Upendra K Kar¹, PhD, Jonathan A Laryea², MD, William C Mustain², MD, Jason Scott Mizell², MD, Dr. Martin Hauer-Jensen¹  , and Dr. Daohong Zhou¹  Division of Radiation Health, Department of Pharmaceutical Sciences, ²Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR

Ageing leads to a progressive deterioration of structure and function of all organs over the time. The progressive accumulation of senescent cells and impairment of stem cells i.e. decline in their ability to maintain homoeostasis is well known in aging. Intestinal homeostasis is regulated by proliferation and differentiation of cycling intestinal stem cells (ISCs). ISCs are nested within a niche consisting of a wide variety of cell types including immune cells, mesenchymal fibroblasts & myofibroblasts, and endothelial cells. Niche-generated signals work in a concert with intrinsic stem cell properties to regulate the stem cell behavior. Senescence of endothelial cells leading to impairment in vascular functionality and neo-angiogenic capability is well documented. In this study we investigated the biological changes in endothelial cells induced to senescence by irradiation. Human Umbilical Vein Endothelial Cells (HUVEC) were exposed to various doses of irradiation i.e. 2Gy to 10Gy. The induction of senescence was noted by BrdU incorporation and senescence-associated β galactosidase” (SA-β-gal) staining.

Induction of senescence led to up regulation of Reactive Oxygen Species (ROS) level which was investigated by MitoSOX Red, peroxidized lipid sensor BODIPY and superoxide anion radicals (DHE MFI). Interestingly these senescent cells also displayed increase in DNA damage which was revealed by γH2AX foci assay. Senescence lead to induction of inflammation, impairment in tissue regenerative processes and immune-mediated clearance. As these features are the hallmark of aging research on senesce is on forefront, because understanding senescence will open the doors to understand the complexity of aging.

This work was supported by Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number “P20 GM109005” and Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1QHP28723.

References:
1. Methods Mol Biol. 2017;1612:97-105. doi: 10.1007/978-1-4939-7021-6_7.
2. Nat Med. 2016 Jan;22(1):78-83. doi: 10.1038/nm.4010. Epub 2015

by Stacy E Harris DNP, APRN, ANP-BC, University of Central Arkansas (UCA)

The University of Central Arkansas hosted the grand opening of the Nabholz Center for Healthcare Simulation (NCHS) on December 9, 2016. The NCHS is located on the second floor of the Doyne Health Science Center (DHSC) and includes 1,341 square feet of newly created simulation area and 4,132 square feet of remodeled clinical laboratory space. The new simulation area consists of two rooms designed to replicate a hospital setting. One patient room has the ability to be transformed into a rehabilitation room with bathroom and home-like features. Each patient room is connected to a control room. The control room is where instructors use audio and video technology to control the high-fidelity patient manikins and run patient care scenarios. Besides storage areas, the new NCHS has two debriefing rooms where students watch their peers perform a patient-care scenario by observing the case via a smart TV. After the scenarios, the students and instructors discuss and debrief the scenario. The NCHS uses uniquely designed clinical experiences to bring students into real-world environments through simulation.

Currently, the senior nursing students are using an evolving simulation case: patient admitted to an emergency room setting with stable chest pain that worsens eventually leading to an Intensive Care Unit admission with a diagnosis of myocardial infarction. The patient scenario deteriorates requiring Advance Cardiac Life Support (ACLS). This type of simulation helps develop competency in high stakes skills in a low pressure environment. One of the Interprofessional simulations involves occupational and physical therapy students assessing patient stability. The simulated case has the patient’s vital signs becoming gradually unstable. The goal of the scenario is to improve communication between the different healthcare disciplines to better meet patient needs.

The nurse practitioner students collaborated with senior exercise science students in a splinting workshop. In the workshop, exercise science instructors presented information about casting, splinting, and musculoskeletal injuries followed by hands-on splinting and casting simulation in the NCHS. Other simulations are based on specific disease states. The occupational therapy instructors have focused on competency testing over assessment of autonomic dysreflexia and seizures disorders.

