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From the Director’s Desk

Summer 2024 Newsletter

By Robin McAtee, PhD, RN, FACHE – Director

Arkansas Geriatric Education Collaborative (AGEC), a Geriatric Workforce Enhancement Program (GWEP) at the University of Arkansas for Medical Sciences (UAMS) Donald W. Reynolds Institute on Aging (DWR IOA)

As I write this summer edition of the AGEC newsletter, I am thrilled to let you know that we have successfully written for and received a new HRSA grant award for the AGEC for the next 5 years beginning July of 2024. I will highlight the new grant components in my fall Director’s Letter to you, but for now I will end this current grant with a final note about the 4M’s Age-Friendly framework.

First, I want to first thank you all for reading last year’s articles here regarding the 4M’s of age-friendly care in general. I enjoyed writing those and being able to discuss those concepts in a framework that embraces older adults and puts what Matters to them in the very center of their care.

This quarter, I just want to let you know that the 4M’s framework has also been translated to include environments outside of just the primary care clinical visit or acute care hospital stay. Research has been completed on the application of these concepts to nursing home residents, surgical hospitals, emergency departments, and convenient or urgent care clinics. There are also guides to help with implementation to each of these settings as well as implementation guides to assist with the implementation or incorporation of the concepts into electronic health records. There are also videos, workbooks, case studies, and media assistance available. The link below is the general link to the IHI’s plethora of resources on the 4M’s framework. It is free to use!

Thank you for reading and if you need information about the 4M’s, please contact us at the AGEC. I look forward to telling each of you all about our new grant in our Fall newsletter! Until then, stay cool and hydrated this summer and have some fun!!

https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/Resources.aspx

Creating Livable Communities for Older Arkansans

Summer 2023 Newsletter

Dr. Peter Gess, Professor of Politics

Students: Kiera Boop, Raven Johnson, Kayla Grabinski, and Phillip Powell

Hendrix College, Department of Politics

As the average age of Arkansas’ population rises, so does the urgency of planning for walkable streets, diverse transportation options and housing, and a variety of activities and services. In partnership with AGEC and AARP Arkansas, students in the Hendrix College course, Advanced Policy Analysis, studied older Arkansans views of livable communities. Students began by creating a telephone survey; this survey was completed by Hendrix and Talk Business & Politics during March 2023.

About the Participants

901 Arkansans completed the automated telephone survey. 68.8% of the respondents were between 65 and 74 years old; 31.2% were 75 years old or older. 87.5% identified as White, non-Hispanic; 6.3% as Black; 0.7% as Hispanic; 0.6% as Asian/Pacific; and 5.0% as other, preferred not to answer, or mixed. 60.2% identified as women, 39.1% as men, and 0.8 as other or preferred not to answer. 23.8% identified their community as urban, 36.2% as suburban, and 40.1% as rural.

Survey Findings

For most questions, at least half of the respondents indicated that they were satisfied with quality-of-life issues. For example, 59.9% of respondents state that the quality of life for older persons is better in Arkansas than other states, or the same as in other states (13.7% state that it is worse, 26.3% don’t know). 86.6% are happier or somewhat happier now than when they were younger (14.0% are less happy now). Importantly, nearly two-thirds of survey participants plan to continue to live out their lives in their current location. Most older Arkansans, 69.2%, feel safe in their communities (and another 27.5% feel “somewhat” safe).

However, there are large differences in the responses between rural and urban/suburban respondents. Rural respondents are much more likely to be satisfied with the cost of living (44.3% of rural respondents find it inexpensive where they live, as compared to 28.0% of urban respondents). In contrast, access to health care and groceries are more challenging for rural, older Arkansans. Only 5.1% of urban respondents travel more than 15 minutes to a grocery store, while 27.1% of rural respondents travel more than 15 minutes (nearly 2% travel more than 30 minutes). Similarly, only 35.0% of urban respondents travel more than 15 minutes to meet their health care needs; 65.9% of rural respondents must do so (with 25.8% traveling more than 30 minutes). Only 2% of urban/suburban respondents are dissatisfied with their healthcare; 11.4% of rural respondents are dissatisfied.

