Short-term goals will help you make physical activity a regular part of your daily life. For these goals, think about the things you’ll need to get or do in order to be physically active. For example, you may need to buy walking shoes or fill out an Activity Log so you can figure out how to fit physical activity into your busy day. Make sure your short-term goals will really help you be active. Here are a few examples of short-term goals:

Today, I will decide to be more active.

Tomorrow, I will find out about exercise classes in my area.

By the end of this week, I will talk with my friend about exercising with me a couple of times a week.

In the next 2 weeks, I will make sure I have the shoes and comfortable clothes I need to start walking for exercise.

Questions to Ask Your Doctor About Exercise

Are you considering adding exercise to your daily routine or significantly increasing your level of activity? Talk to your doctor about the exercises and physical activities that are best for you. During your appointment, you can ask:

Are there any exercises or activities I should avoid? Your doctor can make recommendations based on your health history, keeping in mind any recent surgeries or ongoing health conditions such as arthritis, diabetes, or heart disease. This would be a great time to check with your doctor about any unexplained symptoms you’ve been experiencing, such as chest pain or pressure, joint pain, dizziness, or shortness of breath. Your doctor may recommend postponing exercise until the problem is diagnosed and treated.

Is my preventive care up to date? Your doctor can tell you if there are any tests you might need. For example, women over age 65 should be checked regularly for osteoporosis.

How does my health condition affect my ability to exercise? Some health conditions can affect your exercise routine. For example, people with arthritis may need to avoid some types of activity, especially when joints are swollen or inflamed. Those with diabetes may need to adjust their daily schedule, meal plan, or medications when planning their activities. Your doctor can talk to you about any adjustments you need to make to ensure that you get the most out of your new exercise routine.

Yih Woei Fridell Health Scientist Administrator , Division of Aging Biology (DAB).

Over the past few decades, scientists have made breakthroughs identifying molecular and cellular mechanisms of aging. Researchers have grouped these mechanisms into nine categories considered to be “hallmarks of aging” and, as a result, have created a useful framework to further advance our understanding of the diverse changes that occur as we grow older.

Importantly, these hallmarks also provide scientists with access points that can be manipulated and studied to inform further research about how we might change the ways we age, perhaps through the development of therapies to increase older adults’ health and well-being. In principle, the hallmark mechanisms could be altered to increase or decrease features of aging. NIA-supported research has also indicated that the hallmarks interact with each other in layered and nuanced ways. Our next step is to better understand how the hallmarks interact and whether they should be targeted for interventions individually or in groups.

Three new FOAs to connect the dots

To encourage innovative research on the interactions between hallmarks of aging, NIA has issued three interconnected Funding Opportunity Announcements (FOAs), all with the due date of Oct. 11, 2022:

RFA-AG-23-012 Inter-Organelle Communication as a Platform to Interrogate the Interactions of Hallmarks of Aging (R01 Clinical Trial Not Allowed)

Contact sites where the membranes of cell organelles come together are critical hubs for the transfer of ions, metabolites, lipids, and proteins that have important roles in cellular aging. This FOA aims to deepen our mechanistic understanding of organelle communication and how it shapes the interactions of the hallmarks of aging.

RFA-AG-23-013 Mapping Interconnectivity Among Hallmarks of Aging Under Lifespan Modifications (R01 Clinical Trial Not Allowed)

This FOA is designed to discover whether there are hierarchies among the hallmarks that underlie different changes with age, or if there is a threshold beyond which the hallmarks and/or their interactions with one another become “tipping points” that beyond which the aging process cannot be reversed.

RFA-AG-23-015 Studies of Cytosolic DNAs in the Interactions of Aging Hallmarks (R01 Clinical Trial Not Allowed)

The accumulation of DNA in the cytosol (the fluid portion of a cell’s cytoplasm) has important associations with aging, cellular senescence, and decline of cellular and physiological functions. The goal of this FOA is to explore cytosolic DNAs as integrators of hallmark interactions and instigators of downstream events leading to age-related cellular and tissue deterioration.

Building an innovative aging hallmarks research consortium

While each FOA emphasizes a unique challenge, releasing the trio of opportunities together should increase collaboration and the exchange of data, technical resources, and expertise. We hope the collective impact can lead to a clearer and more comprehensive view of the complex picture of the aging hallmarks and their mechanisms.