The NCHS is providing a wide range of activities for students in the College of Health and Behavioral Sciences. Opportunities vary from assessing patients, designing and implementing interprofessional interventions and evaluating patient outcomes in various clinical situations across the life span. Students use clinical reasoning to make clinical judgments and key decisions that impact the patient’s care. Students are also given the opportunity to learn about and perform specific skills (such as medication administration or sterile procedures). The emphasis of the NCHS is providing students with opportunities to develop competency in skills and situations before entering real-world healthcare environments. The NCHS provides learning opportunities for students in nursing, physical therapy, occupational therapy, family and consumer sciences, communication sciences and disorders, health sciences, and psychology. The simulation program is being developed by representatives from all departments within the College of Health and Behavioral Sciences.

by Andi Daniel, PharmD Candidate 2017 and Lisa C. Hutchison, PharmD, MPH

At some point during the disease progression, 20 to 40% of patients with Parkinson’s disease (PD) experience hallucinations or delusions, referred to as Parkinson Disease Psychosis (PDP). This commonly occurs about 10 years after PD onset.1, 2 Hallucinations are thought to be a result of overstimulation of serotonin receptors, specifically 5-HT2A, or potentiated by overstimulation of dopamine D2 receptors.4 Other potential causes should be addressed in a patient, such as a dementia-related, medication-induced, or delirium-induced hallucinations. But if these causes are ruled-out, therapy directed at PDP can be considered. Historically, PDP has been managed with the atypical antipsychotics, clozapine or quetiapine, which have been considered probably effective and possibly effective, respectively.3 In April 2016, the FDA approved a new agent, pimavanserin (Nuplazid), specifically for PDP. While all three drugs are considered antipsychotics, their targeted receptor activity is different, which explains differences in effectiveness and adverse effects. Clozapine and quetiapine exhibit antagonistic activity on histamine-1 receptors, which causes somnolence, and alpha-1 receptors, which causes orthostatic hypotension. Pimavanserin does not affect either of these receptors. All three agents affect the serotonin receptor 5-HT2A although pimavanserin is a reverse agonist, and it will depress activity of the receptor as well as block its activation (see table).

	Clozapine	Quetiapine	Pimavanserin
Dopamine-2 receptor	Antagonist	Antagonist
Histamine-1 receptor	Antagonist	Antagonist
5-HT1A  receptor		Antagonist
5-HT 2A receptor	Antagonist	Antagonist	Inverse agonist/ antagonist
Alpha-1 receptor	Antagonist	Antagonist
Alpha-2 receptor		Antagonist
Adverse Effects	Granulocytopenia Somnolence Tachycardia Orthostatic hypotension	Somnolence Orthostatic hypotension Weight gain QTc prolongation	Peripheral edema Confusion Nausea, constipation

Among the atypical antipsychotics, clozapine was effective in decreasing the hallucinations of PDP, but it did not show much benefit for delusions. Of note, clozapine has five black box warnings (e.g., severe neutropenia, CNS depression, seizures/ seizure disorder, cardiomyopathy, bone marrow suppression). Because of the potential for granulocytopenia, patients are required to get weekly blood laboratory which makes therapy difficult.

Quetiapine, is considered to be a first line agent for PDP, primarily due to reduced serious adverse effects compared to clozapine, and lack of weekly blood monitoring requirements.5 It is described as “possibly effective” because of eight open label trials where 80% of treated patients showed improvement. Also, quetiapine was compared to clozapine in another study, and showed similar efficacy in reducing psychosis.6 However, in five placebo-controlled trials, only one showed improvement but patients with delusions were excluded from that study, limiting its generalizability.

Pimavanserin significantly decreased psychosis in patients with PDP when compared to placebo in a 6-week study. It was also beneficial in reducing delusions associated with PDP compared to placebo.8, 9 Furthermore, pimavanserin has a favorable adverse effect profile. The most common adverse effects are peripheral edema (7%), confusion (6%), and nausea (7%). Since the medication is still new to the market, it is important to monitor and assess its long term safety. In addition, the Average Wholesale Price is listed as $2340 per month, which limits affordability. Pimavanserin is supplied in 17 mg tablets with a recommended dose of 34 mg once daily except in patients on certain interacting drugs where the lower dose of 17 mg should be used. Although it is new to the market, pimavanserin has short term data confirming benefit in the management of PDP. Support for clozapine and quetiapine in PDP is not as strong and both have significant adverse effects. Given this evidence, pimavanserin may well become the drug of choice for treatment of PDP.

