Emory Health Digest Summer 2025

How to Not Accidentally Die: Tips for a Longer, Healthier Life | 26

The Injury Prevention Research Center at Emory works to mitigate the staggering impact of injury, whether it be from a slip or fall, car crash, sports-related concussion, overdose, or gun violence.

“There is a general perception that people get lonelier as they age, but the opposite is actually true in the US.”

–R obin R icha R dson , assistant p R ofesso R of epidemiology at

e mo R y ’ s R

ollins

s

chool

of p ublic h ealth

13

Dynamic Aging | 38

As many in the US are hitting the 65-plus mark, research is revealing ways to improve the aging process. These include reenvisioning our perception of growing older, using improv techniques in caregiving, and apps that help users remember their daily routines.

PHOTO:

10

“Sometimes it seemed like she was talking about my dad (her brother).”

don’t miss

Improving Your Brain 5

Emory neurosurgeon Sanjay Gupta says memory loss is not a preordained part of aging.

Reducing Gun Violence 11

One person dies from gun-related injuries every 11 minutes in the US. How can we prevent this?

the well

To Our Readers 4

A message from Ravi Thadhani, executive VP for health affairs, executive director of WHSC, and vice chair of the Emory Healthcare Board.

The Well 5

Musicians face higher mental health risks. A cure for HIV. Emory researcher Anant Madabhushi. Top rankings. Grass or artifical turf? Reducing gun violence. Runners and heart attacks. A mammo-

gram for heart health? Middle-age loneliness. Everywhere chemicals. 4Ms for Aging Care. Better sex at any age.

and more

POV 50

When geriatric physician Ted Johnson visited his aunt at her memory care center, he got a real-life lesson in how improv techniques can improve dementia care and communication.

Emory Health Digest

Mary Loftus, Editor

Peta Westmaas, Art Director

Jack Kearse, Photography Director

Martha Nolan, Associate Editor

Jacob Gniesk, April Hunt, Jennifer Johnson, Ruby Katz, Lara Moore, Rob Spahr, Tony Van Witsen, Contributors

Stacey Jones, Copy Editor

Amon MacBeth, Matilda Redfern, Online Communications

Jarrett Epps, Advertising Manager

Matilda Redfern, Kelley Taylor, Production Coordinators

Christiane Beauregard, Cover Illustration

Brian Katzowitz, AVP, Health Sciences Communications

Emory Health Digest is published twice a year for patients, donors, friends, faculty, and staff of the Woodruff Health Sciences Center. © 2025 Emory University

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Inquiries should be directed to the Department of Equity and Civil Rights Compliance, 201 Dowman Drive, Administration Bldg, Atlanta, GA 30322. Telephone: 404-727-9867 (V) | 404-712-2049 (TDD). 25-Emory Health Digest Summer

How animals can heal themselves

In his new book, Doctors by Nature: How Ants, Apes and Other Animals Heal Themselves, Samuel Candler Dobbs Professor of Biology Jaap de Roode explores how animals from butterflies to bears—even family dogs and cats—use natural medicines.

“I definitely look at my dogs differently,” says de Roode, director of the Infectious Diseases across Scales training program in the Woodruff Health Sciences Center. “When they’re eating grass, I think about how that may be a relic behavior of their wolf ancestors to purge worms from their guts.”–Carol Clark

PHOTO KAY HINTON

From our Guest Editor

Camille Vaughan, left, professor of medicine and director of the Emory Center for Health in Aging, is guest editor of this Emory Health Digest special issue on aging well.

I’m Aging Too

As a geriatrician, a doctor focused on the care of older adults, I frequently think about healthy aging. A few months ago, I grabbed some reading glasses and realized I hadn’t been seeing clearly for weeks. The glasses help me focus better at work and home, and they also remind me I’m getting older. On the bright side, they’re a new chance to add some style—now I just have to remember to bring them everywhere.

I’ve grown to appreciate that healthy aging can look different for everyone. It may be the 90-plus-year-old setting records in the 100-meter dash at the Senior World Games or the individual living with multiple sclerosis slowly and patiently teaching their grandchild to knot a necktie. The common thread is enabling older people to, as we consider in age-friendly health care, pursue “what matters most” to them. Sometimes, this means fewer medications or procedures and greater attention to strategies that enhance movement, reduce fall risk, and boost mood and memory.

When I see statistics about the growth in our older adult population, the future need for adult caregivers, or the influence that caretaking for persons with dementia may have on our society, I’m reminded that the statistics are not just about Baby Boomers. The numbers also apply to the generations following—which includes me! Ultimately, healthy aging is influenced by experiences throughout life. In addition to actions we can take, like wearing seatbelts and staying active, the opportunity for us to age with choice and purpose takes community support.

In this special issue, we highlight multiple ways Emory teams are driving innovation and knowledge to support health and longevity for all as well as creative caregiving for our elders.

We’re always looking to generate new strategies to make the golden years of life better. Healthy aging is the result of a lifetime of wise decisions and being a valued part of a society willing to support those efforts.

PHOTO MARY LOFTUS

MAKING A CASE FOR Improving Your Brain

Neurosurgeon Sanjay Gupta says lifestyle changes can significantly impact brain health and potentially slow or reverse cognitive decline. In his book Keep Sharp, he highlights the importance of physical activity, cognitive stimulation, sleep, nutrition, and social connections. Here is an excerpt:

Dementia can be a spectrum, ranging from mild to severe, and some of the causes of dementia are entirely reversible. Alzheimer’s disease, which accounts for more than half the cases of dementia, gets nearly all the attention, and as a result, the terms dementia and Alzheimer’s are often used interchangeably. They shouldn’t be. The word dementia, however, is steeped in our common vernacular, and so is the association with Alzheimer’s disease.

I use both terms with the hope that the conversation, and the words we use to describe the broad condition

of cognitive decline, will shift in the future.

I believe there has been an overemphasis on Alzheimer’s disease as a way to talk about this broad condition, and it has further fueled a widespread sense of fear that memory loss is inevitable as we get older. Perfectly healthy people in their 30s and 40s are alarmed about the implications of common memory lapses, like misplacing their keys or forgetting someone’s name. That is a misguided fear, and memory loss is not a preordained part of aging.

As I started traveling the world talking to people about this topic, I realized something else extraordinary.

According to an AARP survey of Americans aged 34 to 75, nearly everyone (93 percent) understands the vital importance of brain health.

But those same people typically have no idea how to make their brains healthier or that achieving such a goal is even possible.

Most believe [the brain], this mysterious organ encased in bone, is a black box of sorts, untouchable and incapable of being improved. Not true.

opened the black box and touched the human brain. As a result of this training and decades of additional learning, I am more convinced than ever that the brain can be constructively changed, enhanced, and fine-tuned. Just consider that. You probably think of your muscles that way—even your heart, which is a muscle. It is time to realize the same is possible with your brain.

You can affect your brain’s thinking and memory far more than you realize.

The brain can be continuously and consistently enriched throughout your life, no matter your age or access to resources. [As a neurosurgeon] I have

Emory neurosurgeon and epidemiologist Sanjay Gupta is chief medical correspondant for CNN.

Last year, NIH invested $783 million in medical research in Georgia. These dollars supported 11,593 jobs and stimulated an estimated $2.27 billion in economic activity within the state.

Musicians Face Higher Mental Health Risks

Researchers found that popular musicians are an occupational at-risk group for suicide, exposing a need for targeted mental health screenings and interventions within the music industry.

They point to unique challenges faced by musicians such as mental health issues, substance abuse, financial instability, relationship strain, and performance anxiety, which can lead to an increased risk of suicide. These factors are particularly pronounced among female artists and are consistent with occupational mortality data from England and the United States that show higher suicide rates among entertainers.

The study, co-authored by Dorian Lamis, associate professor of psychiatry and behavioral sciences at Emory School of Medicine, and George Musgrave, a sociologist at Goldsmiths, University of London, is published in Frontiers in Public Health.

“This study is a wakeup call to the industry and health care providers,” says Lamis. “Musicians, with their public lives and unique pressures, require tailored, evidence-based strategies to manage and mitigate mental health risks effectively.”–Jennifer Johnson

A Cure for HIV?

Emory’s pioneering work with a class of small molecules known as JAK (janus kinase) inhibitors continues to show how HIV might be cured, after a second patient who received the treatment was declared to be in longterm remission.

The use of JAK inhibitors against HIV began with a discovery led by Christina Gavegnano, associate professor in Emory School of Medicine and the Center for the Study of Human Health in Emory College.

The announcement involved an individual known as the “Oslo patient.” The patient received ruxolitinib, a first-generation JAK inhibitor, for complications following a stem cell transplant from a sibling to treat cancer. Ruxolitinib works as an immunomodulatory drug that may also reduce viral reservoirs. Its potential against the HIV reservoir was first documented by Gavegnano in 2012 and later established in a study led by Emory infectious disease professor Vincent Marconi, with Gavegnano as co-investigator.

The first case of ruxolitinib as part of a potentially curative regimen was documented in the “Geneva patient,” who was declared to be in remission from HIV in 2023 following treatment that included the drug.

The drug’s potency against the HIV reservoir in the Oslo and Geneva cases points to a new path toward a cure. Researchers previously declared individuals living with HIV cured following stem cell transplants from donors with a mutation that makes them resistant to the virus. While the Oslo patient’s stem cell donor had the mutation, the Geneva patient received cells from someone who did not have the mutation.

Gavegnano first came up with the idea to use JAK inhibitors against HIV while working on her pharmacology PhD studies at Emory. Her approach was to reconfigure JAK inhibitors, which were FDA-approved for inflammatory conditions such as rheumatoid arthritis, to control inflammation from HIV by blocking key pathways that allow the virus to persist.

Now she’s preparing to co-lead a new clinical trial using baricitinib, a second-generation JAK inhibitor, to further test the potential for sustained HIV remission without requiring lifelong antiretroviral therapy or a stem cell transplant.

“Courageous efforts from the Geneva patient and his team, and now the Oslo patient and his team, are paving the way for future collaborations and potential for a globally accessible cure for HIV,” Gavegnano says.

The first clinical trial using baricitinib for HIV cure research will be co-led by Gavegnano, Marconi, and Andrew H. Miller, professor of psychiatry and behavioral sciences.–April Hunt

Christina Gavegnano, associate professor in Emory School of Medicine and Emory College

Vincent Marconi, professor of medicine and global health at Emory

CHRIS GASH

I AM AN

Keeping Innovation and Empathy in AI Health Care

A personal tragedy helped shape the career of Anant Madabhushi, who grew up in Chennai in Southern India. In India in the 1990s, he says, good students were encouraged to pursue medicine or engineering. “But my heart was at the intersection of technology, engineering, and health/medicine,” he says.

He discovered an undergraduate program in biomedical engineering. Then, “a very dear aunt of mine lost her life to breast cancer,” he says. “That was one of the inflection points in my formative years. I decided I had a responsibility to use my training to do something about cancer and to have an impact on people’s lives.”

Madabhushi, professor of biomedical engineering at Emory and Georgia Tech and director of the Emory Empathetic AI for Health (Health.AI) Institute, continued his training and education in biomedical engineering at the University of Texas at Austin, where he earned a master’s degree.

During his PhD program at the University of Pennsylvania, he experienced his second inflection point. “I had the good fortune of meeting a couple of

pathologists who introduced me to the area of digital pathology,” he says.

Pathology had made similar leaps in the 17th century, he says, when Antonie van Leeuwenhoek improved microscopes, using them to study microbes and blood cells, and in the 19th century, when Rudolph Virchow advanced the concept that disease could be diagnosed by examining cells.

