Whitney Thomasson

From the Director’s Desk

Spring 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)

Hello everyone, and I hope I can say Happy Spring and it sticks around! As you know, for the past couple of quarters I have been discussing the 4M’s framework of Age-Friendly care. We have reviewed the overall concept of the 4M’s framework and the first “M” of “what Matters” which is the cornerstone of the framework. This quarter, we will move on to another “M”, Medication. As well all know, older adults take more prescribed medications than any other age group in the United States. Many take medications to treat multiple chronic illnesses and others to help prevent certain illnesses or to improve function.

Therefore, the “M” of medication first means that as the practitioner, you must have a complete list of all the medications that your patients are taking; over, behind, and around the counter! Examining their medications to increase their awareness about potential side effects and drug to drug interactions, while also identifying ways to potentially reduce the number of medications they are taking when possible. Practitioners, patients, caregivers, and family members all need to know and understand that as our bodies change with age, our bodies also process medications differently. In addition, older adult bodies react to drugs differently than younger bodies, even if they have been on that medication for decades.

Medications used to treat one condition may also make another condition worse. For example, older adults with memory problems may have worsening symptoms caused by medicines used to treat another symptom or condition. Therefore, it is important that all providers who prescribe medications know about all of the medical conditions and medications that their patient is taking.

That’s why expert attention to Medications—one of the “Ms” of age-friendly care—is such a critical part of an older adult’s care. Therefore, we can now add this to the cornerstone of age-friendly care, What Matters. So, when you are reviewing and/or prescribing medications, not only should you consider all that we have discussed here, but make sure to consider What Matters to the older adult. One medication may improve a condition or symptom they have, but how do the side effects, financial effects, or other “effects”, affect What Matters most to them?

This was just a quick overview of “Medication”, 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 here.

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

Do You Know About Medication Reconciliation?

Spring 2023 Newsletter

Trinity Pullam, MSN, RN, CNE
Assistant Professor of Nursing
Arkansas State University

What is Medication Reconciliation?

Medication reconciliation is the process of obtaining, assessing, and managing a current list of all medications that a patient is taking. (Institute for Healthcare Improvement, 2023). When a patient is admitted to a hospital, they will be asked about their current medications. The patient will be asked to provide the names of medications, the dose, how often medications are taken, and the route the medication is delivered. This list provides the physician and healthcare staff important information about a client’s medication routine. The physician can assess currently ordered medications and choose which medications the patient should be on. This process should happen at admission, anytime a patient moves from one level of care to another, and at discharge. The goal of medication reconciliation is to provide the patient with the correct medications throughout the hospital stay (Institute for Healthcare Improvement, 2023).

Why is It Important?

This list will be used on admission by the physician for evaluation and to assist in choosing the correct medications. This is especially important for older patients as they are more likely to have multiple medications and health issues, and thus, are at increased risk for an adverse drug event. An adverse drug event is unexpected harm caused by medication (Centers for Disease Control and Prevention, n.d.). The use of medication reconciliation at any care transition is an effective way to reduce adverse drug events (Institute for Healthcare Improvement, 2023). Patients in the hospital often need adjustments to their medication routine based on their current conditions. This process may continue if home care is provided or at the primary provider’s office. Despite the importance of making correct medication choices, if a physician does not have access to a current and accurate medication list, the patient is at risk for adverse medication events ( Agency for Healthcare Research and Quality, 2019).

How Can I Improve the Process?

To ensure that healthcare providers are able to choose the best medications for you, it is important for them to have access to an up-to-date list. Here are some strategies that you can follow to ensure that this is possible.

Carry a list of medications

Include all herbs, supplements, and over the counter medication
- Keep this with you in your purse or wallet so it is always available
- Update your list any time a medication is changed
- This will ensure an accurate medication list is always available.

Make sure that your primary provider is informed of any medication changes

As you age and may need to see multiple providers, it is important to inform your primary physician of any changes made by your specialists
- This ensures that your medication history is available to you or other providers

Use the same pharmacy for all prescriptions.

The pharmacists will have access to all current medications and medication allergies
- A list can be obtained from the pharmacy of all medication orders
- When new medications are ordered, the pharmacist can identify any potential issues, contraindications, or interactions.