References:

1. FeÂnelon, G., et al. “Hallucinations in Parkinson’s disease. Prevalence, phenomenology and risk factors. 2000.” Brain 123: 733-45.
2. Lee, Angela H., and Daniel Weintraub. “Psychosis in Parkinson’s disease without dementia: Common and comorbid with other non‐motor symptoms.” Movement Disorders 27.7 (2012): 858-863.
3. Miyasaki, J. M., et al. “Practice Parameter: Evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology.” Neurology 66.7 (2006): 996-1002.
4. Kumar, Santosh, Subhash Soren, and Suprakash Chaudhury. “Hallucinations: Etiology and clinical implications.” Industrial psychiatry journal 18.2 (2009): 119.
5. Tarsy, D. “Management of comorbid problems associated with Parkinson disease.” UpToDate (2015).
6. Shotbolt, Paul, Mike Samuel, and Anthony David. “Quetiapine in the treatment of psychosis in Parkinson’s disease.” Therapeutic advances in neurological disorders 3.6 (2010): 339-350.
7. Fernandez, Hubert H., et al. “Quetiapine improves visual hallucinations in Parkinson disease but not through normalization of sleep architecture: results from a double-blind clinical-polysomnography study.” International Journal of Neuroscience119.12 (2009): 2196-2205.
8. Cummings, Jeffrey, et al. “Pimavanserin for patients with Parkinson’s disease psychosis: a randomised, placebo-controlled phase 3 trial.” The Lancet 383.9916 (2014): 533-540.
9. Yasue, Ichiro, et al. “Serotonin 2A Receptor Inverse Agonist as a Treatment for Parkinson’s Disease Psychosis: A Systematic Review and Meta-analysis of Serotonin 2A Receptor Negative Modulators.” Journal of Alzheimer’s Disease 50.3 (2016): 733-740.

by Justin Martin, OTS Doctorate Program, and M. Tracy Morrison OTD R/L, Chair, Occupational Therapy,  Arkansas State University (ASU)

Personhood is a term used to describe the actions taken by self or others for the purposes of promoting personal autonomy and quality of a life (Little, 2014). Societal conversations about personhood can be found alongside those about spirituality and human rights (Martin & Sabbagh, 2011). While US healthcare policies unanimously promote personhood concepts, the process of preserving personhood during times of personal health decline and increased dependency levels remains relatively unexplored among aging populations.

Mealtime choice is enjoyed as a ritual of personhood during the first year of postnatal development (Birch, Savage, & Ventura, 2007). Infant caregivers are encouraged to facilitate infant engagement levels in the feeding process through varied methods that include increased feeding times, environmental modifications and additional food choices. By mid-childhood, mealtime rituals become expressions of personhood and incorporated into interpersonal social dynamics. By adulthood, mealtime rituals are carried across generations between the parent and offspring. And upon late adulthood, the mealtime ritual may be one of the only remaining expressions of personhood that generalizes into institutionalized care settings (Kiser, Medoff, Black, Nurse, & Fiese, 2010).

There is a paucity of information about the influence of mealtime rituals on the quality of life and the well-being of individuals with Alzheimer’s disease (AD).
Individuals with AD commonly experience negative behaviors including feeding aversions, apathy, anxiety, disinhibition, fear and depression (Burns-Cox, 1980).

These behaviors dramatically increase the level of caregiver burden and increased risk of negative health incidences. Evidence suggests personhood rituals, for example meditation and religious ceremonies, facilitate positive behaviors and neuroprotective changes among individuals with AD (Chow, et al., 2009). Person-centered contexts remain the most appropriate therapeutic approaches for residents with AD because they stimulate positive emotional memories that facilitate cooperative actions that suggest positive developments despite the degenerative nature of AD (Chow, et al., 2009).

