Transgender and Gender Diverse People's Fear of Seeking and Receiving Care in Later Life: A Multiple Method Analysis.

The purpose of the current research is to understand concerns about receiving care in a sample of transgender, gender nonbinary, and gender diverse (TGD) adults across the lifespan. A total of 829 participants, predominantly from the United States and Canada, aged 18-70, completed the Trans Metlife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (TMLS) section on caregiving and are included in this study. We found middle-aged adults, people of Color, and people living with a disability reported the highest level of concern for their ability to function independently because of financial resources, physical concerns, cognitive impairment, or a lack of someone to care for them. Researchers found five overarching thematic categories: (a) No concerns, (b) Anticipated discrimination, (c) Loss of control, (d) Quality of life, and (e) General concerns. Practice implications include recommendations for practitioners to develop care plans with TGD residents and clients to learn the best strategies for affirming their gender identity (e.g., clothing preferences) and to assist TGD residents and clients with the completion of advance directives to allow them to outline their end-of-life care plan, including instructions for gender affirmative care in the event of incapacitation (e.g., dementia, stroke).

Transgender and gender non-conforming adult preparedness for aging: Concerns for aging, and familiarity with and engagement in planning behaviors.

Background: Research on transgender and gender-nonconforming (TGNC) aging is limited. To date, most of the literature about TGNC aging has focused on discrimination (particularly in healthcare), violence and abuse, caregiving and family relations, and religiosity. Aims: The purposes of this study were to: (a) document concerns about aging among TGNC adults, including concerns that are identity-specific; (b) examine preparation for aging and end of life (i.e., familiarity and planning) among TGNC adults; and (c) examine potential differences in familiarity and planning based on gender identity. Methods: One hundred fifty-four individuals who currently or have ever identified as TGNC completed a national online survey assessing these constructs. Results: TGNC individuals reported many concerns about aging, both gender identity-specific and not. The most common aging concern was losing the ability to care for themselves followed by having to go into a nursing home or assisted living facility. The age preparatory behaviors individuals were most commonly aware of included: life insurance, wills, organ donation, regular medical checkups, living wills, durable power of attorney for healthcare, and trusts. Gender-nonconforming individuals had significantly more familiarity with age preparatory behaviors than trans feminine individuals, but had lower levels of planning to engage in age preparatory behaviors than both trans masculine and trans feminine individuals. Conclusion: The current findings highlight the need for providers to address age preparatory behaviors with TGNC individuals or provide referrals to support individuals in this planning.

Mechanics of population aging and survival.

In this paper we extend the previous work of Witten and her team on defining a classical physics-driven model of survival in aging populations (Eakin, Bull Math Biol 56(6):1121-1141, 1994; Eakin and Witten, Mech Aging Dev 78(2):85-101, 1995; Witten and Eakin, Exp Gerontol 32(2):259-285, 1997) by revisiting the concept of a force of aging and introducing the concepts of a momentum of aging, a kinetic energy and a potential energy of an aging population. We further extend the analysis beyond the deterministic Newtonian mechanics of a macroscopic population as a whole by considering the probabilistic nature of survival of individual population cohort members, thus producing new statistical physics-based concepts of entropy and of a gerontological "temperature". These new concepts are then illustrated with application to the classic parametric Gompertz survival model, which is a commonly used empirical descriptor for survival dynamics of mammalian species, human populations in particular. As a function of chronological age the Gompertz Model force, momentum, and power are seen to have an asymmetric unimodal peak profile, while the potential energy has a descending sigmoidal profile similar to that of the survival fraction. The "temperature" is an exponential function of age and the entropy for a future age at a current census age can be represented as a topological surface with an asymmetric unimodal hump.

Impact of Anticipated Bias from Healthcare Professionals on Perceived Successful Aging Among Transgender and Gender Nonconforming Older Adults.

PURPOSE: Transgender and gender nonconforming (TGNC) persons have routinely experienced high rates of violence and discrimination. Discrimination in healthcare can affect the ability of TGNC persons to age successfully as it often deters them from seeking care. The purpose of this study was to determine if anticipation of bias from healthcare professionals, as well as other variables, predicted perceived successful aging in a sample of TGNC adults. METHODS: A total of 384 (of the original 1963) participants older than 50 years completed the relevant parts of an 83-item online survey as part of the Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals. RESULTS: Larger social support networks and higher levels of confidence that a healthcare professional will treat them with dignity and respect as a TGNC person at the end of their life were associated with increased odds of perceiving that they were aging successfully. CONCLUSION: With high rates of discrimination and prejudice toward TGNC persons in various contexts (e.g., healthcare, education, and housing), it is imperative that practitioners, researchers, policymakers, and institutions work together to eradicate healthcare disparities, promote social change, and support an environment that encourages successful aging. This calls for a coordinated, proactive outreach effort to put trust back into a system that has historically let down an entire subset of the population.

