By Gretchen Gibson, DDS, MPH

During this month of celebrating Veteran’s Day, it seemed appropriate to recognize another continued service of our Veterans, beyond their military time. The Million Veteran Program (MVP) is a research program designed to better understand how genes affect health and illness. Data collected as part of the MVP will help enhance disease screening, diagnosis and prognosis for both Veterans and all Americans.
Data collection began in 2011 at various VA hospitals throughout the United States. To date, the MVP has over half a million Veterans who have volunteered and enrolled. Therefore, this is now the world’s largest genomic database, or genetic biorepository. Veterans who volunteer are asked to complete a short questionnaire and donate one vile of blood. This genetic data is linked to their questionnaire and the VA electronic health record to aid in the development of new diagnostic tests, precision or targeted medications, precision therapies and to look at the link of military exposures to genetic susceptibilities to aid in novel approaches to treating these conditions.
Older Veterans are playing a key role in this research. In 2016, Gaziano et al looked at the characteristics of the Veterans who had volunteered thus far. Over 70% of the volunteers were age 60 or over, with a mean age of 64.4 (+13.4) years. An impressive database available to help address many of the chronic issues affecting or older patients.

Currently, there are 15 scientific projects that have been approved to utilize this data for further study. Eight of the ongoing projects include:
• Gulf War Illness risk factors
• Posttraumatic stress disorder risk factors
• Functional disability in schizophrenia and bipolar illness
• Genetic vulnerability of sustained multi-substance use in MVP
• Genetics of cardio-metabolic diseases in the VA population
• Pharmacogenomics of risk factors and therapies outcomes of kidney disease
• Cardiovascular disease risk factors, prevalent cardiovascular disease and genetics in the MVP
• Genetic risk for age-related macular degeneration in diverse Veteran populations

As a dentist in the VA, I have had the privilege to serve America’s Veterans for over 25 years. As the local site investigator for the MVP program at the VA hospital in Fayetteville, AR, I am humbled to see Veterans again stepping up to volunteer their time and information to help improve the health of other Veterans and all Americans. Again, another reason to thank our Veterans.

The Million Veterans Program is accepting volunteers at both the VAs in Fayetteville and Little Rock, Arkansas. If you are a VA-enrolled Veteran, or know a VA-enrolled Veteran who would like to participate, please call the MVP Information Center toll-free at 866-441-6075 for information or to set an appointment at either VA.

References:

Gazianno JM, Concato J, Brophy M. et al. Million Veteran Program: A mega-biobank to study genetic influences on health and disease. J of Clin Epidomiol.2016;70:214-23.

by LaVona Traywick, PhD, University of Central Arkansas and Terry Griffin, PhD, Kansas State University

Society as a whole is aging and there are not enough health care providers in any health related field, including Occupational Therapy, to meet the current or expected needs of the senior adult population (Eldercare Workforce Alliance, 2011). According to the Administration for Community Living (2016), the senior adult population makes up 14.5% of the population in the United States. This number is expected to increase to 21.7% by 2040. Results from the National Ambulatory Medical Care Survey (Ashman, 2015) indicated that senior adults aged 65 and over visited medical offices more than twice the rate than the remaining groups (adults aged 18–64 and children under age 18 years). The current literature shows an increasing need for medical health professionals to work with the aging population.

A study was conducted with the first year, first semester students of the University of Central Arkansas Occupational Therapy graduating class of 2018 to determine their knowledge of aging prior to beginning studies. Once IRB approval was obtained, the modified version of Erdman Palmore’s “Facts on Aging Quiz” (Breytspraak & Badura, 2015) was deployed online via Qualtrics software. Using this convenience sample of 48 students, a 100% response rate was achieved consisting 43 females and five males, with a mean age of 24. Descriptive statistics showed that nine participants want to work in geriatrics, four want to work with adults, 16 want to work in pediatrics, five want to work with all populations, five want to work with special populations (such as spinal cord injuries), and nine were undecided.
The student’s knowledge of aging was poor, average of 33/50 (66%). A variety of analysis methods were applied to the data, but in summary the knowledge about senior adults was poor regardless of the students’ preferred population, year of birth, undergraduate degree, or duration of testing.

There was no significant difference in the test scores for the students who wanted to work in geriatrics as compared to any other population. It was hypothesized that students who desired to work with the senior adult population would have a greater knowledge of aging, but this was not the case. This fact is disconcerting because these students are not understanding the difference between normal aging and the disease process. The data results have brought a heightened awareness to the need to teach aging throughout the entire lifespan, including end-of-life issues.

Additionally, one-third of the entering OT class desires to work with solely pediatric populations. This is of concern due to the increasing need of therapists with the geriatric population. A previous study by Carmel, Cwikel and Galinsky (1992) showed that increasing knowledge alone as indicated by their scores on Palmore’s Facts on Aging Quiz was not enough to change attitudes about aging or the desire to work with the senior adult population. When knowledge of aging is not enough to encourage students to want to work with senior adults, it is even more important for course instructors to create opportunities for students to interact directly with senior adults. As there are limited amount of fieldwork options for students enrolled in therapy programs in general, opportunities for positive interactions with senior adults can be accomplished through Service Learning avenues.