Occupational therapists prioritize “how” or “whether” the person served participates in meaningful activities (i.e. occupations). A fundamental principle within this profession is that the engagement in personhood activities promotes well-being and that well-being is an intrinsic state that promotes the quality of life regardless of health status (Gray, 1998). Occupational therapists (OTs) promote the person’s engagement levels through interventions that incorporate sensory, cognitive, physical and environmental factors. Most commonly, OTs focus interventional efforts around the rituals, habits and routines of the person with AD and they measure outcomes the promote well-being and ability levels pre- and post-intervention (Padilla, 2011).

Occupational therapists utilize numerous therapeutic methods theoretically supported in the cognitive neurosciences (Arbesman & Lieberman, 2011). The use of visual priming and reminiscence to promote engagement and well-being in adults with AD has been proven effective and worthwhile (Burns, Jacoby, & Levy, 1990).

The premise that negative behaviors result in feeding aversions during mealtime also suggests that increased engagement in mealtime activities may promote both feeding and well-being. The feasibility of a program developed to promote personhood during the mealtime ritual was recently explored among a cohort of individuals with AD living in memory care facilities. When residents were provided with contextual supports associated with mealtime options (versus only verbal instructions), their engagement levels in mealtime activities improved. Additionally, caregivers reported reduced burden levels associated with mealtime duties. These observations suggest that mealtime may be the ideal context for therapeutic activities and that well-being may be promoted through personalized mealtime rituals.

Institutional care does not replace the home environment, but personal rituals generalize beyond home environments because they are acts of personhood. And in likeness to the ritual of prayer, the ritual of mealtime activities may be valuable to the well-being of the individual with AD (Greenwood, et al., 2005). Therapeutic programs that reduce barriers to promote engagement in personhood rituals are important considerations during end of life care. The personalized mealtime rituals may be the last personhood ritual available in the adult with advanced AD and therefore may serve as an important therapeutic tool for healthcare professionals working in memory care facilities.

References:

1. Martin, G.A., & Sabbagh, M.N., (2011). Palliative care for advanced Alzheimer’s and dementia: guidelines and standards for evidenced-based care. New York: Springer.
2. Little, M. (2014). Theorising personhood: for better or for worse. European Journal for Person Centered Healthcare, 2(1), 57.doi:10.5750/ejpch.v2il.696.
3. Padilla, R. (2011). Effectiveness of occupational therapy services for people with Alzheimer’s disease and related dementias. The American Journal of Occupational Therapy, 65(5), 487-489.
4. Stages of Alzheimer’s. (2017). Retrieved from alz.org: Alzheimer’s Association: http://www.alz.org/alzheimers_disease_stages_og_alzhemers.asp.

by Ronni Chernoff, Ph.D., FAND, FASPEN, Director, AGEC & Professor, Department of Geriatrics

We are coming to the end of the second year of the Arkansas Geriatric Education Collaborative, a Geriatric Workforce Enhancement Program. It is an appropriate time to look back on our accomplishments during the second year and recap some of the continuing and new achievements. We continue to be proud of what we contributed to the education and training of health professionals, faculty and students who are looking forward to careers in one of the many health care disciplines in Arkansas. We are pleased that there is great interest in the new, updated AR-GEMS online self-study program and our successful summer Institute for faculty, which is scheduled for the week of May 15, 2017. For more information on either of these two programs, email Regina V. Gibson, MALS, RN, CHES at rvgibson@uams.edu. We continue to offer video teleconferences four times/year and have dates but not topics for the Fall series (Oct. 11 and Dec. 13, from 11 a.m. to 1 p.m.). Our newest option, programs available through web-streaming (Blackboard Collaborative), is becoming more popular; this means you can stay at your computer and receive the program in real time and ask questions through the chat option. We are delighted to offer you the opportunity of accessing AGEC programming more conveniently. This month we are launching a needs assessment to gain insight into what you would like to learn more about. If you receive it as paper or online, please take the few minutes needed to fill it out and return it to us. Your input is very valuable to us and we look forward to hearing from you. Feel free to email your suggestions for topics and programs to agec@uams.edu or post a note on our website page.

Look for “Save the Date” cards and announcements for the geriatrics and long-term care 18th annual conference Sept. 21-23, 2017. A Geriatric Grand Rounds on exercise and aging issues in dementia patients is scheduled for May 24 and we will be web-streaming it, video teleconferencing by interactive television, and be live in the Jo Ellen Ford Auditorium at the Donald W. Reynolds Institute on Aging, UAMS.

