized pharmaceutical care,” Excellence in Geriatrics.” northwestern Pennsylvania.” says Dr. Steele. “I want to increase my knowledge so I can better serve older patients.” Heather Miller wears many hats. As a community relations coordinator with UPMC for Life, she

aging.pitt.edu • seniorservices.upmc.com 27 helps to educate insurance plan members on “Gerontology is a field that has always interested Vanessa Talley their benefits and promotes health screenings, me. This program is helping me to improve my Oncology Social Worker UPMC Magee-Womens Hospital disease prevention, and healthy living. She skills so I can address the unique needs of our has also been trained in the Powerful Tools for growing population of older adults.” Caregivers programming and serves as a class At UPMC McKeesport, Bethany Rajaratnam is leader and certified master instructor. viewed as a champion for older adults. She is the In addition, she serves as coordinator of National primary speech pathologist on the Transition Care Senior Health and Fitness Day, working with Unit and Rehabilitation floors where she plays an older adults to promote lifelong exercise and integral role in educating staff on geriatric-focused wellness. And, she works with local community care — a key element of the hospital’s NICHE organizations to tackle Alzheimer’s and mental (Nurses Improving Care for Healthsystem Elders) health issues facing the region’s aging seniors. initiative. She created a handout on oral care for seniors and a Power Point presentation on “My goal has always been to work with older Her colleagues describe her as a “natural” in her dysphagia and safe swallowing. adults. This program is giving me a second chance work with older adults. “I’m excited,” says Ms. to learn more about gerontology so I can realize Miller. “With this graduate certificate, I’ll be able to Mrs. Rajaratnam also serves on a committee my dream of working with geriatric patients.” do more to help with the mental health, physical tasked with training staff across the UPMC Health When Vanessa Talley began pursuing a degree health, and overall well-being of our seniors.” System on “Swallowing Safety and Feeding in social work, she had two special interests: Patients with Visual, Cognitive, and Physical Bethany Rajaratnam Challenges.” As a speech language pathologist, gerontology and child welfare. At the University of Speech-Language Pathologist Pittsburgh, where she was accepted into the child UPMC McKeesport she works closely with older adult patients to welfare program, she went on to earn both her help them return home and live independently. bachelor’s and master’s degrees in social work. “Earning a graduate certificate in gerontology She then began her career as a social worker, will help me identify and address disparities and working with clients at the Allegheny County risks in aging adults,” says Mrs. Rajaratnam. Jail and UPMC Western Psychiatric Hospital.

28 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh She is now an oncology social worker at UPMC week summer program that draws 100 gifted partnership as an important investment — a way Magee-Womens Hospital, where she works high school students from across the nation to to introduce students to the wide range of career with women ages 60 and older who have been the Pitt campus. options available in geriatrics,” she adds. diagnosed with cancer. “By pursuing a graduate “Students selected to participate in the geriatric Rising high school juniors and seniors in the certificate in gerontology, I’m expanding my concentration work with some of the leading academy participate in a rigorous schedule of knowledge so I can help older patients who innovators in the field. They also learn about classes, group discussions, and team projects. are facing cancer live a full life,” says Ms. Talley. the latest research and advancements in aging,” This year’s geriatric course included topics such Wanted: Geriatric Specialists for an notes Karen D. Narkevic, program director for as Healthy Brain Aging and Exercise, Remote Aging Tomorrow the academy. Volunteer faculty for this year’s Monitoring by Telemedicine, the Biology of Aging, Introducing high school students to careers program included administrators and board and Careers in Pharmacy. “The presenters are all in gerontology members of the Aging Institute, practicing practicing professionals, bringing real world health care professionals from the University experience to the classroom,” adds Ms. Narkevic. Every day, 10,000 Americans turn age 65. Not of Pittsburgh’s Division of Geriatric Medicine, and only is our population growing older — by 2020, Site visits to local senior communities and guest speakers from community organizations 55 million of us will be age 65 and older — we’re organizations also allowed students to connect focused on aging. “The Institute sees this also living longer. That increase translates into an one-on-one with older adults, giving these young growing need for more health care professionals people time to talk and listen to their stories and in fields like medicine, nursing, rehabilitation understand their circumstances, and crystallized therapy, and mental health who are highly tuned how theory applies to actual patients, families, to the needs of older adults. and caregivers.

That’s why the Aging Institute is committed to spearheading the geriatric concentration course of the University of Pittsburgh’s Health Career Scholars Academy, an ambitious four-

aging.pitt.edu • seniorservices.upmc.com 29 Too often, seniors and their caregivers struggle alone, isolated by the stress of the challenges they face and unaware of the resources available to them. Engaging with the community and sharing knowledge and resources — showing them they are not alone — is a key objective of the Aging Institute. Through our outreach, we are building awareness and empowering older adults, families, and caregivers through informed decision making and access to needed support.

The following programs are moving under the heading of UPMC Senior Services and will continue creating essential connections for members of the community. Connecting to the Community The Aging Institute Help and connect them to the right resources available in • Has a barrier(s) to self-management of care Referral Line the community to help.” or needs Delivering answers, advice, and a listening ear to Ms. Edwards, a licensed social worker, staffs the • Has a hidden need identified during the older adults and their families call line with her colleague, Melissa Jones, MSN, initial call For older adults and their caregivers, the Aging RN, a geriatric nurse educator. “We’re a great “It’s a streamlined system that helps us to Institute’s Help and Referral Line can be a lifeline team,” says Ms. Edwards. “We bring different better recognize complex cases and defines of support and a vital link to community resources. skills and perspectives that help us to fully how we should follow up with those callers,” assess and address a caller’s situation.” says Ms. Edwards. “Many people call us when they don’t know where to go for help — and increasingly, people The Help and Referral Line has evolved over Good Things Start With a Phone Call are calling us back because they know we can the years, says Ms. Edwards. More than one Connecting to the Resources of the Aging Institute get them the answers they need,” says Ronnie in 10 callers is a return caller – someone who Edwards, MSW, LSW, the Institute’s aging and called previously. “This tells us that they got the Joni Oliver is a natural-born caregiver. She disability coordinator. “The call line has become information they needed and feel comfortable remembers running errands and helping to clean a valuable resource on aging issues for the entire calling again for help,” she says. the home of elderly neighbors as a child. “I’ve community. We work hard to be a one-stop source always loved feeling useful,” she says. In 2019, pathways and protocols were established for information ranging from finding a doctor to to provide better follow-up for callers in need. An education major in college, Ms. Oliver moving to a senior care facility. We don’t always Designed to trigger a more proactive response, embarked on a teaching career at several area have the answers — but we can help get them.” the new system creates a process for handling schools until cutbacks prompted her to earn a The service is free and available to anyone, cases flagged as “difficult.” regardless of location, level of need, or insurance Those identified as difficult cases fall into six affiliation. While the majority of calls come categories of callers: from older adults and their families, health care providers, social workers, and case managers also • Has a poor understanding of initial resource call call in for information and assistance. “As more • Lacks a social network adults choose to age in place, there is a growing need for in-home services, transportation, and • Is a long-distance family member or caregiver caregiver support,” says Ms. Edwards. “We • Has multiple resource needs

32 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh gerontology certificate at a community college. covered topics from rehabilitation to wellness, 30 years ago with grants provided by The “I started working in senior care and that opened and even stress reduction for caregivers.” Pew Charitable Trust and the Commonwealth a new world for me,” Ms. Oliver says. “As an of Pennsylvania. Ms. Oliver also values the community connections activities director, I put many of my teaching that she’s made through the Aging Institute. “We were definitely ahead of the times back skills to good work.” “Ronnie has been very helpful in linking me to then, and we try to continue that tradition of Today, the 62-year-old Pittsburgh resident other support resources. She has fingertip access innovation,” says Missy Sovak, MSW, LCSW, focuses her skills as a full-time caregiver for to what’s available in the region — and beyond,” director of LAH. “Our new role with the Aging her brother-in-law, who has cerebral palsy. she says. “She was even able to help me assist Institute has been a great fit because we share Through Pennsylvania’s Aging Waiver program, my mother in Florida, who has a hearing loss.” a common goal and a common commitment he’s able to stay at home with Ms. Oliver and to supporting older adults. It’s allowing for Her advice to other caregivers? “Do the best her husband instead of living in a skilled nursing greater sharing of resources and creating new you can with an open heart,” she says. “I found facility. Ms. Oliver’s gerontology credentials — opportunities to better serve our clients through I have to create a schedule and stick with it. coupled with training through Pennsylvania’s those resources.” And recognize that you can’t do it alone. Be Department of Aging — qualified her as a home open to getting help — not just from neighbors The program serves nearly 450 clients ranging caregiver, but she is also required to pursue and friends, but also from community resources from their 70s to more than 100 years of age. continuing education in that role. It’s something like the Aging Institute.” The average age is 84, and most are women she welcomes doing. living alone. “I love our mission of keeping older In summer 2017, Ms. Oliver reached out to the There’s No Place Like Home: adults in their homes for as long as they are able,” Aging Institute’s Help and Referral Line looking Helping seniors stay home longer says Ms. Sovak. “Our focus is to connect them for caregiver resources and educational For reasons both economic and emotional, older with the care and services they need to thrive.” opportunities. At the suggestion of Ronnie adults are increasingly opting to stay in their own Clients must be at least 70 years old, meet Edwards, MSW, LSW, the Institute’s aging and homes for as long as possible as they age. That income guidelines, and live in one of nearly two disability coordinator, she began attending choice can come with challenges. dozen Pittsburgh neighborhoods. After assessing monthly educational programs offered by an approved client’s needs and talking with the Aging Institute at UPMC McKeesport. “The The UPMC Living-at-Home (LAH) program — has their friends, family, and health care providers, a classes I’ve taken over the past 18 months have an admirable track record in helping seniors who registered nurse and social worker develop a care been extremely useful,” she says. “They’ve want to age in place. LAH was founded nearly

aging.pitt.edu • seniorservices.upmc.com 33 plan. The program also links older adults with Home (LAH) program when she decided to volunteers who can perform a range of services, apply for a graduate Gerontology Certificate such as grocery shopping, housekeeping, yard Scholarship from the Aging Institute. She was work, running errands, and reading mail. “If one of two recipients of the inaugural scholarship someone can’t manage their own medicines, awarded in 2011. our nurses can prefill pill boxes and insulin “It opened up my world,” says Sandy. “The program syringes as ordered by the client’s doctor,” Resource gave me new insights into the challenges older explains Ms. Sovak. They also can take care adults face. I understood things in a new way.” Networking of doctors’ requests for actions like a monthly A way to exchange ideas and blood pressure check or B12 injections. Her position took her to dozens of different resources to support seniors venues each week — individual patient homes, For an older person living alone, it can be senior centers, and retirement communities — in our community intimidating to invite strangers into their homes, where she conducted geriatric assessments notes Ms. Sovak. She’s proud to say that the On May 14, staff from the Living-at-Home and screenings, and helped to connect her LAH LAH care team is remarkably stable, with most program and the University of Pittsburgh clients with other community and home services members tallying between seven to 28 years of co-hosted an educational event for health they might need. experience with the program. “We work to build a care professionals focused on aging good relationship with each client,” she adds. “They and technology. Presentations included She particularly enjoyed her outreach work at trust us to make appropriate referrals for their care the latest advancement in low vision independent living facilities at UPMC Senior — and we take that responsibility very seriously.” technology, complex prescription Communities. There she conducted a recurring management, and sending reminders “Ask the Nurse” event where residents could ask From First Class to Retirement: through a person’s home television. Sandy Gilmore Says Goodbye More than 60 professionals from hospice, In June, lead geriatric nurse Sandy Gilmore, RN, life and health insurance, and home retired after nearly 20 years spent working health services — including caregiver with older adults. She was in the Aging representatives — attended the event. Institute’s first class of Gerontology Certificate Scholarship recipients.

Ms. Gilmore was already working as a community geriatric outreach nurse for UPMC’s Living-at-

34 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh her about any health-related matter. “My main 3) Volunteer — It’s a great way to connect to role was to educate and give residents person- what’s happening in the world around you. to-person time to talk about their health People benefit from and need the experiences concerns. I was especially vigilant about them and ideas seniors have. It helps ward off getting flu shots — that was a priority for me,” depression and isolation, which are both says Ms. Gilmore. connected to declining mental and physical health. In June 2019, she retired after 37 years as a nurse, including 19 years with the LAH program. “As a Living-at-Home nurse, I tried to intervene when I saw people pulling back or not engaging. “It’s been 19 wonderful and rewarding years. I will I encouraged them to seek help — or at least to collaborating with the Aging Institute to deliver deeply miss my daily interactions with clients. I’ve see me,” says Ms. Gilmore. practical, concrete training to these frontline learned so much from them about life, love, and clinicians and their staff — and connecting them living. They are such an inspiring and loving Geriatric Training Support for to valuable community resources. group,” she says. the Frontline of Care Launched in 2015 by the U.S. Department of “As our population ages, gerontology is a Primary care practices and their staff are the Health and Human Services, GWEP is a $38.7 wonderful career that’s increasingly in demand. focus of a novel Geriatric Workforce Enhancement million program focused on the development Seniors want to stay at home and age in place — Program and Aging Institute initiative. of a health care workforce that is prepared to don’t we all share that dream?” Older adults typically see their primary care deliver high-quality, age-appropriate care Ms. Gilmore offers these lessons she learned during provider (PCP) multiple times a year for medical for older adults. The University of Pittsburgh her nearly two decades of working with seniors: care — but few of these frontline doctors and is one of 44 sites nationwide that received staff have the geriatric training to recognize and GWEP funding through the first funding cycle. 1) Take care of yourself — physically and mentally. manage mental health issues and cognitive decline. I see seniors who have done a great job in one According to Dr. Whyte, PCPs provide the area but not the other. Both are key to living That lack of training has long concerned Ellen M. majority of care for patients’ mental health well as you age — but you need to start young. Whyte, MD, a board-certified geriatric psychiatrist issues like late-life depression, anxiety, and and assistant professor of psychiatry at the cognitive decline. They also face the need 2) Stay connected to your family and friends. Old University of Pittsburgh School of Medicine. to connect these patients and their families age is not a time to be alone; it’s a time to Through the Geriatric Workforce Enhancement to essential social services. share and be with others. Program (GWEP), Dr. Whyte and her team are

aging.pitt.edu • seniorservices.upmc.com 35 “The reality is that busy medical practices don’t practices — involving both clinicians and staff. and these billing codes allow for appropriate have the depth of resources to meet these needs “We feel strongly that every member of office compensation for PCPs for that investment of as well as they’d like. Partnering with the Aging needs to know what to look for,” says Dr. Whyte. time and resources.” Institute on this project made great sense: its “The medical assistant taking vitals or the front The Aging Institute has helped with one of the Help and Referral Line is a terrific resource for office person working on scheduling might be requirements for the higher CMS reimbursement PCPs to help their patients and families,” says the one person that a patient really connects — namely the education of older patients and Dr. Whyte. “We also have involved the Aging with and who can get them talking about their caregivers. “Most of these practices do not Institute to help in our training sessions and their depression.” have social work support on-site; the Aging educational materials.” Caring for older adults can be time consuming, Institute’s Help and Referral Line is the ideal The need is great. There are less than 2,000 often with limited financial reimbursement. resource to connect patients to those services,” board-certified geriatric psychiatrists in the As part of her GWEP programming, Dr. Whyte she adds. United States, far too few to deal with our also educates interested practices about CMS Primary care practices have been eager to nation’s growing population of older adults. incentives for PCPs that provide high-quality learn, she says. “They want to know more about behavioral health care to older patients and “We know that patients want to get all of their identifying and managing cognitive impairment, patients with cognitive impairment. Her team health care, addressing medical as well as mental and treatment options for late life depression and is now working to train staff in the necessary health concerns, from their PCP — that’s where anxiety because they face these issues with their requirements and documentation needed for they are most comfortable,” she says. “Many of patients day in and day out,” says Dr. Whyte. reimbursements for CMS cognitive assessment the practices we contacted are eager for this kind and care planning codes. of education. They want to help in caring for the mental and cognitive health needs of their older “We’ve built templates, created notes, and patients because they see the need.” organized assessments so that these practices can take on this added role with greater Through the Geriatric Workforce Enhancement confidence,” says Dr. Whyte. “It’s the kind Program (GWEP), monthly presentations of care that’s greatly needed by older adults — and training sessions are offered to individual

36 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh

The Celebrating Senior Champions Dinner and Auction, held on October 16, 2019, marked its 11th year of recognizing distinguished individuals for their outstanding accomplishments and focus in creating a better life for seniors. Through research, education, community outreach, and business leadership the 2019 Champions have improved the quality of life for older adults. Since its inception in 2009, this event has presented more than $1.5 million in net proceeds to further charitable care throughout UPMC Senior Communities.