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults.

Despite the growing visibility and acceptance of transgender and gender nonconforming (TGNC) individuals, TGNC older adults experience many barriers in accessing competent and affirming health and social services due to anti-TGNC prejudice, discrimination, and lack of competent healthcare training on the part of healthcare workers. Clinical gerontologists and geriatricians will likely encounter TGNC adults in their practice given population aging and greater numbers of TGNC people who are living in their affirmed gender identities. The American Psychological Association recently published its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which document the unique needs of TGNC individuals and outlines approaches for competent and affirming service provision (APA, 2015). We interpret these Guidelines using a gerontological lens to elucidate specific issues faced by the TGNC older adult along with the practice and policy implications for this population.

Elder transgender lesbians: exploring the intersection of age, lesbian sexual identity, and transgender identity.

This study is the first to examine the experiences and needs of an international sample of current, English-speaking, lesbian, transgender-identified (trans-lesbian) adults around a number of later life and end-of-life perceptions, preparations, and concerns. I analyzed a subset (n = 276) of the cross-sectional data collected from the online Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (N = 1,963). I assessed perceptions and fears around aging, preparation for later life, and end-of-life as well as numerous demographic and psycho-social variables. Despite the overall feeling that they have aged successfully, the respondent trans-lesbian population harbors significant fears about later life. I found that this population, while better-prepared than the overall respondent trans-identified population, is still ill-prepared for the major legalities and events that occur in the later to end-of-life time periods.

Modeling drug resistance in a conjoint normal-tumor setting.

BACKGROUND: In this paper, we modify our previously developed conjoint tumor-normal cell model in order to make a distinction between tumor cells that are responsive to chemotherapy and those that may show resistance. RESULTS: Using this newly developed core model, the evolution of three cell types: normal, tumor, and drug-resistant tumor cells, is studied through a series of numerical simulations. In addition, we illustrate critical factors that cause different dynamical patterns for normal and tumor cells. Among these factors are the co-dependency of the normal and tumor cells, the cells' response mechanism to a single or multiple chemotherapeutic treatment, the drug administration sequence, and the treatment starting time. CONCLUSION: The results provide us with a deeper understanding of the possible evolution of normal, drug-responsive, and drug-resistant tumor cells during the cancer progression, which may contribute to improving the therapeutic strategies.

Introduction to the theory of aging networks.

This chapter will briefly address the history of systems biology and complexity theory and its use in understanding the dynamics of aging at the 'omic' level of biological organization. Using the idea of treating a biological organism like a network, we will examine how network mathematics, particularly graph theory, can provide deeper insight and can even predict potential genes and proteins that are related to the control of organismal life span. We will begin with a review of the history of network analysis at the cellular level and follow that by an introduction to the various commonly used network analysis variables. We will then demonstrate how these variables can be used to predict potential targets for experimental analysis. Lastly, we will close with some of the challenges that network methods face.

Applications to aging networks.

This chapter will introduce a few additional network concepts, and then it will focus on the application of the material in the previous chapter to the study of systems biology of aging. In particular, we will examine how the material can be used to study aging networks in two sample species: Caenorhabditis elegans and Saccharomyces cerevisiae.

End of life, chronic illness, and trans-identities.

In this study, the experiences and needs of a sample of 1,963 current, global, English-speaking, transgender-identified adults responding to the Transgender MetLife Survey (TMLS) as related to a number of later-life and end-of-life (EOL) preparations and concerns were examined. EOL concerns are integrated with concerns and challenges around chronic illness and disability. Overall, this population was significantly ill-prepared for the major legalities and events that occur in the later to EOL time periods. The population was found to harbor significant fears around the future. Drawing on the author's decades of survey research in transgender aging and case data along with current scientific and online literature, illustrative quotations and case examples are provided.

It's Not All Darkness: Robustness, Resilience, and Successful Transgender Aging.