“That concept has persisted, that pathologists look at microbes, tissues, biopsies under a microscope to make a diagnosis,” he says. “Now, though, we can create high-resolution digital images and apply AI algorithms to analyze them.”

Even with these types of advances, Madabhushi doesn’t believe AI will put radiologists or pathologists out of work. “There’s a lot of anxiety among our trainees and attendings about the future with AI, but here we are, and we still have a paucity of radiology and pathology expertise, even at Emory,” he says. “We need to acknowledge that technology is going to have an impact. It means radiologists and pathologists will need to rethink how they practice and render diagnoses with this new armory of powerful technologies.”

PHOTO KAY HINTON

Redirection toward precision medicine

When starting his lab at Rutger’s University, Madabhushi developed algorithms for the grading of breast and prostate cancer. “I showed a breast oncologist these decision-support tools for helping determine the grade of cancers, and he said, ’What you’re doing is fabulous, but I have to be candid, it’s useless to me. As a clinician, I treat breast cancer patients. And the No. 1 thing I need to figure out is who should be treated more aggressively with treatments like chemotherapy, and who could potentially avoid these treatments.’ ”

Madabhushi realized the inability to find the right treatments for his aunt’s breast cancer had resulted in her death. “I was helping the pathologists but not the patients,” he says.

He pivoted his work to focus on precision medicine, using technologies like AI with routine data like radiology and digital pathology scans to address the question of who could benefit from which treatments.

Advancing AI in health care

This emphasis on patients has served Madabhushi well as director of Emory’s Empathetic AI for Health Institute.

“As an immigrant from a lower-middle-income country, I am passionate about trying to have an impact on global health and to develop health technologies that are affordable,” he says. “But we also have to look in our own backyard. In the US, we have a lot of inequity and health disparity.”

Madabhushi points to rural populations that are not getting the same kinds of treatments or access to technologies as someone in an urban setting or at an academic medical center.

AI-supported personalized, precision medicine

could help combat the financial toxicity of disease, he says. (A study in the American Journal of Medicine found 42 percent of cancer patients over age 50 deplete their life savings within two years of their diagnosis.) “Part of my focus is to think about how to modulate the right treatment strategy for each patient, with the maximum likelihood of a favorable response,” he says.

Madabhushi, who is also a research career scientist with the Atlanta VA Medical Center, says AI must be used ethically to develop more equitable health care for all, which is why the Emory Empathetic AI for Health Institute was launched.

“Why use the word ‘empathetic’ in the name?” he asks. “We want to develop AI tools that improve health care and medicine, but we want to do it in a way that isn’t going to leave any group or population behind.”

The Madabhushi team has already achieved significant translational success, including 200plus awarded or pending patents, three spin-off companies, and 40 technologies licensed.

And Georgia Trend magazine recently named Madabhushi to its list of 500 Most Influential Leaders as part of its Technology and Research portfolio.

The mission of AI.Health, he says, is to innovate, deploy, and scale.

“It’s not just about the technology,” he says. “It’s about developing on-the-ground collaborations and getting diagnostic tools to those who can benefit the most, whether in Tanzania or rural Georgia.”

–Mary Loftus

Get the full story on Anant Madabhushi and other Emory researchers.

Anant Madabhushi (left) as a child, with his aunt who died of breast cancer; (center) in Emory’s Health Sciences Research Building II, and (right) with Emory health sciences colleagues.

Top Graduate School Rankings

Emory’s graduate and professional schools are among the best in the nation, according to US News & World Report’s 2025 “Best Graduate Schools” guide.

US News ranks professional schools and programs in public health, medicine, and nursing. The rankings in these areas are based on two types of data: expert opinion about program excellence and statistical indicators that measure the quality of a school’s faculty, research, and students.

When It Comes to Player Safety, the Grass Isn’t Always Greener

A new study published in the Clinical Journal of Sport Medicine reveals a surprising twist in the debate over playing surfaces: young, helmeted football players who suffer concussions on natural grass report more severe symptoms and a greater number of them than players injured on artificial turf.

Morgan HeinzelmannWeisbaum, assistant professor of orthopedics and neurology at Emory School of Medicine

This is the first study to focus on post-concussive symptoms based on playing surface, and it challenges the common perception that grass is the safer option. Morgan Heinzelmann-Weisbaum, assistant professor of orthopedics and neurology at Emory School of Medicine, is first author of the study.

“While this study is novel, keep in mind that it is a pilot study limited

Here are some of the Emory schools and programs included in this year’s national rankings:

n Nell Hodgson Woodruff School of Nursing master’s program continues to be ranked No. 1 in the nation. The school’s doctor of nursing program is No. 8.

n Rollins School of Public Health is No. 2 in the nation.

n Emory School of Medicine ranks as a Tier 1 (highest performing) medical school for research. Last year, US News began assigning group rankings to medical schools instead of individual rankings.

to young, male football players,” says Heinzelmann-Weisbaum. “Our findings do build on previous research that has reported a lower incidence of sports-related concussion (SRC) on turf compared to grass in competitive sports, but they don’t support the safety of one playing surface over another at this time. Additional research is needed to continue investigating a potential relationship between playing surface and SRC/post-concussive symptoms—optimizing player safety is of the utmost importance.”

The study included 10- to 24-year-old male American football players who had sustained a helmet-to-ground SRC and presented to a specialty concussion clinic within 14 days of injury. Study partners included the North Texas Concussion Registry team and principal investigator Munro Cullum, clinical neuropsychologist at the University of Texas Southwestern.–Jacob Gnieski

Working against Gun Violence

One person dies from gun-related injuries every 11 minutes in the US. To address this epidemic, policymakers, community organization members, and other stakeholders gathered on the Emory campus for the second Violence Prevention Symposium.

Organized by 100 Black Men of Atlanta with Emory, the Satcher Health Leadership Institute at Morehouse School of Medicine, and the Dr. Martin Luther King Jr. Center for Nonviolent Social Change, the symposium focused on reducing gun violence. “Gun violence is probably the most inequitable health problem that we live with,” said Mark Rosenberg, a physician who has served on the faculty at Emory’s schools of medicine and public health and led the Task Force for Global Health. “For every young white man killed with a gun, there are 20 young black men killed.”

Jonathan Rupp, director of the Injury Prevention Research Center at Emory, said, “We’re actively working in preventing gun violence by supporting research

that engages young people to develop and test solutions. We’re also working with hospitals, law enforcement, and communities to identify and address hotspots for violence.

“For instance, we might find violence is happening on streets that are dark, and can work with Georgia Power to have burned out bulbs in streetlights replaced. Or if a hotspot involves teens and violence outside of school hours, we might work with a school to start an after-school program.”

Janikqua Cutno, director of the Violence Prevention Program at Emory Hillandale Hospital, said when a gun injury victim enters the hospital, they are matched with a “credible messenger,” someone from their community who has experience with gun violence and can offer counseling. “We can’t say we’re doing this work effectively if we aren’t addressing the root causes of violence, which are social determinants of health such as poverty and lack of opportunity,” said Cutno. “We’ve started bringing

different community partners to the table to try to interrupt the cycle of violence.”

Other presenters included Art Powell, program director of the Offender Alumni Association, a group of formerly incarcerated individuals who get to know and talk with youth who’ve been involved in the juvenile justice system. The association runs a program for students called Real Talk about the Law and a summer program with sessions on life skills. Symposium presenters agreed that a more unified effort is needed.

“Are we going to fund the police force for the next 10 to 20 years? Of course we are,” said Vulcan Topali, professor of criminal justice and criminology at Georgia State University. “The same has to be true for these violence prevention programs.”

–Martha Nolan

View a video summary of the Violence Prevention Symposium at Emory.

PHOTOS: JACK KEARSE

More Runners

Surviving Heart Attacks during Marathons

While more people than ever are running marathons in the US, the risk of dying from a heart attack during a race has fallen dramatically in recent years, according to a new study by Jonathan Kim, associate professor in Emory School of Medicine. The new findings, published in the Journal of the American Medical Association, indicate that while the rate of marathon runners who suffer cardiac arrests remained unchanged, their chance of survival is twice what it was in the past. More than 29 million people completed marathons in the US between 2010 and 2023.

Cardiac arrests remain far more common among men than women, and more common in marathons than half marathons.

What led to the dramatic change in death rates? After interviewing survivors, Kim believes the sport has become more aware of the risks and of the need to have emergency services available. “What we found was that every one of those people got hands-on cardiopulmonary resuscitation (CPR) and the vast majority also had immediate access to an automated external defibrillator. That’s the difference,” he says.

A Mammogram for Heart Health?

In addition to detecting breast cancer, mammograms in combination with artificial intelligence (AI) may also be used to assess cardiovascular health.

A new study by researchers from Emory and the Mayo Clinic used an AI image analysis technique to show how AI can automatically analyze breast arterial calcification and convert the findings into a cardiovascular risk score.

“We see an opportunity for women to get screened for cancer and additionally get a cardiovascular screen from their mammograms,” says Theo Dapamede, postdoctoral fellow at Emory and lead author.

“Our study showed that breast arterial calcification is a good predictor for cardiovascular disease, especially in patients younger than age 60. If we are able to screen and identify these patients early, we can refer them to a cardiologist for further risk assessment.”

Jonathan

Kim,

associate professor in Emory School of Medicine

The survival rate is comparable to the rate in other public places that make defibrillators available, such as airports and casinos.–Tony Van Witsen

Overall findings showed the new model performed well at characterizing patients’ cardiovascular risk as low, moderate, or severe based on mammogram images.

Heart disease is the leading cause of death in the United States, but it remains underdiagnosed in women and awareness is still lacking.

The buildup of calcium in blood vessels is a sign of cardiovascular damage linked to early-stage heart disease or aging. Studies have demonstrated that women with calcium deposits in their arteries have a 51 percent higher risk of heart disease and stroke.–Tony Van Witsen

Middle-Aged Is the Loneliest Number

For adults in the US, loneliness peaks in middle age, according to a new study by an Emory researcher.

Published in the journal Aging and Mental Health, the study found middle-aged Americans demonstrated higher levels of loneliness than older adults.

This designation was shared with only one other country in the study.

The investigation surveyed more than 64,000 adults age 50 and older living in 29 countries

across Europe, North America, and the Middle East.

Led by researchers from Emory’s Rollins School of Public Health, Columbia University, McGill University in Canada, and Univer sidad Mayor in Santiago, Chile, the study showed loneliness generally increases with age.

But middle-aged people in the United States and the Neth erlands felt lonelier than older generations.

“There is a general perception that people get lonelier

as they age, but the opposite is actually true in the US where middle-aged people are lonelier than older generations,” says lead author Robin Richardson, assistant professor of epidemiology at

“Advocacy and interventions to address the loneliness epidemic have historically focused on older adults and adolescents.

Middle-aged adults represent a critical population that is being overlooked.”–Rob Spahr

Early Menopause Can Raise Risk of Glaucoma

New research from Emory explores the underlying mechanisms of how early menopause may be associated with the risk of developing glaucoma. The study, published in Vision Research, examined the effects of aging and surgically induced menopause via ovariectomy on gene expression in the posterior eye and retina.

Using an approach called RNA sequencing, Andrew Feola, assistant professor of ophthalmology, and his team found that surgical menopause altered pathways in the eye associated with immune response and metabolism. Notably, they also found that surgical menopause at an earlier stage led to greater changes in gene activity compared to at a later stage, in genes associated with glaucoma.