References

Agency for Healthcare Research and Quality (2019, September 19). Medication reconciliation. https://psnet.ahrq.gov/primer/medication-reconciliation

Centers for Disease Control and Prevention. (2010, September 28.). Medication safety basics. Medication Safety Program. https://www.cdc.gov/medicationsafety/basics.html

Institute for Healthcare Improvement. (2023). Medication reconciliation to prevent adverse drug events. https://www.ihi.org/Topics/ADEsMedicationReconciliation/Pages/default.aspx

Addressing the Arkansas opioid crisis through pain education

Spring 2023 Newsletter

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By Darshon Reed, Ph.D., Kalista Pettus, & Deanna Rumble, Ph.D.
College of Health and Behavioral Sciences
University of Central Arkansas

Opioid addictions and chronic pain have increased dramatically in the state of Arkansas over the past 5 years. Arkansas is number 2 in the nation for over-prescribing opioid medications according to Arkansas Take Back, which provides a secure way for Arkansans to monitor and dispose of their unused prescription medications (State of Arkansas Office of Drug Director, 2023). This is likely due to the impact of chronic pain on both the physical and mental health of patients. Chronic pain is defined as any pain that lasts longer than three months after the initial injury or stressor (Lunde & Sieberg, 2020). According to the Centers for Disease Control (Center for Disease Control and Prevention, 2021), 27.1% of Arkansans suffer from arthritis which is a main leader in chronic pain. Chronic pain, such as arthritis, can now likely be linked to stress and other psychological factors thanks to new research insights on the topic. With this information, it is critical that health professionals understand how to treat and manage pain to avoid further opioid addictions, overdoses, and other opioid-related tragedies.

The UCA College of Health and Behavioral Sciences is taking the initiative to train future healthcare professionals in knowledge of pain, pain experience, and pain education in order to understand different pain manifestations across populations. Specific courses and training experiences were offered over the 2022-2023 academic year to implement pain education. A few example experiences are included below.

The Occupational Therapy Department offers specialized courses such as Holistic Interventions: Adult to End of Life and Occupational Therapy in Rehabilitation and Disability in their graduate program where students learn pain science and regularly run pain assessments and interventions. Students from the program will utilize these skills by conducting pain assessments alongside physical therapy and nursing students for individuals 50 and older at an upcoming community health fair hosted by the UCA College of Health & Behavioral Sciences in Conway on Saturday, April 15th.
The Psychology and Counseling Department offers an elective course in health psychology and research courses that students are required to take as their capstone experience that include exposure to pain assessment tools and pain education. Dr. Deanna Rumble is a key faculty member that includes pain education in the capstone course. In her research lab students study pain, discuss the different pain rating scales, learn about clinically relevant pain populations, and theories behind why people experience pain. Dr. Rumble’s lab allows students to do a basic cold water pressor task that is frequently used in conditioned pain modulation. Students also conduct tactile filaments and use TENS units to simulate pain. Some of the research questions students have addressed in the lab include: “Does physical discomfort impact cognitive challenges?” and “Can online induction of mood affect self-reported pain expectations?”. Dr. Rumble’s students will present the findings of these research questions at the upcoming Arkansas Symposium for Psychology Students on Saturday, April 22, 2023.
The School of Nursing invited Nisa Khan, APRN, FNP-C, to talk with third-year BSN to DNP Nurse Practitioner Students about alternative treatments for pain and when to refer for other types of treatment rather than increasing opioids. Students from the nursing program will utilize this knowledge when assisting occupational and physical therapy students with pain assessments and education at an upcoming community health fair hosted by the UCA College of Health & Behavioral Sciences in Conway on April 15th.
The Physical Therapy department hosted a special lecture by Dr. Adriaan Louw, PT, Ph.D. for students, faculty, and the public on November 3, 2023. Dr. Louw completed his doctorate in pain neuroscience education and is a Certified Pain Specialist. Dr. Louw talked about how science is changing our approach to pain and the incorporation of pain science in undergraduate and graduate degrees. Students from the physical therapy program will utilize this knowledge when conducting pain assessments and education with occupational therapy and nursing students for individuals 50 and older at an upcoming community health fair hosted by the UCA College of Health & Behavioral Sciences in Conway on April 15th.

References

Centers for Disease Control and Prevention. (2021, September 23). Arthritis Statistics by State. https://www.cdc.gov/arthritis/data_statistics/state-data-current.htm

Lunde, C.E., & Sieberg C.B. (2020). Walking the Tightrope: A Proposed Model of Chronic Pain and Stress. Frontiers in Neuroscience, 14(270). doi: 10.3389/fnins.2020.00270

State of Arkansas Office of Drug Director. (2023, April 4). The Arkansas Opidemic. Arkansas Take Back. https://artakeback.org/opioid-education/arkansasopidemic/

Hendrix Teams up with AGEC to Engage Low-Income Older Arkansans in Social Technology

Spring 2023 Newsletter

By Dr. Jennifer Peszka, Professor, Psychology
Dr. Anne Goldberg, Professor, Sociology/Anthropology
and Dr. Pete Gess, Professor, Psychology
Hendrix College

During Spring 2021, in collaboration with AGEC, Hendrix faculty and students collected data on loneliness and satisfaction with social interactions in older Arkansans. Three major findings were identified: 1) there had been a reduction in group interactions and satisfaction with social interactions accompanying the pandemic for many older Arkansans, 2) online social interactions did lead to some satisfaction fulfilling lost in-person interactions, and 3) older Arkansans with financial strain were not as likely to utilize technology to supplement their social interactions. During the Spring of 2022, our group tried to address those findings by providing technology access, events to attend, and technical support to a group of low-income older Arkansans.