In general, therapy programs in graduate schools are striving to teach as much material as possible in a condensed amount of time to stay competitive. Given no significant difference in test scores based on undergraduate degree, more emphasis needs to be placed in gerontological literacy in undergraduate programs across all disciplines. It could also be argued that prerequisites for incoming therapy students include a basic gerontology or lifespan development course.

In conclusion, the students’ knowledge of aging was less than desired and their intentions to work with senior adults was relatively low compared to other groups. It would be beneficial to the current students as well as the older patients if educators could incorporate more positive senior adult interaction opportunities along with teaching on aging. Future studies should look at other ways besides knowledge gain to change attitudes towards aging. Future studies should also look at the benefit of undergraduate education in gerontology for preparation of health care workers.

References:
1. Administration of Community Living. (2016). Administration on aging. Retrieved from http://www.aoa.acl.gov/Aging_Statistics/index.aspx

2. Ashman, J.; Hing, E.;Talwalkar, A. (2015) Variation in Physician Office Visit Rates by Patient Characteristics and State, 2012: NCHS Data Brief No. 212, September 2015. Retrieved fromhttp://www.cdc.gov/nchs/data/databriefs/db212.htm
3. Breytspraak, L. & Badura, L. (2015). Facts on aging quiz (revised; based on Palmore (1977;1981). Retrieved from http://info.umkc.edu/aging/quiz/.

4. Carmel, S; Cwikel, J.; Galinsky, D. (1992) Changes in Knowledge, Attitudes, and Work Preferences Following Coures I Gerontology among Medical, Nursing, and Social Work Students. Educational Gerontology, Vol. 18, Issue 4
Eldercare Workforce Alliance. (2011). Geriatrics workforce shortage: A looming crisis for our families. Retrieved from https://eldercareworkforce.org/research/issue-briefs/research:geriatrics-workforce-shortage-a-looming-crisis-for-our-families

by Shanon Brantley, MCD, CCC-SLP, Arkansas State University

Communication is a complex task. Communication between healthcare professionals and patients often increases this complexity due to reduced or poor health literacy skills of patients. Health literacy refers to “the degree to which individuals can obtain, process, and understand basic health information and services they need to make appropriate health decisions” (Healthy People 2010). Approximately one-third of adult Americans, including nearly 820,000 Arkansans (37 percent) are affected by low health literacy (Bakker, Koffel, Theis-Mahon, 2017 and Coleman, Peterson-Perry, & Bumsted, 2016). Even more staggering is that 70 percent of older adults (65 yrs. and older) in the United States have low health literacy skills (Kobayashi, Wardle, Wolfe & Wagner, 2015 & Chesser, Woods, Smothers, & Rogers, 2017). The impact of low health literacy is associated with increased hospitalizations, increase use of health services, increase in medication errors, reduced compliance with health care instructions, reduced use of preventive health behaviors, increased medical expenses, and an increase in mortality rates (Hadden, 2015, National Network of Libraries of Medicine, Toronto & Weatherford, 2015).

Low health literacy in older adults is often associated with age-related changes, such as a decline in cognitive ability, hearing or vision loss, and factors of socioeconomic status (Chesser et al., 2016). However, the consequences of low health literacy in older adults are particularly crucial due to a need for more frequent health information and services because of their increasingly complicated health issues (Kobayashi et al., 2015). Due to the large population of individuals with low health literacy and its devastating effects, it is essential that healthcare professionals have adequate awareness and understanding of health literacy issues (Atcherson, Zraick, & Hadden, 2013, Coleman, Hudson, & Maine, 2013) to assist patients/clients make good healthcare decisions for themselves (Greenwood, 2017).

Unfortunately, Coleman (2011) reports that healthcare professionals have less than adequate education in the principles of health literacy. To address this issue, educators of health professions should incorporate health literacy into their educational curriculum (Hadden, 2015). However, healthcare professionals who have already “completed their education will need accessible educational programs to ensure they have the skills to identify and educate patients with limited health literacy” (Jukkala, Deupree, & Graham, 2009, p. 301). The critical need for healthcare professionals to play a role in recognizing and addressing low health literacy of their patients/clients is also evident in a statement by the Joint Commission (https://www.jointcommission.org/about_us/history.aspx) which “requires that patients not only receive but also understand information that is relative to their medical condition and care” (DeMarco & Nystrom, 2010, p. 295).

Although the U.S. Department of Health and Human Services (2010) developed the U. S. National Action Plan to Improve Health Literacy, there are currently no widely accepted guidelines on health literacy education for healthcare professionals (Coleman, Hudson, & Maine, 2013). However, some topics of health literacy that healthcare professionals may focus improvements on include: spoken communication and written communication of healthcare professionals, self-management and empowerment of patients/client, and support systems for healthcare professionals and patients/clients. Each topic is important and should be addressed to improve patients’ and clients’ health literacy. Although there are no well-established guidelines for health literacy education for healthcare professionals, there are several health literacy training opportunities for healthcare providers available online. Two common and free health literacy education resources are provided below.