“Factors important to how the eye responds during glaucoma are genes related to the extracellular

matrix, a network of genes that play a role in tissue function and cell communication, and transforming growth factor-beta (TGF-β), which plays a role in regulating cellular processes and how a cell responds to an injury,” Feola says. “However, this effect diminished with age.” They also found that a key regulator of cell survival, the transcription factor Fos, reduced its activity following surgical menopause and with aging, suggesting a potential link to glaucoma. These findings reinforce clinical evidence that early menopause may heighten the risk of developing glaucoma for women and highlight the importance of considering women’s health factors in glaucoma research and treatment. Understanding how menopause timing influences ocular health paves the way for targeted strategies to reduce disease risk in aging populations.–Ruby Katz

’Everywhere Chemicals’

Phthalates—the synthetic chemicals used in everyday products from food packaging, personal care, toys, and more—have been linked to abnormal neurological development in infants.

The study, published in Nature Communications, is the first to use untargeted metabolomics (all small molecules or metabolites in a biological system) to connect a mother’s phthalate exposure to a newborn’s metabolites, and those to neurological development.

“This represents an important step forward in understanding how prenatal chemical exposures shape infant development at the molecular level,” says senior author Donghai Liang, associate professor of environmental health at Emory’s Rollins School of Public Health.

Donghai Liang, associate professor of environmental health in Rollins School of Public Health

Phthalates make plastics softer and more flexible and are found in polyvinyl chloride (PVC) products such as vinyl flooring, medical devices,

children’s toys, food packaging, and shower curtains. The chemicals are also in personal care products including deodorant, nail polish, perfumes, hair gels, shampoos, soaps, and body lotions.

Phthalates are endocrine disruptors that have been linked to preterm birth, infant genital abnormalities, childhood obesity, asthma, cancer, cardiovascular issues, and low sperm count and testosterone in men.

“We conducted this study because phthalates are everywhere in our daily lives,” Liang said, hence their nickname “everywhere chemicals.”

People can reduce their exposure to phthalates by using glass, stainless steel, or cast iron; not using nonstick cookware; not putting plastic food containers in the microwave or dishwasher; improving air circulation; and dusting with a damp cloth.

When buying personal care products, look for those labeled “phthalate-free” and check ingredient lists, Liang says. Phthalates may be listed as DEP (diethyl phthalate), DBP (dibutyl phthalate), or BBzP (butyl benzyl phthalate). Use the Environmental Working Group’s SkinDeep database to check which chemicals a product may contain.–Rob Spahr

Aging Well at Any Age

WWhat matters to you as you age? What are your priorities?

Gardening? Hiking?

Traveling? Playing with the grandchildren? Aging in place? Volunteering? Taking action now is the way to ensure that what’s most important to you in your later years is something you still have the mental acuity and physical ability to do. Overshoot now, reap the rewards later. In the following pages, we’ve compiled some tips and techniques that can be helpful along the way.

Anti-Aging Supplements Do They Really Work?

Anti-aging supplements promise everything from smoother skin to sharper memory, stronger bones, and a longer life. But with so many bold claims and flashy labels, how do you separate the hype from the helpful? While no pill can stop time, some supplements can support healthy aging—especially when your body’s natural nutrient levels start to dip. Touch base with your health care provider first, though, because supplments can interfere with other medications, says dietician Jessica Alvarez, assistant professor at Emory School of Medicine. Nothing is going to work as well as eating a well-balanced diet, heavy on quality fruits and vegetables with adequate lean protein, she adds. But even people who eat well may find they could use some help as they age. Here are six supplements that might actually be worth taking:

CALCIUM is essential for maintaining strong bones and teeth. It also supports muscle function, nerve signaling, and heart health. As people age, especially postmenopausal women, bone density naturally declines. Adults over 50 should aim for 1,200 mg per day, ideally split between food and supplements. More than 2,000 mg per day may cause kidney stones.

PROTEIN is vital for muscle repair, immune function, and maintaining strength. Aging leads to a gradual loss of muscle mass, and nearly all older adults can benefit from taking a protein supplement, especially if sedentary or recovering from illness or surgery. Older adults should aim for 1.0–1.2 grams of protein per kilogram of body weight per day. That’s about 68–82 grams daily for a 150-pound person.

FISH OIL or omega-3 fatty acids (EPA and DHA) support heart health and brain function and can reduce inflammation. People with diets low in fatty fish (like salmon or sardines), or those with heart disease risk factors, should consider taking it. The recommended daily dosage is 250-500mg of combined EPA and DHA.

Jessica Alvarez, assistant professor at Emory School of Medicine

VITAMIN D supports calcium absorption, bone health, and immune function, and may play a role in mood regulation. Older adults produce less vitamin D from sunlight, and those who live in northern climates, wear sunscreen regularly, or have darker skin may be deficient. Recommended dose is 600–800 IU daily for most adults. Do not exceed 4,000 IU a day.

MAGNESIUM plays a role in regulating blood pressure and blood sugar as well as ensuring healthy muscle and nerve function. Many older adults don’t get enough magnesium through their diet. Certain medications (like diuretics or proton-pump inhibitors) can lower magnesium levels. The recommended dose is 320 mg per day for women, 420 mg for men.

VITAMIN B-12 helps with red blood cell formation, brain function, and DNA synthesis. Older adults often absorb B-12 less efficiently. Adults only need a little—2.4 mcg daily.

Alvarez notes that not all supplements are created equal. To ensure safety and quality, she looks for products that are USP verified, which means they’ve been tested by the US Pharmacopeia for purity and potency. Also look for options that are free of unnecessary additives, such as artificial colors or fillers.

ELEMENTS OF BETTER CAREGIVING

Ugochi Ohuabunwa is medical director of the Acute Care for the Elderly Unit and chief of the geriatrics service line at Grady Memorial Hospital in Atlanta. Grady is an “age-friendly health system,” meaning the hospital provides four evidence-based elements of high-quality care to patients 65 and older.

“We make sure every member of our health care team is skilled in elder care, all working with the patient to reduce functional decline and improve overall outcomes,” says Ohuabunwa. “What are the measures you can put in place across the system to improve outcomes for older adults? The 4Ms.”

1

WHAT MATTERS

Know what each older adult’s specific health outcome desires are and align care acccordingly. “We’re not talking just about end goals but what their goals are on a daily basis They are a part of deciding what they want to do, what is most meaningful and important to them.”

4

MOBILITY

2

MEDICATION

When drug therapy is necessary, use age-friendly medications that do not interfere with other priorities. “We flag high-risk medications that might cause, for example, a fall or delirium, and a pharmacist gives feedback to our teams. Would you consider other alternatives? The goal of geriatrics is to use low-risk, high-benefit medicines unless there is no option.”

Ensure that older adults move safely every day so they can maintain function and meet their “What Matters” goals. “They tell us what they want to do for the day, but our medical team also tells them what activities should be done. We focus on both short-term and long-term goals.” EHD

Aging Well at Any Age

Ugochi Ohuabunwa, Emory professor of geriatrics and gerontology

3

MENTATION

Protect older adults’ brain health and mental health by preventing, identifying, treating, and managing dementia, depression, and delirium across all settings of care. “We incorporate screening tools, and every 12 hours our teams report on the mood of the patient. We also offer activities that are preventive or therapeutic for mental health and brain acuity. Medical students will come out on the weekends and spend time with the patients who are high risk.”

Aging Well at Any Age

Running with Your Crew

THERE IS OVERWHELMING SCIENTIFIC EVIDENCE that exercise is a “medicine” that can prevent and treat chronic disease; those who “take it” live longer, with a higher quality of life. The list of benefits is long, from lower risk of heart disease, stroke, cancer, obesity, and diabetes to improved cognitive function, sleep, and mental health. You don’t have to start with a marathon, however. “Going from inactivity to any activity is more helpful than you may think,” says Sharon Bergquist, Emory internal medicine physician and author of The Stress Paradox. “If you are a couch potato, here is some encouragement: in both of these studies, the greatest health benefits were achieved early on, when participants went from doing nothing to doing something.”

Here is a list of simple and actionable habits Bergquist recommends, from which you can choose one or more: Walk 8,000+ steps a day; move throughout the day, at least 250 steps per hour; do strength training at least twice per week; spend time in nature, at least 2.5 hours per week; get moderate-intensity exercise per week; add short sprints of high-intensity activity, like running up a flight of stairs; do a high-intensity interval training (HIIT) workout at least once a week.

EHD PHOTO JACK KEARSE

You can sign up for the Winship 5K Oct. 4, 2025.

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Better Sex

Improving sexual functioning across the adult life span

Sex is one of the most common and normal human behaviors, says psychologist Candice Hargons, yet it remains relatively taboo as a topic.

“Many people worry about being judged, either for being perceived as too sexual or not sexual enough,” she says. “A major focus of my work is to normalize talking and learning about sex to improve sexual functioning across the adult life span.”

Hargons, Rollins associate professor in behavioral, social, and health education psychology, is the author of Good Sex: Stories, Science, and Strategies for Sexual Liberation and leads the SMASHER Lab the Study of Mental and Sexual Health Equity in Relationships laboratory.

Good sex can improve overall quality of life, reduce relationship distress, and boost mood and sleep, she says. But, she adds, sexual dysfunction and concerns about sexual intimacy are “incredibly common.” For example, erectile dysfunction can affect up to 80 percent of men at some point in their lives, while sexual concerns impact 40 to 50 percent of women.

Hargons’ focus is on ensuring that everyone has

access to the knowledge and skills relevant for “the good sex ‘seasonings’ of passion, pleasure, intimacy, and communication.”

Passion can wane over time. “As life gets more intertwined and partners become very familiar with each other, they can feel less and less compelled to connect sexually,” Hargons says.

Intimacy takes many forms including physical, sexual, emotional, social, intellectual, financial, and spiritual. “Intimacy is the feeling of closeness—or being known and seen for who you truly are which helps build trust and the ability to be vulnerable.”

Improving a sexual relationship often comes down to communication—the way we let our partners know what we want and do not want. The verbal and nonverbal ways we communicate with each other about sex, she says, require both expressive (talking) and receptive (listening) skills, as well as the ability to address each person’s fears.

“Begin by identifying what you like and don’t like sexually,” Hargons said.

“An easy way to do this is to create a ’yes, no, maybe so’ list. In the ‘yes’ section, write things you enjoy and want to keep doing sexually as well as things you have not tried yet that you want to try. In the ‘no’ section, write things you don’t enjoy and do not want to do anymore and things you haven’t tried and are not interested in trying. In ‘maybe so,’ write things you’re curious about but are only willing to try in specific settings or circumstances.

“You can share this list with your partner, but even if you aren’t ready to do that, you will have enhanced your sexual self-awareness and are better positioned to ask your sexual partner for what you want.” EHD

Candice Hargons, associate

professor in behavioral, social, and health education in Rollins School of Public Health

YOU SHOULD BE

W dancin' yeah!

Whether it’s swing dancing, ballet, or tango, a regular dance routine improves cognition and quality of life as we age and may even help prevent the onset or progression of disease.

“The evidence is pretty strong that dancing can help individuals with dementia,” says Madeleine Hackney, associate professor in Emory’s Department of Medicine. “Dancing offers social engagement and aerobic exercise and includes the balance training that older individuals need to stay on their feet. It’s cognitive and physical rehabilitation rolled up into one.” Hackney, in addition to her work in academia and therapeutic dance, is a professional dancer with performance credits in Mona Lisa Smile, Mad Hot Ballroom, and the muscial Evita.

