As �鶹��ý’s aging population continues to grow—with nearly one-third of residents projected to be 65 or older by 2035—second-year medical student Kristal Xie at the (JABSOM) at the is being recognized for her dedication to caring for the state’s ��ū��ܲԲ�.

Xie recently received the Nā Lima Kōkua Award from the �鶹��ý Pacific Gerontological Society, which recognizes students demonstrating exceptional dedication to gerontology. Presented in memory of the organization’s first president, Tony Lenzer, the award honors Xie’s service, research and commitment to older adults in �鶹��ý.

“This experience has strengthened my commitment to advancing the health and well-being of older adults,” Xie said. “I’m grateful to my mentors, especially Dr. Kamal Masaki, and to my loved ones for their continued support.”

Early exposure sparks a passion for geriatrics

Xie’s interest in geriatrics began during her first year at JABSOM when medical students are required to complete community service. She was selected to participate in WISH—Wellness Initiative for Seniors in �鶹��ý, a program that connects students with ��ū��ܲԲ� through weekly visits at Kuakini Medical Center.

Caring for our ��ū��ܲԲ� is an opportunity to serve the community that raised us.
—Kristal Xie

“Talking story with ��ū��ܲԲ� helped bring our classroom learning to life,” Xie said. “It made me more aware of how to meet patients where they are and think about what support they might need.”

Her experience with WISH inspired two research projects—one focused on strengthening family engagement in elder care and another examining the health impacts of social isolation. She is currently working on hospital discharge planning research aimed at improving communication and safety for older adults returning home.

“Caring for our ��ū��ܲԲ� is an opportunity to serve the community that raised us,” Xie said.

In addition to the Nā Lima Kōkua Award, Xie has received multiple scholarships recognizing her work in gerontology. She is now considering a career in geriatrics, guided by mentors in JABSOM’s Department of Geriatric Medicine, one of the largest fellowship programs in the nation and serving communities across the U.S.

Read more at .

�鶹��ý’s aging population is growing faster than the rest of the U.S., with more than 21% aged 65 and older (compared to less than 18% nationwide) creating an urgent need for specialized healthcare for our ��ū��ܲԲ�. In response, philanthropists Allen and Anne Abaya established the Nohara-Abaya Geriatrics Fellowship Award in 2023 at the University of �鶹��ý at ����ԴDz� (JABSOM). Now in its second year, the award continues to support young doctors and nursing practitioners committed to careers in geriatrics.

Related �鶹��ýNews story: Critical shortage in geriatric medicine tackled by JABSOM pilot programs

“It makes you feel that what we are doing is worthwhile, you know? We’re getting more and more passionate about it because we see more examples of where the need is there,” said Anne Abaya.

Recipients make an impact

For alumnus Trace “Kaimana” Kalei, caring for ��ū��ܲԲ� is deeply personal. “In �鶹��ý, our ��ū��ܲԲ� mean a lot to us, and being able to care for them is a way of us being able to give back to our ʻohana and to our community. It’s a privilege,” Kalei said.

Kalei also recognized the financial burden of training locally. “It’s a very valuable gift and we’re very grateful for it. It will help support many other folks down the road.”

Maxwell Shen discovered his interest in geriatrics during his JABSOM internal medicine residency program at Tripler Army Medical Center. “A lot of the patients that I took care of were the elderly population, so that’s where my interest grew,” he said. “It was really eye-opening to watch [my mentor] work, as well as giving me different types of pearls.”

Serving the elderly population has long been a goal for alumna Daniella Orias. “I, personally, have always loved geriatrics. It’s always been a huge part of my passion and so, even through my family medicine (residency) training, I’ve always held a really soft spot for it,” she said. “It’s a really tremendous honor that they’ve been providing this for us, so that we can keep trying to help out with our geriatric community and our ��ū��ܲԲ�.”

Looking ahead

“As we look forward, the geriatric population is only going to get larger. This (program) will help to provide support for that,” Kalei said.

“We figure, anything we can do to help get those numbers up (those interested in geriatric care), it feels good,” Abaya added.

