Home Modification and Repairs for Older Adults: Challenges and Opportunities for State Units on Aging

The home environment plays a critical role in adults' ability to stay in their homes and communities as they age, commonly referred to as aging in place. Yet the majority of older adults' homes lack supportive features. Home modification is the process of making changes to a home to increase independence, safety, and health. Often combined with related repairs, home modification and repair (HMR) can be minor, such as adding grab bars and removing tripping hazards, or major, such as installing roll-in showers and ramps. Although HMRs can support people as their needs change and even preclude moves to institutional settings, numerous barriers challenge the ability of older adults and caregivers to access them.In response, the Administration for Community Living (ACL) funded the University of Southern California (USC) Leonard Davis School of Gerontology to implement the project, "Promoting Aging in Place by Enhancing Access to Home Modifications." Its goal is to address the barriers to home modification access and service delivery by increasing the availability and awareness of home modification at the national, state, and local levels. A key activity of this project was to develop a knowledge base of state HMR activities and programs for older adults and persons with disabilities with a focus on the State Units on Aging (SUAs). These agencies develop and implement state plans and support services for older persons, adults with physical disabilities and their families. SUAs administer funds, including those provided through the Older Americans Act (OAA), to support HMR services through local Area Agencies on Aging (AAAs) and other state and local entities (e.g., OAA Title VI organizations that serve older Native Americans). SUAs can play a significant role in HMR by including it in state plans, providing designated funding, raising awareness, and coordinating with other state agencies such as housing, disability, and health.In October 2019, USC and its ACL project partner ADvancing States administered an online survey of directors of the 56 SUAs (which ADvancing States represents). The 10-question closed and open-ended survey sought to ascertain SUA activities, challenges, and opportunities in HMR. With extensive follow-up through February 2020, 50 SUAs completed the survey (an 89% response rate).This report summarizes the survey results, giving a bird's eye view of SUA roles in HMR and shining a light on examples of SUA HMR activities. Its purpose is to encourage greater involvement and coordination in HMR service delivery among agencies with a stake in assuring older Americans' ability to age in place.Click "Download" to access this resource.Tags: Older Americans Act, Area Agencies on Aging, State Units on Aging, Home-and Community-Based Service

β3-Integrin Expression on Tumor Cells Inhibits Tumor Progression, Reduces Metastasis, and Is Associated with a Favorable Prognosis in Patients with Ovarian Cancer

The role of the vitronectin receptor (αvβ3-integrin) as a tumor promoter seems well established, and, consequently, therapies that block this integrin are currently in clinical testing. We undertook the current study to determine whether αvβ3-integrin is an appropriate target in ovarian cancer treatment. Expression of β3-integrin in SKOV3ip1 ovarian cancer cells led to the overexpression of αvβ3-integrin on the cell surface and increased adhesion. However, αvβ3-integrin-overexpressing cells showed impaired invasion, protease expression, and colony formation. These results were recapitulated in xenograft studies: αvβ3-integrin-expressing cells showed increased adhesion to mouse peritoneum, but the overall number of metastatic nodules (105 versus 68 tumors) and tumor weight were significantly lower than those in the parental SKOV3ip1 cells. The αvβ3-integrin-overexpressing cells had a decreased proliferation rate mediated by inhibition of cyclin B1 and induction of phospho-Cdc2 and p53 expression, consistent with a G2M cell cycle arrest. Confirming the above results, inhibition of β3-integrin in cultured or primary OvCa cells decreased adhesion but increased invasion and proliferation. Patients with tumors expressing high β3-integrin had significantly better disease-free and overall survival (52 months versus 27 months, P < 0.05). This study shows that αvβ3-integrin expression on tumor cells actually slows tumor progression and acts as a tumor suppressor. Therefore, the vitronectin receptor might not be an appropriate therapeutic target in ovarian cancer

Proceedings of the Survivorship Care in Neuro-Oncology Workshop sponsored by the Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT).

BackgroundSurvivorship for those living with primary CNS cancers begins at diagnosis, continues throughout a person's life, and includes caregivers. Opportunities and challenges exist to advance survivorship care for those living with primary CNS cancers that necessitate stakeholder involvement.MethodsIn June 2021, NCI-CONNECT convened a two-day virtual workshop about survivorship care in neuro-oncology. Two expert panels provided key recommendations and five working groups considered critical questions to identify strengths, weaknesses, opportunities, and threats to the advancement of survivorship care and developed recommendations and action items.ResultsThe following action items emanated from the workshop: seek endorsement of meeting report from stakeholder organizations; address barriers in access to survivorship care and provider reimbursement; advance survivorship research through NIH and private grant support; develop a survivorship tool kit for providers, people living with primary CNS cancers and their caregivers; provide accessible educational content for neuro-oncology, neurology, and oncology community providers about survivorship care in neuro-oncology; and establish core competencies for survivorship care for neuro-oncology providers to be included in training and standardized exams.ConclusionsAction items aim to address access and reimbursement barriers, expand patient and provider education, develop core competencies, and support survivorship research through funding and other supports