We are also optimistic that these three FOAs will spark additional scientific collaboration and data sharing to broadly advance the field of aging biology. We plan to help in this process by organizing regular scientific meetings and virtual conferences to build an innovative network of investigators and labs studying new approaches to understanding the hallmarks of aging. This network will serve as a platform to report updates, share technical advances and resources, and tackle research hurdles.

If you are interested in helping advance our understanding of aging hallmarks, we encourage you to apply by Oct. 11! If you have questions, please contact the NIA Division of Aging Biology.

www.nia.nih.gov.

by Michelle McMurry-Heath

Over 6 million Americans suffering from Alzheimer’s just received a gut-punch from the federal agency that oversees Medicare. So did their loved ones.

In mid-January, the Centers for Medicare and Medicaid Services made an unprecedented decision to cut off most seniors’ access to an entire class of Alzheimer’s treatments. CMS’s actions will have a significant impact on dementia research — and could dash Americans’ hopes for a cure. And this decision will hit vulnerable minority and other underrepresented populations especially hard.

The decision most immediately impacts Medicare enrollees who were considering Aduhelm, a medicine that the FDA approved in June. The drug reduces amyloid plaque in the brain, which many — but not all — scientists believe is a trigger for Alzheimer’s.

The FDA weighed the science and determined that an accelerated approval — which the agency has used for promising treatments for HIV and cancer in the past — offered the best path forward. It gives patients, many of whom are hardest hit by a disease, access to a needed therapeutic option, while additional studies are done.

The bureaucrats at CMS evidently disagree with FDA scientists’ approach, which has long been viewed as the gold-standard for science-based safety and efficacy standards.

The Medicare administrator announced it would restrict access to Aduhelm — and any other future “monoclonal antibodies that target amyloid for the treatment of Alzheimer’s disease” — to a minuscule sliver of people enrolled in CMS-approved clinical trials, all of which could take several years. The proposal excludes millions of Medicare beneficiaries currently living with the disease, and it will impact people of color particularly hard.

Studies show that over the last two decades, even though minorities are at an increased risk of developing Alzheimer’s, 94.7% of clinical trial participants for developmental Alzheimer’s treatments have been white.

The decision marks a significant setback for Alzheimer’s research. Nearly 100 Alzheimer’s programs have failed in the past decade. So the FDA’s accelerated approval of Aduhelm, the first new Alzheimer’s treatment since 2003, wasn’t just hopeful news for patients; it was a historic event that gave researchers, and investors, confidence to continue plugging away in search of new treatments.

Today, there are companies of all sizes working to develop treatments to stop, prevent, or slow the progression of Alzheimer’s using a variety of novel strategies. Small biopharma companies are leading the majority of these programs.

If Medicare — which pays for the vast majority of Alzheimer’s treatment — won’t cover a new drug, despite the FDA’s experts ruling that the medicine has great potential, companies would be foolish to keep investing in risky, hugely expensive Alzheimer’s research.

CMS officials are, in effect, setting themselves up as a second drug-approval agency. CMS is not equipped for this. They lack the expertise to tackle these scientific questions – and legally, the agency appears to have exceeded its authority.

If unchallenged, this reproach — and this unilateral assertion of drug-evaluation powers — could harden into a precedent that could damage our treatment-approval process irreparably. And the onslaught of Alzheimer’s and other difficult to treat diseases will continue unchecked for generations to come.

Michelle McMurry-Heath is a physician-scientist and president and CEO of the Biotechnology Innovation Organization. This piece originally ran in the Hill.

The healthy human brain contains tens of billions of neurons—specialized cells that process and transmit information via electrical and chemical signals. They send messages between different parts of the brain, and from the brain to the muscles and organs of the body. Alzheimer’s disease disrupts this communication among neurons, resulting in loss of function and cell death.

The cell body contains the nucleus, which houses the genetic blueprint that directs and regulates the cell’s activities.
Dendrites are branch-like structures that extend from the cell body and collect information from other neurons.
The axon is a cable-like structure at the end of the cell body opposite the dendrites and transmits messages to other neurons.
The function and survival of neurons depend on several key biological processes:

How Does Alzheimer’s Disease Affect the Brain?
The brain typically shrinks to some degree in healthy aging but, surprisingly, does not lose neurons in large numbers. In Alzheimer’s disease, however, damage is widespread, as many neurons stop functioning, lose connections with other neurons, and die. Alzheimer’s disrupts processes vital to neurons and their networks, including communication, metabolism, and repair.