The Centers for Disease Control and Prevention offers a one-hour online continuing education course accredited by the Accreditation Council for Continuing Medical Education (ACCME) titled, Health Literacy for Public Health Professionals. This course is free of charge and can be found at the following link: https://www.train.org/cdctrain/course/1057675/.
The Agency for Healthcare Research and Quality (AHRQ) division of U.S. Department of Health & Human Services offers evidence-based health literacy guidance to adult and pediatric practices through the AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition. This toolkit offers 21 tools for improving health literacy, appendices with over 25 additional health literacy resources, and a quick start guide. This guide is available to download at the following link: https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html

Health literacy can significantly affect the health status of patients and has consequently become a national concern (Hester & Stevens-Ratchford, 2009). In order to provide the best care possible for our growing population, health professionals need an appropriate understanding of key concepts affecting their care such as health literacy. Additional health literacy education and training resources are provided below to assist in improving healthcare professional’s awareness and understanding of low health literacy:

● Center for Health Literacy at University of Arkansas for Medical Sciences. http://healthliteracy.uams.edu/
● U.S. Department of Health and Human Services, Office of Center for Disease Control and Prevention – National Action Plan to Improve Health Literacy. https://health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf
● Health Literacy Tool Shed – http://healthliteracy.bu.edu/
● U.S. National Library of Medicine – Health Literacy Information Resources. https://www.nlm.nih.gov/services/queries/health_literacy.html

References:
1. Agency for Healthcare Research and Quality. (2017). AHRQ health literacy universal precautions toolkit. Retrieved from https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.htmll
2. Atcherson, S., Zraick, R., Hadden, K. (2013). A need for health literacy curriculum: Knowledge of health literacy among US audiologists and speech-language pathologists in Arkansas Education for health, 26(2), p. 85-88.
3. Bakker, C. J., Koffel, J. B., & Theis-Mahon, N. R. (2017). Measuring health literacy of the upper midwest. Journal of the Medical Library Association, 105(1), 34-43.
4. Chesser, A. K., Keene Woods, N., Smothers, K., & Rogers, N. (2016). Health literacy and older adults. Gerontology and Geriatric Medicine, 5. Retrieved from https://doi.org/10.1177/2333721416630492
6. Coleman, C. (2011). Teaching health care professionals about health literacy: A review of the literature. Nursing Outlook, 59(2), 70–78. Retrieved from http://doi.org/10.1016/j.outlook.2010.12.004
7. Coleman, C. A., Hudson, S., & Maine, L. L. (2013). Health literacy practices and educational competencies for health professionals: A consensus study. Journal of Health Communication, 18(sup1), 82–102. Retrieved from http://doi.org/10.1080/10810730.2013.829538
8. Coleman, C. A., Peterson-Perry, S., & Bumsted, T. (2016). Long-term effects of a health literacy curriculum for medical students. Family Medicine, 48(1), 49–53.
9. DeMarco, J., & Nystrom, M. (2010). The importance of health literacy in patient education. Journal of Consumer Health on the Internet, 14(3), 294–301. Retrieved from http://doi.org/10.1080/15398285.2010.502021
10. Greenwood, M. (2017). Arkansas Blue Cross launches health literacy campaign. Arkansas Blue Cross and Blue Shield. Retrieved from https://www.bcbs.com/news/press-releases/arkansas-blue-cross-launches-health-literacy-campaign
11. Hadden, K. B. (2015). Health literacy training for health professions students. Patient Education and Counseling, 898(7), 918-920.
12. Jukkala, A., Deupree, J. P., & Graham, S. (2009). Knowledge of limited health literacy at an academic health center. Journal of Continuing Education in Nursing, 40(7), 298-302-304, 336. http://doi.org/10.3928/00220124-20090623-01
13. Kobayashi, L. C., Wardle, J., Wolf, M. S., & von Wagner, C. (2015). Cognitive function and health literacy decline in a cohort of aging English adults. Journal of General Internal Medicine, 30(7), 958–964. Retrieved from http://doi.org/10.1007/s11606-015-3206-9
14. Toronto, C. E., & Weatherford, B. (2015). Health literacy education in health professions schools: An integrative review. Journal of Nursing Education, 54(12), 669–676. Retrieved from http://doi.org/10.3928/01484834-20151110-02
15. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy. Washington, DC: Author.

by Ashley McPhee, PharmD Candidate and Lisa Hutchison, PharmD, MPH, University of Arkansas for Medical Sciences  (UAMS) College of Pharmacy

Herpes zoster, commonly known as shingles, is a viral infection that causes a painful rash. The rash usually occurs on one side from the middle of the back toward the chest, but it can occur in other areas as well. Shingles is the result of reactivation of the existing but undeveloped varicella zoster virus (VZV). This is the virus that causes chickenpox.1 Nearly all older adults have the VZV dormant in their nervous system because they were exposed to chicken pox as a child.2 Protection from reactivation is dependent on cell-mediated immunity. This type of immunity decreases as we age, if we have certain diseases, or medications. An example of disease and medications include Human immunodeficiency virus (HIV) and high dose steroid treatment. The average age for shingles to occur is about 64 years.1
Current 2017 Centers for Disease Control (CDC) guidelines recommend shingles vaccination. This vaccine (Zostavax©), is a live, attenuated vaccine. This means that the vaccine is living and produces disease, but it has been weakened so that it produces immunity but not illness.3 Currently, the CDC recommends that adults ages 60 years and older get one dose of the vaccine. They should get it even if they have had shingles before. Since the vaccine is live, patients who are pregnant, have severe immunodeficiency, or on systemic immunosuppressive therapy should not receive it. In addition, patients with malignant conditions such as those that affect bone marrow or patients with HIV and a CD4+ T-lymphocyte count less than 200 cells/µl should also not receive the vaccine.4 These individuals may not be able to mount a response to the virus to create antibodies.