Along with our first responder organizations to help our law enforcement, firefighters, and emergency medical technicians (EMTs) recognize and manage people with dementia, we are developing additional partners to provide training and support materials to make them better able to help these older adults in need. We continue to collaborate with our partners to provide useful and relevant information on aging to seniors who attend AARP programs and local Arkansas Aging Initiative sites for lifestyle and educational workshops.

The new www.agec.org website has been launched and offers easier navigation and more features. Please visit the website and read all about our new features. There are two portals, one for health professionals and one for community members who are not health professionals.

Have a great spring and enjoy the beautiful weather!

by Lisa VanHoose, Ph.D., PT, MPH, Assistant Professor, Physical Therapy
University of Central Arkansas (UCA), AGEC Fellow

What is the most common cancer treatment-related side effect in senior cancer survivors?
You probably guessed it, if you are a cancer survivor or the loved one of a cancer survivor. Fatigue is the most common cancer treatment related side effect in senior cancer survivors1, 2. Senior is defined as 65 years of age or older. Cancer increases the risk and severity of fatigue in older persons2. Most senior cancer survivors report cancer related fatigue (CRF) at some time during cancer treatment1, 2. The National Comprehensive Cancer Network defines CRF as “a distressing, persistent subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual function”3. In layman’s terms, CRF the condition affects one’s ability to perform routine tasks and does not respond to typical strategies, such as rest, change in diet, or lowering stress. The disruptive symptoms can begin with the start of treatment and may continue years after treatment has ended4.5.

How is cancer-related fatigue (CRF) treated?
The first step in CRF treatment focuses on reducing any personal factors that may be contributing to one’s stress. Cancer survivors may benefit from counseling regarding issues that may contribute to stress such as finances, nutrition, and behavior management including coping. Strategies such as mind-body awareness, relaxation, or sleep therapy may also be beneficial in minimizing stress. Next, the cancer survivor will need to work with his/her medical and rehabilitation team (s) to identify potential medical causes for CRF. Nutritional deficits, anemia, pain, and other conditions and diseases can contribute to the severity of fatigue. A management plan will be created, put in place, and evaluated for its impact. Fatigue is a unique symptom. The medical/rehabilitation team and the patient will work together to identify strategies that will work best for the patient. Medications will be assessed for adverse drug effects and interactions that may be responsible for CRF. Medications will include prescribed and over-the counter medications, including herbal supplements.

Physical activity has been strongly encouraged to address CRF. A customized exercise plan from a community, medical, or rehabilitative care provider can minimize the risk of injury and address the special considerations of the older cancer survivor. An exercise plan will include both endurance activities (walking, jogging, or swimming) and light weight training. Yoga has been recommended to address CRF, pain, and other side effects of cancer3. Other recommendations include scheduling activities during times when you have the most energy, limiting naps to less than one hour, focusing on one task at a time, and delegating or eliminating nonessential tasks. Cancer related fatigue (CRF) is a common side effect of cancer treatment, but it can be effectively treated for improved function and quality of life.

Disclaimer: The comments/opinions are those of the author and not necessarily those of the AGEC. All content found in this article is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this newsletter. Dr. VanHoose may be reached at lvanhoose@uams.edu if you have questions about the content.

by Gretchen Gibson, DDS, MPH, Veterans Health Administration Central Office (VHACO)

This newsletter segment is not necessarily written for your patients, but more for your “future patients” and even you and your family. Retirement planning is a process that is supposed to start long before they day you leave your job for the last time. Planning is the key word.

When this is discussed, it evolves around making sure there are adequate funds that any retirement benefits are in place that any wills or trusts are in place; that debt is taken care of as much as possible; and that you have adequate resources to take you through retirement years.