At first, Alzheimer’s disease typically destroys neurons and their connections in parts of the brain involved in memory, including the entorhinal cortex and hippocampus. It later affects areas in the cerebral cortex responsible for language, reasoning, and social behavior. Eventually, many other areas of the brain are damaged. Over time, a person with Alzheimer’s gradually loses his or her ability to live and function independently. Ultimately, the disease is fatal.a computer generated graphic of the brain with labels pointing to the cerebral cortex, entorhinal cortex, and the hippocampus

What Are the Main Characteristics of the Brain with Alzheimer’s?
Many molecular and cellular changes take place in the brain of a person with Alzheimer’s disease. These changes can be observed in brain tissue under the microscope after death. Investigations are underway to determine which changes may cause Alzheimer’s and which may be a result of the disease.

Communication. Neurons are constantly in touch with neighboring brain cells. When a neuron receives signals from other neurons, it generates an electrical charge that travels down the length of its axon and releases neurotransmitter chemicals across a tiny gap, called a synapse. Like a key fitting into a lock, each neurotransmitter molecule then binds to specific receptor sites on a dendrite of a nearby neuron. This process triggers chemical or electrical signals that either stimulate or inhibit activity in the neuron receiving the signal. Communication often occurs across networks of brain cells.

For More Information About Alzheimer’s Brain Changes
NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
800-438-4380
[email protected]
www.nia.nih.gov/alzheimers

High and low blood pressure levels among different older age groups were associated with varying dementia risks, according to research published in JAMA Internal Medicine. The prospective observational study showed that high systolic blood pressure in people more than 60 years old decreases the risk of dementia, but both lower and higher blood pressure are associated with decreased dementia risk in people older than 75.

Although midlife hypertension is associated with an increased risk for dementia, this risk in older people has not been well researched. Previous studies have reported a U-shaped association between blood pressure and dementia risk, where both high and low blood pressure are associated with increased risk; however, the evidence for this association is limited. The JAMA Internal Medicine study collected blood pressure, onset of dementia, and mortality data from seven population-based cohort studies, including the NIA-funded Adult Changes in Thought (ACT) study.

Researchers analyzed data on more than 17,000 participants from these cohorts and divided the participants into different age groups. In the younger age groups (60 to 70 years old), higher blood pressure was associated with lower dementia risk. The older age groups (75 years and older) showed the U-shaped association where high and low blood pressures were associated with decreased dementia risk. Interestingly, these associations for decreased dementia risk were not attributable to longer survival with lower blood pressure.

This study provides new evidence about how blood pressure affects dementia risk in older people, which previously has not been clearly defined. The researchers note that these observational study results contradict evidence from randomized controlled trials, including the NIA-supported Systolic Blood Pressure Intervention Trial – Memory and Cognition in Decreased Hypertension (SPRINT MIND) study that suggested controlling high blood pressure can reduce dementia risk. They explain that the novel association in this study may be because their cohorts consist of a broader, older population rather than a specific subgroup of older people with high blood pressure and other cardiovascular risk factors.

Since this was an observational study, the study authors suggest further research is needed to understand the cause behind the associations that it found, including randomized controlled trials to find the best strategies for controlling blood pressure in older people. Study co-author Zachary A. Marcum, Pharm.D., Ph.D., at the University of Washington, is a Paul B. Beeson Emerging Leaders Career Development Award in Aging recipient.

This research was supported in part by NIA grant K76AG059929.

Through the NIA-supported Dog Aging Project (DAP), scientists aim to understand how a complex combination of genes, lifestyle, and environment influence aging not only for dogs but for humans as well. In a perspective recently published in Nature, the researchers describe how they hope to establish the foundation for an innovative, community science approach to aging research in dogs.

There is still much to learn about the mechanisms underlying individual aging. Most of what is known about the biology of aging comes from laboratory studies of mammals such as mice and rats, and invertebrates like fruit flies and nematodes. To better understand how genes and environment affect aging in animals outside of a lab and closer to our own life-course experiences, and to generate knowledge that could more readily translate to human aging, the DAP has turned to the companion dog.