Using AGEC funding, 21 Chromebooks were purchased and delivered to 3 low-income housing facilities for older adults in Conway, Arkansas for 1 month.We worked with one staff person at each housing facility to schedule the events and to check the Chromebooks out to residents upon their request at any time to use on their own for events such as online AGEC events. Each Tuesday at Noon for 1 month, we produced online Memory Cafés (social interactions with a craft or activity as the theme) designed and led by Hendrix students (Food memories, Pencil Painting, Trivia, and Fun with Clay). For each café, one or two Hendrix students and/or faculty members set up the Chromebooks in a common area at three older-adult housing facilities and assisted residents using the Chromebooks to Zoom across the three older-adult housing facilities and to engage in the planned activity.

About the participants

Four students and 15 older Arkansans participated in the program.

Assessment

Pre and post whole program assessments were designed and given to the contact staff person from each housing facility and kept with the Chromebooks to encourage completion. Post café assessments were also designed for each individual café. The goal of the assessment measures was to understand happiness, loneliness, comfort socializing online, and subjective well-being before and after events. Only 8 participants completed the pre-program data and only 1-2 completed the post-program data. Therefore, the results reported below should be taken with caution as the N is very small and unequal in the pre- and post-groups.

What they told us

Before and after the program, participants reported their comfort in using computers to socialize online and their enjoyment in using computers to socialize online on a scale from 1 – 7 where 1 meant not at all and 7 meant a great deal. The program increased comfort and enjoyment of socializing online using computers. They also reported an increased sense of belongingness on a belongingness scale with scores ranging from 4-28 (See Figure 1).

Summary: In person social interactions can decrease with aging. Providing online social interaction availability (technology, support, etc.) could help to offset this loss and protect from loneliness. A second iteration of our program will take place during Spring 2023 addressing the limits in the current program with assessment completion. Making sure that technology interactions are accessible to all older Arkansans is a worthwhile goal.

Figure 1. Comfort and Enjoyment using computers to socialize and feelings of belongingness before and after intervention program.

UCA faculty and students provide accessible services for Arkansans at risk for and diagnosed with Alzheimer’s Disease and Related Dementias (ADRD)

Winter 2023 Newsletter

By Darshon Reed, Ph.D. & Kalista Pettus
College of Health and Behavioral Sciences
University of Central Arkansas

The students in the College of Health & Behavioral Sciences at UCA are making a difference in the lives of Central Arkansans at risk for or diagnosed with Alzheimer’s Disease and Related Dementias (ADRD), as well as their caregivers through the Interprofessional Therapeutic Activity Program (I-TAP). The I-TAP consists of four sub-programs including the Student-Led Therapeutic Activity Program (S-TAP), Student-Led Dementia Caregiver Coaching Program (S-DCCP), Resilient Care Support Group, and the Student-Led Wellness Screening Clinic (S-WSC). With these four sub-programs, I-TAP meets the needs of older Central Arkansans that are at risk or already diagnosed with dementia or related diseases and their caregivers. These programs aim to improve quality of life for the participants as well as provide support and resources to the caregivers, which has been identified as a critical need in Central Arkansas. The I-TAP program is unique and innovative as all of its sub-programs utilize interprofessional collaboration of undergraduate and graduate students who are under the supervision of licensed clinicians. It is meant to increase access and quality of care as well as to provide educational resources to both those affected with such diseases and the public.

The Student-Led Therapeutic Activity Program (S-TAP) will run during the spring 2023 semester. During this time, over 75 students from Exercise Science, Physical Therapy, and Occupational Therapy will provide wellness education, physical activity, cognitive engagement, and risk assessment to improve quality of life, while providing respite and support for caregivers. Sessions for this program will be held one to two times a month. Each session will be approximately an hour to an hour and a half with part being individual activities and the other part being group focused activities.