Information and technology needs follow a similar pattern. 2.4% of urban/suburban respondents lack access to fast and reliable internet; 13.3% of rural respondents lack access. Perhaps unsurprisingly, 27.5% of rural respondents state there are not enough interesting recreational activities nearby (compared to only 13.0% of rural/suburban respondents). Rural respondents are divided on the types of activities they would most like to see; they prefer restaurants/shopping (27.4%), but also list outdoor activities (11.9%), indoor activities (11.9%), and arts/entertainment activities (11.1%).

Policy Recommendations for the City of Conway, Arkansas

As a component of the Advanced Policy Analysis course, students utilized the survey results and additional research to develop a list of policy recommendations for the City of Conway, where Hendrix College is located. In 2020, the city performed a citizens survey and found that 64 percent of the respondents found Conway to be a good or excellent place to retire; however, this was the lowest percentage of all similar categories (e.g., Conway is a excellent place for families, children, etc.).

The Talk Business & Politics survey results are listed by US congressional district; although the students were unable to identify Conway-specific respondents, they were able to generalize using the Arkansas 2^nd Congressional District (it is important to recognize that Little Rock is also located in the 2^nd District). 81.6% of 2^nd District respondents feel government should be more responsive to their needs. This is higher than for the other congressional districts.

43% of 2^nd District respondents interact in person with family, friends, or social groups outside the home once a week, or less frequently. Before the pandemic, 91.2% of older Arkansas residents were somewhat or very satisfied with their level of social connection; during and after the pandemic, there was a 12.5% decrease in this level of satisfaction (2022 Hendrix College-Talk Business survey).

Recommendations for the City of Conway include:

Establish a citizen-advisory committee to advocate for the needs and concerns of older residents;
Hold public forms to solicit input from older residents;
Extend the hours of the Farmers Market;
Create more intergenerational traffic at local events by including new vendors with multigenerational interests (art, food, coffee, clothing, etc.);
Develop marketing and advertising strategies that target older residents;
Ensure all city events have sufficient and accessible seating; and
Continue plans to develop a Conway Entertainment District.

Educating and Sharing Information

On April 17, 2023, in partnership with AGEC and Arkansas AARP, Hendrix College hosted the symposium, “Creating Livable Communities for Older Arkansans.” The program featured a variety of speakers and topics, including:

Mike Watson, director of livable communities for the national office of AARP, provided an overview of livable communities;
Ashley McBride, state director of AARP Arkansas, shared about livable communities on the local level, including AARP’s work in Little Rock;
Hendrix students presented their research findings and policy recommendations.

The symposium recording can be found here: https://vimeo.com/event/3237520

Livable Communities For Older Arkansans Video

Using Interprofessional Education to Improve Health Outcomes in the Geriatric Community

Summer 2023 Newsletter

Darshon Reed, Ph.D.

Associate Dean and Professor of Psychology

University of Central Arkansas, Department of Psychology and Counseling

Over 100 UCA students and faculty in the College of Health & Behavioral Sciences (CHBS) participated in a communitywide health fair focused on individuals 50 and older on Saturday, April 15^th, 2023. The UCA School of Nursing partnered with Second Baptist Church of Conway to coordinate and host the community health fair, which included a variety of screenings for older adults. The departments within CHBS that collaborated to provide screenings included School of Nursing, Exercise and Sport Science, Physical Therapy, Occupational Therapy, and Nutrition, Family and Consumer Sciences.

