March 30, 2013

Agility4Life
Quality of Life through Measured Movement
Agility For Life Justin Ho, Uday Chaka

http://www.agility4life.com

March 30, 2013

Agenda
Company

Overview Solution Overview Demonstration Business Insight

March 30, 2013

Who is Agility4Life?

Vision be health monitoring solution for seniors by utilizing movement signals to predict and enhance health outcomes

To help PREVENT adverse events To help DETECT adverse events

Ultimately help seniors live independently, away from intensive care or nursing homes Why now?

Aging Population 10k new seniors / day existing resources will be strained to provide sufficient care Advancements in computer vision technology Advancements in movement/gait science Regulatory changes to better incentivize stakeholders to invest in technology to improves quality of care

Core Team

Uday Kiran Chaka Founder, Duke MBA Justin Ho Founder, Duke MBA Seshadri Srinivasan, PhD Founder, Research Lead Stacy Fritz, PhD authority in walking science Tiffany Shubert, PhD research scientist in Aging

Extended Team

Front / Back End Developers Hardware engineer Hardware/UI designers Image Analysis Scientists Geriatrician
http://newsroom.pamf.org/2012/10/pamf-innovationcenter-developer-challenge-winners/

Company Overview

Solution Overview

Demonstration

Business Insight

March 30, 2013

What is Agility4Life?
Phase I
Prevention

Prototypes Built
- Fall Risk - Cognitive Declines - Sensory Declines

Health assessment and risk detection tool based on walking speed

Phase II
Detection

Fall Detection/Monitoring System Advanced Fall Risk Assessment and Disease Prediction Suite based on complex movement patterns

Phase III
Prevention

Company Overview

Solution Overview

Demonstration

Business Insight

March 30, 2013

Key Solution Features

Real-time detection of falls

Daily monitoring and assessments of overall health based on walking speed Provide early warnings of health deteriorations based on walking speed Real-time alerts sent to designated care taker(s) in case of fall

Ability to distinguish between real falls and false positives (e.g. lying down, sitting)

Online health overview dashboard

Alert protocols include SMS text, Email, and can be customized to integrate with existing facility alarm systems Ability by senior to easily deactivate alert if fall is not serious

Summarizes captured data to show metrics, warnings, and trends Accessible only by senior and his/her designated caretaker(s) HIPPA compliant platform that can integrate with hospital systems if need be

Company Overview

Solution Overview

Demonstration

Business Insight

March 30, 2013

Value of Real-Time Fall Detection

Value to Senior (and his/her primary caretaker)

Peace of mind when fall occurs someone would be alerted immediately More likely to recover/survive if falls are detected and treated early

Remaining on floor for >2 hours after a fall increases risk of dehydration, pressure ulcers, rhabdomyolysis, hypothermia, and pneumonia Special urgency for cardiac arrest issues where 3-minute reduction in call-to-shock time improves odds of survival almost 4-fold *

Value to Providers

Improved quality of care for its members Differentiator to attract new members Helping meet organizational service objective of keeping its seniors living independently Annual savings of ~$2MM for 3000 unit facility

Value to Payer

* http://usatoday30.usatoday.com/news/nation/ems-day2-cover.htm
Company Overview Solution Overview Demonstration Business Insight

March 30, 2013

Value of Walking Speed Assessment

Value to Senior (and his/her primary caretaker)

Opportunity to take control of own health

Continuous monitoring of a key vital sign walking speed to assess health status Early warning of functional declines and risk of falls gives opportunity for intervention before its too late

Value to Providers

Improved quality of care for its members Differentiator to attract new members Helping meet organizational service objective of keeping its seniors living independently

Value to Payer

Early intervention reduces the likelihood of hospitalization, disease complications, and moving into nursing homes saving millions

Company Overview

Solution Overview

Demonstration

Business Insight

March 30, 2013

A Bit More on Walking Speed

Latest medical research confirms that Walking Speed/ Gait Speed is a good indicator of overall health status, including