The Alzheimer’s Disease and Dementia Arkansas State Plan 2021-2025 prioritizes the need for accessible services for ADRD including: 1) public awareness and education, 2) access and quality of care, 3) family caregiver support, & 4) dementia training and workforce development. The I-TAP addresses all four of these priority issues by engaging health professions students to perform interventions that provide education, physical activity, cognitive engagement, caregiver respite and support, and risk assessment. Involvement of students bolsters workforce development by increasing healthcare professionals’ knowledge regarding the complex needs of those with ADRD and their caregivers. Further, I-TAP programs are free of charge to all participants, which allows access despite financial resources. Financial support for the program has been generously provided through a recent grant from the Blue and You Foundation for a Healthier Arkansas in the amount of $51,801.00 which will fund the program for the entirety of 2023. Dr. Kerry Jordan and Dr. Melissa Allen received this grant from the Blue and You Foundation to continue to meet the needs of Central Arkansas while simultaneously providing training opportunities for students.

Geriatric Student Scholars 2022-2023 Selected

It is with great pleasure that the UAMS Arkansas Geriatric Education Collaborative (AGEC) announces its 2022-2023 selection for the Geriatric Student Scholars program – Dhielan Bustos (College of Health Professions), Ranique Daniel (College of Nursing), Stephanie Graves (College of Health Professions), Szarria Thomas (College of Pharmacy), and Julia Townsley (College of Medicine).

The purpose of the Student Scholars program (sponsored by AGEC) is to increase health professions students’ interest and exposure to older adults, to improve knowledge of older adults and the specialized care they need and to promote interprofessional collaboration among health professions students.

We are so excited to announce the Geriatric Student Scholars for FY 2023 to support emerging health professionals education and participation surrounding specialized needs for older adults, and to foster interprofessional collaboration in academic and clinical geriatrics. The goal of the Geriatric Workforce Enhancement Program (GWEP) is to enhance the quality of health care for elderly Arkansans through research, education and training. The Geriatric Student Scholars program is an excellent way to achieve this goal and mentor future healthcare team members.
AGEC Director, Robin McAtee, Ph.D., RN., FACHE

The Arkansas Geriatric Education Collaborative is a program of the University Of Arkansas for Medical Sciences – Donald W. Reynolds Institute on Aging. The collaborative is funded by a Health Resources and Services Administration grant of $3.7 million for a Geriatrics Workforce Enhancement Program.

Geriatric Student Scholars – Congrats!

Dhielan Bustos (Third-year Doctor of Physical Therapy student, NWA campus)
Ranique Daniel (Fourth-year BSN student)
Stephanie Graves (Second-year Physician Assistant student)
Szarria Thomas (Second-year Pharmacy student)
Julia Townsley (Second-year Medicine student)

Dhielan Bustos is a third-year Doctor of Physical Therapy student at the UAMS-NWA campus. He is originally from California but was raised in New Jersey and attended Rutgers University where he received his Bachelor of Science degree in Neurobiology. Dill, a nickname he goes by, has worked in many settings that led to his acceptance to PT school that included a skilled nursing facility, an outpatient sports clinic, and an outpatient geriatric clinic. Besides studying, Dill likes coffee, going to the gym, playing tennis, and spending time with friends and family. His interests in geriatrics began at his first PT tech job in a skilled nursing facility where he got to work with many geriatric patients with complex medical conditions. He recognized just how powerful the rehabilitation can be for older adults by assisting with exercises, providing care, and witnessing their incredible progression. In his career as a physical therapy student, he looks to figure out ways at which he can incorporate higher intensity interval training in the older adult population as part of their treatment plan. Dill is very thankful for being chosen to be a Geriatric Student Scholar and is excited to gain insight on how he can improve the lives of older adults.

Ranique Daniel is a Senior BSN Student from Marked Tree, Arkansas. She is a recent University of Arkansas Alumna (Woo Pig!) and first-generation college graduate with a B.S. in Public Health and minor in Medical Humanities. She is honored to have been selected as a Geriatric Student Scholar, and looks forward to expanding her knowledge on serving this special population. She had the opportunity of working with this population this past summer with a student nurse internship at Wellth, Inc., and has always had the desire to learn more about their standard of care after taking care of her own great grandmother for many years. She witnessed a deficit in the care for older adults during this time in the Delta region of Arkansas, and this made her realize the importance of how much further it is we have to go, and it starts with us! This is a wonderful opportunity to work with this interdisciplinary team and the UAMS Geriatric Education Collaborative to further advance her education, and she looks forward to what this year brings!

Szarria Thomas is a second-year pharmacy student at University of Arkansas Medical Sciences. She has a received a Bachelor of Science in Biology with a chemistry minor. Her past and current experience working in retail pharmacy with geriatric patients, exposed to her the importance of the need of more exploration of the care of geriatric population. The opportunity to immerse into the study of how medications effect geriatric patients is intriguing and imperative to the future. Her goal as an AGEC scholar is to gain knowledge through research that will propel her passion to clinically provide exceptional care as well as knowledge to the geriatric community.