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June is Alzheimer’s and Brain Awareness Month. Alzheimer’s disease affects an estimated 31,000 �鶹��ý residents, about 11% of those age 65 and older. As �鶹��ý’s population continues to age, the number of Alzheimer’s cases is expected to rise significantly in the coming decades. Gina Fujikami, a clinical assistant professor at the University of �鶹��ý at ����ԴDz� and a geriatrics medicine physician, shares insights on prevention, early detection and advances in diagnosis and treatment.

What is Alzheimer’s disease, and how does it affect the brain?

Alzheimer’s is a type of dementia caused by a buildup of amyloid and tau protein plaques in the brain. These plaques lead to brain damage, resulting in memory loss and cognitive difficulties. While these proteins often begin accumulating in middle age, not everyone with them develops Alzheimer’s, and much about the disease remains unknown.

How has diagnosis and treatment improved recently?

Diagnosis has advanced from relying mostly on clinical exams and memory tests to now include specialized blood tests and PET (Positron Emission Tomography) scans that detect amyloid and tau proteins in the brain. These tools enable earlier and more accurate diagnosis. In terms of treatment, new medications target these plaques to slow disease progression, though research continues on their long-term benefits.

How can people reduce their risk, and how can they tell normal forgetfulness from symptoms of the disease?

Maintaining heart health through exercise, managing blood sugar, cholesterol and blood pressure is important for brain health. Mental and social activities like puzzles and socializing also help. Occasional forgetfulness is normal, but consistent memory issues that interfere with daily life, such as forgetting routes home or leaving appliances on, should prompt a medical evaluation.

What is the situation with Alzheimer’s in �鶹��ý, and what support services are available?

About 31,000 residents in �鶹��ý—around 11% of those 65 and older—are living with Alzheimer’s. Cases are expected to double by 2050, creating challenges for families and caregivers. The provides caregiver support groups, educational programs and outreach, including support groups for those in early stages of dementia.

What is the Silver Alert system, and how does it help those with cognitive impairments?

Recently implemented in �鶹��ý in July 2024, the Silver Alert is a community notification system similar to the Maile Alert for missing children. It is used when seniors or individuals with cognitive impairments go missing, helping law enforcement and the public respond quickly to ensure their safe return.

Fujikami and colleagues will be featured in an upcoming event, Research Roundtable: The Era of Treatment, hosted by the Alzheimerʻs Association Hawaii Chapter, June 14 8:30 a.m.—12:30 p.m. at JABSOM. .

In February, University of �鶹��ý at ����ԴDz� programs brought dementia education and caregiving resources to Molokaʻi, offering residents a rare chance to connect with experts and support services close to home.

Hosted by the at the and (GWEP) at the , in partnership with ALU LIKE, Inc., the event drew strong community interest and highlighted the growing need for aging and brain health support in rural areas.

“Sharing knowledge outside the walls of academia is critical,” said Miquela Ibrao, associate director of Hā Kūpuna. “When we equip families and caregivers in rural areas with the tools they need, we reduce health disparities and empower communities.”

For Curtis Crabbe, attending was personal. “I initially showed up to learn about my potential in acquiring dementia,” he said. “I ended up observing the huge disparity Molokaʻi has in disseminating any information on dementia and its associated challenges.”

Held at a time when access to health education on the island remains limited, the event featured a talk by Aida Wen, GWEP principal investigator and geriatrician with The Queen’s Health System, along with interactive sessions in Tai Chi, Hawaiian language, and creative writing. Social worker Sara Tompkison and Alzheimer’s Association’s Cindy Fowler led a session on the Positive Approach to Care.

To increase long-term access to geriatric services, GWEP and Queen’s have begun offering telehealth support to ��ū��ܲԲ� on Molokaʻi.

Organizers say the momentum is growing. A follow-up event is planned for September to share more about brain health and caregiving resources. This effort is part of a larger initiative by Hā Kūpuna and ALU LIKE to reach underserved communities statewide. Previous events have taken place in Kona, Hilo and Pāhoa.