Stability and Balance Risk of Falling Dementia, Cognitive Status Motivation and Mental Health Survival and Well Being Musculoskeletal Condition, Joints, Motor Control Sensory and Perceptual Function (Vision and Ears)

Changes in Walking Speed correlate with changes to health. Studies show that for seniors:

Average walking speed < 0.6 m/s is indicative of poor health status Walking Speed decrease (change of -0.1 m/s) indicates health deterioration Walking Speed increase (change of +0.1 m/s) shows improvement See Appendix for a comprehensive list of walking speed implications

Walking requires body support, timing and power. It places demands on the brain, spinal cord, peripheral nerves, muscles and joints, heart and lungs, and the blood thus when organ systems are not working property, gait speed slows. - Dr. Studenski S*

Walking Speed is specific, measurable, objective and correlates with health

Company Overview

Solution Overview

Demonstration

Business Insight

March 30, 2013

Unobtrusive Experience
Agility4Life Detectors capture and assess movement signals; process and transmit relevant data including position coordinates, time, identified movement characteristics wirelessly to CPU hub.

Distance Point B Point A

Agility4Life CPU Hub triangulates data from multiple detectors and sends summarized information including detected fall and walking speed to Agility4Life software application in the cloud. Also contains manual override button in case of false alarm alerts.

Company Overview

Solution Overview

Demonstration

Business Insights

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March 30, 2013

Analytics in the Cloud

Agility4Life Application in the Cloud
Summarized Information

Personalized Agility4Life Web Site

Data Base

Analytics Engine

Trend Generator
Push/pull requests SOAP/REST architecture JSON/XML

Immediate Fall Alert SMS Text Message Email Existing Facility Warning System*
* Customized based on facility-specific system and processes

Company Overview

Solution Overview

Demonstration

Business Insight

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March 30, 2013

Privacy / Ease of Use

Secure login so only senior and his/her designated caretaker(s) can see data A4L does not capture or store images in the cloud assessment of images done on detector device in real time; images discarded immediately One time set up takes about 45 minutes pending number of rooms Unobtrusive usage senior does not have to wear anything or modify daily routines Non-invasive look and feel small form factor, blends into wall Simple button to press if fall detected is false alarm

Company Overview

Solution Overview

Demonstration

Business Insight

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March 30, 2013

Validated by Experts
Name
Doctor

Runner-Up in PAMF linkAges Competition!

Title
Physician Lead, Palo Alto Division Geriatric Medicine Program, Palo Alto Medical Foundation (PAMF) Program Director & Assistant Professor at University of South Carolina Physical Therapy Program Adjunct professor, Physical Therapy, at UNC, Research scientist at the UNC Center for Aging and Health Senior Research Scholar and Director of Academic and Research Support, Stanford Center on Longevity Care Center Administrator, Vi Palo Alto, Independent Living & Assisted Living (IL & AL) Facility CFO of Secret Harbor, Provider of home care (HC) services for Seniors Senior Vice President, Health 2.0 Entrepreneur & Consultant, Geriatrics

Dr. Peter Cheng Stacy Fritz, PHD, PTI Dr. Tiffany Shubert, PHD Ken Smith Mr. Joachim Yo Andersen Mr. Al Lewandowski Mr. Jean-Luc Neptune Katy Thomas Fike, PHD

Industry

IL/AL/HC Facilities

Academic

Agility4Life solution has been reviewed positively by a PAMF physician, academics, researchers, seniors, administrators of Assisted and Independent Living facilities and industry veterans
Company Overview Solution Overview Demonstration Business Insight

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March 30, 2013

Demonstration
Fall

Detection Videos show various fall patterns detected

Falling backwards Falling forward Falling straight down Non-fall (sitting down / slowly lying down)

Walking

Speed Assessment See Appendix for description

Company Overview

Solution Overview

Demonstration

Business Insight

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March 30, 2013

Successful Beta Prototype

Agility4Life signed up a senior to participate in a beta to test the solution to measure Walking Speed