Julia Townsley

Julia Townsley is a second-year MD student in the College of Medicine at UAMS. She is from Fayetteville, AR, where she grew up and would later attend college. She received a B.S. Degree in Biomedical Engineering at the University of Arkansas. Julia is the President of the UAMS Geriatric Interest Group and is completing the Honors in Underserved Primary Care Program. With experience being a caregiver for her grandmothers, Julia was drawn to geriatric medicine from a young age and is excited to work with the aging population. She is grateful for the opportunity to be an AGEC Geriatric Student Scholar and is looking forward to the experiences she will have within the program. Her future goals include working as a geriatrician to be an advocate for elder patients and to provide a supportive community for her patients. In her free time, Julia is a singer for a local church and enjoys spending time with her friends.

From the Director’s Desk

Fall 2022 Newsletter

Happy fall to everyone! I know most of us are very happy to see the trees turning and the temperatures dropping. The AGEC and partners have started fall programs and classes and are very busy. This quarter I want to talk a little more in-depth about the AGEC’s clinical focus on the 4M’s framework of Age-Friendly Care.

In 2017, The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association and the Catholic Health Association of the United States, had a vision and plan to infuse healthcare with a new concept called age-friendly care. The IHI defined age-friendly care as care that “Follows an essential set of evidence-based practices; Causes no harm; and Aligns with What Matters to the older adult and their family or other caregivers”. Therefore, if a healthcare system wants to become certified as an Age-Friendly Health System, they must provide care that meets evidence-based elements of high-quality care, known as the “4Ms,” to all older adults in their system.

The 4Ms are: What Matters, Medication, Mentation, and Mobility. The first M regarding What Matters is regarded as essential and if done properly, all of the M’s revolve around it. All care should center around what Matters most to the older adult. This is where the conversation with the patient, family, and caregiver(s) begins. The healthcare team should discuss the older adult’s health outcome goals and care preferences, including end-of-life care, across all settings. Their goals and preferences then dictate the overall plan of care. Medication, should be age-friendly and not compromise mentation, mobility or What Matters. Mentation is the next M where providers should work to prevent, identify, treat and manage dementia, delirium, depression, and other conditions that affect the mind. Finally, Mobility is considered. The team should ensure safe movement and function that supports what matters to the older adult and what promotes meaningful activities. This was a simplified and quick summary of the age-friendly framework and I would encourage you all to learn more. More information can be found at https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Documents/IHIAgeFriendlyHealthSystems_GuidetoUsing4MsCare.pdf.

The AGEC has a wonderful rural clinical partner that is essential to our success with implementing age-friendly care, ARcare. ARcare is a federally qualified healthcare clinic (FQHC) network that works tirelessly in rural communities to ensure patients are able to benefit from accessible, affordable, quality, routine medical care. Services from ARcare include primary care, behavioral health, pharmacies, community outreach programs, and more. When approached in late 2018 about being part of the AGEC, ARcare staff were enthusiastic and embraced the concepts inherent in the 4M’s framework of Age-Friendly Care. Since beginning the partnership in 2019, Dr. Leah Tobey, our AGEC Clinical Coordinator, has taught this framework in six ARcare rural clinics. She continues to update new staff, work on quality improvement projects, and helps with rural community projects. To date, the ARcare network has five clinics that are certified level I or II as Age-Friendly by the Institute for Healthcare Improvement. We are proud of ARcare and their work with making their care age-friendly and we would encourage all who provide care to older adults to consider these 4Ms.

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

Changes in Social Interactions in Older Arkansans across the COVID-19 Pandemic

Fall 2022 Newsletter

By Dr. Jennifer Peszka, Professor, Psychology
Dr. Anne Goldberg, Professor, Sociology/Anthropology
and Dr. Pete Gess, Professor, Psychology
Hendrix College

Previous research shows that loneliness is detrimental to healthy aging. When the COVID-19 pandemic struck, it led to early calls for strict limitations to in-person social interactions (lockdowns and social distancing). During Spring 2021, Hendrix College and AGEC conducted a telephone survey of nearly 867 older Arkansans to examine social connection and isolation during the COVID-19 pandemic. Those data indicated that during the early part of the pandemic, in person social interactions and satisfaction with social interactions declined. While not a completely satisfying replacement, supplementing lost in-person social interactions with technology facilitated communication did help buffer some of the negative impact on satisfaction for some participants. During Spring of 2022, we conducted a follow-up survey to replicate previous findings, look for changes as social interactions began to shift back to normal, and to add additional questions to probe further into findings seen in the original survey data.