However, a new shingles vaccine (Shingrix©) will soon be available. This vaccine is a non-live, recombinant subunit containing a piece of the Herpes zoster virus that will stimulate the immune system most efficiently. The new vaccine is given intramuscularly in two separate doses, and is indicated for patients 50 years and older. This vaccine was shown to produce the desired effect 90% of the time, across all age groups.2 The previous vaccine was only about 50% effective.3 t In October 2017 the CDC’s Advisory Committee on Immunization Practices  (ACIP) voted in favor of recommending this new vaccine for patients who are 50 years and older even if they have received Zostavax previously. They also determined that Shingrex© would be preferred over Zostavax© for these individuals.2  One concern is that the trials with this vaccine did not include patients who were immunocompromised.5 The vaccine is not live, so this should not necessarily be a contraindication for vaccination. However, ACIP does mention immunocompetence as part of their requirement for recommendation at this time.2 It is possible the recommendation will change based on post-marketing data after the general population has been receiving the vaccine. For now, it provides a great alternative vaccine for patients who were previously not eligible due to age, providing more effect.

References:
1. Dworkin, R. H., Johnson, R. W., Breuer, J., et al. Recommendations for the Management of Herpes Zoster. Clinical Infectious Diseases. 2007; 44(1):S1–S26.
2. Shingrix approved in the US for prevention of shingles in adults aged 50 and over. 2017. https://www.gsk.com/en-gb/media/press-releases/shingrix-approved-in-the-us-for-prevention-of-shingles-in-adults-aged-50-and-over/
3. Shingles (Zoster): Questions and Answers Information about the disease and vaccine. http://www.immunize.org/catg.d/p4221.pdf
4. Immunization Schedules. 2017. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
5. Highlights of Prescribing Information. 2017. https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Shingrix/pdf/SHINGRIX.PDF

 

by Robin McAtee, PhD, RN, FACHE, Director, Arkansas Geriatric Education Collaborative at UAMS

This is my first “From the Director’s desk” article from the Arkansas Geriatric Education Collaborative (AGEC), the Geriatric Workforce Enhancement Program for Arkansas. I am excited as we begin this year of grant activities and what this year holds for us. I have rather large shoes to fill with Dr. Chernoff handing the reigns of this grant to me in July of this year, but am very confident in that she has been an exceptional mentor to me for the past decade (or more) and is still by my side helping and guiding with sage advice! Thank you Dr. Chernoff for conceptualizing and implementing the AGEC initiatives for success and for your knowledge and leadership. The geriatric field and practitioners have benefited greatly from your contributions!

As we begin the final year of this three year grant, we are starting with well-established and multiple programs and partners. We are still working with our academic partners the University of Central Arkansas and Arkansas State University, the UAMS Centers on Aging (formally the AAI), the UAMS Regional Programs (formally the AHECs), AARP, CareLink, CHI McAuley Senior Center, Mainline Clinic in Lincoln County, the Arkansas Department of Aging and Adults Services, multiple long-term care facilities and many others! During the past 2 years, with the new mandate of the GWEP to include community members, we have dramatically expanded our partners and our aging network. I firmly believe that this expansion has strengthened our impact on care of older adults.

We have also strengthened our original mission to train healthcare professionals and students of the healthcare professions in the field and science of Geriatrics. We have also expanded this group to include first responders (police, firefighters, EMTs, paramedics) and direct care workers. In addition, we are constantly seeking new and innovative ways to reach and teach these audiences. We are reaching more and more as we have evolved from paper based and face-to-face trainings to more on-line and web-streaming activities. We are constantly searching for ways that health professionals want to learn, so if you have an idea, please let us know!

 

by Alicia S. Landry, PhD, RDN, LDN, SNS, Nina Roofe, PhD, RDN, LD, FAND, Andreina Guedez, MS, Dietetic Intern, Taylor Sherrill, MS, Dietetic Intern, University of Central Arkansas

Patients who have been diagnosed with dementia or Alzheimer’s disease (AD) often experience unintentional weight loss. Malnutrition and unintentional weight loss may lead to the loss of ability to do activities of daily living related to meal consumption such as using feeding utensils and chewing/swallowing.¹ Complications of malnourishment include greater infection rate, anemia, hypotension, and increased level of difficulty in healing wounds and pressure ulcers.

In patients who have a chronic illness, achieving or maintaining healthy body weight is critical. Healthy fats along with antioxidants, vitamins, and minerals are essential for optimal well-being and improved cognitive function. Unfortunately, patients diagnosed with AD or dementia often experience challenges related to meal consumption.¹ Patients may be unable to self-feed or have loss of taste and swallowing function which makes food unappealing whether at home, assisted living, or in skilled nursing facilities. General recommendations to increase meal consumption in patients with AD or dementia include minimizing distractions, providing feeding assistance, modifying consistencies of food, or providing appetite stimulants. After seeing first-hand the challenges related to mealtimes and the resultant effects of diminished nutrient consumption in patients with AD or dementia, two graduate level dietetic interns committed to researching nutrient consumption in these patients.