Participant Profile Name: Angelina H (Patient A) Age: 86 Sex: Female Health Care Provider: PAMF Palo Alto Resident Lives Alone

Overview

Trends

Risks

Details

Actual screen shots from the beta website for the participant Measures Walking Speed accurate to 1/15th of a second Trends are vivid and easy to interpret
Solution Overview
Demonstration

The charts are easy to understand. They give valuable feedback and incentive to exercise Angie H (Beta Test Participant)
Business Insight

Company Overview

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March 30, 2013

Health Monitoring has business value

Hospital Nursing Home Assisted Living Independent Living Home

High cost

Low cost

Preventative Care: Early detection of potential problems by seniors, care-givers or family members, community programs, and doctors/therapists, by reviewing Walking Speed summaries helps prevent adverse or catastrophic events

Better quality of life for seniors Less dependence on others for daily activities Delay the onset or reduce the likelihood of transitioning from home to nursing homes Avoid significant financial burden placed upon family members avg. of $70k / year

Living at home or in a Low Cost facility with similar care: Providers and Senior Living Facilities deliver higher standard of service at lower cost, realize better occupancy rates and revenues

Improved quality of care away from hospitals and physicians means less re-visits for same issue, improving bottom-line for hospitals Improved quality of care in senior living centers or assisted living facilities means less flow into nursing homes, where the margins for operators are typically less attractive

Monitoring activities and health saves money for seniors and health system overall by preventing falls and helping seniors live in lower cost facilities like home
Walking Test May Predict Heart Surgery Risks WebMD article
Company Overview Solution Overview Demonstration Business Insight

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March 30, 2013

Agility4Life - Addressable Market for Health Monitoring

Two main addressable markets worth $3.5B

Seniors living alone in private homes Independent and assisted living facilities

Private home seniors

11.3M non-institutionalized seniors live alone (1.1M in CA) Total Market size of ~$3.3B annual revenue in US (assume $50 initial purchase/senior + $20 monthly fee/senior)

Independent / Assisted living facilities

~1M seniors live in ~40k independent/assisted living facilities nationwide Top 10 assisted living and top 10 independent living facilities combine to serve ~260K seniors, totaling ~$75M market Total market size of $250M (assume $1000 initial purchase/facility + $20 monthly fee / senior)

http://www.consumerreports.org/cro/money/retirement-planning/choosing-an-assisted-living-facility/overview/index.htm

Company Overview

Solution Overview

Demonstration

Business Insight

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March 30, 2013

Agility4Life Pricing
Alternatives
Full monitoring at Nursing Homes Moving into Assisted Living Treatment due to illness/falls Get-Up-and-Go Tests BeClose Full Monitoring

Monthly Cost Monthly Cost w/o Insurance w/ Insurance

$7,000 * $3,300 $1,600 $7,000 $3,300 $400

Key Differences to Agility4Life

- Loss of independence - Pain and suffering - Loss of some independence - Pain and Suffering - Temporary / permanent decline in mobility Monthly Hospital Visits May not be as accurate No comprehensive historical records - Does not provide walking speed

$100 $80

$15 $80

Agility4Life

$20/senior monthly subscription fee + $20 Wireless access (3G models) $40-50 one-time product price

* http://www.elderlawanswers.com/resources/article.asp?id=8717&Section=4&state

Company Overview

Solution Overview

Demonstration

Business Insight

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March 30, 2013

Agility4Life Intellectual Property

Agility4Life

has filed a provisional patent on Fall identification, posture detection, temperature identification and reliable estimation of walking speed using Passive Infrared array and Optical Cameras: Subsequent assessment of general health, including fall risk, using posture, fall history and walking speed A broad-based family of patents in this area will protect Agility4Lifes interests in the long term

Company Overview

Solution Overview

Demonstration

Business Insight

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March 30, 2013

Agility4Life Competitive Analysis

Alternatives
Features Accuracy Frequency Automated Cost effective Ease of set-up Supporting technologies User Interface, EHR/EMR link *** *** *** *** *** *** ***

Agility4Life

Stop watch & tape

*** * * ** *** ** *

Motion detector
* *** *** ** * * *

WebCam/ Kinect
*** *** *** * *** * *

Radar

Pedometer, strap-on devices

*** ** * ** *** *** **

* *** *** ** *** * *

Agility4Life is the best solution!