38 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh This year, two Grand Champions were recognized The Community Champion recipient for 2019 was This year’s Caregiver recipient is Ralph T. for their scientific work and accomplishments: the Greater Pittsburgh Community Food Bank DeStefano. Mr. DeStefano retired in 1999 William E. Klunk, MD, PhD and Chester A. Mathis, under the leadership of Lisa Scales, President following a very successful career in labor law PhD, Distinguished Professors. Dr. Klunk is a and CEO. Through advocacy efforts, Greater practice and health care, much of which was Distinguished Professor of Psychiatry and Pittsburgh Community Food Bank has become spent expanding the UPMC Passavant campus. Neurology and Co-Director of the Alzheimer a primary driver in comprehensive anti-hunger He has been a very influential force, particularly Disease Research Center at the University of endeavors regionally, statewide, and at the in the Northern region of Pittsburgh, for many Pittsburgh and past Chair of the Medical and national level. decades and is truly an ambassador to the Scientific Advisory Council of the National UPMC Passavant campus. Seniors who are food insecure are more likely Alzheimer’s Association. Dr. Mathis is a to have health concerns and with anticipated Ralph was instrumental in supporting the evolution Distinguished Professor of Radiology at the growth in the senior population, the organization of Cumberland Woods Village independent living University of Pittsburgh, Director of the University is dedicated to ensuring that no senior need campus, with primary focus on the adjoining of Pittsburgh Positron Emission Tomography (PET) choose between buying food or medicine. conference center and performance theatre, Facility, and UPMC Endowed Chair of PET Research. Annually 1.6 million meals are provided to seniors. that now serves as an important social outlet for For their joint efforts, the two colleagues share thousands of seniors coming from many areas the 2004 MetLife Foundation Award, the 2008 of Pittsburgh. He has taken a personal interest Potamkin Prize and the 2009 Ronald and Nancy in the lives of the many seniors whom he has Reagan Research Institute Awards for research helped guide and has contributed greatly to the in Alzheimer’s disease. reputation, growth, and community awareness of the entire UPMC Passavant campus.

aging.pitt.edu • seniorservices.upmc.com 39 Research Publication Highlights

A recognized pioneer in the field of geriatrics, the University of Pittsburgh continues its leadership role as one the nation’s foremost institutions of higher education conducting research focused on improving the care and quality of life of older adults. The scope, depth, and continuity of work conducted collaboratively by our University partners — experts in disciplines as diverse as medicine, public health, nursing, social science, psychiatry, epidemiology, and ethics — positions our region as an epicenter of aging-related research and innovation.

Select Funding Mechanisms of FY18 Aging-Related Federally Sponsored Research at the University of Pittsburgh Million

P01 P2C P30 P50 R01 R21 R37 R56 RF1 T32 U01 U54 UFI

Select Sources of FY18 Aging-Related Federally Sponsored Research at the University of Pittsburgh

FY16 FY18 Million

NCI NEI NHLBI NIA NIAID NIAMS NICHD NIDDK NIEHS NIGMS NIMH NINDS Centers of Excellence Center for Late-Life and Anxiety in Older for PT (47.5%) compared pain. The purpose of this Mathis CA, Lopresti BJ, Alzheimer’s Disease Depression Adults with Knee to CBT (20.5%). Non- study was to describe pain Kamboh MI, Cohen AD, Research Center Prevention and Osteoarthritis: Results of responders re-randomized and mood response to Snitz BE, Klunk WE, (ADRC) Treatment (CLLDPT) a Sequenced Multiple to an increased dose of venlafaxine among older Aizenstein HJ. Amyloid Director: Oscar Lopez, Director: Assignment Randomized the same intervention adults with chronic low Deposition Is Associated MD; Co-Director: William Jordan F. Karp, MD Trial (SMART) Study. experienced a response back pain (CLBP) and with Different Patterns E. Klunk, MD, PhD The CLLDPT provides a American Journal of rate of 73%, higher than depression relative to of Hippocampal The ADRC performs and research infrastructure to Geriatric Psychiatry. In for switching. These opioid exposure. Opioid Connectivity in promotes research promote and support Press. 2019 Oct; 27(10): results suggest it may exposure was analyzed as Men versus Women. designed to gain an investigations that will 1035-1045. PMCID be dose and not type of prescribed (yes or no) and Neurobiology of Aging. understanding of the improve real world PMC6739151. these interventions that by morphine equivalent 2019; 76: 141-150. [PMID: etiology and pathogenesis practice in the care of is necessary for clinical dosing (MED). Patients 30711677; NIHMS of Alzheimer’s disease Finding: Older adults older adults living with benefit. This finding co-prescribed an opioid 1515576]. (AD) and the mechanisms with knee osteoarthritis depression and other may guide providers to were less likely to report a underlying the cognitive and comorbid Finding: The effects severe mood and anxiety stay the clinical course pain response to and neurobiological subsyndromal of brain amyloid on disorders. It focuses on for up to 12 weeks before venlafaxine. MED was changes. It also develops depressive symptoms functional connectivity developing and testing switching. negatively correlated with strategies targeted at are at elevated risk in preclinical AD differ novel medication, pain response. Depression effective early diagnoses for incidental major Stahl S, Jung C, Weiner by sex. In men but not psychosocial, and response was not and treatments for AD and depression or anxiety DK, Peciña M, Karp JF. women, greater amyloid behavioral interventions impacted. These findings other dementias. The disorders. The aims of Opioid Exposure burden was associated to improve mood and suggest that clinicians publications of the ADRC this intervention– Negatively Affects with greater cognitive outcomes and may wish to consider highlight a focus on development SMART Antidepressant Response hippocampal- reduce the disability either nonopioid or imaging biomarkers, trial were to evaluate to Venlafaxine in Older prefrontal connectivity. associated with late-life alternative antidepressant neuropsychiatric the clinical effect of Adults with Chronic Low Characterizing sex depression. approaches to pain characterization including cognitive behavioral Back Pain and Depression. differences in responses management in these the provision of high Karp JF, Zhang J, Wahed therapy (CBT) and Pain Medicine. E-pub, for AD-related complex patients. It is quality, behaviorally AS, Anderson S, Dew physical therapy ahead of print. pathologies, as in reassuring that opioids characterized samples for MA, Fitzgerald K, Weiner (PT), as well as the the present study, Finding: Serotonin do not prevent genetic and postmortem DK, Albert S, Gildengers order of effects of can help guide the norepinephrine reuptake depression response. studies, and early A, Butters M, Reynolds the interventions, on development of sex- inhibitors (SNRIs) are stage disease. CF. Improving Patient patient–reported Wu M, Thurston RC, specific prevention and commonly co-prescribed Reported Outcomes and outcomes. Stage 1 Tudorascu DL, Karim HT, treatment strategies. Wang L, Ying J, Fan P, with opioids for chronic Preventing Depression response was higher DeMichele-Sweet MA,

42 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh Weamer EA, Lopez OL, provide a biomarker and Aβ1-42/Aβ1-40 ratio American Journal of or reflect another keeping older adults Kofler JK, Sweet RA. The signature to identify compared with those Geriatric Psychiatry. 2018 underlying process that healthy. Effects of Vitamin D use a subpopulation of who did not. Aβ1 levels Sep; 26(9): 977-984. results in both higher CA Marron MM, Harris TB, on outcomes of patients who can did not predict dementia [PMCID: PMC6482956]. and lower AD Boudreau RM, Clish CB, psychotic symptoms in benefit from vitamin D in mild cognitive pathophysiology. Finding: This study Moore SC, Murphy RA, Alzheimer’s disease treatment. impairment participants. investigated the Murthy VL, Sanders JL, patients. The American We concluded that there Center for Aging and Lopez OL, Chang YF, Ives relationship between Shah RV, Tseng GC, Journal of Geriatric was an inverse Population Health DG, Snitz BE, Fitzpatrick cognitive activity (CA), Director: Anne B. Wendell SG, Zmuda JM, Psychiatry. 2019 Sept; association between AL, Carlson MC, Rapp S, and Aβ deposition and Newman, MD, MPH Newman AB. Metabolites 27(9): 908-917. [PMCID: Aβ1-42 and Aβ1-42/ Williamson JD, Tracy RP, glucose metabolism in The Center for Aging and Associated with Vigor PMC6693492]. Aβ1-40 ratio to risk DeKosky ST, Kuller LH. 199 cognitively normal Population Health to Frailty Among of dementia in CN Finding: Vitamin D was Blood Amyloid Levels participants. All (formerly the Center for Community-Dwelling participants. Cerebral associated with delayed and Risk of Dementia in participants underwent Healthy Aging) generates Older Black Men. and cardiovascular onset of psychotic the Ginkgo Evaluation of Pittsburgh Compound-B new solutions to the Metabolites. 2019 disease and renal symptoms in patients Memory Study (GEMS): (PiB) and [18F] challenges of an Apr 30; 9(5). pii: function are important with AD. Its mechanisms A Longitudinal Analysis. fluorodeoxyglucose- aging society through E83. doi: 10.3390/ determinants of of action provide a novel Alzheimers & Dementia. positron emission population-based research metabo9050083. increased Aβ levels direction for 2019 Aug; 15(8): tomography and that promotes healthy [PMID: 31052232]. and must be considered development of drugs to 1029-1038. doi: 10.1016/j. completed a aging, longevity, and in evaluations of Finding: This project prevent or treat jalz.2019.04.008. questionnaire designed prevention of disability. relationship of plasma found that certain small psychosis in AD. In to measure current CA. Supported in part by Finding: Increased Aβ and subsequent risk molecules including addition, AD and/or Linear regression models the Centers for Disease plasma Aβ1-40 and of dementia. some lipids and amino psychosis-related genes revealed a significant Control and Prevention’s Aβ1-42 levels were acids were characteristic were enriched in the list Lyons CE, Tudorascu D, negative relationship (CDC) Prevention associated with gender of older men who were of genes most perturbed Snitz BE, Price J, between PiB retention Research Centers (women), age, low vigorous vs. frail and by vitamin D, specifically Aizenstein H, Lopez OL, and CA and a significant Program, the Center education, creatinine could help in uncovering genes involved in the Lopresti B, Laymon C, positive relationship orchestrates epidemiologic levels, history of stroke, the biologic state of regulation of calcium Minhas D, Mathis C, between glucose and public health and hypertension. healthy aging vs. frailty. signaling downstream of Klunk W, Cohen AD. The metabolism and CA. research on aging, trains Cognitively normal (CN) the vitamin D receptor relationship of current These data suggest that professionals in population Cawthon PM, Travison participants who suggesting that genetic cognitive activity to CA may have a direct research methodology, TG, Manini TM, Patel S, developed dementia had variations in vitamin brain amyloid burden beneficial effect on the and conducts community Pencina KM, Fielding RA, lower levels of Aβ1-42 D-regulated genes may and glucose metabolism. pathophysiology of AD outreach with a goal of

aging.pitt.edu • seniorservices.upmc.com 43 44 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh Magaziner JM, Newman Finding: This project is to test whether we Damluji A, Forman DE et care units. JAMA Internal doi: 10.1001/ AB, Brown T, Kiel DP, reevaluating cut-points can lower chronic al. Older adults in the Medicine. 2019; 179: jamainternmed.2019. Cummings SR, Shardel M, for sarcopenia, using inflammation in older cardiac ICU: Factoring 676-684. 2005. Guralnik J, Woodhouse data from the Health adults and will set the geriatric syndromes in Finding: In a quarter of Finding: The risk of LJ, Pahor M, Binder E, Aging and Body stage for future the management, cases, both clinicians adverse events has been D’Agostino RB, Xue QL, Composition Study interventions. prognosis, and process and families ignored the well-described in both Orwoll E, Landi F, Orwig conducted here at Pitt. of care. A Scientific Division of values and preferences the hospital and nursing D, Schaap L, Latham N Statement from the Pahor M, Anton SD, Geriatric Medicine of incapacitated ICU home, but there are few NK, Hirani V, Kwok T, American Heart Beavers DP, Cauley JA, Director: Neil M. patients during family data regarding adverse Pereira S, Rooks D, Association. Circulation. Fielding RA, Kritchevsky Resnick, MD conferences about events during the Kashiwa M, Torres- 2019; 140. SB, Leeuwenburgh C, Designated a National goals of care. Moreover, transition of hospitalized Gonzalez M, Menetski JP, Lewis KH, Liu CK, Lovato Center of Excellence by Finding: With age, when they did try to patients back to the Correa-De-Araujo R, LC, Lu J, Manini TM, the John A. Hartford cardiovascular disease attend to such issues, nursing home. This study Bhasin S, and Sarcopenia McDermott MM, Miller Foundation, the University is much more likely to the conversations revealed an incidence of Definition and Outcomes ME, Newman AB, of Pittsburgh’s Division of be superimposed on typically lacked robust nearly 40%, and the Consortium Conference Radziszewska B, Stowe Geriatric Medicine is other comorbidity, deliberation about key majority were participants. Establishing CL, Tracy RP, Walkup MP, committed to excellence in polypharmacy, and end-of-life values like preventable. the Link Between Lean Wu SS, Ambrosius WT; geriatric research, clinical age-related decline in physical, cognitive, and Mass and Grip Strength Tyagi SH, Perera S, ENRGISE study care, and training. Its physiologic capacity psychosocial function, Cut-points With Mobility Clarkson BD, Tadic SD, investigators. Effect of research includes the of nearly all organ as well as spirituality. Disability and Other Resnick NM. Nocturnal losartan and fish oil on biology of aging, cancer, systems. This overlap has Interventions are needed Health Outcomes: excretion in healthy plasma IL-6 and mobility dementia, depression, falls, important implications to improve patient- Proceedings of the older women and in older persons. The frailty, heart disease, for the approach to and centered, shared Sarcopenia Definition rationale for a safer ENRGISE Pilot incontinence, infections, management of patients decision-making for and Outcomes approach to sleep randomized clinical trial. mobility, osteoporosis, admitted to the cardiac critically ill patients near Consortium Conference. disruption. Journal of the Journals of Gerontology pain, pharmacotherapy, ICU, and these are the end of life. Journals of Gerontology American Geriatrics Series A: Biomedical resilience, and sarcopenia. extensively reviewed in Series A: Biomedical Kapoor A, Field T, Society. 2019; Aug 22. Sciences and Medical The division also has NIH this scientific statement Sciences and Medical Handler SM, et. al. doi: 10.1111/jgs.16144 Sciences. 2018 Dec 12; support for a Cancer and of the AHA. Sciences. 2019 Mar 14; pii: Adverse events in doi: 10.1093/gerona/ Aging Center, an Older Finding: Insomnia occurs glz081. doi: 10.1093/ Scheunemann LP, et al. long-term care residents gly277. Epub ahead of Americans Independence most commonly in older gerona/glz081. Epub Clinician-family transitioning from print. [PMID: 30541065]. Center (Pepper), and adults, but its treatment in ahead of print. [PMID: communication about hospital back to the several NIH-funded these individuals remains 30869772]. Finding: This important patients’ values and nursing home. JAMA research training grants. least effective and most clinical trial was the first preferences in intensive Internal Medicine. 2019;

aging.pitt.edu • seniorservices.upmc.com 45 likely to cause falls and medication use in older that bisphosphonate facilitates targeted cerebrovascular disease, 74-80. doi: 10.1111/ fractures. Although adults. Journal of the therapy may be patient-provider depression in the elderly, jgs.15603. [Epub 2018 there is a bidirectional American Geriatrics discontinued for women communication. It has polypharmacy in Oct 11]. relationship between Society. 2019; 67: 674-94. who no longer have low the potential to save long-term care, and Liu H, Povysheva N, Rose insomnia and nocturia, hip bone density after significant health care end-of-life care. Finding: Update of the ME, Mi Z, Banton JS, Li the latter is rarely 3-5 years of treatment, resources and improve landmark and W, Chen F, Reay DP, addressed in treatment but it should be quality of life for millions Weiner DK, Gentili A, extensively-used “Beers Barrionuevo G, Zhang F, guidelines. This study of continued for those of older Americans, and Rossi M, Coffey-Vega K, list” of drugs to avoid in Graham SH. Role of robustly healthy seniors, whose bone density it is part of an ongoing Rodriguez KL, Hruska KL, treating older adults. UCHL1 in axonal injury all of whom had normal remains abnormal. multisite VA trial. Hausmann L, Perera S. Aging Back Clinics - a and functional recovery bladder function, revealed Nayak S, Greenspan SL. Madill E, Samuels R, Geriatric Research Geriatric Syndrome after cerebral ischemia. that nocturia was present A systematic review and Newman DP, Boudreaux- Education and Approach to Treating Proceedings of the in over half and that, in meta-analysis of the Kelley M, Weiner DK. Clinical Center Chronic Low Back Pain National Academy of 90%, the cause was effect of bisphosphonate Development of an (GRECC) in Older Adults: Results Sciences of the United nocturnal polyuria. More drug holidays on bone evaluative, educational, Director: Steven Graham, of a Preliminary States of America. 2019; notably, most with mineral density and and communication- MD, PhD Randomized Controlled 110: 4643–4650.. nocturnal polyuria also osteoporotic fracture facilitating app for older The GRECC is funded by Trial. Pain Medicine. 2019 had reduced bladder risk. Osteoporosis Mental Illness adults with chronic low the Department of Sep 10. doi: 10.1093/pm/ capacity, suggesting that International. 2019; 30: Research, Education, back pain: Patient Veterans Affairs and pnz179. [Epub ahead of addressing both the 705-720. and Clinical Centers perceptions of usability provides an integrated print]. PMID: 31503275. excess nightly excretion (MIRECC) Finding: Bisphosphonates and utility. Pain Medicine. program of basic and small bladder Aspinall SL, Springer SP, Site Director: Gretchen L. can be a double-edged 2019; May 7. pii: pnz088. biomedical, clinical, and capacity may be safer Zhao X, Cunningham FE, Haas, PhD sword. Although they are doi: 10.1093/pm/pnz088. health services research; than the current approach Thorpe CT, Semla TP, The Mental Illness the cornerstone of education of trainees and to geriatric insomnia and Finding: The authors Shorr RI, Hanlon JT. Research, Education and osteoporosis treatment, practitioners; and clinical also more effective. created an office-based Central Nervous System Clinical Centers (MIRECC) they also can cause demonstration projects app that screens for key Medication Burden and were established by 2019 American Geriatrics atypical fractures and designed to advance conditions that drive Risk of Recurrent Serious Congress with the goal of Society Beers Criteria osteonecrosis of the jaw. knowledge regarding the pain and disability in Falls and Hip Fractures in researching the causes Update Expert Panel. Yet consensus is lacking care of the elderly, with chronic low back pain, Veterans Affairs Nursing and treatments of mental American Geriatrics as to when they can be an emphasis on stroke. Its provides evidence-based Home Residents. Journal disorders and using Society 2019 Updated discontinued. This research focus includes education about these of the American Geriatrics education to put new AGS Beers Criteria for critical analysis revealed neuronal-cell death in conditions, and knowledge into routine potentially inappropriate stroke, gene therapy in Society. 2019 Jan; 67(1):

46 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh clinical practice in the study, Veterans Finding: This is the first between structural innovative treatments. Finding: While young Veterans Administration. reported moderate pain study to examine the brain abnormalities in The team of investigators muscle is capable of Specialized mental health severity and endorsed feasibility and effect depression and the at the Claude D. Pepper restoring the original centers of excellence experiencing sleep of Brief Behavioral effects of exercise on Older Americans architecture of damaged (MHCoE) are an essential disturbance at least Treatment for Insomnia brain structure in adults, Independence Center myofibers, aged muscle component of the VA’s several days in the (BBTI) in older adults to highlight possible offers complementary displays a markedly response to meeting the past 2 weeks. Veterans with comorbid late-life neural mechanisms that expertise, outstanding reduced regeneration. mental health needs of who more frequently treatment resistant may mediate the positive research productivity, We show that expression veterans. experienced sleep depression. The findings effects of exercise on and ongoing studies to of the “anti-aging” disturbance reported suggest that BBTI is a depressive symptoms. address this problem. protein, α-Klotho, is Tighe C, Youk A, Ibrahim higher levels of pain feasible treatment for The prefrontal cortex, The center brings together up-regulated within S, Weiner D, Vina E, catastrophizing and insomnia in older adults anterior cingulate cortex, faculty from five schools young injured muscle Kwoh C, Gallagher R, lower levels of pain and that it may also be hippocampus, and within the University of as a result of transient Bramoweth AD, self-efficacy; higher an effective adjunctive corpus callosum emerged Pittsburgh: medicine, Klotho promoter Hausmann L. Pain catastrophizing and lower treatment for depression as structural neural nursing, public health, demethylation. The Catastrophizing and self-efficacy, in turn, were in this difficult to markers that may serve allied health, and studies demonstrate Arthritis Self-Efficacy associated with higher treat population. as targets for exercise- engineering. a role for α-Klotho in as Mediators of Sleep levels of osteoarthritis based treatments the regulation of Disturbance and Gujral S, Aizenstein H, Sahu A, Mamiya H, symptom severity. for depression. mitochondrial function. Osteoarthritis Symptom Butters MA, Reynolds CF, Shinde SN, Cheikhi A, Severity. Pain Medicine. Gebara MA, DiNapoli EA, Grove G, Karp JF, & Pittsburgh Winter LL, Vo NV, Stolz D, Scheunemann LP, Ernecoff 2019; Advance online Lederer L, Bramoweth AD, Erickson KI. Exercise for Claude D. Pepper Roginskaya V, Tang WY, NC, Buddadhumaruk P, publication. doi:10.1093/ Germain A, Kasckow JW, Depression: a Feasibility Older Americans St Croix C, Sanders LH, Carson SS, Hough CL, pm/pnz187. & Karp J. Brief behavioral Trial Exploring Neural Independence Center Franti M, Van Houten B, Curtis JR, Anderson WG, treatment for insomnia in Mechanisms. American Director: Susan L. Rando TA, Barchowsky A, Steingrub J, Lo B, Finding: A secondary older adults with late-life Journal of Geriatric Greenspan, MD Ambrosio F. Age-related Matthay M, Arnold RM, analysis of baseline data treatment-resistant Psychiatry. 2019; 27(6): Balance Disorders in older declines in alpha-Klotho White DB. Clinician- from a clinical trial depression and insomnia: 611-616. doi: https://doi. people are common, drive progenitor Family Communication examining a positive a pilot study. Sleep and org/10.1016/j. disabling, and often cell mitochondrial About Patients’ Values psychological intervention Biological Rhythms. 2019; jagp.2019.01.012. complex. A concentrated, dysfunction and impaired and Preferences in for Veterans with pain Advance online multidisciplinary effort is muscle regeneration. Intensive Care Units. from knee osteoarthritis Finding: In a systematic publication. doi:10.1007/ needed to understand its Nature Communications. JAMA Internal Medicine. (PI: Hausmann; IIR13-080) review, this study s41105-019-00211-6. causes and consequences 2018; 9(1): 4859. 2019; 179(5): 676-684. was conducted. In this examined the overlap – and to develop