PHOTO JACK KEARSE

Hackney researches how the adapted Argentine tango (“Adaptango”) alters mobility and cognitive impairment of older adults through weekly 1.5hour dance lessons. She is also examining the neural correlates of internally and externally guided lower limb movement.

“These classes improve motor cognitive integration, the ability to think and do at the same time,” she says. “There are two forms of balance: static— an example is standing on one foot—and dynamic, when you’re walking from one foot to the other by losing and regaining balance with every step. All these abilities are related to independence so that older adults can retain functionality in society and their homes.”

Diego Remolina, assistant professor of medicine in the Division of Geriatrics, emphasized the significance of maintaining balance, muscle mass, and new neuropathways in older adults. “For your brain to follow a dance routine, you will be working your cardiovascular system and developing endurance as you move. This will help maintain muscle mass and prevent falls, which are often multifactorial injuries in older adults,” says Remolina. “Most importantly, dance is an opportunity to learn something new, the key to developing new neuropathways, which is what your brain needs to maintain cognition.”

Indeed, everyone can “find joy in movement,” says Rollins School of Public Health adjunct associate professor Kara Jacobson, who founded the Atlanta Dance Academy (TADA), which offers a free senior dance movement therapy program (far right).–Lara Moore

PHOTO JACK KEARSE

“We’ve seen improvements in psychosocial health, self-esteem, independence, gait speed, and balance.”— madeleine hackney

Madeleine Hackney, associate professor of medicine in the Division of Geriatrics and Gerontology

Diego Remolina, assistant professor of medicine in the Division of Geriatrics and Gerontology

Emory Healthcare patient Laura Reilly (left) with dance instructor Jessica Flores (far left), takes ballet classes for balance and posture as part of her recovery from dual knee replacement surgery.

PHOTO JACK KEARSE

PHOTO COURTESY TADA

PHOTO COURTESY TADA

How to Not Accidentally Die

AND OTHER ADVICE FOR A LONGER, HEALTHIER LIFE

By Martha Nolan

NE SLIP ON THE STAIRS, A MOMENT OF

DISTRACTION BEHIND THE WHEEL, OR A

MISSTEP ON THE FIELD—INJURIES CAN HAPPEN IN AN INSTANT, AND THEY CAN HAVE LASTING PHYSICAL AND PSYCHOLOGICAL CONSEQUENCES.

The Injury Prevention Research Center at Emory (IPRCE) works to mitigate the staggering impact of injury in Georgia and the Southeast.

The center focuses on the most significant injury concerns of the region, which include drug overdoses, violence, falls, traumatic brain injuries, and traffic accidents. These threats tend to overlap.

“There’s a reason we don’t just have an overdose prevention center or a motor vehicle crash prevention center,” says Jonathan Rupp, director of IPRCE. “We know some of the things we can do to prevent an overdose are going to

have an impact on motor vehicle crashes. Similarly, the things we do to prevent bullying have an effect on overdoses. That’s the reason we have an injury prevention center—all these things end up being interrelated.”

IPRCE experts shared tips with Emory Health Digest for how to stay one step ahead of injury and keep yourself and your loved ones out of harm’s way.

Don’t fall

FALLS ARE THE LEADING CAUSE OF UNINTENTIONAL INJURIES for children and older adults. While tikes can typically bounce right back up, folks aged 65 and older can suffer life-changing damages, resulting in limited mobility, loss of independence, and even death.

“Many people consider falls to be a natural part of aging, but they are not,” says Elizabeth Head, deputy director of the injury prevention program at the Georgia Department of Public Health and co-leader of the Fall Prevention Task Force. “If you fall, there is a reason you fell, and much can be done to help prevent it. And it behooves you to prevent falls because if you have fallen once, you are more than twice as likely to fall again.”

Here are a few tips to help you remain vertical:

Talk with your doctor. Be sure to tell your doctor if you have fallen, worry about falling, or feel unsteady on your feet. Review your medications with your doctor once a year, even the over-the-counter drugs you are taking. As you get older, the way medicines work in your body can change, perhaps making you sleepy or dizzy. “People who take more than four prescription medications are more at risk to have a fall,” says Head. “That’s generally because of the interactions of those medications.”

Get your eyes and feet checked once a year. Age can bring vision changes, such as cataracts and glaucoma, making it easier to trip over things. It’s also a good idea to have your feet checked annually, and to wear proper footwear. Choose shoes that have a textured sole to prevent slipping, grip your foot well so you don’t slide out of them, and provide adequate support.

Make your home safer. Simple adjustments can lessen the risk of falling in your home. Keep floors and stairs free of clutter, and reconsider throw rugs, which can be a trip hazard. Install grab bars, use non-slip mats, and use motion-sensor nightlights, especially in bedrooms and bathrooms. Have a sturdy step stool available in case you need to reach something from a high shelf—never climb up onto a chair or table.

Drive smarter

Exercise to improve your balance and strength. Many senior centers, YMCAs, and other locations offer evidence-based falls prevention exercise programs, such as tai chi, Moving for Better Balance, the Otago Exercise Program, Matter of Balance, and more. “The newest and coolest offering I’ve seen is Bingocize,” says Head. “It’s Bingo, which everybody loves, with questions about fall risk, fall prevention, and the like. In addition, they also do some exercises that can be done seated or standing.”

Even if you can’t make it to a specific class, there are many things you can do on your own to improve your odds of avoiding falls. Walking whenever you can improves balance and confidence. When watching TV, stand and lift your legs up and down and side to side, perhaps while holding on to the back of a chair. Turn your ankle in slow circles in one direction then the other. “All of these things can improve strength and balance,” says Head.

The Fall Prevention Task Force serves as Georgia’s statewide falls prevention coalition and is working to expand falls prevention in rural areas. It also has created a virtual fall prevention series, “Falls Free Friday,” available on YouTube.

JONATHAN RUPP DOESN’T USE THE TERM CAR ACCIDENT. “An accident is not preventable,” says Rupp, the co-lead of the Transportation Safety Task Force. “Crashes, on the other hand, are preventable. That’s why we always say car crash.”

In Georgia, transportation had yielded its spot as the number one cause of injury to violence and overdose in recent years, but it still claims many victims. In 2022, 1,797 people lost their lives in traffic fatalities in Georgia. In the entire country, that number was more than 42,500. The biggest culprit in all crashes, from fender-benders to fatalities, is distracted driving, accounting for more than 90 percent of all incidents. According to Georgia Traffic Safety Facts, at any point during daylight hours, about 15 percent of drivers in Georgia are engaging in risky behaviors such as texting,

hand-held phone calls, eating, or drinking. Even if you are paying complete attention to the road, the driver in the car coming toward you may not be.

Rupp advises all drivers to avoid distractions while driving. If you must talk on the phone, use the Bluetooth hands-free option or, even better, wait until you are done driving to have that conversation. Consider putting your phone in “Do Not Disturb”

NEVER GET BEHIND THE WHEEL IF YOU’VE BEEN DRINKING. About 30 percent of fatal crashes involve an impaired driver.

ALWAYS WEAR YOUR SEAT BELT.

Not using a seatbelt in a crash increases your risk of death by up to 60 percent.

mode and store it out of reach. Along the same lines, driving is not the time to touch up your makeup, eat your meal, or try to retrieve items that have spilled. Keep your eyes, hands, and mind on the task at hand—driving.

Rupp’s other pieces of advice for avoiding transportation injuries are well-known but bear repeating:

OBEY SPEED LIMITS.

More than 20 percent of fatal crashes are related to excessive speed.

Of course, you don’t have to actually be in a car to be injured by one. Each year, pedestrian and bicyclist fatalities comprise about 19 percent of all traffic fatalities, according to the US Department of Transportation. For bicyclists, wearing a helmet is the best line of defense. According to the National Institutes of Health, helmets provide a 69 percent reduction in the risk of head and brain injuries for bicyclists involved in motor vehicle crashes.

Bicyclists and pedestrians should not expect drivers to see them, says Rupp. “Wear highly visible clothing. If it’s dusk, have a light. Stay in the areas where you are supposed to be. Most pedestrian injuries happen because the pedestrian is in a place the driver does not expect.”

Admittedly, cars are getting safer. Today they come with features such as lane departure warnings, automatic braking systems, and blind spot detection. But those features are only in newer cars and there are plenty of older models still on the road. And if you are driving too fast or recklessly, you may be injured despite multiple safety features.

The Transportation Safety Task Force provided advocacy work that led to the passage of the hands-free phone law in Georgia, as well as giving feedback and input to the Governor’s Office of Highway Safety on safety fact sheets and measurements of seat belt use and driver distraction.

MAINTAIN A SAFE DISTANCE between you and other cars on the road to allow for time to react to sudden changes. BE PATIENT. BE PATIENT. BE PATIENT.

Watch your noggin

TRAUMATIC BRAIN INJURIES (TBIS) ARE CAUSED BY A BUMP, BLOW, OR JOLT TO THE HEAD that disrupts the normal function of the brain. TBIs can result from car crashes, falls, physical assault, and sports-related injuries, to name a few of the most common culprits, and they range from mild to moderate to severe.

Moderate to severe TBIs require immediate attention. “If you’ve had an accident or fall or banged your head in some way, and you then lose consciousness, have nausea and vomiting, or vision disturbances, you need to go to the emergency room,” says Jonathan Ratcliff, associate professor of emergency medicine and neurology and a member of the Traumatic Brain Injury Task Force.

Mild TBIs, often called concussions, pose a different problem. Many people aren’t aware they have one. “If I break my arm, it’s readily visible and I lose function in my arm,” says Ratcliff. “But if I get a concussion, I might just have headaches or dizziness. People are used to pushing through symptoms like those.”

concussion. But if your original injury has healed completely, experts now believe a second injury may not be cumulative, according to Ratcliff. “It’s almost like your brain gets a full reset,” he says.

For moderate or severe TBIs, the primary injury kicks off a cascade of events that creates inflammation, leading to the death of brain cells. No known intervention can stop the cascade. There are no effective therapies specific to TBIs, although Emory physicians have had good results with aggressive care aimed at getting all markers back to the normal range. “We make sure the blood pressure stays in a good range,” says Ratcliff. “If pressure is building somewhere in the brain, we relieve it. We make sure glucose stays in the normal range. We’ve been getting better and better outcomes over time.”

Pushing through, however, is the wrong thing to do. “For an athlete, every minute he or she continues to play after having the concussion is associated with a prolongation of symptoms,” says Ratcliff. “The same goes for someone working at his computer who gets a bad headache after suffering a mild TBI—if he keeps working with that headache instead of resting, healing will be delayed.”

People with a mild TBI can recover safely at home, but it’s a good idea to go to your primary care doctor for a check-up. Most people are fine within seven to 10 days and don't require therapy or intervention.

But if symptoms persist beyond 10 days or start to get worse, you should go back to your doctor. It’s also important to realize TBIs can be cumulative. So if you suffer another injury before your first one is completely healed, the damage will be compounded, leaving you to struggle with long-term effects of the

Preventing TBI depends on your exposure. Athletes should make sure they use quality protective equipment and practice safe techniques. “There are ways to make a tackle in football, for example, that are safer than other ways,” says Ratcliff.

If an athlete suffers a blow to the head, he or she should stop playing immediately and be evaluated.

Drivers and passengers should always wear their seatbelts in cars. Automobiles have become safer with the addition of multiple airbags and improved restraint systems. That has actually resulted in more concussions, but for a good reason. “These are people who might have experienced severe TBIs in the past,” Ratcliff says, “but now in a crash they are experiencing a milder form of concussion.”