The companion dog is an ideal animal to study biological aging. Dogs are one of the most variable animal species in terms of size, shape, and behavior. Like humans, dogs vary in life expectancy and the spectrum of diseases they are likely to encounter. Companion dogs experience nearly every functional decline and disease of aging that people do, and these diseases are diagnosed and treated within a health care system that parallels human health care in many ways. Dogs also share the human environment, and given that they age more rapidly than humans, they enable unique opportunities for longitudinal and interventional studies.

DAP-targeted study populations consist of dogs of all breeds (purebred and mixed breed), ages, sizes, and sexes. Participation in the DAP is open to all geographic regions in the United States, including urban, suburban, and rural areas. DAP scientists are collecting a wide range of information — electronic veterinary medical records, environmental data, and genome-wide sequencing — as well as blood, urine, hair, and feces.

Data that will provide veterinarians and scientists with tools to assess how well a specific dog is aging and set the stage for studies on factors that influence normal aging. DAP researchers have already begun collecting and analyzing the data that lay the groundwork for canine-specific aging processes.

Whole-genome sequencing data that will help identify genetic variants, environmental and lifestyle factors, and the interactions that are associated with diverse measures of aging. The DAP is on track to complete sequencing of the genomes of 10,000 dogs by the end of 2022.

These data will generate predictive and prognostic biomarkers of aging and will point to causal factors that explain the mechanisms by which specific genetic or environmental factors influence aging. These should also be useful biomarkers for clinical studies to develop anti-aging therapies.

The DAP also includes a clinical trial in dogs using a one-year course of weekly low-dose rapamycin, which has been shown to extend lifespan and improve health in mice. The intent is to test the hypothesis that this compound can increase lifespan, improve heart and cognitive function, and reduce age-related disease incidence in middle-aged, large-breed dogs. This represents the first clinical trial of a drug with lifespan and healthspan metrics as endpoints in any species outside of a laboratory.

In addition to making important contributions to veterinary medicine, the ambitious goals set by the DAP research initiative hold the potential of transforming the field of aging research.

This research was supported by NIA grant U19AG057377.

by Carol Leish, MA

Ventura County Area Agency on Aging (VCAA), in collaboration with Community Memorial Health System (CMHS), debuted their seminars on Health & Wellness for Older Adults & People with Disabilities.

Maziar Goshtasbi, MD, who is a gerontologist, gave the first talk: Healthy Aging. It was, via Zoom, on February 17, 2022.

“The expertise in our county to help our aging population and those with disabilities is profound,” according to, Maureen Hodge, LCSW, High Risk Manager for CMHS, and member of the VCAAA Advisory Council. “Allowing experts to share their wealth of information for caregivers and loved ones will only enhance their knowledge and ability to handle significant changes as people age at any stage of life.”

Dr. Goshtasbi said that the World Health Organization defines health in a multidimensional way, as “complete physical, mental and social well-being, not merely the absence of disease or infirmity. And, its vision includes ideas such as meaning and purpose, connectedness, dignity, adaptation, and resilience.”

“Adopting positive lifestyle behaviors increases longevity, decreases chronic disease, and improves quality of life in old age,” according to Dr. Goshtasbi. “Contributors to health include: Health care (10%); social circumstances (15%); Genetics (30%); and, Behavioral patterns (40%).”

Dr. Goshtasbi said that, “The term ‘healthy aging’ often conjures an idea state of freedom from illness of medical conditions. However, in reality, healthy aging requires adaptation to stress, change, and adversity, which is resilience.

“Prevention of cognitive decline occurs with lifestyle interventions (e.g., nutrition, exercise, cognitive training, maintaining social connectedness, and managing vascular risk factors.

“Some risk factors for functional decline are: cardiovascular disease, diabetes, COPD, arthritis, being overweight, smoking. Some protective factors are high levels of physical activity and emotionally supportive social networks.”

The American Geriatrics Society’s framework for health aging in 2019 was outlined as a holistic approach to interventions to promote health aging that accommodates the diversity of health trajectories as we age. “These domains include: 1) Facilitating social engagement; & 2) Promoting health, preventing injury and managing chronic conditions. Other domains are: 1) Promoting health, preventing injury and managing chronic conditions; 2) Optimizing cognitive health; 3) Optimizing physical health; and 4) Optimizing mental health.”