A new study reveals that global life expectancy (LE) increases have slowed significantly, suggesting humanity is approaching a biological ceiling for life expectancy.

Led by the University of Illinois at Chicago, the research published in , includes contributions from Bradley Willcox, a geriatric medicine researcher at the University of �鶹��ý at ����ԴDz�’s (JABSOM) and Kuakini Honolulu Heart Program Center of Biomedical Research Excellence-Center for Translational Research on Aging. Willcox’s expertise in gerotherapeutics—interventions aimed at addressing aging at its molecular level—plays a critical role in understanding this trend.

The study indicates that despite medical advances in reducing infant and late-life mortality, life expectancy in the world’s longest-living populations has increased by only 6.5 years since 1990. This deceleration has startled many demographers who have relied on models predicting continuous increases in life expectancy.

Lead author S. Jay Olshansky stated that the most significant advances in longevity through medical breakthroughs have already been achieved. “Most people alive today at older ages are living on time manufactured by medicine,” he said. “But these medical band-aids are producing fewer years of life, implying that the rapid increase in life expectancy is now over. We should shift our focus to efforts that slow the effects of aging and extend healthspan (the time spent living in good health).”

The study examined data from the eight longest-living countries, including Hong Kong and the U.S. While long-lived locales showed markedly slower LE gains, American life expectancy actually decreased during this period.

Implications for social programs

In 1990, Olshansky and colleagues published a that argued humans were approaching a ceiling for life expectancy of around 85 years, with the most significant gains already achieved. Others predicted that advances in medicine and public health would accelerate 20th-century trends upward into the 21st century, which has implications for Social Security and other public health programs.

Willcox noted the importance of these findings for planning retirement: “How do we realistically plan for our future? What data source do we trust to determine how long we might live?”

In 2014, Elaine Flores joined the , benefiting from its tips on wellness and body knowledge. She shared the lessons with her husband, Eddie Flores, founder of L&L Hawaiian Barbecue.

“She gave me all the tips, so that’s why I’m so healthy,” Eddie joked.

The Mini-Medical School, based at the University of �鶹��ýat ����ԴDz�ʻs , was founded by UH ����ԴDz� Chancellor Emeritus Virginia Hinshaw and Rosita Leong. The program celebrated its 10-year anniversary in 2023, and has been providing crucial education on healthy aging for
�鶹��ý’s aging population, which boasts the longest life expectancy in the U.S.

To support the school’s mission, the Flores family donated $100,000 to establish an endowment. Kamal Masaki, the current director of the program and chair of the Department of Geriatric Medicine, expressed her gratitude, noting the importance of maintaining healthy aging resources for
�鶹��ý‘s residents.

“We want to make sure that the Mini-Medical School goes on in perpetuity,” she said.

The Flores family hopes their donation encourages more people to attend the program. Eddie, a proud UH graduate, said the program meant a lot to them.

“Elaine and I are honored to make this donation. The Mini-Medical School is a tremendous asset to the community, and we are proud to support it.”

Now retired from L&L, Eddie and Elaine enjoy traveling, volunteering and spending time with family. They recognize the importance of staying healthy, especially as grandparents. Eddie, of Filipino-Chinese heritage, emphasized that programs like the Mini-Med School are vital for reaching underrepresented groups and helping more people maintain good health.

The Mini-Medical School offers two sessions annually, one in spring and one in fall, providing participants with expert knowledge on aging and health. Its next hybrid session begins on September 28.

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More than 70 students across various health programs at gained valuable insights into the multifaceted nature of providing patient-centered age-appropriate care through a symposium in January.

Community Health Education Program Director Hilary Hacker said, “This symposium, created from a shared commitment to excellence in healthcare training, aims to transcend traditional silos.”

The collaboration with the University of �鶹��ý’s Geriatrics Workforce Enhancement Program drew students from practical nursing, community health worker, physical therapy assistant, occupational therapy assistant, respiratory care practitioner and medical assisting.