Company Overview Solution Overview Demonstration Business Insight

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March 30, 2013

Agility4Life Roadmap/ Go to Market Strategy

Q3/Q4 2014 Q1/Q2 2014 Q3/Q4 2013

Partner w/Insurance companies, Providers Partner w/Retailers, Medical Supplies Distributors

Improve analytics

Public Launch w/Direct sales, Distributors

Add new form factors for detectors Public Beta Launch w/Partners (ALF), Managed Care Organizations (MCOs)

Q1/Q2 2013

Add new signals, enhance website to improve user experience Pilot: Homes of seniors, Assisted Living Facility (ALF)

Improve person recognition/filtering, add connectors to EMR, EHR, PHR

Company Overview

Solution Overview

Demonstration

Business Insight

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March 30, 2013

Agility4Life Partnership Plan

Current Status - completed proof of concepts, rough prototypes, received validation from experts; now we need to:

Validate theres a need of this product from senior homes If so, continue to invest money, time, energy to build up product for real trials (~2 month effort)

We want to be a pilot partner of senior living facilities, and conduct beta tests

Two Evaluation Trials, each contains:

5 senior units 1 month span Pre-trial walk through of facility and one time set up of system Post-trial interviews with senior, caretaker, and facility member(s)

As an initial partner we will:

Customize our solution specifically to your facility so to leverage existing warning systems/alarms and processes Once productized, free 1 year usage of product for seniors who participate in trial

Company Overview

Solution Overview

Demonstration

Business Insight

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March 30, 2013

Agility4Life Founder Bios

Uday Chaka

Entrepreneur and management consultant with deep strategy, technology, and execution experience Co-founded mobile social gaming company, advised Fortune-100 firms on product development and supply chain operations Worked at Pricewaterhouse Coopers (PwC), Cisco, HP, Infosys Holds MBA in Health Sector Management from Duke University and BS in Technology from Indian Institute of Technology (IIT)

Justin Ho

Experienced healthcare and management consulting professional Deep product management, marketing, sales operations, and technology experiences Worked at Accenture, Boston Scientific, Cardinal Health, and Genentech Holds MBA in Health Sector Management from Duke University and BS in Biomedical Engineering from Johns Hopkins University

Seshadri Srinivasan

Sr. Staff Scientist, Product Lead, Feature Lead & Research Lead Expert on Image Processing, Medical Imaging & Systems Engineering Worked at Siemens Medical Solutions and startups Authored 11 patens overall, including 5 patents on color doppler imaging, all of which were granted: (7946990, 7887484, 7887487, 8047991, 8098910) Holds Ph.D in Electrical Engineering from Houston University and B.S. in Electrical Engineering from Anna University
Solution Overview Demonstration Business Insight

Company Overview

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March 30, 2013

Agility4Life - Summary
Captures and Analyzes Activity Patterns to Monitor Health

Improves Quality of Care for Seniors

Helps Seniors Age Independently Away from Hospital / Nursing Homes

Great team With a Unique solution In a Growing market Social Mission Preventative Care Need of the hour

Agility4Life hopes to win the Startup Challenge!

Company Overview Solution Overview Demonstration Business Insight

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March 30, 2013

THANK YOU!