We review the recent psychosocial literature on transgender aging. We also report relevant in-press results from the Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (TMLS) on end-of-life and later-life trans-aging. To obtain relevant literature, we employed the search engines Google Scholar, Stanford Highwire, and PubMed/Medline. Databases searched included Web of Science, Cinhal, PsyINFO, Gender Studies Database, Sociological Abstracts, and Social Services Abstracts. Keyword searches included "transgender" and "transsexual." Key phrases included "transgender aging," "transsexual aging," and "LGBT aging." Years searched were from January 1, 2011, through April 26, 2013. We found two types of articles: LGBT aging-related (or lumped aging) articles and articles that focused specifically on transgender aging, or trans-aging. We found that the articles spoke of concerns and fears regarding discrimination, potential abuse at the hands of caregivers, inability to live out their lives in their true identities, risk of becoming homeless, loss of independence, and dementia, among other concerns. We note that the elder trans-identified population is significantly ill-prepared for the major legal issues that arise and events that occur in the later-life to end-of-life time periods. Despite these difficulties, a few articles spoke of resilience and successful aging in the population. Some TMLS respondents indicated that they were considering either "detransitioning," that is, changing social presentation to the pretransition gender identity, or suicide (which some referred to as euthanasia) as means of managing the severe problems they expected to encounter later in the aging process. A number of potentially modifiable risk factors exist within this population. Modification strategies include increasing the population awareness of the need for end-of-life legal preparations for members of the trans-identified community as well as those who serve it. There is a continued need to reduce stigma and to include gender identity/gender presentation in nondiscrimination and hate crime statutes. Despite these difficulties, there is a resilience and robustness that can be found in many individuals within the community of transgender older adults. There is a need to investigate this further.

A biomechanical model of wound contraction and scar formation.

We propose a biomechanical model for investigating wound contraction mechanism and resulting scarring. Extracellular matrix is modeled as fiber-reinforced anisotropic soft tissue, with its elastic properties dynamically changing with the density and orientation of collagen fibers. Collagen fibers are deposited by fibroblasts infiltrating the wound space, and are dynamically aligned with both migrating fibroblasts and tissue residing tension field. Our new 2D hybrid agent-based model provides a comprehensive platform for examining the mechanobiology in wound contraction and scar formation. Simulation results are consistent with experimental observations and are able to reveal the effects of wound morphology and mechanical environment on contraction patterns. Our model results support the hypothesis that scar formation is the product of collagen fiber synthesis and alignment in the presence of the tensile stress field generated by a wound contraction process.

Modeling the effects of a simple immune system and immunodeficiency on the dynamics of conjointly growing tumor and normal cells.

In this paper, we develop a theoretical contribution towards the understanding of the complex behavior of conjoint tumor-normal cell growth under the influence of immuno-chemotherapeutic agents under simple immune system response. In particular, we consider a core model for the interaction of tumor cells with the surrounding normal cells. We then add the effects of a simple immune system, and both immune-suppression factors and immuno-chemotherapeutic agents as well. Through a series of numerical simulations, we illustrate that the interdependency of tumor-normal cells, together with choice of drug and the nature of the immunodeficiency, leads to a variety of interesting patterns in the evolution of both the tumor and the normal cell populations.

Chemotherapy in conjoint aging-tumor systems: some simple models for addressing coupled aging-cancer dynamics.

BACKGROUND: In this paper we consider two approaches to examining the complex dynamics of conjoint aging-cancer cellular systems undergoing chemotherapeutic intervention. In particular, we focus on the effect of cells growing conjointly in a culture plate as a precursor to considering the larger multi-dimensional models of such systems. Tumor cell growth is considered from both the logistic and the Gompertzian case, while normal cell growth of fibroblasts (WI-38 human diploid fibroblasts) is considered as logistic only. RESULTS: We demonstrate, in a simple approach, how the interdependency of different cell types in a tumor, together with specifications of for treatment, can lead to different evolutionary patterns for normal and tumor cells during a course of therapy. CONCLUSIONS: These results have significance for understanding appropriate pharmacotherapy for elderly patients who are also undergoing chemotherapy.

An in silico approach to the analysis of acute wound healing.