It is helpful to see the aspects of patient care through the lens of other health professionals
—Elizabeth Kalahiki, respiratory care student

“I genuinely enjoyed interacting with all the health science students,” said Jesse Temple, a student in the physical therapist assistant program. “Not only was I able to understand how to establish a better patient plan of care, but my knowledge was enhanced on each representative’s role within the health care team. I can’t wait to work alongside each and every one of them!”

UH ����ԴDz� Professor and Geriatric Medicine Chair Kamal Masaki prefaced the symposium with insights on “Developing an Age-Friendly Health System,” after which student groups were introduced to a geriatrics case to identify issues and develop preliminary management plans. Actors representing a patient and his daughter shared what mattered most to them, and the teams reconvened to adjust their plans with those considerations.

“It was beneficial to witness and understand how important every field is when working together for the ultimate care and needs of the patient,” said practical nursing student Skye Kalehuawehe. “I know that this experience will help me advance as a future nurse and that I can use these skills learned today to my advantage to give the best possible care to those in need.”

Student teams presented their care plans, followed by a panel discussion where faculty and professionals from diverse healthcare fields shared their clinical experiences and discussed lessons learned.
“This was a great opportunity to collaborate with other health fields to formulate a plan from varying perspectives with the patient’s wishes in mind,” said Elizabeth Kalahiki, a respiratory care student. “It is helpful to see the aspects of patient care through the lens of other health professionals. As a future respiratory care practitioner, I had a chance to see how patient care continues after discharge, as most of our involvement has been in an acute setting.”

The shortage of geriatricians nationwide is staggering—demand is estimated at 30,000 with fewer than 7,000 practitioners. This leaves a crucial gap in healthcare services as the elderly population expands. In �鶹��ý, the demand for geriatricians far outpaces the supply: �鶹��ý holds the title of highest life expectancy in the nation at 80.7 years, along with the highest percentage of residents aged 85 and older, according to recent U.S. Census data.

Philanthropists Anne Nohara-Abaya and her husband Allen Abaya were compelled to provide a solution and established two pilot programs to support and encourage students to pursue geriatric care as a specialty at the University of �鶹��ý at ����ԴDz� (JABSOM). The couple started the Nohara-Abaya Loan Repayment and Scholarship Award and the Nohara-Abaya Curriculum Support Fund.

“It was eye-opening,” said Anne, who learned more about the shortage after attending the . “Hawaiʻi has so many seniors—how much better would things be if we had more geriatricians?”

Professor and Chair of JABSOM’s Department of Geriatric Medicine Kamal Masaki recognizes the paradox: “It’s very sad because I think older patients could really benefit from this expertise.”

Supporting young doctors in geriatric care

The Nohara-Abaya Loan Repayment and Scholarship Award recipients receive $50,000 toward student loan relief and/or financial support—providing an opportunity for young doctors facing financial barriers to pursue their passion for geriatric care in favor of choosing a more lucrative specialty in order to quickly pay off student debt.

The UH Geriatric Medicine Fellowship is one of the largest programs of its kind in the country, and it boasts a remarkable record of nearly half of its graduates choosing to practice in �鶹��ý and the Pacific region.

Born and raised in �鶹��ý, Kathryn Kianalani Choo Loy, JABSOM geriatric medicine fellow, cannot imagine practicing anywhere else and is grateful to be one of first recipients of this award.

“My hope is that I can be a support system for my patients who are going through so many transitions at their age, and need someone with patience and compassion to help them remain not just healthy—but happy as well,” said Choo Loy. “I am also passionate about making sure caregivers are taken care of too and will think of their health and wellbeing as part of my responsibility as well.”

Growing expert nurse practitioners

The goal of the second pilot program established by the Abayas is to inspire and encourage more Advanced Practice Registered Nurses, or APRNs, to become experts in caring for the elderly. The Nohara-Abaya Curriculum Support Fund will be used to create a unique program for nurse practitioners that exposes them to the geriatrics specialty through interprofessional education and collaboration with JABSOM medical students.

Administered by the JABSOM Department of Geriatric Medicine, the program will be available to nurse practitioner students enrolled across three institutions including UH ����ԴDz�, Chaminade University and �鶹��ý Pacific University.