About the participants

603 older Arkansans completed the automated telephone survey. 68.3% of the participants were between 65 and 74 years old, and 31.7% were 75 years old or older. 86.5% identified as White, non-Hispanic; 8.0% as Black; .2% as Hispanic; and 5.3% as other, preferred not to answer, or mixed. 65.9% identified as women, 33.2% as men, and 0.8% as preferred not to answer. To examine economic status, we asked them to indicate how often they worry about paying their monthly bills. 8.1% said always, 15.0% said frequently, 34.9% said seldom, and 42.0% said they never worry about paying their bills.

What they told us

Frequency of interactions: In the 2021 survey, 76% of participants reported curtailing their in-person social interactions since the pandemic began at least some, 41% were curtailing a lot. Now, when the virus is waning and vaccines are widely available, curtailment was not as widely spread with about one half reporting they were curtailing their in-person social activities at least some (50.4%) and substantially fewer were curtailing it by a lot or completely (27.6%) (See Figure 1). For in person activities, in 2021, only about one-third (31%) of the sample was engaging in in-person social activities multiple times a week, but in 2022, we saw that double (63%).

Social satisfaction: 93% of the participants rated themselves as satisfied with their social connection before the pandemic, that number reduced to 67% during the pandemic in 2021, and this has started to recover now in 2022 with 78% of the participants rating themselves as satisfied with their social connections now.

Social technology use: In 2022, we investigated a specific kind of social technology: the video chat. Video chatting was prevalent in this sample even before the pandemic, with about 40% of the sample engaging in video chatting multiple times a week before the pandemic began. About one-quarter of the participants (22.8%) reported using video chat even more during the pandemic.

In 2021, during the pandemic, 60% of the participants said they felt socially connected when engaging in online social interactions. In 2022, after an additional year of these sorts of interactions, it seems there has been a slight increase in satisfaction, with about 10% of participants being less likely to disagree with this and 10% being more likely to agree, with 70% of participants reporting feeling socially connected when engaging in these online interactions (See Figure 2).

Summary: In person social interactions and satisfaction with social interactions are still lower than during pre-pandemic times, but they are starting to recover. Nonetheless, some older Arkansans find themselves experiencing loneliness and isolation even when there is no pandemic. These findings suggest that with practice and motivation older Arkansans can increase their technological interactions and that these can serve as a reasonably satisfactory replacement to in person social interactions when necessary. We should work to develop programs to increase fluency and availability of social technology for older Arkansans.

Management of Weight Loss in Hospitalized Older Adults

Fall 2022 Newsletter

By Lisa C. Hutchison, Pharm.D., MPH, BCPS, BCGP
University of Arkansas for Medical Sciences (UAMS) College of Pharmacy

Weight loss is often identified during hospitalization when older adults are assessed. Up to 60% of hospitalized older adults are malnourished or at risk for malnutrition, and this is associated with threefold increased costs and co-morbidities such as pressure injuries, infections, and falls.1 Length of stay and mortality increase as a result. Appetite often diminishes when illness develops and patients are admitted to the hospital. Families and caregivers become more vigilant as their loved one has an acute illness, requesting interventions that would improve appetite and nutritional status.

Non-pharmacological methods often implemented during hospitalization to combat nutritional deficits usually include addition of protein/calorie supplements. An approach used less often is to liberalize the diet. For example, a low sodium diet is a standard order for individuals with cardiac disease. A low sodium diet can significantly decrease blood pressure in individuals with hypertension by 4.5mmHg/2.4mmHg on average,2 but a recent randomized controlled trial, SODIUM-HF, did not verify dietary sodium restriction to 1500mg/day was associated with a reduction in mortality or cardiovascular hospitalization/emergency department visits in ambulatory care patients over a year.3 Removing a dietary sodium restriction and encouraging family members and caregivers to select food items the patient likes should be considered. Mealtime is often a social event, and having family or friends eat along with the older adult can improve the amount of food ingested.

Careful review of a patient’s medication list may reveal drug therapy that is contributing to anorexia. Drugs well-known to cause anorexia include amiodarone, SSRI’s, SNRi’s, phenothiazines, opioids, acetylcholinesterase inhibitors, and digoxin.4 Drug-induced nausea may present with anorexia. Stopping these medications, or reducing them to their lowest effective dose, may aid in restoring a patient’s appetite. Another contributor may be drug-induced constipation which can present as anorexia. Finally, some medication regimens include a large number of oral tablets or capsules with a volume that equates to a small meal. A focused attempt to reduce pill burden or to spread out their administration may help to improve appetite.

Medications are sometimes used off-label to stimulate appetite and induce weight gain in older adults. Most commonly used are mirtazapine, megestrol, and dronabinol.4,5 Dronabinol works as a cannabinoid to increase appetite, but as would be expected, causes significant central nervous system side effects. Megestrol is approved by the US Food and Drug Administration for anorexia or cachexia associated with AIDS or cancer. As a synthetic progestin, it can increase appetite, however, small studies and retrospective data show mixed results with increasing weight or strength in older adults. So while it may cause increased dietary intake, any gain of weight is likely increased body fat. Megestrol can increase blood pressure, blood glucose, and risk for thromboembolism.