Contact: Uday.chaka@agility4life.com
Company Overview Solution Overview Demonstration Business Insight

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March 30, 2013

APPENDIX

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March 30, 2013

Agility4Life: Summary Screen

Senior profile

Account Information

Agility4Life recommendation for the senior

Company Overview Solution Overview
Demonstration

Daily and weekly average speeds and changes

Partnership Opportunities

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March 30, 2013

Agility4Life: Trends Screen

Senior profile

Account Information

Trend line of walking speed over a period of time

Company Overview Solution Overview
Demonstration

Large fluctuations could indicate certain medical conditions

Partnership Opportunities

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March 30, 2013

Agility4Life: Risks Screen

Senior profile

Account Information

Risk factors based on walking speed

Company Overview Solution Overview

Seniors risk level based on the average walking speed

Demonstration

Partnership Opportunities

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March 30, 2013

Agility4Life: Hours Screen

Senior profile

Account Information

Does the walking speed vary widely?

Company Overview Solution Overview
Demonstration

Does Walking speed vary widely during the day morning vs. mid-day?
Partnership Opportunities

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March 30, 2013

Use Case Disease Maintenance

Has not taken medication on schedule the past 3 weeks, and does not tell anyone

Lynn, 68 year old grandmother, lives alone in private home, primary care taker is her son Thomas, who lives in another state

Without Agility4Life

Has depression, often times forgets to take medication

Depression worsens in following weeks, leads to general health deterioration

Thomas no longer thinks Lynn can live independently, moves her to assisted living

Total Cost: $3,300/month for Assisted Living1 Decreased independence Lower quality of life

With Agility4Life

Has depression, often times forgets to take medication

Has not taken medication on schedule the past 3 weeks, and does not tell anyone

Agility4Life sends warning signal to Thomas

Thomas calls

Lynn, asks clarifying questions and finds out she has not been taking medication

Thomas reiterates

importance of medication, asks neighbor to check up on Lynn. Depression does not deteriorate, Lynn stays in her home.

1http://www.assistedlivingfacilities.org/articles/assisted-living-costs.php/

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March 30, 2013

Use Case Disease Maintenance

Has Multiple Sclerosis, knows from experience decline in mobility is sign of exacerbation of disease

Nancy, 79 year old grandmother, lives alone in private home, primary care taker is her daughter Pam who lives close by

But both

Without Agility4Life

Nancy and Pam do not notice visually minor mobility declines

Exacerbation of MS occurs, severe urinary tract infection develops, causing pain and suffering

Total Cost: $1,000 for treating urinary tract infection and MS exacerbation Pain and Suffering

With Agility4Life

Has Multiple Sclerosis, knows from experience decline in mobility is sign of exacerbation of disease

Pam notices minor mobility declines via Agility4Life notification

Pam asks Nancy to

check for common MS exacerbation factors and schedules appointment with Nancys physician for checkup

Nancy, along with

her physician catches the onset of urinary tract infection and is able to treat it effectively before it becomes serious

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March 30, 2013

Use Case Preventative Diagnosis

During doc visit: does not bring up symptom for fear of being sent to nursing home

Ted, 74 year old grandfather, recently moved into independent living center.

falls and suffers hip fracture

Condition worsens

Without Agility4Life

Has minor dizzy spells for the past 3 weeks

Total Cost: $20k for treatment/therapy1 Pain and Suffering Decreased long term mobility Increased risk of fatality

With Agility4Life

Has minor dizzy spells for the past 3 weeks

During doc visit: does not bring up symptoms for fear of being sent to nursing home

But via Agility4Life doc sees average walking speed varied greatly from past week to past month

Doc asks clarifying questions: discovers dizziness; suspects vestibular disorder and prescribes physical therapy

Ted follows treatment doc verifies improvement with Agility4Life report Ted stays in independent living

1http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html

References
WS value (m/s) < 0.6 >1.0 < 0.6 >1.0 < 1.0 >1.0 Functional Link to Walking Speed Dependent in ADL's and IADL's Independent in ADLS More likely to be hospitalized Less likely to be hospitalized Need interventions to reduce falls Less likely to have adverse events Author Studenski Studenski Studenski Studenski MonteroOdasso MonteroOdasso Year 2003 2003 2003 2003 2005 2005

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March 30, 2013

Journal J Am Geriatr Soc. J Am Geriatr Soc. J Am Geriatr Soc. J Am Geriatr Soc. J Gerontol A Biol Sci Med Sci. J Gerontol A Biol Sci Med Sci.