Music therapy, defined as the use of music and its elements (sound, rhythm, melody, and harmony) as an intervention to optimize quality of life and improve health and wellbeing, ^{2, 3} has been used as a form of non-pharmacological treatment for patients with AD and dementia. Benefits of music therapy include improvement in recalling personal memories, common knowledge such as colors and events, general cognitive function, and increasing ability to speak plainly.³ Music therapy may provide an approach to increasing meal consumption in patients diagnosed with AD or dementia; ⁴ therefore, the purpose of this study was to determine the impact of music on meal consumption in individuals diagnosed with AD and dementia.

Noon meal consumption was measured over the course of six days; three with music and three without. The highest average means, on day two (527.47 g) and day four (625.27 g), were both days in which music was played for the participants. However, after computing means for music and non-music days, there was no significant difference between average meal consumption with or without music. There were several limitations noted in the research but providing music therapy may still be a promising alternative therapy. In future research, evaluating the administration of music (i.e. headphones, ambient noise), consistency of music playing (i.e. every meal, every day for a week), and type of music (i.e. classical, swing, jazz) are important considerations.

A second graduate student noted that since the prevalence of dementia has increased, innovative prevention/treatment strategies are even more relevant to provide cost savings and alleviate caretaker burden. Use of antioxidant vitamins to improve cognitive function in older adults has been examined to a limited extent.⁵ Quantifying current consumption of these vitamins (i.e., Vitamin C, Vitamin E, and β-carotene) in dementia patients is needed so that caretakers know if supplementation to the normal diet is warranted.

The researcher collected menus from a long term care facility for three days and then collected percentage eaten for all items offered for breakfast, lunch, and dinner, as well as age and diagnosis. Patients in this study met recommendations for Vitamin C and β-carotene; however, Vitamin E was deficient, providing some evidence that antioxidant vitamin intake in meals was not optimum.

Megadoses of antioxidant vitamins have shown an improvement in cognitive function; ^{5, 6} thus, dietary intake would need supplementation in order to achieve therapeutic effects in these patients. In facilities such as the one where this study was conducted, implementing use of standardized recipes and menu items like carrots, plant-based oils, citrus fruits, bell peppers, and other antioxidant rich foods could be one way to increase intake of Vitamin C, Vitamin E, and β-carotene in patients with AD or dementia.

While encouraging students to conduct research in settings like this may seem intimidating to mentors and advisors, rewards to the students and relationship building with the community are benefits. Unintended (but positive) outcomes from this research included updating menus for residents, reevaluating methods of meal service, and conducting presentations for long term care directors on ways to incorporate music therapy in daily activities for patients with AD or dementia. The students have been able to gain professional skills, research experience, and valuable community contacts through the process.

Finally, recognizing the impact that meal consumption may have on the health and well-being of a patient diagnosed with AD or dementia is critical to improving health and well-being. The incorporation of music during mealtimes along with appropriate vitamin supplementation may improve nutrient intake in patients with AD and dementia and thus warrants further research.

 

References:

1. Gillette-Guyonnet S, Nourhashemi F, Andrieu S, De Glisezinski I., Ousset, PJ, Riviere D, Vellas B. Weight loss in Alzheimer Disease. Am J Clin Nutr 2000; 71: 637s-642s.
2. Li C, Liu C, Yang Y, Chou M, Chen C, Lai C. Adjunct effect of music therapy on cognition in Alzheimer’s Disease in Taiwan: A pilot study. Neuropsychiatr Dis Treat 2015; 291. doi:10.2147/ndt.s73928
3. Simmons-Stern NR, Budson AE, Ally BA. Music as a memory enhancer in patients with Alzheimer’s Disease. Neuropsychologia; 2010, 48(10): 3164-3167. doi:10.1016/j.neuropsychologia.2010.04.033.
4. Fukui H, Arai A, Toyoshima K. Efficacy of music therapy in treatment for the patients with Alzheimer’s Disease. Int J Alzheimers Dis; 2012: 2012:531646. doi:10.1155/2012/531646.
5. Li Y, Liu S, Man Y, Li N, Zhou Y. Effects of Vitamin E and C combined with β-carotene on cognitive function in the elderly. Experimental & Therapeutic Medicine 2015; 9(4): 1489-1493. doi: 3892/etm.2015.2274
6. Viveky N, Toffelmire L, Thorpe L, Billinsky J, Alcorn J, Hadjistavropoulos T, Whiting SJ. Use of vitamin and mineral supplement in long-term care home residents. Appl Physiol Nutr Metab 2012; 37(1): 100-105. doi: 1139/H11-141

 

 

 

J.E. Camp MSN, APRN, AGCNS-BC, Edited by Linda Tate, PhD, APRN, ACNS-BC

Arkansas State University

Is it warm where you are? The temperature outside may be hot enough to melt the pavement but it is still hot enough to have to rethink outside jogging.  If you are looking for indoor ways to work or if you like to exercise with your friends, Drums Alive® may be a great option. This is a music-based program which is grounded in science.