The complex interactions that characterize acute wound healing have stymied the development of effective therapeutic modalities. The use of computational models holds the promise to improve our basic approach to understanding the process. By modifying an existing ordinary differential equation model of systemic inflammation to simulate local wound healing, we expect to improve the understanding of the underlying complexities of wound healing and thus allow for the development of novel, targeted therapeutic strategies. The modifications in this local acute wound healing model include: evolution from a systemic model to a local model, the incorporation of fibroblast activity, and the effects of tissue oxygenation. Using these modifications we are able to simulate impaired wound healing in hypoxic wounds with varying levels of contamination. Possible therapeutic targets, such as fibroblast death rate and rate of fibroblast recruitment, have been identified by computational analysis. This model is a step toward constructing an integrative systems biology model of human wound healing.

Shortest-path network analysis is a useful approach toward identifying genetic determinants of longevity.

BACKGROUND: Identification of genes that modulate longevity is a major focus of aging-related research and an area of intense public interest. In addition to facilitating an improved understanding of the basic mechanisms of aging, such genes represent potential targets for therapeutic intervention in multiple age-associated diseases, including cancer, heart disease, diabetes, and neurodegenerative disorders. To date, however, targeted efforts at identifying longevity-associated genes have been limited by a lack of predictive power, and useful algorithms for candidate gene-identification have also been lacking. METHODOLOGY/PRINCIPAL FINDINGS: We have utilized a shortest-path network analysis to identify novel genes that modulate longevity in Saccharomyces cerevisiae. Based on a set of previously reported genes associated with increased life span, we applied a shortest-path network algorithm to a pre-existing protein-protein interaction dataset in order to construct a shortest-path longevity network. To validate this network, the replicative aging potential of 88 single-gene deletion strains corresponding to predicted components of the shortest-path longevity network was determined. Here we report that the single-gene deletion strains identified by our shortest-path longevity analysis are significantly enriched for mutations conferring either increased or decreased replicative life span, relative to a randomly selected set of 564 single-gene deletion strains or to the current data set available for the entire haploid deletion collection. Further, we report the identification of previously unknown longevity genes, several of which function in a conserved longevity pathway believed to mediate life span extension in response to dietary restriction. CONCLUSIONS/SIGNIFICANCE: This work demonstrates that shortest-path network analysis is a useful approach toward identifying genetic determinants of longevity and represents the first application of network analysis of aging to be extensively validated in a biological system. The novel longevity genes identified in this study are likely to yield further insight into the molecular mechanisms of aging and age-associated disease.

Predicting aging/longevity-related genes in the nematode Caenorhabditis elegans.

We present a novel mathematical/computational strategy for predicting genes/proteins associated with aging/longevity. The novelty of our method arises from the topological analysis of an organismal longevity gene/protein network (LGPN), which extends the existing cellular networks. The LGPN nodes represent both genes and corresponding proteins. Links stand for all known interactions between the nodes. The LGPN of C. elegans incorporated 362 genes/proteins, 160 connecting and 202 age-related ones, from a list of 321 with known impact on aging/longevity. A 'longevity core' of 129 directly interacting genes or proteins was identified. This core may shed light on the large-scale mechanisms of aging. Predictions were made, based upon the finding that LGPN hubs and centrally located nodes have higher likelihoods of being associated with aging/longevity than do randomly selected nodes. Analysis singled-out 15 potential aging/longevity-related genes for further examination: mpk-1, gei-4, csp-1, pal-1, mkk-4, 4O210, sem-5, gei-16, 1O814, 5M722, ife-3, ced-10, cdc-42, 1O776Co, and 1O690.

(M,R)-systems, (P,M,C)-nets, hierarchical decay, and biological aging: reminiscences of Robert Rosen.

I have the pleasure to present a number of personal experiences that I had with Robert Rosen, both as his student and as a research colleague, and I will describe how this affected my academic career over the past decades. As a matter of fact, Rosen's work with (M,R)-systems as well as his continuing mentorship guided me into my own research in gerontology and geriatrics. Amazingly, this still continues to affect my work in complexity theory after 30 years.

Impaired wound healing.

Nonhealing wounds represent a significant cause of morbidity and mortality for a large portion of the population. One of the underlying mechanisms responsible for the failure of chronic wounds to heal is an out-of-control inflammatory response that is self-sustaining. Underappreciation of the inherent complexity of the healing wound has led to the failure of monotherapies, with no significant reduction in wound healing times. A model of the inflammatory profile of a nonhealing wound is one in which the equilibrium between synthesis and degradation has been shifted toward degradation. This review summarizes the current information regarding acute wound healing responses as contrasted to the delayed response characteristic of chronic wounds. In addition, some initial complexity theoretical models are proposed to define and explain the underlying pathophysiology.