With these two pilot programs underway, Masaki is excited for the future of geriatric care in �鶹��ý.

“They’re a wonderful couple, they want to help the community, they see the needs that are there and they figured out a way that they can give back and I’m so thrilled,” said Masaki of the donors’ generosity. “The more people that go into the field of geriatrics, I think it’ll be better for our community.”

Rafia Hasina, 64, has been waiting for years to attend a popular program that engages the local ��ū��ܲԲ� (elder) population at the University of �鶹��ý at ����ԴDz� (JABSOM). The Dr. Rosita Leong Mini-Medical School on Healthy Aging is celebrating its 10th anniversary this year.

“One of my friends took these Mini-Med School classes before COVID. Since then, I’ve waited to be accepted and finally got in,” Hasina said.

She was all smiles on October 14 as she finally got her hands on a 300+ page binder that she said holds the key to unlocking a healthier life in her later years.

The fall 2023 semester covers topics such as rheumatoid arthritis, breast and prostate cancers and spine strengthening. It also dedicates sessions to topics such as what to expect when undergoing surgery and how to use exercise as medicine.

“There is so much we need to know about our health, especially aging,” Hasina said.

In addition to the binder containing her “homework,” Hasina will return to JABSOM each Saturday morning for the five-week course tailored to issues affecting �鶹��ý‘s ��ū��ܲԲ�.

“I’m especially interested in learning how to reduce suffering and pain,” she said. “Mini-Med School also offers timely advice on future life planning and decision making if something serious happens. This knowledge will make me feel more comfortable if I’m ever forced to make these tough decisions.”

Each year, there are 10 new topics over five weeks in the spring, and the same speakers and topics are repeated during five weeks in the fall.

“One thing we really want people to do as they age is to remain as healthy as possible and to continue to be lifelong learners,” said Kamal Masaki, JABSOM’s Mini-Med School director. “The philosophy of the Mini Medical School is to be mentally active. Our students are doing that by learning here. We encourage them to be mentally, physically and socially active, and to have nutritional balance.”

Masaki, who is also the chair of JABSOM‘s Geriatric Medicine Department, is glad to see the program flourishing and believes the messages during the program will lead to a healthier ��ū��ܲԲ� population in �鶹��ý. So far, roughly 1,000 people have participated over the past decade.

The Mini-Medical School was started in 2014 by Virginia Hinshaw, who was a faculty member at JABSOM and chancellor emeritus of UH ����ԴDz�.

During the pandemic, Mini-Med School went entirely online but is transitioning back to in-person classes.

For more information on the program, email mmsaging@hawaii.edu. Read more on the .

Medical students aren’t the only ones having to adapt to changes in learning due to the current COVID-19 situation at the University of �鶹��ý at ����ԴDz� (JABSOM). This fall, approximately 150 seniors have gone online to be a part of the .

The brainchild of Virginia Hinshaw, its recently retired director and UH ����ԴDz� chancellor emerita, the Mini-Medical School started at JABSOM in 2014 in partnership with the . The school was designed to prepare participants for the second halves of their lives by delivering relevant scientific information on aging, similar to what medical students learn but tailored for a public audience. Originally held annually each spring, a repeat session is also held in the fall due to overwhelming demand.

As life spans increase, so does the interest in “healthy aging,” especially in �鶹��ý, where life expectancy is the longest in the country. By the end of the decade, �鶹��ý will lead the nation in percentage of seniors in the population, with one-third of its residents aged 65 years or older.

The Mini-Medical School is led by Kamal Masaki, professor and chair of the Department of Geriatric Medicine, with assistance from Chang Kim, the program’s director of operations. Masaki took over the program amid the ever-evolving pandemic, and with an eye toward safety for her students, faculty and staff, she has transitioned the normally in-person five-week course online via Zoom. Several practice sessions were held for the students prior to the start of the program, giving them an opportunity to learn how to use Zoom.

The current session has proven that JABSOM’s medical students aren’t the only ones in their families with a thirst for learning, as several of them picked up the course binder and materials for their parents and grandparents who are enrolled in the Mini-Medical School.

—By TC Chun