Drums Alive® takes place in a class room full of bright colored, large inflated rubber balls which sit neatly on top of small baskets. To begin class, everyone sits in a chair, in front of their “ball” drum.  All are given drumsticks and small, pool noodles.  The teacher, Mrs. Samantha Hollis, led the group while everyone else followed her directions.  Everyone got to “beat” the drum and even use a couple of dance steps, all to the cadence of the very upbeat and entertaining music.

Drums Alive® helped to work up a sweat and provided a good workout. Exercising in a class like this can raise the heart rate, increase breathing and provide added health benefits that can result from such exercise if done consistently.  The health benefits can include better heart health through stress management, blood fat and sugar reduction.  One study determined that drumming “is a worthy alternative to more traditional forms of exercise (De La Rue, Draper, Potter & Smith, 2013, p. 868).”  De La Rue et al (2013) pointed out that this was true for their study with rock/pop. Romeo, Coburn, Brown & Galphin (2016, p. 35) study results showed “heavy metal drumming” met certain guidelines for aerobic fitness. While participants in the studies were younger adults, according to the handout from Drums Alive©, participants can benefit “whether are young, old, healthy or ill (UAMS COANE, 2017).”

If you are looking for exercise for you or for your patients that is fun and evidence-based, then Drums Alive® may be for you.   These classes are held at many Centers on Aging across Arkansas:  For information contact:

Samantha Hollis, BSN, RN

Drums Alive® Trainer

870-207-7595

SHollis@UAMS.edu

 

References:

De La Rue, S. E., Draper, S. B., Potter, C. R., & Smith, M. S. (2013). Energy expenditure in rock/pop drumming.  International journal of sports medicine, 34(10), 868-872.  Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23559410

Drums Alive. (2017). Discover the drummer in you.  Retrieved from http://www.drums-     alive.com/

Romero, B., Coburn, J., Brown, L. & Galphin, A. (2016). Metabolic demands of heavy metal

drumming. International Journal of Kinesiology and Sports Science, 4(3), pp. 32-36.

Retrieved from  http://www.journals.aiac.org.au/index.php/IJKSS/article/view/2567

The University of Arkansas for Medical Sciences (UAMS) Center on Aging-Northeast

(COANE). (n.d.). Drums Alive®. Little Rock, AR: UAMS Donald W. Reynolds Institute

on Aging.

Google links to the song information:

https://www.google.com/#q=greased+lightning+1978+by+written+by

https://www.google.com/#q=sittin+on+the+dock+of+the+by+1984+by+written+by

https://www.google.com/#q=withc+doctor+by+19+by+written+by

https://www.google.com/#q=foot+loose+by+1984+by+written+by

 

by Ashley Bizzell, PharmD Candidate, & Lisa C Hutchison, PharmD, MPH 

University of Arkansas for Medical Sciences

Older adults with diabetes find it more difficult to control their blood glucose and reach target hemoglobin A1C values.  One reason they have more difficulty is the difference in pharmacokinetics that medications have in older adults, specifically changes in absorption, distribution, metabolism, and excretion. Antidiabetic medications in particular can cause serious consequences in older adults if not prescribed and used appropriately; following literature recommendations and guidelines can be helpful to ensure both efficacy and safety of these drugs in elderly patients.

One major concern for older adults is their risk for hypoglycemia with antidiabetic medications. This can lead to serious consequences including increased risk for falls, fractures, and central nervous system decline.  For these reasons, target hemoglobin A1C (Hgb A1C) goals are less stringent in older adults where clinicians should aim for a Hgb A1c of 7.5 to 8% as compared to less than 7% for younger adults.¹

After the target Hgb A1C has been determined, therapy must be selected.  If lifestyle changes are inadequate to reach target Hgb A1C, diabetes can be managed with different classes of medications.  However, one must recognize which medications to avoid in older adults, especially in those with renal insufficiency, cardiovascular disease, or polypharmacy. Sulfonylureas such as glipizide and glyburide should be used with caution in older adults as they pose an increased risk for hypoglycemia. The AGS Beers Criteria specifically recommends against the use of glyburide in older adults as the risk for hypoglycemia is too high.² Another class of concern are the insulins which can be very effective for controlling blood glucose, but can also be problematic  in the elderly patient. First, insulins are currently only available for subcutaneous injectable administration, which can be difficult for elderly patients with physical or cognitive impairment.  Long-acting insulins such as insulin glargine or insulin detemir are preferred forms of insulin for older adults as these insulins have a decreased risk for hypoglycemia and allow for easier regimens with fixed doses only once or twice a day in contrast to short-acting insulins such as insulin lispro or insulin aspart which can have more complex regimens.³  Although insulin can be used safely to manage blood glucose in older adults, the AGS Beers Criteria recommends against the use of insulin sliding scales for chronic management as this dosing regimen carries an increased risk of hypoglycemia.²

Metformin remains a first line agent for diabetes that is relatively safe and effective.  This is a preferred option in older adults unless renal insufficiency is present.  The most common adverse effects of metformin are diarrhea, nausea, and vomiting.  Recent studies alert clinicians to the risk of vitamin B₁₂ and folic acid deficiency, recommending testing before signs or symptoms of deficiency are evident.⁴ These micronutrients should be monitored annually along with hemoglobin and renal function.