Healthy aging can be achieved at any stage of life. Dr. Goshtasbi said, “Let’s live happier and healthier lives since it’s not o.k. to suffer when getting older.” Dr. Maziar Goshtasbi practices at Community Memorial Health System’s Midtown Medical Group Pirie Road clinic in Ojai. Phone: (805) 640-2323. He is currently accepting new patients.

by National Institute on Aging

Vitamins and minerals are two of the main types of nutrients that your body needs to survive and stay healthy. Find information on some of the essential vitamins recommended for older adults and how to get the recommended amount within your diet.

Vitamins help your body grow and work the way it should. There are 13 essential vitamins — vitamins A, C, D, E, K, and the B vitamins (thiamine, riboflavin, niacin, pantothenic acid, biotin, B6, B12, and folate).

Vitamins have different jobs to help keep the body working properly. Some vitamins help you resist infections and keep your nerves healthy, while others may help your body get energy from food or help your blood clot properly. By following the Dietary Guidelines, you will get enough of most of these vitamins from food.

Like vitamins, minerals also help your body function. Minerals are elements that our bodies need to function that can be found on the earth and in foods. Some minerals, like iodine and fluoride, are only needed in very small quantities. Others, such as calcium, magnesium, and potassium, are needed in larger amounts. As with vitamins, if you eat a varied diet, you will probably get enough of most minerals.

It is usually better to get the nutrients you need from food, rather than a pill. That’s because nutrient-dense foods contain other things that are good for you, like fiber.

Most older people can get all the nutrients they need from foods. But if you aren’t sure, talk with your doctor or a registered dietitian to find out if you are missing any important vitamins or minerals. He or she may recommend a vitamin or dietary supplement.

If you do need to supplement your diet, look for a supplement that contains the vitamin or mineral you need without a lot of other unnecessary ingredients. Read the label to make sure the dose is not too large. Avoid supplements with mega-doses. Too much of some vitamins and minerals can be harmful, and you might be paying for supplements you don’t need. Your doctor or pharmacist can recommend brands that fit your needs.

Different foods in each food group have different nutrients. Picking an assortment within every food group throughout the week will help you get many nutrients. For example, choose seafood instead of meat twice a week. The variety of foods will make your meals more interesting, too.

Measurements for Vitamins and Minerals

Vitamins and minerals are measured in a variety of ways. The most common are:

mg – milligram (a milligram is one thousandth of a gram)

mcg – microgram (a microgram is one millionth of a gram. 1,000 micrograms is equal to one milligram)

IU – international unit (the conversion of milligrams and micrograms into IU depends on the type of vitamin or drug)

Recommended Sodium Intake for Older Adults

Sodium is another important mineral. In most Americans’ diets, sodium primarily comes from salt (sodium chloride). Whenever you add salt to your food, you’re adding sodium.— it’s added to many foods during processing or preparation.

How much sodium is okay? People 51 and older should reduce their sodium intake to 2,300 mg each day. That is about one teaspoon of salt and includes sodium added during manufacturing or cooking as well as at the table when eating. If you have high blood pressure or prehypertension, limiting sodium intake to 1,500 mg per day, about 2/3 teaspoon of salt, may be helpful. Preparing your own meals at home without using a lot of processed foods or salt will allow you to control how much sodium you get. Try using less salt when cooking, and don’t add salt before you take the first bite. If you make this change slowly, you will get used to the difference in taste. Also look for grocery products marked “low sodium,” “unsalted,” “no salt added,” “sodium free,” or “salt free.” Also check the Nutrition Facts Label to see how much sodium is in a serving.

Eating more fresh vegetables and fruit also helps — they are naturally low in sodium and provide more potassium. Get your sauce and dressing on the side and use only as much as you need for taste.

High school seniors impacted by Alzheimer’s disease can win up to $5,000 for college through the Alzheimer’s Foundation of America’s (AFA) Teen Alzheimer’s Awareness Scholarship. Students can enter the contest by visiting www.alzfdn.org/scholarship. The deadline for submissions is March 1, 2022.

“Teens across the country are making an impact because they’ve been impacted by Alzheimer’s— they are caring for loved ones, volunteering, working at care settings, raising awareness and conducting research,” said Charles J. Fuschillo, Jr., AFA’s President and CEO. “These college scholarships will help tomorrow’s leaders in the fight against Alzheimer’s disease with their college education. We invite all high school seniors who have been affected by Alzheimer’s to enter.”