Bike riders should always wear a helmet and make sure it’s in good shape. Unlike football helmets, which are designed to withstand multiple blows, bike helmets should be replaced after a crash—or even after being dropped from a height. The foam compression in bike helmets is not made to withstand multiple blows.

EDEL

RODRIGUEZ

Drug dangers

FOR THE FIRST TIME IN DECADES, PUBLIC HEALTH DATA SHOWS A SUDDEN DROP IN OVERDOSE DEATHS. The CDC reports a decline of more than 22 percent from August 2023 to August 2024. That’s a huge reversal from the double-digit percentage increases in recent years.

Experts aren’t sure why. “We certainly have increased access to medication-based treatment for addiction,” says Joseph Carpenter, associate professor of emergency medicine and co-leader of the Drug Safety Task Force. “We’ve seen increased knowledge and availability of naloxone, which reverses most opioid overdoses. And some are theorizing there’s been a shift in the drug supply, making it a bit less lethal. But it’s conjecture at this point.”

Still, roughly 100,000 people die of overdoses each year. “In this epidemic, everyone is affected,” says Carpenter. More than 40 percent of Americans know someone who has overdosed. The best line of defense is to avoid becoming dependent on opioids. But if you are recovering from surgery or an injury, says Nicholas Giodano, assistant professor of nursing and

co-leader of the Drug Safety Task Force, be honest with yourself and your provider about your pain. “Patients who have poorly managed post-operative pain are at greater risk for prolonged opioid use. Try other approaches, such as over-the-counter drugs like Aleve, topical solutions like Tiger Balm or lidocaine patches, even mindfulness exercises.” If you do get an opioid prescription, Sarah Febres-Cordero recommends you also get naloxone (brand name Narcan) and keep it at your bedside. The assistant professor of nursing says, “You’ve just had surgery and are probably groggy. You might take your opioid, then forget and take another pill.”

“You will not cause any harm if you give someone Narcan and they are not overdosing,” says Febres-Cordero.

If you or a loved one has developed an opioid use disorder, the Substance Abuse and Mental Health Services Administration (SAMHSA) can suggest treatment centers near you. When using opioids, harm reduction strategies save lives. Fentanyl test strips are available at drug stores

as well as online at sites such as Aniz Inc., Dancesafe.org, and Georgia Harm Reduction Coalition. Drug checking is underused, says Febres-Cordero. “Studies have shown that the more informed consumers are about drugs they buy from the unregulated drug market, the more likely they are to change behaviors.” Many harm reduction sites also offer sterile syringes and Narcan. Three-quarters of people who die from a drug overdose die at home alone. People who use drugs should have someone with them who can call 911 and give Narcan if they become unresponsive. Hotlines such as Safe Spot (1-800-9720590) have a trained operator who will stay on the line and call for help if needed.

If you are willing, carry Narcan in your car or pack. If you encounter someone who may have overdosed—who is unresponsive and breathing abnormally— administer Narcan.

Normalize safety

FIREARM SAFETY - Violence, unfortunately, pervades our society. It cuts across ages, backgrounds and ethnicities. It can take the form of assault, intimate partner violence, suicide, and elder or child abuse. All forms can be interconnected. And people who experience one form of violence are more likely to experience others.

The Violence Prevention Task Force works on violence prevention in multiple ways. One focus is the common denominator in many forms of violence: firearms. Firearm injuries were the leading cause of death in the US among children and teens ages 1 to 19 in 2022, and among the five leading causes of death for people ages 1 to 44. More people suffer nonfatal firearm-related injuries than die, and survivors are often left with physical disabilities, chronic pain, and trauma-induced psychological issues.

About one in three Americans have guns in their homes. In Georgia it’s one in two. It’s critical, say gun safety advocates, to store your firearm securely in the home. That means more than putting a gun out of sight and out of reach. All firearms should be stored—unloaded—in a container that locks. Ammunition should be stored separately and locked.

Parents should talk to their children about guns. “We did a study and found it’s not easy for kids to tell

INTIMATE

PARTNER VIOLENCE - Sangmi Kim, assistant professor in the Nell Hodgson Woodruff School of Nursing and co-leader of the Violence Prevention Task Force, focuses on intimate partner violence. About 41 percent of women and 26 percent of men in the US have experienced intimate partner violence in their lifetime. It can seem like an easy problem to solve—just leave the abusive partner. But that can seem impossible. “Many victims are financially depen-

the difference between toy guns and real guns,” says Sofia Chaudhary, assistant professor of pediatrics and emergency medicine and a co-leader of the violence prevention task force. “Parents need to talk to children about that. Tell them never to touch or pick up a gun, and if they see one, tell a grown up.”

If your child is going to someone else’s house—even a relative’s—you should ask in advance if they have a gun in the house and if so, if it is locked up. You should also ask about guns in cars, since many people store firearms in their vehicles. If you don’t like the answers you get, suggest the children gather at your house instead. “Asking these types of questions can feel invasive, but they can be lifesaving,” says Chaudhary. Safe gun storage is important in youth suicide prevention. The time between suicidal ideation and acting upon it is typically brief in young people. If they can’t get to a gun immediately, the desire to act may well pass. Toward that end, Chaudhary has piloted a program to give out lock boxes to families of youth who come into pediatric emergency departments for acute mental health concerns, as well as counseling parents about the risks of having an accessible firearm. These families report increased rates of locking up their firearms afterward.

dent on their partner,” says Kim. “And often, children are involved, which complicates things. Women may not even be aware that what they’re experiencing is abuse. Some may experience isolation from family and friends and face barriers to accessing resources. These challenges can stem from limited knowledge about available services, partner monitoring and control, lack of transportation or childcare.”

Kim says prevention efforts need to move beyond the individual. “Violence prevention requires changes at the community and societal levels,” says Kim. “We need consistent policies nationwide to protect and support victims along with trauma-informed services to meet their health and societal needs. Intimate partner violence cannot be normalized.” EHD

PAUL GIOVANOPOULOS

Researchers use artificial intelligence to search the human retina for clues to diseases elsewhere in the body.

LOOK INTO MY EYES

By Tony Van Witsen

The eye is a transparent sphere, a microcosm of the body whole. Its transparency offers doctors and researchers an unobstructed view of blood vessels, nerves, and connecting tissues. By analyzing subtle ocular changes, researchers can detect early signs of systemic diseases. This has created an emerging field of study—oculomics, a science so new it didn’t have a name until 2020.

Ophthalmologist Sruthi Arepalli and biomedical engineer Sudeshna Sil Kar embody the interdisciplinary nature of oculomics. They worked together to make pathbreaking discoveries about Alzheimer’s disease, an ailment completely outside their respective specialties.

“I’ve always been a little interested in Alzheimer’s,” says Arepalli, assistant professor of ophthalmology in Emory School of Medicine. “My mom works at the National Institutes of Health in the National Institute of Aging. I grew up hearing about these diseases.”

Sil Kar, assistant scientist in Emory School of Medicine, became invested when her father was diagnosed with Alzheimer’s. “When the disease was detected, it was too late because there is no treatment for this,” she says. “I

wanted to know whether we could detect the disease earlier.”

Eyes provide clues to diseases

Oculomics joins two separate technologies to look into the human eye for clues about a range of human diseases including Alzheimer’s. The first is optical coherence tomography (OCT), a tool invented in the 1990s that uses low power laser light to capture a cross section of the layers within the human retina and its substructures such as the optic nerve and the tiny retinal arteries and veins. Ophthalmologists have used OCT for many years to look for early signs of eye disease.

More recently, biomedical engineers recognized that artificial intelligence (AI) could analyze OCT imagery and data to yield fresh insights into

Sruthi Arepalli, assistant professor of ophthalmology at Emory School of Medicine.

Sudeshna Sil Kar, assistant scientist at Emory School of Medicine

“We see a lot of diseases in the retina: diabetes, hypertension, lymphoma, multiple sclerosis, lupus. All these things can impact the retina in predictable patterns. You’re sort of like Sherlock Holmes.”

Sruthi Arepalli, ophthalmologist

Rohan Dhamdhere, doctoral student in Emory School of Medicine

Amrit Singh,

graduate research assistant in Emory School of Medicine

diseases and disorders throughout the body. “We see a lot of diseases in the retina,” says Arepalli. “Diabetes, hypertension, lymphoma, multiple sclerosis, lupus. All these things can impact the retina in predictable patterns. You’re sort of like Sherlock Holmes.”

The connection is particularly true for brain-related diseases like Alzheimer’s.

“The retina is the window of the brain,” Sil Kar notes, “because it is connected to the brain through the optic nerve. We tried to find the association between retina structural changes, vascular changes, and Alzheimer’s disease.”

Finding

innovations through AI

Arepalli and Sil Kar collaborated with Anant Madabhushi, director of the university-wide Emory Empathetic AI for Health Institute, to look for subtle changes in the shape of retinal blood vessels that could be correlated with other markers of Alzheimer’s.

“The blood vessels in a retina are not linear. They’re complex and they branch,” Arepalli says. “So putting it into an AI system that analyzes for things like this, looking at the disorganization of the architecture, you can then measure the areas of the blood vessels that are abnormal compared to a normal control.”

In a new study, Arepalli, Sil Kar, and collaborators examined the network of vessels in the retinas of people with Alzheimer’s, along with retinas of healthy individuals.

Through machine learning, they identified places where the vessel branching departed from its normal structure. These were more prevalent in patients with Alzheimer’s than in the control patients.

When they combined this data with data from the subjects’ cerebrospinal fluid—the classic test for early identification of Alzheimer’s—the two kinds of data together yielded a

result that distinguished between the Alzheimer’s patients and the control group with near-perfect accuracy.

With further validation, their discovery could lead to clinical tests predicting Alzheimer’s earlier and more accurately than current tests.

But the technique isn’t limited to Alzheimer’s.

Madabhushi believes many current medical diagnostic techniques will benefit from AI’s greater analytical powers.

“It’s almost like you’re using just 1 percent of the total amount of data available in the image and largely ignoring the rest of it,” he says. “AI is now scouring the remaining 99 percent of the data and trying to find and unearth more useful patterns.” “It’s ripe with potential,” Arepalli adds. “There are a lot of subtle changes within organ systems that we’re not able to appreciate in the same way that AI can.”

Recently, two other researchers working with Madabhushi found that changes in retinal blood vessels showed signs of being early predictors of heart disease.

Doctoral student Rohan Dhamdhere studied chronic kidney disease patients, who often have a higher risk of cardiovascular disease. “Early signs of issues with the heart can be seen in smaller vessels,” he says. “The circulatory system of the eye is the same as the heart. So retinal images are a very good way to look at vascular changes and effectively predict if there are going to be future changes or risk of cardiovascular disease.”

Graduate student Amrit Singh, who studied timing of major cardiovascular events in healthy patients, noted that heart diseases involve blockage of the arterial walls.

“Either a block deposition or hardening of the vessels,” he says. “So it was natural, given that we have retinal imaging, to see whether the changes would start in the smaller vessels.”

NORMAL

Fractals share similar branching patterns at each level

In their separate studies, both researchers used AI models to analyze the micro vessels in their subjects’ retinas, looking for different patterns of twisting and curvature in their retinal arteries as well as different patterns of branching off from the main vessel.

Dhamdhere and his collaborators used a deep learning model to analyze the retinas of 811 patients with chronic kidney disease. Their eye-based model for coronary risk outperformed an existing, widely used risk model based on traditional measures such as cholesterol levels, blood pressure, and body mass.