Glucagon-like peptide-1 (GLP-1) agonists, including exenatide and liraglutide, have also been used safely and effectively in older adults, however there are no studies specifically in the older adult population. Dipeptidyl peptidase-4 (DPP-4) inhibitors including sitagliptin and saxagliptin are also considered relatively safe in older adults. Because their actions are glucose dependent, they have low risk for hypoglycemia with similar efficacy to other classes.³   However, GLP-1agonists and DPP-4 inhibitors require dosing adjustments in patients with renal insufficiency.

When treating older adults for diabetes, one must use an individualistic approach with added caution in this population due to multiple co-morbidities. Guides such as the AGS Beers Criteria can help guide decisions for the busy clinician.

 

 

References:

1. “AGS Beer’s Criteria for Potential Inappropriate Medication Use in Older Adults.” The American Geriatrics Society, 2015. Accessed 26 July 2017.

2. “American Diabetes Association Standards of Medical Care in Diabetes—2017.” The Journal of Clinical and Applied Research and Education, Diabetes Guidelines, vol. 40, no. 1, Jan. 2017, p. S50. Accessed 26 July 2017.

3. Kim, Kyung S., Soo K. Kim, Kyung M. Sung, Yong W. Cho, and Seok W. Park. “Management of Type 2 Diabetes Mellitus in Older Adults.” Diabetes and Metabolism Journal, 2012, pp. 336-44. Accessed 26 July 2017.

4. Kancherla, V, Elliott, JL, Patel BB, et al. “Long-term Metformin Therapy and Monitoring for Vitamin B12 Deficiency Among Older Veterans.”  J Am Geriatr Soc, 2017, 65:1061-6.

 

 

 

By Regina V. Gibson, PhD, MALS, RN, CHES

AGEC/GWEP Program Coordinator

Elder abuse is any form of mistreatment that results in harm or loss to an older person; it is an important public health problem. A 2017 study based on the best available evidence from 52 studies in 28 countries from diverse regions, including twelve low- and middle-income countries, estimated that, over the past year, 15.7% of people 60 years and older were subjected to some form of abuse. This is likely to be an underestimation, as only one in 24 cases of elder abuse is reported, in part because people are often afraid to report cases of abuse to family, friends, or to the authorities (Elder Abuse Fact Sheet, 2017)

As more people are living longer, the issue of elder abuse is now getting the attention of law enforcement, and medical and research communities. In the United States, the 2010 Census recorded the greatest number and proportion of people age 65 and older in all of decennial census history: 40.3 million, or 13% of the total population and this “Boomer Generation” effect will continue for decades (Research: Statistics/Data) .The aging population will require more care and protection than is currently available or possible (Elder Abuse, 2017) and will also be more susceptible to various forms of abuse (physical, financial, emotional, psychological, neglect, fraud, and scams) (Nina Plonka, 2013).

Old age can be described as both a family and a societal burden. Some older adults age gracefully and remain independent, living in their own homes well into their 90s. These older adults are able to manage their affairs and are not hindered by debilitating diseases or severe cognitive issues. However, many older adults often find themselves having to live with a relative when they are no longer able to take care of themselves due to decreasing mental capability as seen in those with dementia, or chronic debilitating diseases. Additionally, it may be necessary for some older adults to be placed in long term care facilities. Sadly there are also older adults without family support who live alone. These are the people who are more susceptible to loneliness, isolation, depression, and/or self-neglect, the latter of which is a form of abuse. Neglect, the failure of caregivers to fulfill their responsibility to provide needed care, may be an issue. Perpetrators may be paid attendants, family members, employees of long term care facilities or others.

When speaking of elder abuse, there are older adults who are particularly vulnerable because of memory impairments, communication abilities, and loss of judgment.

Many people with dementia are unable, frightened, or embarrassed to report abuse. As dementia progresses, so does the risk of all types of abuse. Abuse among this population is a hidden offence, perpetrated by people on whom they depend (Research: Statistics/Data).

Unless mandated reporters do what they are obligated to do, many cases of abuse go unreported.  There is a long list of mandated reporters listed in the 2010 Arkansas Code § 12-18-402 (2010 Arkansas Code). The bottom line, however, is that anyone who suspects that an older adult is being abused, has an obligation to report it.

It is understandable that caring for impaired family members, especially those with dementia is stressful, but these stresses should never be an excuse for elder abuse or neglect. Thankfully there are resources available for caregivers to work through the stress of caring for a loved one. Locally, in Arkansas, AARP offers an excellent comprehensive Caregiver Resource Guide. (Resources).  Other resources for caregivers include Adult Protective Services, Arkansas Area Agencies on Aging (AAA), Arkansas Department of Human Services Division of Aging and Adult Services, Long-Term Care Ombudsman, and the University of Arkansas for Medical Sciences (UAMS) Donald W. Reynolds Institute on Aging, and Alzheimer’s Arkansas, just to name a few (Arkansas Caregiver Resource Guide, 2017).

This article in no way completely describes all of the types of abuse that may be inflicted on older adults, but it is intended to raise awareness that elder abuse continues to be a problem that must be continually addressed.