Mirtazapine is a popular choice for improving appetite due to its safety profile. This antidepressant is relatively well-tolerated with significant side effects of marked sedation, xerostomia, increased cholesterol, and constipation. Increased appetite as a side effect is reported in 17% of patients, therefore, clinicians began trying it in older adults for anorexia.6 Most studies have been in older adults with depression, and results were mixed. A retrospective study of hospitalized patients evaluating use of mirtazapine, megestrol and dronabinol showed improvement in percentage meal intake but no differences between these agents. A control group was not included so authors were unable to assess the effect of other changes, particularly the effect of improvement in admission disease/symptoms.7

So what is best practice? The Choosing Wisely campaign suggests we optimize social supports, provide feeding assistance, and clarify patient goals and expectations instead of prescribing appetite stimulants or high-calorie supplements for treatment of anorexia in older adults.8 Furthermore, we should first assess if this symptom is an adverse drug event of an already prescribed medication. Finally, as with all medications, if pharmacological interventions are subsequently tried, periodic assessment of benefit and risk is important to consider if the appetite stimulant should be continued.

References:

Shrader E, Baumgartel C, Gueldenzoph, et al. Nutritional status according to Mini Nutritional Assessment is related to functional status in geriatric patients—independent of health status. J Nutri Health Aging, 2014; 18:257-63.
Lai JS, Aung YN, Khalid Y, Cheah SC. Impact of different dietary sodium reduction strategies on blood pressure: a systematic review. Hypertens Res, 2022; doi: 10.1038/s41440-022-00990-5. Online ahead of print.
Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF):an international, open-label, randomized, controlled trial. Lancet, 2022; 399:1391-1400.
Cheung NC, Noviasky JA, Ulen KR, Brangman SA. Efficacy and safety of megestrol in the hospitalized older person. Sr Care Pharm, 2022; 37:284-92.
Fox CB, Treadway AK, Blaszczyk AT, Sleeper RB. Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly. Pharmacotherapy, 2009; 29:383-97.
Howard ML, Hossaini R, Tolar C, Gaviola ML. Efficacy and safety of appetite-stimulating medications in the inpatient setting. Ann Pharmacother, 2019; 53:261-7.
American Geriatrics Society/American Board of Internal Medicine Foundation. Choosing Wisely. www.ChoosingWisely.org.

Caregiver Strain: Strategies for Prevention

Fall 2022 Newsletter

Sarah Davidson, DNP, RN, CNE
Associate Dean, College of Nursing and Health Professions
Arkansas State University

Caring for an elderly family member comes with great rewards and equally great complications. The complexities of caregiving may become difficult to manage and caregivers are especially susceptible to caregiver role strain. Caregiver role strain occurs when caregivers experience stress because of the increased responsibility, change in lifestyle, and financial obligations associated with taking care of another person (Caregiver Role Strain, 2020; Kimura, et al., 2019). The demands of caring for someone with a chronic illness or condition that prevents them from taking care of their basic needs may lead to exhaustion and stress (Caregiver, 2009). Caregivers may also experience feelings of frustration, sadness, guilt, and isolation (Caregiver Stress: Tips for Taking Care of Yourself, 2022; Franzen et al., 2021). Almost 60% of caregivers also work outside the home. Juggling work, family and caregiving responsibilities often becomes overwhelming and leads to diminished productivity, unanticipated financial strain, and missed opportunities for professional growth (10 Tips to Manage Caregiver Role Strain, 2020; Andersson et al., 2019; Dickson et al., 2022)). Responsibilities are often magnified by the large number of co-morbid medical conditions generally experienced by elders and difficulties navigating through the healthcare system increase along with the complexity of care (Dickson et al., 2022). The uncertainty of life expectancy and associated emotional strain add to the already complicated situation (Hovland & Kramer, 2019).

Meeting the challenges associated with caregiving starts with recognition of the normal symptoms experienced by many caregivers. Withdrawal from usual activities; losing interest in things normally enjoyed; feeling irritated, angry, and moody; or having thoughts of suicide and death are often common in caregivers. Those caring for others may have trouble concentrating; feel overwhelmed; and suffer from increased health and sleep problems along with appetite changes. The high levels of stress associated with caregiving often have negative health effects. Although these symptoms are frequently experienced by caregivers, achieving a balanced, stable life can be reached with knowledge of and access to helpful resources (Caregiver Stress: Tips for Taking Care of Yourself, 2022; Kimura et al., 2019).