What is often not thought about are planning for issues of health, and in this case, issues regarding oral health. The average age for retirement is now around 63. Most everyone knows that dental benefits are often acquired through insurance programs through employment. When retirement begins, these benefits end. Many people do not know that Medicare does not cover dental benefits, except in very extreme cases. There has been some suggestion that dental benefits be added to Medicare Part B, but this is by no means a given and most likely a long time off, if at all. There is the possibility of private coverage in retirement, but this needs to be well thought out, to make sure the benefits will meet your needs. One website, http://www.mouthhealthy.org/en/dental-care-concerns/paying-for-dental-care, takes you through some questions and answers regarding dental care and what you may require in the way of dental benefits. However, just like planning for fiscal retirement, it is in your best interest to plan for dental health in retirement as well. Putting off extensive work till after retirement may not be wise if you have not planned for the full cost in your budget.

A great amount of research has shown that a healthy mouth is beneficial for a healthy quality of life. Eating, smiling and verbal interaction are key parts to a happy retirement and you need to do this pain free and comfortably. A frank discussion with your dentist is appropriate as you think about your date of retirement to discuss the change in your dental benefits and how best to approach this. This also brings up an important point regarding continuing dental care after retirement. Many people will put off preventive or maintenance dental care due to the cost. However, it is wise to consider the cost of repair versus the cost of maintenance.

As we age, there are factors that can increase the risk of dental disease, such as increased risk for dry mouth and issues associated with other systemic diseases. Discuss with your dentist what should be the most appropriate length of time between recall or preventive visits, based on your individual situation. Your dentist will take into account how well you can keep your teeth clean at home, how much dental treatment you currently have and how easy it is for you to maintain that.  As with any disease process, the earlier that a problem is caught, the easier it is to deal with.  Fluoride use has proven to reduce cavities in adults as well as children. Talk to your dentist and hygienist about the best fluoride regime for you, based on your risk for future cavities. If the dentist and hygienist are regularly evaluating the health of your gums, early intervention regarding periodontal or gum disease can help you keep your natural teeth a lot longer.

Finally, the risk of oral cancer does increase with increasing age, and having someone check your mouth at least yearly, especially if you drink moderate to heavy and/or use tobacco, is recommended. Dental care provided at your retirement will most likely not be the last dental treatment you will need, but making sure your mouth is in a healthy state at that time and then taking the steps to maintain that oral health for as long as you can will be another way of helping to assure a happy retirement.

by Besdine R et al.; American Geriatrics Society Task Force on the Future of Geriatric Medicine
submitted by Regina V. Gibson, MALS, RN, CHES, Arkansas Geriatric Education Collaborative

In response to the needs and demands of an aging population, the field of geriatric medicine has grown rapidly during the past three decades. The discipline has defined its core values as well as the knowledge base and clinical skills needed to improve the health, functioning, and well-being of older persons and to provide appropriate palliative care. Geriatric medicine has developed new models of care, advanced the treatment of common geriatric conditions, and advocated for the health and health care of older persons. Nevertheless, at the beginning of the 21st century, the health care of older persons is at a crossroads. Despite the substantial progress that geriatric medicine has made, much more remains to be done to meet the healthcare needs of our aging population. The clinical, educational, and research approaches of the 20th century are unable to keep pace and require major revisions. Maintaining the status quo will mean falling further and further behind. The healthcare delivery and financing systems need fundamental redesign to improve quality and eliminate waste. The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has identified five goals aimed at optimizing the health of older persons:

1. ensure that every older person receives high-quality, patient-centered health care
2. expand the geriatrics knowledge base
3. increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons
4. recruit physicians and other healthcare professionals into careers in geriatric medicine
5. unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors.

Geriatric medicine cannot accomplish these goals alone. Accordingly, the Task Force has articulated a set of recommendations primarily aimed at the government, organizations, agencies, foundations, and other partners whose collaboration will be essential in accomplishing these goals. The vision described in this document and the accompanying recommendations are only the broad outline of an agenda for the future. Geriatric medicine, through its professional organizations and its partners, will need to mobilize resources to identify and implement the specific steps that will make the vision a reality. Doing so will require broad participation, consensus building, creativity, and perseverance. The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician workforce is a recipe for expensive, fragmented health care that does not meet the needs of our older population.

By virtue of their unique skills and advocacy for the health of older persons, geriatricians can be key leaders of change to achieve the goals of geriatric medicine and optimize the health of our aging population. Nevertheless, the goals of geriatric medicine will be accomplished only if geriatricians and their partners work in a system that is designed to provide high-quality, efficient care and recognizes the value of geriatrics.