College-bound high school seniors are invited to apply for the scholarship by submitting an essay (1,500 words maximum) describing how Alzheimer’s disease has impacted their lives and what they have learned about themselves, their family and/or their community through their experience with Alzheimer’s. Essays can be submitted by visiting www.alzfdn.org/scholarship. Students already attending college are not eligible to participate.

Awards range from first prize of $5,000, second prize of $3,500, third prize of $2,500, fourth prize of $1,500, and fifth prize of $1,000 to honorable mentions between $750 and $400. Since the program’s inception, more than $350,000 in college scholarships have been awarded.

AFA has been able to provide these scholarship funds with the generous support of charitable donors.

Individuals wishing to support this and other programs and services for families affected by Alzheimer’s disease can do so by visiting www.alzfdn.org/donate or calling AFA at 866-232-8484.

The Alzheimer’s Foundation of America is a non-profit organization whose mission is to provide support, services and education to individuals, families and caregivers affected by Alzheimer’s disease and related dementias nationwide and to fund research for better treatment and a cure. Its services include a National Toll-Free Helpline (866-232-8484) staffed by licensed social workers, the National Memory Screening Program, educational conferences and materials, and “AFA Partners in Care” dementia care training for healthcare professionals.

For more information about AFA, call 866-232-8484, visit www.alzfdn.org, follow us on Twitter or connect with us on Facebook, Instagram or LinkedIn. AFA has earned Charity Navigator’s top 4-star rating for six consecutive years.

by Amy Cameron O’Rourke, author of The Fragile Years

A 78-year-old man had a stroke on the golf course. His partners called 911 and he was rushed to the ER, but the poor guy never regained full consciousness. The COVID-19 pandemic added another level of stress and heartache to the matter, with ventilators in short supply and hospital protocols changing by the minute. That’s where I came in. As an advocate for the man’s family, I organized an emotional Zoom meeting with his wife and grown children.

When his wife learned of the failing condition of his lungs, heart and other major organs, she knew. “I’m losing him, aren’t I? Why didn’t the hospital tell me this?” It was a question I could not answer, despite my suspicions. It happens all too often with clients in the fragile years. Families are left in the dark and not given the information they need to make critical decisions.

Hospitals and nursing homes should absolutely take every measure possible to keep older patients alive while at the same time being mindful that compassion is about quality of life – not saving lives at all costs.

When well-intentioned but unnecessary medical procedures prolong the lives of older adults, the suffering they cause is rarely worth it.

It’s time to hit the reset button and end the culture of treatment that causes more harm than benefit. What can you do to ensure your loved one receives compassionate elder care? In my book, The Fragile Years, I outline some key action steps families can take in this tender chapter of life:

Arm yourself with the tools to make informed, compassionate decisions about quality of life well in advance of a medical crisis. Ask your loved one what their preferences are in different scenarios.

Get to know your older loved one’s values around end-of-life events – and respect them when the time comes.

Before life-prolonging steps are taken, ask your older loved one what they would like.

Remember to put your loved one’s desires first. Allow them a more natural and peaceful end of life if that is what they want.

Have the courage to make decisions that may appear contrary to the medical profession’s opinions.

If your loved one is experiencing cognitive decline, be prepared to be their compassionate spokesperson. Firmly demand the care they would want if they were making the decision themselves.

It’s never too early to become familiar with the many legal, business and staffing considerations that shape nursing homes’ decisions, where everything from fear of lawsuits to fatigue come into play. Communicate with them accordingly.

After that revelatory Zoom meeting, the difficult next step was to determine where his family wanted him to spend his final hours.“Home,” his wife said. “With me and the kids.”

We arranged to have him discharged from the hospital and taken home, where hospice care had already been set up. He died 36 hours after coming home, surrounded by his loved ones. His widow called a few days later and expressed her gratitude. “I am at peace,” she said. “I am sad he is gone, but I am at peace.”

It’s not easy, helping someone through end-of-life decisions, especially if you don’t agree with all of them. I tell family members and friends to let go of who the loved one was, and also let go of your need for them to change. Give them the final gift of your understanding, compassion and generosity of spirit.

Amy Cameron O’Rourke is a nationally-known pioneer and advocate for senior care in the U.S.