It is vital that healthcare professionals have a holistic health perspective and have the ability to work collaboratively with other healthcare team members. The community health fair’s focus on older individuals allowed students direct access and experience working with the aging population while also providing a learning environment that supported interprofessional education. Screenings included blood pressure, blood glucose, depression, polypharmacy, healthy eating, balance and functional mobility, fine motor, exercise endurance, low vision, and financial literacy. Health fair participants received health passports that included their screening results and were encouraged to share this information with their primary healthcare physician. Those that did not have a primary healthcare physician or who did not have access to care were provided information about the UCA Community Care Clinic housed in the Interprofessional Teaching Center (ITC) at 2200 Bruce Street in Conway, AR.

The ITC offers collaborative and one-on-one healthcare services to the Central Arkansas community. The providers within the ITC are not only practitioners, but also instructors in their specialty fields. Thus, the clinic provides a unique, hands-on experience for students to learn from experienced practitioners and from students within other healthcare disciplines while also meeting the healthcare needs of the community. Follow-up debriefings with students and faculty will occur during the fall 2023 semester to plan for more health fairs for older populations.

Students at Arkansas Colleges of Health Education Engage in Geriatric-Focused Education and Training

Summer 2023 Newsletter

Jennifer Moore, PhD, OTR/L, FAOTA, CLA – Dean, School of Occupational Therapy

Through the generous subaward granted, students from the Schools of Occupational and Physical Therapy – ACHE OT and ACHE PT at the Arkansas Colleges of Health Education were able to engage in a geriatric-focused education and training.

Specifically, an evidence-based curriculum that includes quality physical, mental, and emotional care while infusing cultural, ethical, patient-centered concepts that focus on what matters most to the older adult was incorporated in ACHE OT and ACHE PT doctoral curricula. The learning activities focused on the Age-Friendly Health System’s 4 M’s (Mentation, Mobility, Medication & What Matters). The following learning experiences and activities were carried out:

The components of the 4M’s Age-Friendly Care Curriculum were created and embedded into occupational therapy’s Productive Aging course and physical therapy’s Geriatric Physical Therapy course. The learning activities will be implemented in the courses during the Fall 2023 semester. Examples of learning activities:
- Interprofessional Fall Risks and Home Evaluation assignment – students from occupational therapy, physical therapy, and nursing will collaborate to conduct a fall risks assessment and home evaluation, analyze the results of the assessments, and design a program to ensure the safety of the older adults living in their homes. This face-to-face collaboration will help students learn how to work effectively as an interprofessional team to provide best practice for the older adults served.
- Intraprofessional assignment with occupational therapy and occupational therapy assistant students (ACHE OT and Delaware OTA programs). This virtual collaboration will help students learn how to work effectively as an intraprofessional team to provide best practice for the older adults served.
- Fall prevention program – led by trained Matter of Balance faculty, occupational therapy students will engage/help facilitate in the Matter of Balance Fall Prevention Program with community dwelling older adults in Sebastian County.
- Assistive Technology assignment – students from ACHE OT will design, train/educate older adults from the community in the use of assistive technologies to enhance independence with self-care activities, home and community mobility, health management (medication management, exercise, etc.), leisure, and social participation. This assignment will help students incorporate knowledge and skills learned from the Optimizing Occupations Through Technology course in the Doctor of Occupational Therapy program.
- Walkability assignment – students from ACHE OT will engage in a walkability study. The purpose of this assignment is for students to gain competency in evaluating and designing solutions for older adults to enhance community mobility.
- CarFit – students from ACHE OT will engage in a CarFit experience. The purpose of this assignment is for students to gain competency in evaluating the needs of older adults to enhance community mobility and driving safety.
- Dementia assignment – students from ACHE OT will engage in a dementia simulation through the use of technology and experience. The purpose of this assignment is for students to gain a better understanding of the challenges of patients with dementia and their family experiences to be a better healthcare provider.
Acting Creates Therapeutic Success (ACTS) – the subaward funds provided resources to support the ACTS program for older adults with intellectual and developmental disabilities (ID/DD) in the community. ACTS is a community based program designed to provide opportunities for participation in the performing arts. The program is led by occupational therapy faculty and students, is held weekly throughout the year, and culminates in a public performance. In addition, students have the opportunity to engage with older adults with ID/DD in the program; thereby developing knowledge and skills in best practice as they work with this population.
The public is invited to attend The Great Diamond Heist that will be held on August 29, 2023 at 6:00 at the AR Colleges of Health Education Research Institute Health and Wellness Center, 1000 Fianna Way, Fort Smith, AR. For more information, please contact Jennifer Moore at jennifer.moore@achehealth.edu