 

Reference:

J Am Geriatr Soc. 2005 Jun;53(6 Suppl):S245-56.

https://www.ncbi.nlm.nih.gov/pubmed/15963180

U.S. National Library of Medicine National Institutes of Health

 

by Amy Shollenbarger, Ph.D., CCC-SLP

Communication is vital to humanity. Most individuals acquire language with relative ease, yet as we age, certain changes in communication may occur as a part of the normal aging process. Normal changes that occur in our ability to communicate as we age may include language, speech, swallowing, or hearing. Understanding normal changes due to aging is important so we know when further examination by a speech-language pathologist or audiologist, due to abnormal changes, may be needed (Busacco, 1999).

Hearing is most negatively affected as we age, with approximately 35% of individuals over the age of 65 having some type of hearing loss (Bance, 2007). Articulation, or the way we produce speech sounds, remains adequate as we age (Hooper & Cralidis, 2009) although significant tooth loss may impact articulation skills (Busacco, 1999). Changes in voice skills may include more tremor, breathiness, roughness, or pitch changes, but intelligibility is not usually affected (Ryu et al., 2015). Receptive language ability may decrease due to slower auditory processing, but expressive language is usually not affected other than minor word finding difficulties (Yorkston, Bourgeois, & Baylor, 2010). Swallowing may require greater effort or time as one ages, which may lead to weight loss (Busacco, 1999).

Communication skills stay relatively intact and improve throughout childhood and the adult years. Let’s examine normal aging and communication from the 20’s and beyond (adapted from Loudermill, Lowry, & McCullough, 2010). Long term memory, complex reasoning, and creativity are greatest in your 20’s. In the 30’s minimal changes begin to occur, but performance on functional, everyday tasks is not affected. As individuals move into their 40’s, slight word finding difficulties may occur. More effort is required to do things like remember phone numbers, do mental calculations, or play challenging card games. Reduced short term memory begins to be noticeable. In your 50’s, processing speed slows down, and it takes longer to learn new things. Problems with visuospatial skills occur. For example, you may occasionally forget where you parked or have more difficulty copying a three-dimensional design. It is more difficult to multitask and harder to maintain attention and remember details. For example, you may remember fewer details of a novel or movie than a younger person would. Placing an event in time and place becomes more difficult. You may remember the event but not exactly when or where it occurred. Word finding difficulties occur, but do not interfere with everyday tasks. In your 60’s, decreased attention, memory, and slower processing of information occurs. It becomes more difficult to tune out distractions. You may have difficulty remembering names or retrieving well-known words, which can be frustrating at times. However, performance on daily tasks should not be negatively affected. In your 70’s, cognitive abilities vary greatly due to various factors such as education, nutrition, and genetics. Those with other health problems – hypertension, diabetes, and heavy alcohol use – show a decline in memory and general cognitive ability. However, individuals in their 70’s and beyond who are aging normally and in good health, should maintain adequate communication skills.

There are several things individuals can do to preserve communication and cognitive abilities as discussed by Calvagna (2016). Continue learning – pick up a new hobby, try a new recipe, learn a new language. Stay physically active by exercising. Keep your mind active by reading, doing crossword puzzles, and engaging in crafts. Eat healthily and avoid tobacco. Engage in social interaction and communicate with family and friends regularly. Volunteer for a cause or a charity, join clubs and/or participate in religious activities. All of these things will keep your brain healthy and active, and contribute to good communication skills as one ages.

References
Bance, M. (2007). Hearing and aging. Canadian Medical Association Journal, 176(7), 925-927, doi: 10.1503/cmaj.070007

Busacco, D. (1999). Normal communication changes in older adults. Let’s Talk, 72, 49-50.

Calvagna, M. (2016). Ten tips for healthy aging. Health Library: Evidence-Based Information.

Hooper, C. R., & Cralidis, A. (2009). Normal changes in the speech of older adults. You’ve still got what it takes, it just takes a little longer! Perspectives on Gerontology, 14(2), 47-56.