Kimura et al. (2019) found that caregiver burden can be reduced through emotional and practical support. Asking for and accepting help may be difficult but is one of the most valuable ways to deal with stress. A strong support team of family and friends along with health care resource personnel can provide a break from daily caregiving tasks. The caregiving load can be alleviated through the establishment of a routine of self-care to maintain health. Setting realistic goals that focus on what can be accomplished without outside assistance and using social and professional resources to fill in the gaps may relieve anxiety. Support groups for a variety of disorders are available in most areas and provide a healthy outlet to talk with others facing the same situation. Caregivers may take personal time by using respite care options such as short-term nursing homes, adult day care, or in-home respite. (Caregiver Stress: Tips for Taking Care of Yourself, 2022). The eventuality of death remains at the forefront of caregiver worries and hospice care professionals can alleviate much of this with information about expectations along with psychosocial and spiritual support (Hovland & Kramer, 2019).

Health care providers play an essential role to connect caregivers with resources. Caregivers are often hesitant to ask for assistance, therefore, during each health care encounter assessments should include questions regarding the mental and physical status of the caregiver (Onega, 2013). The Caregiver Strain Index (CSI) (1983) is a useful tool that addresses many symptoms commonly identified in caregivers. The Modified Caregiver Strain Index (MCSI) (Thornton & Travis, 2003) is a shorter, quicker assessment tool that addresses financial, physical, psychological, social, and personal areas of identified stress to help health care providers recognize caregivers in need of more in-depth assessment and/or follow-up. The MCSI is easy to administer and has higher reliability than the original CSI although the CSI is more useful to measure caregiver strain in outcomes research (Thornton & Travis, 2003).

Caring for an elderly family member provides immense rewards and affords time for families to adjust to the inevitability of loss. Recognizing the stressors associated with caregiving and developing healthy strategies to deal with them can be accomplished by creating a strong support system, taking time to maintain personal health, and utilizing personal and professional resources. Healthcare professionals are at the forefront of identifying caregivers in need of resources with regular, thorough assessments that may include the CSI or MCSI.

References

10 Tips to Manage Caregiver Role Strain (2020). CaringBridge. https://www.caringbridge.org/resources/caregiver-role-strain/

Andersson, M.A., Walker, M.H., & Kaskie, B.P. (2019). Strapped for time or stressed out? Predictors of work interruption and unmet need for workplace support for among informal elder caregivers. Journal of Aging and Health, 3(4), 631-651. DOI: 10.1177/0898264317744920.

Caregiver (2009). Family Caregiver Alliance. https://www.caregiver.org/resource/caregiving/?via=caregiver-resources,all-resources

Caregiver Role Strain (2020). University of Wisconsin School of Medicine and Public Health. https://patient.uwhealth.org/healthfacts/6921

Caregiver Stress: Tips for Taking Care of Yourself (2022). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/caregiver-stress/art-20044784

Dickson, V.V., Melnyk, H., Ferris, R., Leon, A., Arcila-Mesa, M., Rapozo, C., Chodosh, J., & Blaum, C.S. (2022). Perceptions of treatment burden among caregivers of elders with diabetes and co-morbid Alzheimer’s Disease and related dementias: A qualitative study. Clinical Nursing Research, 0(0). doi.org/10.1177/10547738211067880

Franzen, S., Eikelboom, W.S., vanden Berg, E., Jiskoot, L. C., van Hemmen, J., & Papma, J.M. (2021). Caregiver burden in a culturally diverse memory clinic population: The caregiver strain index-expanded. Dementia and Geriatric Cognitive Disorders, 50, 333-340. DOI: 10.1159/000519617

Hovland, C.A. & Kramer, B.J. (2019). Barriers and facilitators to preparedness for death: Experiences of family caregivers of elders with dementia. Journal of Social Work in End-of-Life & Palliative Care, 15(1), 55-74. DOI: 10.1080/15524256.2019.1595811

Kimura, H., Nishio, M., Kukihara, H., Koga, K., & Inoue, Y. (2019). The role of caregiver burden in the familiar functioning, social support, and quality of family life of family caregivers of elders with dementia. Journal of Rural Medicine, 14(2), 156-164.

Onega, L.L. (2013). The Modified Caregiver Strain Index (MCSI). Try This: Best Practices in Nursing Care to Older Adults, The Hartford Institute for Geriatric Nursing, New York University, College of Nursing, 14. https://hign.org/consultgeri/try-this-series/modified-caregiver-strain-index-mcsi

Thornton, M. & Travis, S.S. (2003). Analysis of the reliability of the Modified Caregiver Strain Index. Journal of Gerontology, 58(2), S127-132. doi: 10.1093/geronb/58.2.s127