Singh and colleagues, studying 2,120 patients with no prior history of cardiovascular disease, also found their model predicted risk better than another existing risk model that incorporated factors such as age, sex, race, cholesterol level, and smoking. With further validation, he thinks this procedure could become a routine screening tool used in medical exams.

Empowering physicians

“Everyone goes to a primary care physician,” he observes. “So empowering primary care physicians with this tool can help earlier screening of high-risk patients, which is currently not being done.”

Despite these innovations, Madabhushi thinks medical images are still being underused as a diagnostic tool, making them a continuing target for the insights AI models can provide.

ALZHEIMER’S

Irregular branching patterns at each level

His team is investigating whether retinal images also can produce insights into other diseases such as Parkinson’s and diabetes, working in close collaboration with medical specialists. “I know who I am and what I know,” he says. “I’m proud of the fact I’m a biomedical engineer, but I also appreciate that I don’t have a degree in medicine. But I am willing and eager to learn.”

When all the stakeholders go in with that attitude, Madabhushi says, amazing things can happen. “The greatest compliment I can get when I give a talk about my research and somebody asks, ’At which hospital do you practice pathology? Or radiology?’ Of course, I’m none of those things, but it clearly reflects that I’m willing to make the effort to truly understand other domains.”

This range of new possibilities convinces Emory’s researchers that the full power of retinal imagery is only beginning to be discovered. “There’s tremendous excitement about the ability of machine learning to recognize patterns that aren’t always apparent to the human eye or even to human judgment,” says Madabhushi. “It’s a great example of where the actual diagnostic information is highly underused.”

“We’re looking at how retinal imaging can be helpful for overall systemic health,” Amrit Singh agrees. “That includes not only cardiovascular diseases, but neurodegenerative diseases for, say, Parkinson’s and Alzheimer’s and maybe also the spectrum of cancer.” EHD

CAN YOUR PUPILS PREDICT ALZHEIMER’S?

Researchers at the Emory Goizueta Brain Health Institute have found a possible new way to detect early brain changes linked to Alzheimer’s disease. It involves how pupils naturally expand and contract and their relationship with brain activities, measured by magnetic resonance imaging (MRI).

The research suggests that pupil movements could help track activity in a key brain region called the locus coeruleus, one of the first areas affected by Alzheimer’s. “Findings point to the potential development of novel biomarkers for detecting early changes in Alzheimer’s,” says Deqiang Qiu, co-director of the Biomarker Core for Imaging at Goizueta Alzheimer’s Disease Research Center.

Researchers identified a network of brain regions connected to pupil activity, showing that this network weakens with age, which impacts memory, problem-solving skills, and spatial awareness. Higher levels of a protein called tau—an early sign of Alzheimer’s—were closely connected to these changes.

ILLUSTRATION: MICHAEL KONOMOS MEDICAL ILLUSTRATOR ESOM

RESEARCH STRATEGIES FOR IMPROVING

The Dynamics of Aging

By Lara Moore

Healthy aging is more than the absence of disease, it is a reenvisioning of our perception of growing older. These researchers are creating new pathways to support the journey.

Healthy Aging Holistically

While lifespan has dramatically improved in the past 70 years, aging issues have also become worse in some ways because of changes in diet, lifestyle, stress, and social relationships. As many Americans are hitting the 65-plus mark, research that links the psychological and social experiences of aging to its biological markers is revealing ways to improve the aging process.

Vincent Marconi, professor of infectious diseases in Emory School of Medicine and professor of global health in the Rollins School of Public Health, has co-edited a special issue of the journal Aging Cell that challenges biomedical research’s traditional focus on individual aging-related diseases such as diabetes, cancer, heart disease, and dementia in favor of science that focuses on the whole person.

“A lot has been learned about the biological aging process, both at the cellular and the molecular levels,” says Marconi.

Vincent Marconi, professor of infectious diseases and global health.

individuals facing chronic conditions, stress, and socioeconomic barriers.”

The special issue of Aging Cell, co-edited with Monty Montano of Harvard Medical School and Kris Ann Oursler of Virginia Tech, investigates aging-related topics including:

n Whether genetic variations in centenarians confer protection from age-related diseases

n Cardiorespiratory fitness and its role in health and lifespan

n The association between complexity of blood pressure fluctuations and vascular alterations due to aging

The special issue of Aging Cell was created to reconceptualize healthy aging as a holistic process.

n How religious and existential variables relate to psychosocial factors and biomarkers related to cardiovascular risk.

“However, improving both lifespan and health is a difficult challenge because health is affected by so many factors, including the environment and genes. It’s particularly difficult to do this for

n Impact of physical activity and exercise compared with lack of muscle use on gene function

Beyond the absence of disease, a growing body of evidence suggests healthy aging must also integrate every aspect of the body and mind to optimize the way people experience their lives. These include thinking, behavior, the senses, the cells, and the molecules.

A Creative Approach to Dementia Care

Having dementia changes everything, from perspective to orientation. Each change, though, holds an opportunity for family care partners to meet people living with dementia “where they are now.” But how?

To answer this question, the collaboration Improving Care through Improv was formed among Emory clinicians, Georgia State University gerontologists, local theatre improvisers, and community educators. Funded by Georgia Gear, a geriatrics workforce program funded by the US Health Resources and Services Administration (HRSA), and the Emory Roybal Center for Dementia Caregiving Mastery, this pilot program teaches non-professional caregivers improvisation skills to foster empathetic and effective communication.

Led by Dad’s Garage Theatre Company, the program teaches

improvisation techniques to help caregivers navigate unexpected conversations and situations with empathy and flexibility. One such technique is the “yes, and …” principle. Through this method, caregivers validate the care recipient’s experience by replying with “yes and …” as opposed to “no, that’s untrue.”

This approach spares those living with dementia from having to repeatedly confront harsh realities, such as the loss of a spouse.

“Improv encourages caregivers to meet patients where they are, fostering empathetic and responsive interactions,” says Ted Johnson, chair of the department of family and preventive medicine at Emory.

Workshops are designed for family care partners, professional caregivers, and students.

Members from the program, researchers, and Emory Integrated

Emory partnered with Georgia State and local artists and educators to create the Improving Care through Improv program. (Left, Dad’s Garage Theatre Company improv group in Atlanta)

Memory Care studied how improv training may support dementia care, transitioning its use to an evidence-based practice.

The study identified four key approaches used by effective care partners that align with improv principles: knowing the person, meeting people where they are, being in the moment, and viewing every encounter as an opportunity for meaningful engagement.

According to the study, using improv is a kinder, gentler way to help caregivers relate to those living with dementia as they encounter changes and new challenges.

Over the past two years, this program has expanded to nursing homes, assisted living communities, and professional conferences.

To learn more, visit the Improving Care through Improv website dadsgarage.com/care.

PHOTO COURTESY DAD’S GARAGE

MapHabit and Neurotrack

Alzheimer’s and other dementias are progressively deteriorating conditions. “We wondered, ’Are there things that we can do to help maintain the person’s independence longer?’” says Stuart Zola, former director of Emory National Primate Research Center and Emory professor of psychiatry and behavioral sciences emeritus. The result: not one but two helpful innovations.

reminders, develop a custom care plan, and communicate with family members and clinicians.

“The idea of developing MapHabit revolved around visual mapping, a technique I used to teach, which creates associations and develops a visual map of these associations to depict a bigger picture,” says Zola.

MapHabit not only supports the brain health and habit memory of those living with dementia, it also supports their caregivers. In NIH-supported studies, 75 percent of participants reported an improvement, and caregivers reported a 35 percent reduction in stress.

Early detection

The evidence-based app enables users to capture images from their daily living routines, such as brushing teeth or taking medicine, to create true-to-life

The evidence-based app MapHabit is focused on the concept that good health is rooted in daily habits. Those with Alzheimer’s disease and related dementias (ADRD), however, need assistance remembering and performing healthy habits such as hygiene as well as managing comorbidities like diabetes or high blood pressure.

Mapping your habitat

MapHabit, an app that offers stepby-step, customizable photos and videos, was developed by Zola and Emory business alum Matt Golden. The evidence-based app enables users to capture images from their daily living routines, such as brushing teeth or taking medicine, to create true-to-life modules of how to perform that task. The pictures and videos feature the users’ own surroundings and belongings. MapHabit users receive a personal encrypted device, which only shows MapHabit content and can send daily

Neurotrack Technologies uses an FDA-registered device to provide clinicians with a three-minute cognitive screening to aid in the early detection of cognitive decline.

It can help decipher the difference between typical signs of aging and those from early onset Alzheimer’s. Just two in five adults with probable dementia have a diagnosis, and early intervention is key.

Neurotrack was developed based on Zola’s and a colleague’s research at Emory’s National Primate Research Center, which led to the discovery that cognitive decline could be identified using eye-tracking technologies.

“Our focus is on early detection of cognitive decline and interventions that you might begin to develop if you have some idea that you might be on that trajectory. For example, we know that things like sleep, good nutrition, exercise and staying cognitively engaged are the pillars that might help delay the onset of Alzheimer’s.”

Emory’s Integrated Memory Care

The Alzheimer’s Association recently reported that more than 10 perfect of Georgia’s population—or roughly 188,000 people—live with Alzheimer’s disease or related dementias, and that number is slated to grow.

The report also indicates that 64 percent of the state’s 374,000 unpaid caregivers reported having at least one chronic health condition such as diabetes, and a whopping 59 percent of those caregivers reported struggling to tend to their health needs because of being “on duty 24/7.”

Last year, Georgia caregivers also worked a total of 775 million unpaid hours.

Emory’s Integrated Memory Care (IMC) is piloting a voluntary, alternative Medicare payment model, and one notable component of the new model, called GUIDE, is that it will cover respite for caregivers.

This collaboration between Emory IMC and the Centers for Medicare & Medicaid Innovation Center is designed to improve quality of life, help those with Alzheimer’s or related dementias remain in their homes and decrease strain on unpaid caregivers.

Differences in this new payment model include coverage for training courses for caregivers, a 24/7 support line, and a new billing structure, which pays based on outcomes rather than services rendered.

“As a long-time participant in this space, we are pleased to partner with the Medicare Innovation Center to test the GUIDE model, anticipating that it will improve lives,” says Carolyn Clevenger, founder and director of Emory Integrated Memory Care and professor at the Nell Hodgson Woodruff School of Nursing.

A joint initiative between the School of Nursing and Emory Healthcare, Emory IMC offers streamlined geriatric primary care, dementia care, and caregiver education.

The nurse-managed practice, available as an outpatient clinic at 57 Executive Park in Brookhaven and 18 other Atlanta-area senior living communities, has treated and managed more than 3,000 patients since 2015.

Medicare patients diagnosed with dementia living in most metroAtlanta ZIP codes may enroll in the GUIDE payment model by contacting Emory Integrated Memory Care. Prescreening may also be requested by visiting nursing.emory.

edu/imc

Carolyn Clevenger, director of Emory Integrated Memory Care

Does Empathy Come with Reciprocity?

It’s already well-documented that perpetual unforgiveness and anger wreak havoc on the body. One study in the Journal of the American College of Cardiology credits chronic anger with a 19 percent increase in developing heart disease—even among healthy populations.

But how does being empathetic influence one’s health?

A new study from Emory, funded by the National Institute on Aging, will test whether caregivers of those living with dementia who receive cognitive empathy training will have improved health outcomes. This study builds on the results of a previous pilot study, funded by Emory’s Roybal Center, the Center for Health and Aging, and Georgia’s Aging and Disability Resource Connection, that measured before-and-after emotional well-being and brain activation (fMRI) of the caregivers as well as their blood for proinflammatory biomarkers.

These proinflammatory biomarkers, called cytokines or CRP, are not only associated with chronic stress but also with traumatic events such as major car accidents or being hospitalized with severe COVID-19. Having too many cytokines contributes to inflammation, a well-known contributor to many age-related diseases.

concerned about remembering the doctor’s name when I meet him.”

Following the study, the brain imaging (fMRI) of caregivers who received cognitive empathy training showed that the parts of the brain associated with cognitive empathy and emotion regulation became more active. One area of consistent activation, for example, was the ventrolateral prefrontal cortex, critical to emotional regulation. These changes were associated with reduced stress in caregivers. Following this pilot study, caregivers reported decreased levels of depression, anxiety, perceived stress, and burden. Regarding the cytokines, or proinflammatory biomarkers, the study states that were was some preliminary indication that empathy training may decrease inflammation in some individuals, but the findings warrant a larger study.

As caregivers experience elevated levels of stress, this study examines how they would be affected by a 10-day training period, in which the caregivers photographed their loved ones with dementia every day, writing captions describing how they may be feeling to accompany each photo. One example from the study featured an elderly gentleman with a caption stating, “I feel anxious when I have to go to the doctor. I don’t remember the doctor’s name or why we’re going, but my wife says I have to go. I feel

“I feel anxious when I have to go to the doctor. I don’t remember the doctor’s name or why we’re going, but my wife says I have to go. I feel concerned about remembering the doctor’s name when I meet him.”

“Our working model is that cognitive empathy improves relationships among the caregivers and care recipients when the caregiver becomes more empathetic and starts to adopt their mental perspective more easily,” said James Rilling, lead author on the study and a professor of psychology at Emory’s College of Arts and Sciences. “If the relationship improves, you would expect there to be less stress for both parties, and it’s known that psychological stress can increase levels of inflammation,” he adds.

Rilling says there will be more than 20 million family caregivers in the US by 2060, citing a growing crisis and the need for interventions that improve caregiver health and emotional well-being.

The new study is also led by Ken Hepburn, a professor at Emory’s Nell Hodgson Woodruff School of Nursing. “The photo-captioning process challenges caregivers to inhabit the thoughts, feelings, and experiences of persons living with these illnesses,” says Hepburn. “Such acts of cognitive empathy may enhance caregivers’ daily care effectiveness and may also enable them to maintain an emotional connection with persons whose illness is gradually eroding their capacity to connect with themselves, others, and the world around them,” he adds.

The interdisciplinary project also involved the School of Medicine’s Molly Perkins, professor and co-director with Hepburn of the Emory Roybal Center for Dementia Caregiving Mastery, and researchers from the Rollins School of Public Health, including professor John Hanfelt and senior biostatistician Liping Zhao, both from the Department of Biostatistics and Bioinformatics and Emory’s Goizueta Alzheimer’s Disease Research Center.

EMORY HEALTHY AGING STUDY

Prediction and Prevention

The Emory Healthy Aging Study has been examining the effects of aging on both our physical and mental health since 2016.

More than 20,000 volunteers have filled out the Healthy Aging questionnaire, which helps researchers learn how diet, exercise, hobbies, and health history affect the development of disease as we age.

“There is so much we still don’t know about brain diseases like Alzheimer’s, so it’s important to get as many people as possible to participate in research studies like this to increase our ability to prevent these diseases in the future,” says Allan Levey, Woodruff Professor of Neurology at Emory and the Goizueta Foundation Endowed Chair for Alzheimer’s Disease Research.

Healthy aging habits, according to the Emory Healthy Aging Study 2024-2025 annual report, include:

EXERCISING REGULARLY Engage in a minimum of 2.5 hours of moderate or 75 minutes of vigorous exercise per week and two days of resistance training.

ENGAGING IN BRAIN-STIMULATING ACTIVITIES Stay social, travel, learn a new language, play an instrument.

CUTTING OUT VICES

Do not smoke and avoid drinking heavily.

EATING HEALTHY FOODS

Enjoy a Mediterranean-style diet, high in nutrients your brain and body need to age well.

The Healthy Aging Study is still seeking volunteers to participate. Involvement ranges from filling out a questionnaire to physical testing.

The report offers free webinars by Emory aging experts as well.

“The Emory Healthy Aging Study aims to uncover key factors that influence brain health and aging. With thousands of participants, this research is paving the way for earlier detection and better prevention of cognitive decline and dementia,” says Alvaro Alonso, the Stephen D. Clements Jr. Chair in Cardiovascular Disease at Rollins School of Public Health.

DINNER WITH A DOCTOR

How to Increase Your Health Span

By Mary Loftus • Illustration Christiane Beauregard • Photography Jack Kearse

Aging well is a hot topic these days. Popular magazines offer “7 Anti-Aging Supplements to Try,” “The New Old Age,” “Increasing Your Health Span,”

“Prioritizing Your Aging Trajectory,” and “80 Is the New 60.”

By 2040, the number of people 65 and older will double. Perhaps even more shocking, it’s projected that half of today’s 5-year-olds could live to 100.

The gist: it’s even more important to stay healthy and functional for as many decades as possible.

But successful aging is about more than the absence of illness. In addition to getting sick, older adults are concerned about retaining their independence, maintaining a sense of community and purpose, and being in control of their lives.

Emory Health Digest asked two experts on aging—Carolyn Clevenger, gerontological nurse practitioner and director of Emory’s Integrated Memory Care Clinic, and Camille Vaughan, professor of medicine and director of the Division of Geriatrics and Gerontology—to host our Dinner with a Doctor this issue.

Over courses of deviled eggs, seasonal salads, wild-caught salmon, and beluga lentils, panelists asked about topics from the logistics of caring for aging parents to which exercises are best in midlife to increase strength and balance. And each of our experts gave their top five recommendations for increasing your lifespan and your health span.

One panelist was worried about her 80-something mother, who has a lot of medical issues and needs help organizing her files, medications, and appointments. “I want to make sure I have the right tools and that I’m offering good solutions,” she says. “Also, how do you

Dinner with a Doctor hosts and panelists gathered at Emory Point’s General Muir to discuss healthy aging across the life span.

know when it’s Alzheimer’s or dementia?”

“One of the things that happens early on in cognitive impairment is impairment in executive function, which shows up in an inability to remember passwords and to log back into things,” says Clevenger. “You need to frame this very respectfully: ’Mom, I really want to be able to support you better.’

Some parents are wide open; others will say, ’No, this is my business.’” If she has a digital medical record like MyChart, you can log in by proxy and be able to see notes from the visits.”

“It’s the practical things you’re trying to get your hands on: log ins, passwords, tax information, birth certificates, marriage certificates, deeds, and titles.”

“Do you have power of attorney for health

care and finances? They are separate,” says Vaughan. “Who is the default decision maker? If nothing is written down, it’s going to be spouse first, then adult children. Siblings are treated equally. If there are preferences, it’s good to get that down in a document.”

“I also want to do what I can to avoid some of the health conditions she and my grandmother have had, if possible,” adds the panelist.

“Well, I can tell you that, specific to Alzheimer’s, for most people who develop that late in life there is likely not a genetic component but other

plemental insurance, or other organizations like the VA cover.

“When thinking about your resources, also think about family networks and social relationships,” Vaughan says. “I have two children and my parents live with us, so we already have a multigenerational household; my kids are used to that.

“Also if you have long-term care insurance, as a few of my patients still do, that can help offset the cost of an aging life care manager and some other services,” says Clevenger.

factors,” says Clevenger. “The brain is connected to the rest of body, so autoimmune disorders, treatments for other diseases, bypass surgery, those can trigger changes in the brain.”

“There’s a group of specialists called geriatric care managers, largely nurses or social workers, who can help for a fee, if you don’t have the bandwidth,” Vaughan says. “They can accompany individuals to appointments, take detailed notes, report back, and share information among providers.”

Many of the resources available to older adults and their care partners in the US are fee-based, she adds, but always check into what Medicare, sup-

If she were prioritizing general safety concerns for aging parents, says Clevenger, she would pay attention to: medications (not taking them or taking too many); finances and important bills (like electricity, rent, or mortgage payment); driving; and firearms.

“If they are gun owners, what is the plan if are unable to manage their firearms or feel unsafe?” she asks. “The plan should start with how many do they have and where are they.”

A panelist who is an only child asks how she can prepare for her parents’ aging, since she has no siblings to share the responsibilities.

“In my research and focus groups with family caregivers, even if there are siblings, it tends to be one person who handles things. Also, you will have people in your village who are not necessarily family, as well,” says Clevenger.

Nothing is risk-free

A panelist asks about fall prevention. How can you prevent falls? Convince people not to get on ladders or roofs? And is it true that sometimes people fall because their hip breaks, and not that they break a hip when they fall?

“That is a phenomenon because of brittle bones,” Vaughan says. “I’ve tried to avoid fear talk because these are successful adults. They have made it [to an advanced age.] A better approach is to promote agency.”

Vaughan explains the “4Ms of Age-Friendly Care,” a framework for improving health care for older adults developed by a team led by the Institute for Healthcare Improvement: What Matters Most, Medication, Mentation (Mind), and Mobility.

“The idea is that all of these things interact with each other. How do your medications influence your mind? How does your mobility impact your fall risk?” she asks. “And how do you align all of that with what matters most to you in this phase of life?”

The focus of exercise is often on moderate intensity cardio, she says. But strength training and other types of exercise as especially important as we age. “Chair stands can be a very functional exercise,” she says. “Just sit in a chair and stand up without using your arms. Doing that 15 times in 30 seconds (for people 60-plus) is one of our assessments for fall risk. You have to be able to get up. There are exercises that help you with activities of daily life.”

It’s important to maintain activity, core strength, and stability,” Clevenger says. “In midlife, whatever you’re not using, you’re losing. You will start to have muscle loss if you’re not doing anything.”

A panelist says his parents are in their 60s and are just starting to slow down a bit. “I can see them getting winded easier while doing a chore that used to be routine. Are there kinds of activities/movements they can do to help this?”

Our experts agree that, even as we age, we should take calculated risks to remain active and moving. “Everything is a tradeoff,” Clevenger says. “Restricting movement because you’re afraid of falling is also risky.”

A fall, especially one that happens when someone is just walking along or doing normal daily activities, is often a symptom of something else: the pneumonia that’s been brewing, a lack of balance, dizziness, or even osteoporosis.

Use it or lose it

“Would you rather hurt yourself lifting weights or lifting a bag of dog food? Or even putting on your socks?” asks Vaughan.

PANELISTS

Tai chi, the ancient Chinese martial art form, is very helpful for balance and may help reduce falls in older, frail adults, said Vaughan. “We were actually part of the trials here at Emory that supported that finding some 20 years ago,” says Vaughan. The benefit became most apparent by the fourth month of the study, when risks of falling were reduced by 40 percent as participants became less dependent on walkers and wheelchairs and learned the movements of tai chi.

“Does it have to be tai chi?” asks the panelist. “I’m not sure my dad would do that.”