aging.pitt.edu • seniorservices.upmc.com 47 Finding: Little is known Hergenroeder AL, speeds <0.08 m/s. Fouquerel E, Barnes RP, Barroso-González J, autophagy as a about whether clinicians Barone Gibbs B, Barriers to monitor Uttam S, Watkins SC, García-Expósito L, compensatory survival and surrogate decision Kotlarczyk MP, Perera S, usability included Bruchez MP, Opresko PL. Hoang SM, Lynskey ML, mechanism. This team makers follow Kowalsky RJ, Brach JS. inability to apply monitor Targeted and Persistent Roncaioli JL, Ghosh A, discovered that the recommended strategies Accuracy and and access the step 8-Oxoguanine Base Wallace CT, Modesti M, combined inhibition of for shared decision Acceptability of display. Monitor accuracy Damage at Telomeres Bernstein KA, Sarkar SN, RAD51AP1 protein and making by incorporating Commercial-Grade was rated as the most Promotes Telomere Loss Watkins SC, O’Sullivan autophagy may be a intensive care unit (ICU) Physical Activity important feature, and and Crisis. Molecular RJ. RAD51AP1 Is an promising new strategy patients’ values and Monitors in Older Adults. ability to interface with a Cell. 2019 July 11; 75(1): Essential Mediator of for treating aggressive preferences into Journal of Aging and smart device was the 117-130.e6. doi: 10.1016/j. Alternative Lengthening cancers that use ALT to treatment decisions. Physical Activity. 2019; least important feature. molcel.2019.04.024. of Telomeres. Molecular maintain telomeres. The study found that 27(2): 222-229. 35. This study identified the Epub 2019 May 14. Cell. 2019 Oct 3; 76(1): Qian W, Kumar N, most clinician-family limitations of the current [PMID:31101499]. 11-26.e7. doi: 10.1016/j. Finding: The aim of this Roginskaya V, Fouquerel E, conferences about commercial activity molcel.2019.06.043. study was to evaluate Finding: Telomeres are Opresko PL, Shiva S, prognosis and goals of monitors in both step Epub 2019 Aug 7. [PMID: the accuracy of seven the caps at chromosome Watkins SC, Kolodieznyi D, care for critically ill counting accuracy and 31400850]. commercial activity ends that shorten as we Bruchez MP, Van Houten B. patients appear to lack usability features for monitors in measuring age, and critically short Finding: Cancer Chemoptogenetic important elements of older adults. steps in older adults with telomeres cause cellular cells must maintain damage to mitochondria communication about varying walking abilities aging. Oxidative stress telomere lengths for causes rapid telomere values and preferences, University of and to assess monitor caused by an excess of immortalization and dysfunction. Proceedings with robust deliberation Pittsburgh Cancer acceptability and unstable reactive oxygen unlimited growth, and of the National Academy being particularly Center Genome usability. The Accusplit molecules accelerates nearly 15% of cancers of Sciences of the United deficient. Interventions Stability Program AX2710 Accelerometer Patricia Opresko, PhD telomere shortening. maintain telomeres by States of America. 2019 may be needed to better Pedometer had the and Ben Van Houten, By developing a tool the ALT mechanism. Sep 10; 116(37): 18435- prepare surrogates for highest accuracy PhD, co-leaders. to selectively induce This study from the 18444. doi: 10.1073/ these conversations and (93.68% ± 13.95%), Advancing the oxidative damage only O’Sullivan laboratory pnas.1910574116. Epub improve clinicians’ whereas the Fitbit understanding, diagnosis, at the telomeres, Dr. showed that RAD51AP1 2019 Aug 26. [PMID: communication skills for Charge had the lowest and treatment of cancer Patty Opresko and protein is required for 31451640]. eliciting and incorporating (39.12% ± 40.3%). Device through basic, her team showed that ALT, and that disruption patients’ values and Finding: Using a new accuracy varied based translational, clinical, telomere damage directly of this protein led to preferences into chemoptogenetic on assistive device use, and population-based drives telomere loss telomere shortening in treatment decisions. approach, this team led and none of the monitors research programs. and causes telomeres ALT positive cancer cells by Dr. Ben Van Houten were accurate at gait to shorten faster. and activation of

48 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh showed that hydrogen team of health care discontinuation With Changes in Opioid Scheunemann LP, be needed to enhance peroxide released from professionals offers care evaluated the Prescriptions or Pain Ernecoff NC, clinicians’ communication damaged mitochondria for patients with life- associations between Severity Among People Buddadhumaruk P, skills to include patients’ caused oxidation of limiting illnesses, and polypharmacy, symptom Living With HIV and Carson SS, Hough CL, values and preferences nuclear proteins, provides comfort and burden, and quality of Chronic Pain. Journal Anderson WG, Steingrub in treatment decisions. alterations in nuclear support to those patients life (QOL) in 372 patients of Acquired Immune J, Lo B, Matthay M, morphology, but not and their families. The with advanced, life- Deficiency Syndromes. Arnold RM, White DB. gross genomic damage. following publications are limiting illness. The study 2019; 81(2): 231-237. Clinician-Family Analysis of telomeres relevant to today’s trend found that among adults 10.1097/qai. Communication About indicated that this of focusing on patients’ with advanced illness, 0000000000001998. Patients’ Values and targeted mitochondrial desires for care at the end taking more medications Preferences in Intensive Finding: Marijuana use damage led to telomere of life and the importance is associated with higher Care Units. JAMA for chronic pain is double-strand breaks, of communicating clearly symptom burden and Internal Medicine. 2019; commonly reported fragility and loss within with the patient and lower quality of life. The 179(5): 676-684. 10.1001/ among people living 48 hrs. of the initial insult. physician or clinician. authors note that future jamainternmed.2019. with HIV, although there This work has important priorities for treating 0027. Schenker Y, Park SY, is limited empirical implications in cancer and patients in this setting Jeong K, Pruskowski J, evidence to support its Finding: This study aging. For an interview should include attention Kavalieratos D, Resick J, use. In this study, 433 involved a secondary with Ben Van Houten, to medication-related Abernethy A, Kutner JS. people living with HIV analysis of audio- describing this work see: symptoms and shared Associations Between completed self-report recorded clinician-family https://www.upmc.com/ decision-making Polypharmacy, Symptom measures of chronic conferences between media/news/082619- regarding deprescribing. Burden, and Quality of pain and marijuana use. surrogates and clinicians pnas-van-houten. Life in Patients with Merlin JS, Long D, Becker Among the participants, of 249 incapacitated, UPMC Palliative and Advanced, Life-Limiting WC, Cachay ER, 28% reported marijuana critically ill adults. Supportive Institute Illness. Journal of Christopolous KA, use in the past 3 months. Findings indicated that (PSI) General Internal Claborn KR, Crane HM, However, there was no most clinician-family Director: Robert Medicine. 2019; 34(4): Edelman EJ, Lovejoy TI, evidence that marijuana conferences about Arnold, MD 559-566. 10.1007/ Mathews WC, Morasco use in people living with prognosis and goals The PSI was established to s11606-019-04837-7. BJ, Napravnik S, HIV is associated with of care for critically improve the quality of life O’CLeirigh C, Saag MS, improved pain outcomes ill patients lack Finding: This secondary of patients whose diseases Starrels JL, Gross R, or reduced opioid communication about analysis of baseline data are no longer responsive Liebschutz JM. Marijuana prescribing. values and preferences. from a trial of statin to curative treatments. Its Use Is Not Associated Future interventions may

aging.pitt.edu • seniorservices.upmc.com 49 Administrative Staff & Leadership

Administrative Staff Bridgeside Point Daniel E. Forman, MD Neil M. Resnick, MD Director of Emerging Therapeutics, Associate Director, Aging Institute of Phone: Kirsten Schwoegl, CRA Aging Institute of UPMC Senior Services UPMC Senior Services and the University 1-866-430-8742 Administrative Director and the University of Pittsburgh of Pittsburgh Website: Daniel Stump Chair, Section of Geriatric Cardiology, Chief, Division of Geriatric Medicine and Academic Administrator Professor of Medicine, University of Gerontology Aging.UPMC.com Pittsburgh School of Medicine Thomas P. Detre Professor of Medicine seniorservices.upmc.com Tari Deiss Director, John A. Hartford Foundation, Financial Assistant/Purchasing Susan L. Greenspan, MD Center of Excellence in Geriatric Medicine Associate Director, Clinical and Toren Finkel, MD, PhD School of Medicine, University Director, Aging Institute of UPMC Senior Translational Research, Aging Institute of Kathy Brickett of Pittsburgh Services and the University of Pittsburgh Administrative Coordinator UPMC Senior Services and the University of Pittsburgh Professor of Medicine, Division of Charles F. Reynolds III, MD Cardiology, School of Medicine, Madeleine Henrie Director, Osteoporosis Prevention and Immediate Past Director, Aging Institute University of Pittsburgh Administrative Assistant Treatment Center of UPMC Senior Services and University G. Nicholas Beckwith III and Dorothy B. Program Director/Principal Investigator, of Pittsburgh Beckwith Chair in Translational Medicine, Executive Committee Pittsburgh Claude D. Pepper Older Distinguished Professor of Psychiatry Americans Independence Center University of Pittsburgh/UPMC UPMC Endowed Professor in Robert M. Arnold, MD Director, Bone Health, UPMC Medical Director, UPMC Palliative and Geriatric Psychiatry, Emeritus, Charles F. Reynolds III, MD Magee-Womens Hospital Supportive Institute University of Pittsburgh Immediate Past Director, Aging Institute of Professor of Medicine, School of Medicine, Director, Institute for UPMC Senior Services and University University of Pittsburgh Edmund M. Ricci, PhD, MLitt of Pittsburgh Doctor-Patient Communication Professor in Clinical and Translational Associate Director, Evaluation Sciences, Chief, Section of Palliative Care and Distinguished Professor of Psychiatry Science Institute, School of Medicine, Aging Institute of UPMC Senior Services Medical Ethics UPMC Endowed Professor in Geriatric University of Pittsburgh and the University of Pittsburgh Psychiatry, Emeritus, University of Pittsburgh Leo H. Criep Chair in Patient Care Professor & Director Emeritus, Institute for Professor of Medicine, School of Medicine, Taafoi S. Kamara, MPH Evaluation Science in Community Health, Deborah S. Brodine, MHA, MBA University of Pittsburgh Administrative Director Graduate School of Public Health, President, UPMC Western Psychiatric Aging Institute of UPMC Senior Services University of Pittsburgh Hospital & UPMC Senior Services Deborah S. Brodine, MBA, MHA and the University of Pittsburgh President, UPMC Western Psychiatric Loren H. Roth, MD, MPH Mary Ann Sander, MHA, MBA, NHA Hospital & UPMC Senior Services Anne B. Newman, MD, MPH Distinguished Professor Emeritus of Vice President, Palliative Care and Clinical Director, Aging Institute of Psychiatry, University of Pittsburgh Supportive Services Toren Finkel, MD, PhD UPMC Senior Services and the University Consultant, UPMC Western Director, Aging Institute of UPMC Senior UPMC Community Provider Services of Pittsburgh Psychiatric Hospital Services and the University of Pittsburgh Chair, Department of Epidemiology Taafoi S. Kamara, MPH Professor of Medicine, Division of Katherine M. Detre Endowed Chair of Mary Ann Sander, MHA, MBA, NHA Administrative Director Cardiology, School of Medicine, Population Health Sciences Vice President, Palliative Care and University of Pittsburgh Director, Center for Aging and Supportive Services Melissa Jones, MSN, RN G. Nicholas Beckwith III and Dorothy B. Population Health UPMC Community Provider Services Geriatric Nurse Educator Beckwith Chair in Translational Medicine, University of Pittsburgh/UPMC Distinguished Professor of Epidemiology Ronnie Edwards, MSW, LSW Professor of Medicine, and Clinical and Aging and Disability Coordinator Translational Science Jen Albaugh Graduate School of Public Health, Administrative Coordinator University of Pittsburgh

Peggy Edinger Administrative Coordinator

52 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh Richard Schulz, PhD Robert M. Arnold, MD Rafael J. Engel, PhD, MSW Diane P. Holder Associate Director, Education, Aging Medical Director, UPMC Palliative and Associate Professor Executive Vice President, UPMC Institute of UPMC Senior Services and the Supportive Institute Coordinator, Gerontology President, Insurance Services Division University of Pittsburgh Director, Institute for Doctor-Patient Certificate Program President and CEO, UPMC Health Plan Distinguished Service Professor of Psychiatry Communication Principal Investigator, John A. Hartford Professor, Epidemiology, Sociology, Chief, Section of Palliative Care and Practicum Partnership Program in A. Everette James, III, JD, MBA Psychology, Community Health, Nursing, Medical Ethics Aging Education Dean (Interim), Graduate School of Health and Rehabilitation Sciences, Leo H. Criep Chair in Patient Care School of Social Work, University Public Health School of Medicine Professor of Medicine, School of Medicine, of Pittsburgh Associate Vice Chancellor for Health Program Director, Gerontology, University University of Pittsburgh Policy and Planning Center for Social and Urban Research Toren Finkel, MD, PhD Executive Director, Health Policy Institute Director, University of Pittsburgh Michael Boninger, MD Director, Aging Institute of UPMC Senior M. Allen Pond Professor of Health Policy Director, Geriatric Education Center President, UPMC Innovative Services and the University of Pittsburgh and Management of Pennsylvania Homecare Solutions Professor of Medicine, Division of Graduate School of Public Health, Director, Center for Caregiving Research, Senior Medical Director for Post-Acute Cardiology, School of Medicine, University of Pittsburgh Education and Policy, University of Pittsburgh Care, UPMC Health Services Division University of Pittsburgh Professor and UPMC Endowed Vice Chair G. Nicholas Beckwith III and Dorothy B. Taafoi S. Kamara, MPH Bennett Van Houten, PhD for Research, Department of Physical Beckwith Chair in Translational Medicine, Administrative Director Associate Director, Basic Science Research, Medicine & Rehabilitation University of Pittsburgh/UPMC Aging Institute of UPMC Senior Services Aging Institute of UPMC Senior Services University of Pittsburgh Schools of the and the University of Pittsburgh and the University of Pittsburgh Health Sciences Daniel E. Forman, MD Richard M. Cyert Professor of Molecular Director of Emerging Therapeutics, Carrie R. Leana, PhD Oncology, Department of Pharmacology Jennifer S. Brach, PhD, PT Aging Institute of UPMC Senior Services George H. Love Professor of Organizations and Chemical Biology Associate Dean of Faculty Affairs and the University of Pittsburgh and Management Graduate Faculty in Molecular Biophysics and Development Chair, Section of Geriatric Cardiology, Professor of Business Administration, and Structural Biology (MBSB) at the Associate Professor, Department of Professor of Medicine, University of Medicine, and Public & International Affairs University of Pittsburgh and Carnegie Physical Therapy, School of Health and Pittsburgh School of Medicine Director, Center for Healthcare Mellon University Rehabilitation Sciences, University Management, Katz School of Business of Pittsburgh Lawrence A. Frolik, JD, LLM Co-Leader, Genome Stability Program, John E. Murray Faculty Scholar Academic Dean, Marshall Webster UPMC-Hillman Cancer Center Physician Leadership Program Deborah S. Brodine, MBA, MHA Professor Emeritus of Law, School of Law, Academic Director, Executive President, UPMC Western Psychiatric University of Pittsburgh MBA Healthcare Aging Institute Board of Directors Hospital & UPMC Senior Services Fabrisia Ambrosio, PhD, MPT Susan L. Greenspan, MD University of Pittsburgh Associate Professor and Research Scientist, Anthony Delitto, PhD, PT, FAPTA Associate Director, Clinical and John Lovelace, MS, MSIS Professor and Dean, School of Translational Research, Aging Institute Department of Physical Medicine and President, UPMC for You, Inc. Rehabilitation, School of Medicine, Health and Rehabilitation Sciences, of UPMC Senior Services and the University of Pittsburgh University of Pittsburgh University of Pittsburgh President, Government Programs and Individual Advantage Director of Rehabilitation for Director, Osteoporosis Prevention and UPMC International Jacqueline Dunbar-Jacob, PhD, RN, FAAN Treatment Center Distinguished Service Professor and Dean, Program Director/Principal Investigator, Susan C. Martin, MSN, RN Senior Director, Clinical Improvement/ School of Nursing Pittsburgh Claude D. Pepper Older Patient Safety Department Professor of Psychology, Epidemiology & Americans Independence Center Wolff Center at UPMC Occupational Therapy, University Director, Bone Health, UPMC of Pittsburgh Magee-Womens Hospital Professor of Medicine, School of Medicine, University of Pittsburgh Professor in Clinical

aging.pitt.edu • seniorservices.upmc.com 53

Tami Minnier, RN, MSN, FACHE Edmund M. Ricci, PhD, MLitt Elizabeth R. Skidmore, PhD, OTR/L, Fabrisia Ambrosio, PhD, MPT Chief Quality Officer, UPMC Associate Director, Evaluation Sciences, FAOTA, FACRM Associate Professor and Research Scientist, Executive Director, The Beckwith Institute Aging Institute of UPMC Senior Services Associate Dean of Research Department of Physical Medicine and for Innovation in Patient Care and the University of Pittsburgh Chair and Professor, Department of Rehabilitation, School of Medicine, Professor & Director Emeritus, Institute for Occupational Therapy, School of Health University of Pittsburgh Rick Morycz, PhD, QCSW, LCSW, FGSA Evaluation Science in Community Health, and Rehabilitation Sciences Director of Rehabilitation for Associate Professor of Psychiatry, Graduate School of Public Health, University of Pittsburgh UPMC International Medicine, and Social Work University of Pittsburgh University of Pittsburgh School of Medicine Bennett Van Houten, PhD Panagiotis (Takis) Benos, PhD Geriatric Services, Western Psychiatric Daniel Rosen, PhD, MSW Associate Director, Basic Science Research, Professor and Vice Chair of Faculty Institute and Clinic David E. Epperson Professor of Social Work Aging Institute of UPMC Senior Services Affairs, Department of Computational University of Pittsburgh and the University of Pittsburgh and Systems Biology, Department of Anne B. Newman, MD, MPH Richard M. Cyert Professor of Molecular Biomedical Informatics Clinical Director, Aging Institute of Loren Roth, MD, MPH Oncology, Department of Pharmacology Director, Center for Translational UPMC Senior Services and the University Distinguished Professor Emeritus of and Chemical Biology Bioinformatics of Pittsburgh Psychiatry, University of Pittsburgh Graduate Faculty in Molecular Biophysics Director, Molecular Systems Modeling (MSM) Chair, Department of Epidemiology Consultant, UPMC Western and Structural Biology (MBSB) at the Director, Joint CMU-Pitt PhD Program in Katherine M. Detre Endowed Chair of Psychiatric Hospital University of Pittsburgh and Carnegie Computational Biology Population Health Sciences Mellon University University of Pittsburgh Mary Ann Sander, MHA, MBA, NHA Director, Center for Aging and Co-Leader, Genome Stability Program, Vice President, Palliative Care and Meryl A. Butters, PhD Population Health Supportive Services UPMC-Hillman Cancer Center Distinguished Professor of Epidemiology Associate Professor of Psychiatry and UPMC Community Provider Services Clinical and Translational Science Professor of Medicine, and Clinical and Helene Weinraub, MPH Vice President, Medicare, Translational Science University of Pittsburgh Richard Schulz, PhD UPMC Health Plan Graduate School of Public Health, Associate Director, Education, Aging Judy L. Cameron, PhD University of Pittsburgh Institute of UPMC Senior Services and Robert J. Weyant, MS, DMD, DrPH Professor of Psychiatry the University of Pittsburgh Associate Dean, Professor, and Neil M. Resnick, MD Director of Pitt Science Outreach Distinguished Service Professor Chair, Dental Public Health and Associate Director, Aging Institute of Director of Working For Kids: Building Skills of Psychiatry Community Outreach UPMC Senior Services and the University University of Pittsburgh Professor, Epidemiology, Sociology, School of Dental Medicine, of Pittsburgh Psychology, Community Health, Nursing, University of Pittsburgh Kirk I. Erickson, PhD Chief, Division of Geriatric Medicine Health and Rehabilitation Sciences, Professor, Department of Psychology and Gerontology School of Medicine Healthy Brain Aging Initiative University of Pittsburgh Thomas P. Detre Professor of Medicine Program Director, Gerontology, University Director, John A. Hartford Foundation, Center for Social and Urban Research Howard J. Aizenstein, MD, PhD Tamer S. Ibrahim, PhD Center of Excellence in Geriatric Medicine Director, University of Pittsburgh Charles F. Reynolds III and Ellen G. Professor, Bioengineering School of Medicine, University Director, Geriatric Education Center Detlefsen Endowed Chair in Geriatric Department, Psychiatry Psychiatry and Professor of Bioengineering of Pittsburgh of Pennsylvania University of Pittsburgh Director, Center for Caregiving and Clinical and Translational Science Charles F. Reynolds III, MD Research, Education and Policy, University of Pittsburgh Immediate Past Director, Aging University of Pittsburgh Institute of UPMC Senior Services and University of Pittsburgh Distinguished Professor of Psychiatry UPMC Endowed Professor in Geriatric Psychiatry, Emeritus, University of Pittsburgh

aging.pitt.edu • seniorservices.upmc.com 55 John M. Jakicic, PhD Caterina Rosano, MD, MPH Distinguished Professor and Chair, Tenured Professor, Epidemiology Department of Health and Physical Activity Graduate School of Public Health Director, Physical Activity and Weight University of Pittsburgh Management Research Center University of Pittsburgh Stephen F. Smagula, PhD Assistant Professor, Psychiatry Taafoi S. Kamara, MPH University of Pittsburgh Administrative Director Aging Institute of UPMC Senior Services Abbe N. de Vallejo, PhD and the University of Pittsburgh Associate Professor of Pediatrics and Immunology, School of Medicine, Anne B. Newman, MD, MPH University of Pittsburgh Clinical Director, Aging Institute of Associate Professor, Division of Pediatric UPMC Senior Services and the University Rheumatology, Children’s Hospital of of Pittsburgh Pittsburgh of UPMC Chair, Department of Epidemiology Director, Flow Cytometry Core Facility, Katherine M. Detre Endowed Chair of John G. Rangos Research Center Population Health Sciences Faculty, University of Pittsburgh Director, Center for Aging and Cancer Institute Population Health Investigator, Pittsburgh Claude D. Pepper Distinguished Professor of Epidemiology Older Americans Independence Center Professor of Medicine, and Clinical and Faculty, McGowan Institute for Translational Science Regenerative Medicine Graduate School of Public Health, University of Pittsburgh Peter Wipf, PhD Distinguished University Professor Vineet K. Raghu of Chemistry PhD Candidate in Computer Science Professor of Pharmaceutical Sciences, University of Pittsburgh Professor of Bioengineering Director of the Combinatorial Chemistry Charles F. Reynolds III, MD Center and the Center for Chemical Immediate Past Director, Aging Institute of Methodologies and Library Development UPMC Senior Services and University University of Pittsburgh of Pittsburgh Distinguished Professor of Psychiatry UPMC Endowed Professor in Geriatric Psychiatry, Emeritus, University of Pittsburgh

56 2019 Annual Report - Aging Institute • UPMC Senior Services & the University of Pittsburgh Aging Institute 2019 Annual Report UPMC Senior Services & the University of Pittsburgh UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

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