 

 

References:
1. 2010 Arkansas Code. (n.d.). JUSTIA. Retrieved August 08, 2017, from http://law.justia.com/codes/arkansas/2010/title-12/subtitle-2/chapter-18/subchapter-4/12-18-402

2. Arkansas Caregiver Resource Guide. (2017, August 15). Little Rock, Arkansas, USa. Retrieved from http://www.aarp.org/content/dam/aarp/home-and-family/caregiving/2016/2016-03/ar-caregivers-resource-guide-nov-2015.pdf

3. Elder Abuse. (2017, March 30). National Institute of Justice. Washington, District of Columbia, USA. Retrieved August 03, 2017, from https://www.nij.gov/topics/crime/elder-abuse/Pages/welcome.aspx

4. Elder Abuse Fact Sheet. (2017, June). World Health Organization. Retrieved August 15, 2017, from http://who.int/mediacentre/factsheets/fs357/en/

5. Neglect and Self-Neglect. (2008). National Committee for the Prevention of Elder Abuse. White Plains, New York, USA. Retrieved August 03, 2017, from http://www.preventelderabuse.org/elderabuse/neglect.html

6. Nina Plonka, R. B. (2013, June 19). 6 Types of Elder Abuse in our Society. Caregiver Services. Miami, Florida, USA. Retrieved August 08, 2017, from http://www.csicaregiver.com/blog/6-types-of-elder-abuse-in-our-society/

7. Paley, A. (2011, December 04). Manging Medications for Elderly Patients. Pharmacy Times Newsletter. Cranbury, New Jersey, USA. Retrieved August 02, 2017, from http://www.pharmacytimes.com/news/managing-medications-for-elderly-patients

8. Research: Statistics/Data. (n.d.). National Center on Elder Abuse. Alhambra, California, USA. Retrieved August 03, 2017, from https://ncea.acl.gov/whatwedo/research/statistics.html#perpetrators

9. Research: Statistics/Data. (n.d.). National Center on Elder Abuse. Retrieved August 15, 2017, from https://ncea.acl.gov/whatwedo/research/statistics.html

10.Resources. (n.d.). Center of Excellence on Elder Abuse & Neglect. Irvine, CA, USA. Retrieved August 15, 2017, from http://www.centeronelderabuse.org/resources.asp

11. What is Elder Abuse? (n.d.). National Committee for the Prevention of Elder Abuse. White Plains, New York, USA. Retrieved August 02, 2017, from http://www.preventelderabuse.org/elderabuse/

By Ronni Chernoff, PhD, FAND, FASPEN, AGEC/GWEP Director

The Arkansas Geriatric Education Collaborative (AGEC), a Geriatric Workforce Enhancement Program, has entered the third year of a 3-year grant. As we look forward to a new grant cycle at the end of 2017, we are making some changes to position us for new funding for the future. There will be some inevitable changes. The AGEC Director (Dr. Ronni Chernoff) will be retiring in June, 2018. To assure a smooth transition she has handed the reign to the Associate Director (Dr. Robin McAtee) effective July 1, 2017. Dr. McAtee is a PhD-prepared nurse who has had a notable career as a nurse, hospital administrator, and educator. She has worked on the Arkansas Aging Initiative as Associate Director and is responsible for replicating the care-giver training grant at the rural centers on aging. She has worked on the AGEC activities since 2010, and has worked very closely with Dr. Chernoff during the past two years. There is no doubt she will do an outstanding job.

Our year two progress report was recently submitted and we are proud to announce that we exceeded all of our goals for the time frame. We are already working on ideas for a new grant cycle; in preparation for a new grant submission in early 2018 for 2018-2021 funding, we have developed a statewide needs assessment. We really want, need and appreciate your input and ideas. Please think about what information or experiences you would like to have to provide better care to our older adult patients. The needs assessment survey is available on our webpage so please respond to it! The more input we have, the more valuable our future events will be for you. In the meantime, feel free to e-mail your suggestions for topics and programs to agec@uams.edu or post a note on our website page.

Our junior faculty fellows, Dr. Lisa VanHoose (physical therapy faculty at UCA) and Dr. Upendra Kar (research faculty in the UAMS College of Pharmacy) both recently attended the International Association for Geriatrics and Gerontology meeting in San Francisco. We anticipate great things from both of them and are delighted to be able to offer them this opportunity.

We continue to offer video teleconferences four times/year; to sponsor Alzheimer’s disease-focused geriatric grand rounds twice yearly; offer Arkansas Geriatric Education Mentors and Scholars (ARGEMS) for health care professionals; host the Summer Institute for faculty members who want an update on geriatric content; sponsor training for first responders, community members, and others. The next AGEC event will be a video teleconference on Elder Justice: Recognizing and Responding to Elder Abuse, part of our Patient Safety series, that will be broadcast on October 11. For those interested in education and programs in geriatrics, more information can be obtained at our website, www.agec.org,

As we plan ahead, we would love to hear from you about what you would like to know more about. Please take the time to answer the questions on line or using the mailed survey if you were randomly selected.

We all wish you a very happy and successful new academic year and look forward to your participation in one or more of our programs. Hope to see you soon!