“What would he do? Just encourage the best thing for him,” says Vaughan. “There are community-based programs, the YMCA, exercise classes that

EXPERTS

Laura Redfern, director of project management

Peta Westmaas, creative director

Carolyn Clevenger, professor of nursing, gerontological nurse practitioner, director of Emory’s Integrated Memory Care clinic

Matilda Redfern, communications coordinator Camille Vaughan, professor of medicine and director of the division of geriatrics and gerontology

Daniel Christian, senior writer, content and brand story Ashlee Gardner, assistant director of strategic communications

can be standing or seated. The VA has a series of exercise videos on YouTube called Gerofit. You can ride a recumbent bike. There are some great options.”

Almost all exercise forms beat placebos, says Clevenger. “There is an awareness now that, ’If we want to do this at 80, we need to do this at 40.’ We can anticipate some slow down, so overshoot early. If you stop doing activities, then you have consequences.” Her in-laws are doing Silver Sneakers, a walking group that includes other exercises, such as resistance training with bands.

“My parents do walk a lot,” the panelist says. “My dad walks on the beach, which seems good, since he’s walking on sand.”

“Yes, the level of walking you’re aiming for is that you can talk while you’re doing it but not sing,” Vaughan says. “If you can sing while you’re walking, you’re not walking quite fast enough.”

Factors in Aging Well

When asked about their top recommendations for healthy aging at every age, the experts said to focus on things in your control: don’t smoke, consume alcohol only in moderation, wear a seatbelt, wear a helmet, get physically active, manage stress, maintain good social connections, reduce inflammation, get good sleep, and practice gun safety.

“For example, we routinely screen for high blood pressure and cholesterol and have great medications now, like statins and metformin. There are specialists in everything from menopause to sleep. We know many more things now about maximizing health and longevity in midlife than the generation ahead of us,” says Vaughan.

A panelist says, “Yes, I have a group of friends, we have a virtual chat each week, and it turns out all of them have high blood pressure except for me. They live the same way that I do, so I was completely taken aback.”

Walking with a friend, consistently, provides accountability and social engagement, and “you actually release positive hormones that are brain healing when you’re with friends,”

Clevenger says. You also tend to walk longer and faster with a friend or in a group.

Clevenger says genetics and family history do have an impact on high blood pressure, with about half the population developing hypertension as they age. “A stiffening of blood vessels occurs, and we release more hormones that tighten blood vessels. Blood pressure is called the silent killer for a reason, that’s why it’s important to do an annual physical and have screenings. It’s something you don’t want to ignore.”

Vascular disease can also lead to cognitive impairment, says Vaughan, so treating high blood pressure is important because it can influence the course of dementia or Alzheimer’s.

Also, pay attention to inflammation levels and your microbiome, says Clevenger, who tries to avoid ultra-processed foods, makes sure she gets enough fiber, eats fermented foods, and ingests 30 different plants in a week (even if just a small amount of each, for the variety). Intermittent fasting (eating during a condensed period of the day, such as 8 hours, and then not eating for an extended period, such as 16 hours) is also showing some promise in improved health and aging, she says.

Medical advances have made living longer and healthier a reality, and many conditions that used to age or kill people prematurely can now be prevented or managed.

But a host of other factors influence dementia as well, some known, such as repeated head trauma as in football or boxing, and some unknown.

“There are people who die with Alzheimer’s pathology in their brains that have no symptoms,” adds Clevenger. “What’s different about them vs. those with lots of symptoms who can’t keep up with day-to-day things? Probably other factors. Brain cells need enough blood flow with proper oxygen, not too many toxins, neurotransmitters that are in balance. They need an optimal, happy environment that is not inflamed. It might be that inflammation damages brain cells and then you see the effects of the Alzheimer’s disease.”

Growing old is a success story

“Once you get into your 70s and 80s you’ve already made it,” says Vaughan.

“People 85 and over are the fastest growing population. Great, that’s a success! Yay, vaccines! We have succeeded in a lot of things that help people age well,” she says. “And so, we do see more diseases that happen later in life. That’s worrisome, but it’s also because we’ve succeeded in more people getting to that ’later in life’ phase.”

It’s never too late to prioritize your health and ward off some of the negative aspects that inevitably accompany aging.

One way is cognitive stimulation, says Clevenger. “I’m not talking about crossword puzzles,” she says. “I’m talking about learning something new, talking to people who are interesting, experiencing new places, thinking about things in a different way, employment that challenges your mind.”

Vaughan says she sees the social engagement aspect as being most important. “Of the medications that have proven to be somewhat successful in slowing the progression of Alzheimer’s in some people, like donepezil or Aricept, social engagement performs just as well.”

And social engagement is at risk right now, she adds, in “the way people think they’re socially interacting but

they’re not.” The virtual world we spend much of our time in doesn’t involve the same interplay of real-life conversation, she says – listening, adjusting, responding.

Panelists ask a few final questions over dessert (and yes, there was cheesecake).

“When would you say someone should switch from their primary care physician to a geriatrics specialist?”

“When the discussion of what matters most to you is what you want driving your care,” Clevenger says. “If there are multiple things on your problem list and you want somebody who knows how to manage the total picture; quality of life and function.”

“There’s a lot of value to a longstanding primary care relationship too, that person who has known you over the years and knows when something has changed,” says Vaughan.

“Honestly, there are not going to be enough geriatricians to take care of every person over 65. People who are 80-plus years old, even really healthy ones, are more vulnerable when they enter the health care system, so access to someone with geriatrics expertise as you get into those years would be very valuable.” Geriatricians are also helpful when “there are cognitive concerns, or you’re managing a lot of medications.”

Gerontology (the multidisciplinary study of aging) and geriatrics (the medical care and treatment of older adults) saw a boost in interest from medical students and residents after the pandemic but “still not enough,” says Clevenger.

“We lost 3 percent of our population over 85 in the US during COVID. No one talks about that. The isolation, the lockdown of long-term care communities, the lack of services,” says Vaughan. Clevenger adds that people living with dementia had a 40 percent excess risk of death with COVID before vaccinations became widely available.

“For kids born today, what are chances they will exceed 100 or 110?” asks another panelist. “That’s not how I think about it, honestly,” says Vaughan. “I just want them to have a long, meaningful life that is full of purpose.” EHD

Yes, and . . .

Improv tools are helpful for caretakers

My cousin and I were signing my aunt out of her memory care facility to go into town for breakfast. When the aide at the front reception recognized me as an unfamiliar face, she asked my aunt, “Who’s come to visit you today?”

My aunt smiled. “That’s my grandson.”

I clarified, “I’m actually her nephew.”

My aunt stopped smiling. She seemed taken aback by my tone and confused by my answer. By choosing to correct her, I had missed an opportunity.

This essay by Emory geriatric physician Ted Johnson originally appeared on the STAT news website in a slightly different format.

PHOTO COURTESY JOHNSON FAMILY

I am a geriatric physician and co-lead the federally funded Emory Geriatric Workforce Enhancement Program, called Georgia Gear. We work to improve the care and quality of life for all older adults, focusing on the unique needs of those living with Alzheimer’s disease and related dementias as well as their families and caretakers. We ally with talented and like-minded partners to amplify their work and collectively come up with eye-opening solutions to difficult problems. And one of my favorite solutions is improv.

Improvisers talk about the concept of “yes, and …”, a core tenet of improv, which means accepting what has been offered and building on it. The tenets of improvisation and practices for meaningful engagement with people with dementia complement each other quite well.

Coming back to my interaction with my aunt—I did nothing wrong, but I could have done better. I opted to correct and call out the precise relationship: that I’m my aunt’s nephew and not her grandson.

I had other choices. I could redirect or join. I reflected on who needed to hear the facts about how my aunt and I were family. My cousin already knew. The aide at the facility was simply trying to engage with my aunt.

I needed to use strategies from Improving Care through Improv training. George State University professor of gerontology Candace Kemp and Amanda Lee Williams, an Atlanta-based improviser, co-lead the training. They have trained more than 1,500 participants. Here are some better “yes, and” answers I took away from the training. So many possible choices could have followed my aunt’s statement, “That’s my grandson.” Each endorses the kernel of what she said, builds on it, and helps my aunt look good, while furthering the conversation: “Yes, and it is a great day for family time!”

“Yes, and we are headed out for great conversation and a delicious and filling breakfast!”

“Yes, and because it is so cold outside, we’re taking these warm hearts out to enjoy a cup of hot coffee!”

Our group is not the first to use improv training for dementia professionals or family and friend care partners. Two prior programs have published on “improv for care” and “improv to improve.” They found that care partners trained in these techniques had decreased depression and a decreased feeling of burden.

Our program is unique because we partner closely with gerontologist researchers and improv educators. Our gerontologists provide the technical details and framework of the “improvisation mindset.” Our improvisers— many of whom have family members with dementia—teach care partners to apply these techniques and find they work.

Care partner participants say they enjoy the training and recommend it to others.

We want to make this training widely available. Dad’s Garage, a nonprofit theatre company in Atlanta, and Georgia Memory Net, a state program supporting those living with dementia, have developed an online library of free video training that will soon be available. The short video clips walk people through how to use improv tools and techniques to change common, challenging scenarios into opportunities for connection.

Here is how the rest of the breakfast outing went: After correcting my aunt, I moved on. She forgot the whole episode. Pick yourself up, dust off, and get back on the horse, as my uncle would say. With an improvisation mindset, there is always a next chance (especially, let’s be frank, when you’re working with dementia patients).

My cousin is a rock-star family care partner, always helping the conversa-

tion move forward. My aunt frequently spoke about “Dad.” Most of the time, she was talking about our grandfather (her dad). But sometimes it seemed like she was talking about my dad (her brother). She would talk about the 1990s, then the 1950s, then 2010. Sometimes she’s a mom with a large family; other times, she’s a teenager answering her parents’ house phone.

My aunt and I have always lived thousands of miles apart, but during that visit, I saw the aunt I remembered: engaged, animated, funny, a little spicy, and opinionated. She orders coffee but doesn’t drink it. She eats two pancakes, a threeegg omelet, and a pile of potatoes—a lot for someone who’s 4-foot-10.

I’m not sure my aunt recognized me, but I recognized her. EHD

Geriatric physician Ted Johnson, chair of Emory Family and Preventive Medicine, works in the Integrated Memory Care primary care program supporting people living with dementia and their families.

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All over the world, people are living extraordinary lives, full of happiness and with hardly any heart disease, cancer, or diabetes. Sanjay Gupta, Emory neurosurgeon and CNN chief medical correspondant, has been on a decades-long mission to understand how they do it, and what we can learn from them. Scientists now believe we can even reverse the symptoms of Alzheimer’s and dementia and grow sharper and more resilient as we age.

Podcast episode: Why We Need to Embrace Stress

Most of us try to avoid stress at all costs. But Sharon Bergquist, Emory internist and author of The Stress Paradox, says too little stress can be just as bad for you. Bergquist sits down with Gupta to explain the surprising science behind how some stress can make you healthier.

Your Fantastic Mind, the nationally syndicated Emmy Award-winning PBS television show produced by Emory Brain Health in partnership with Georgia Public Broadcasting, turns its attention to memory. Dive into stories on how AI is used to detect Alzheimer’s, lifestyle interventions to slow cognitive decline, how future doctors are being trained in dementia care, and emerging research linking pollution and memory loss.

Season 6: Focus on Memory

Health Wanted, a weekly radio show and podcast produced in partnership with WABE, brings need-to-know public health headlines and breaks down the science behind trending topics. Host Laurel Bristow, an infectious disease researcher leading social media science communication at Rollins School of Public Health, covers everything from Ozempic to the ozone, all in pursuit of better health.

To hear an episode as soon as it’s out, follow us @emoryrollinssph or visit wabe.org/healthwanted.

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