The Schools of Occupational and Physical Therapy from the Arkansas Colleges of Health Education thank Arkansas Geriatric Education Collaborative for providing the generous funds to support these activities and opportunities that enhance the learning of healthcare students and enrich the lives of older adults.

Updated AGS Beers Criteria® of 2023

Summer 2023 Newsletter

Mohamad Salamah

Lisa C. Hutchison, Pharm.D., MPH, BCPS, BCGP

Every few years, a panel is assigned by the American Geriatrics Society (AGS) to update the AGS Beers Criteria^® for Potentially Inappropriate Medications (PIM) for older adults (65 years or older). In 2023, the criteria was updated with a revised list of medications that can be harmful to older adults. Since most older adults are on at least one or more prescription medications, it’s important to identify possible drug-drug interactions or any harm medications can cause in chronic conditions that are often associated with older adults. The goal of the 2023 AGS Beers Criteria^® is to minimize the possible exposure of older adults to PIMs by educating clinicians and patients about evaluating if the risks of certain medications are justified in the use of older adults.¹

The AGS Beers Expert Panel divides the list into 5 different categories:

1. Medications considered as potentially inappropriate in all older adults

2. Medications potentially inappropriate in patients with certain diseases or syndromes

3. Medications to be used with caution

4. Potentially inappropriate drug-drug interactions

5. Medications whose dosages should be adjusted based on renal function.²

The 5-category system is similar to the 2019 Beers Criteria^®.³ The 2023 panel consisted of 12 experts that were involved in different healthcare fields such as nursing, medicine, and pharmacy. They investigated evidence on individual drugs published between 2017 to 2022 to determine how to update the 2019 AGS Beers Criteria^® which was based on previous evidence. Both lists used the Delphi method to cast their opinion and reach a final decision regarding the drugs to include.^1,3

Notable changes are seen in the 2023 AGS Beers Criteria^® following the recent update from the panel. For example, aspirin, which was previously used regularly in primary prevention of cardiovascular disease, was moved from the “use with caution” table and is now deemed as category 1, which is a PIM not recommended for use in all older adults. Older adults who are already on aspirin as primary prevention of cardiovascular disease are recommended to stop taking it as the risk outweighs the benefit.^1,3 Key changes in anticoagulants are likely the biggest headline of the new update (See Box 1). Warfarin is now listed as a medication to be avoided unless direct oral anticoagulants like apixaban are contraindicated when an initial therapy is needed for venous thromboembolism (VTE) or nonvalvular atrial fibrillation (AF). Rivaroxaban is now considered a medication to avoid in older adults for long-term treatment of nonvalvular AF and VTE due to risk for bleeding; before this update it was listed as a ‘use with caution’ medication for older adults.

Adapted from Reference 1; DOAC = Direct Oral Anticoagulant; INR= International Normalized Ratio

Changes also occurred in the class of anticholinergics, which should be avoided in older adults to reduce the cumulative anticholinergic burden that can cause an increased risk of falls, constipation, delirium and possibly dementia. In the 2019 criteria, all anticholinergics were listed together, but are now split up into the categories of Antihistamines, Central Nervous System (antiparkinson anticholinergics), and Gastrointestinal (antispasmodics).^{1, 3}

There were also changes in medications used for the treatment of diabetes. All sulfonylureas are now recommended to avoid in favor of newer antidiabetic agents to decrease the risk of prolonged hypoglycemia, cardiovascular death and stroke, which are more likely to occur with sulfonylureas. However, of the newer agents, sodium-glucose cotransporter-2 inhibitors are recommended to be used with caution due to the increased risk of euglycemic diabetic ketoacidosis and urogenital infections in older adults.¹

The 2023 AGS Beers Criteria^® can aid practicing clinicians as well as other healthcare professionals in deciding appropriate therapies for older adults; however, it should be noted that the criteria does not apply in the case of hospice. Additionally, the criteria are focused on medications that are available in the U.S. rather than worldwide.² This is important to address since there are other medications worldwide that can also prove to be more harmful than helpful to older adults which the AGS Beers Criteria^® may not cover. The goal for the 2023 AGS Beers Criteria^® remains to improve the quality of care and life for older adults by guiding healthcare professionals in selecting optimal medications for treating older adults.

References:

American Geriatrics Society 2023 updated AGS Beers Criteria^®for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;1‐30. DOI: 10.1111/jgs.18372
Meyer K. Mook H. What’s on tap: 2023 Beers Criteria update. Pharmacy Today July 2023. www.pharmacist.com › DesktopModules › EasyDNNNewsWhat’s on tap: 2023 Beers Criteria update – pharmacist.com (Accessed August 16, 2023)

Palliative Care: What Older Adults and Caregivers Should Know

Summer 2023 Newsletter

Addie Fleming, MNSc, RN, CCRN, CNE, ACUE – Assistant Professor

Sarah Dearing, MSN, RN – Chair, AASN Programs

Arkansas State University, School of Nursing

The worldwide population is getting older due to advances in medical care. However, the needs of the aging population differ greatly from the needs of the younger population. Compared to younger adults, older adults often live with multiple complex medical diagnoses, functional dependency, cognitive decline, and increased frailty. As a result of the differences, the needs of the older adults, caregivers, and their families are often unmet due to the complexity associated with older adults’ medical care. Palliative care can be used to provide the needed support in all aspects of the older adults’ medical care (Schelin, et al., 2023).

Palliative care is derived from the word “palliate”, which means to comfort. More specifically, palliative care is a clinical approach of providing comfort to a person by identifying and addressing the physical, psychological, social, and existential suffering of the person related to an illness, injury, or disease process (Tolchin et al., 2022). Palliative care focuses on providing the best quality of life for a person through treatment and management of the symptoms they experience. All persons receiving palliative care experience an increase in communication from the physician and care team specific to care, decrease in health-care utilization (including hospital stays), and improved satisfaction with their quality of life (Schelin, et al., 2023). Palliative care can be basic (primary) or complex (specialty) depending on the needs of the older adult. Basic palliative care can be provided by any clinician and is typically used for a general approach. However, for those requiring a more specific treatment plan can receive care from a specialist trained in hospice and palliative medicine (Tolchin et al., 2022). An older adult or caregiver can find a palliative care provider by visiting the National Hospice and Palliative Care Organization (2023) at https://www.nhpco.org/find-a-care-provider/.

Palliative care is often mistaken for hospice care because both healthcare services focus on patient needs and quality of life, however, the two services are not interchangeable. Both services focus on the person’s needs and quality of life, but hospice care focuses on the period closest to death. Hospice care is specifically reserved for persons at the end of life who are expected to have less than six months to live and allows for limited treatments. Palliative care focuses on managing the person’s treatments and other needs to maintain the highest quality of life for the person with the illness, injury, or disease (CaringInfo, 2023).

The World Health Organization (2020) estimates that globally about 14% of patients who need palliative care are receiving it – meaning an estimated 56.8 million people are in need of palliative care. Older adults and their caregivers often are not aware of the services and benefits associated with palliative care. The following bullet points summarize some services and benefits of this ‘extra layer of support’ as highlighted by CaringInfo, a program of the National Hospice and Palliative Care Organization (2023):

Focuses on managing symptoms of the illness, injury, or disease to provide the highest quality of life possible (pain control, stress reduction, etc.)
Curative and therapeutic treatments can continue (dialysis, chemotherapy, surgery, etc.)
Available to persons in any care setting (home, nursing home, hospital, etc.) usually by a team of specially trained doctors, nurses, and other specialists
Medicare, Medicaid, and many insurance plans often cover the medical portions, including the Veterans Affairs (VA) for veterans.
Non-medical services include help with insurance forms, help with options for care and housing, help with advance directives, and spiritual care.
All services (medical and non-medical) provided for as long as they are needed and can change based on the person’s need.

As you can see, palliative care is a resource for anyone living with an illness, injury, or disease that causes distressing symptoms. Older adults and caregivers benefit from palliative care through improved management and treatment of the symptoms they experience. A higher quality of life is often the result of palliative care for both the caregiver and the older adult (World Health Organization, 2020) – so everyone can focus on enjoying their lives and not managing an illness, injury, or disease.

References

CaringInfo. (2023). What is palliative care? https://www.caringinfo.org/types-of-care/palliative-care/

National Hospice and Palliative Care Organization. (2023). Find a care provider. https://www.nhpco.org/find-a-care-provider/

Schelin, M. E., Fürst, G. C., Rasmussen, B. H., & Hedman, C. (2023). Increased patient satisfaction by integration of palliative care into geriatrics: A prospective cohort study. PLOS ONE, 18(6), 1-15. https://doi.org/10.1371/journal.pone.0287550

Tolchin, D. W., Brooks, F. A., & Knowlton, T. (2022). The state of palliative care education in United States physical medicine and rehabilitation residency programs: Heterogeneity and opportunity for growth. American Journal of Physical Medicine & Rehabilitation, 101(12), 1156-1162. https://doi.org/10.1097/PHM.0000000000002072

World Health Organization. (2020, August 5). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care

From the Director’s Desk

Summer 2023 Newsletter

By Robin McAtee, PhD, RN, FACHE – Director

Arkansas Geriatric Education Collaborative (AGEC), a Geriatric Workforce Enhancement Program (GWEP) at the University of Arkansas for Medical Sciences (UAMS) Donald W. Reynolds Institute on Aging (DWR IOA)

This quarter I will be continuing my writing about the 4M’s framework of Age-Friendly care. We have reviewed the overall concept of the 4M’s framework, the first “M” of “what Matters” (the cornerstone of the framework) and last quarter we reviewed Medication. This summer quarter we will move on to Mobility.

As you can guess, “mobility” involves a LOT! It is critical to what matters and can be greatly impacted by medications! Here we can see how all of these “M’s” intertwine and are co-dependent. So, when reviewing Mobility, we need to first assess, recognize and document limitations. First, some factors that increase the mobility risk factors include; aged 65+, female, obesity, chronic physical conditions such as arthritis, diabetes and other joint conditions or injuries. Risk factors also include mental conditions such as depression, dementia, delirium, to just name a few. The main goal is to ensure that the older adult moves safely in every day circumstances to maintain function and do “What Matters” to them. So next, one would screen for mobility limitations and then work to create safe everyday environments including the use of adaptive equipment when appropriate.

We also need to work with the entire geriatric team to consider the other 4 M’s such as assessing any medications that may sedate the older adult, cause postural hypotension, cause dizziness, or contribute to other factors that might impair mobility and therefore decrease their ability to do what Matters. In addition, other appropriate measures might include a consult to physical and or occupational therapy.

Mobility is vital for us all to do what Matters, it is no different for an older adult. However, with older adults, there are many more contributing factors and information that must be considered.

This was just a quick overview of “Mobility”, and there is a lot more to learn and apply with this “M”, but I hope it helps to inform and remind us to use the 4 M’s and to always consider each “M” within the context of What Matters Most. If you want to learn more, additional information can be found at

https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx

If you would like more information or training regarding the 4M’s of Age-Friendly care, please contact the AGEC.