>1.0

Less likely to have adverse events

Cesari

2005

<.15

d/c to SNF

Rabadi

2005

> 0.15 > 1.3

d/c to home more likely Extremely fit Higher risk for Persistent Lower Extremity Limitation Higher risk for Persistent Severe Lower Extremity Limitation

Rabadi Studenski

2005 2003

<1.0

Cesari

2005

<1.0

Cesari

2005

<1.0

Higher risk of death

Cesari

2005

<1.0 <1.05 < 1.0 <0.8 <0.8 <0.7 <0.6 <0.42 <0.42 <0.2 <0.15 ~0.67 ~0.89 ~1.11 ~1.33

Higher risk for hospitilization Cognitive Decline within 5 years Death and hospitalization within 1 year Mobility and ADL disability at 2 years Mortality risk at 2 years and 3.8 years Risk of death, hospitalization, institutionalism and falls Functional and cognitive decline Functional impairments Severe walking Disability Extremely Frail Institutionalism and high dependence Self Care Husehold Activities Carry Groceries, Light yardwork Climb several flights of stairs

Cesari Inzitari Studenski Ostir Ostir MonteroOdasso Studenski Atkinson Atkinson Studenski Friedman Studenski Studenski Studenski Studenski

2005 2007 2003 2007 2007 2005 2003 2005 2005 2003 1988 2003 2003 2003 2003

Article Title Physical performance measures in the clinical setting. Physical performance measures in the clinical setting. Physical performance measures in the clinical setting. Physical performance measures in the clinical setting. Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years andolder Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years andolder Prognostic value of usual gait speed in well-functioning older people-results from the Health, Aging and Body Composition Study Admission ambulation velocity predicts length of stay and discharge disposition following stroke in an acute rehabilitation hospital. Admission ambulation velocity predicts length of stay and discharge disposition following stroke in an acute rehabilitation hospital. Physical performance measures in the clinical setting. Prognostic value of usual gait speed in well-functioning older people-results from the Health, Aging and Body Composition Study Prognostic value of usual gait speed in well-functioning older people-results from the Health, Aging and Body Composition Study Prognostic value of usual gait speed in well-functioning older people-results from the Health, Aging and Body Composition Study Prognostic value of usual gait speed in well-functioning older people-results from the Health, Aging and Body Composition Study Gait speed predicts decline in attention and psychomotor speed in older adults. Physical performance measures in the clinical setting. Measures of lower body function and risk of mortality over seven years follow up Measures of lower body function and risk of mortality over seven years follow up Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years andolder Physical performance measures in the clinical setting. Predictors of combined cognitive and physical decline Predictors of combined cognitive and physical decline Physical performance measures in the clinical setting. A prospective trial of serial gait speed as a measure of rehabilitation in the elderly. Physical performance measures in the clinical setting. Physical performance measures in the clinical setting. Physical performance measures in the clinical setting. Physical performance measures in the clinical setting.

J Am Geriatr Soc. Neural Rehab and Repair Neural Rehab and Repair J Am Geriatr Soc.

J Am Geriatr Soc.

J Am Geriatr Soc.

J Am Geriatr Soc.

J Am Geriatr Soc. Neuroepidemiolo gy J Am Geriatr Soc. Am J Epidemiol. Am J Epidemiol. J Gerontol A Biol Sci Med Sci. J Am Geriatr Soc. J Am Geriatr Soc. J Am Geriatr Soc. J Am Geriatr Soc. Age and Ageing J Am Geriatr Soc. J Am Geriatr Soc. J Am Geriatr Soc. J Am Geriatr Soc.