Loudermill, C., Lowry, M., & McCullough, K.C. (2010). The aging brain: What’s normal and what’s not. Presentation at the Arkansas Speech-Language-Hearing Association annual convention, Little Rock, AR.

Ryu, C. H., Han, S., Lee, M., Kim, S. Y., Nam, S. Y., Roh, J., & … Choi, S. (2015). Voice changes in elderly adults: Prevalence and the effect of social, behavioral, and health status on voice quality. Journal of The American Geriatrics Society, 63(8), 1608-1614. doi:10.1111/jgs.13559

Yorkston, K. M., Bourgeois, M. S. & Baylor, C. R. (2010). Communication and aging. Physical Medicine and Rehabilitation Clinics of North America, 21(2), 309-319.

by Towino Paramby  CScD, CCC-SLP, Veronica Rowe Ph.D., OTR/L, Nina Roofe Ph.D., RDN, LDN, and SLP Graduate Students Kirsten Kubinski, and Laura Jones

Graduate students at the University of Central Arkansas teamed up for a two-day collaboration focusing on interprofessional education (IPE) on September 16th and 19^th of 2016. Interprofessional education is defined by two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010).  The speech-language pathology, occupational therapy, and dietetics programs came together for a combined lecture led by Dr. Towino Paramby, Dr. Veronica Rowe, and Dr. Nina Roofe.  The lecture emphasized the importance of interprofessional collaboration in the healthcare setting.  Topics covered included dysphagia, adaptive devices used for eating, specific modified diets, scope of practice, and interprofessional collaboration.  These three professions, when working together, can implement a successful treatment plan for the overall health of patients, often those of the geriatric population.   

The second day of the interprofessional collaboration allowed students to work together in a hands-on learning experience through a two-part lab. Observations of hands-on learning have shown that students demonstrate strong communication tied to working in teams (Bass et al, 2011). Through this lab, students experienced the use of adaptive eating equipment, prepared and tasted thickened liquids, assisted feeding, and observed a linespread demonstration. The linespread is a quick and inexpensive viscosity test, which allows practitioners to compare the effect of a particular food or ingredient. This information is useful when thickening liquids to certain consistencies for safe swallowing. Adaptive equipment used for eating are helpful tools for promoting independence to patients with physical disabilities such as arthritis, stroke, Parkinson’s disease, poor vision, etc. The graduate students were assigned random case studies and were responsible for selecting the most appropriate adaptive equipment for their “patient”. Goggles and other devices were provided to simulate different impairments such as decreased vision, strength, and poor fine motor coordination that are often found in the geriatric population. Students were able to assess how their selected pieces of adaptive equipment worked while simulating these common disabilities to gain further insight on the potential benefits of the equipment occupational therapists can provide for clients with a range of difficulties. On the left, speech-language pathology and occupational therapy graduate students work together on their case study.

The second part of the lab focused on the use of thickened liquids with patients affected by swallowing disorders, also known as dysphagia. Presbyphagia, which is swallowing difficulty associated with aging, is the second most common reported symptom in geriatric medicine (Charpied, 2009). Thickened liquids are often recommended by speech-language pathologists to patients as a way to adjust consistencies for easier swallowing. This lab allowed students to test both pre-thickened liquids as well as prepare their own liquids at varying consistencies. This lab not only gave students the opportunity to practice preparing thickened liquids, and modified diets, but more importantly, they gained first-hand experience which will allow them to better empathize with future patients. On the left, Dr. Paramby explains the use of thickened liquids to a group of graduate students.

Through this two-day collaboration, graduate students from three different fields of study expanded their knowledge of each profession’s scope of practice. More importantly, these students learned how interprofessional collaboration can result in the maximum benefit for a patient in the healthcare setting (WHO, 2010).

 

 

References:

Bass, Kristin M., Danielle Yumol, and Julia Hazer. “The Effect of Raft Hands-on Activities on

Student Learning, Engagement, and 21st Century Skills.” RAFT Student Impact Study. Rockman et al, 2011. Web. 24 Jan 2012.

 Charpied, George. “Presbyphagia: Hidden Risk in the Geriatric Population.” American Speech-    Language Hearing Association (2009): 1-6. 2009. Web. 17 Oct. 2016.

World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization. See http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf.