Whitney Thomasson

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

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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

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)

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.
Mirtazapine In: Lexicomp® Wolters Kluwer Copyright 2022 UpToDate, Inc.
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

Occupational Therapy Doctoral Capstone Students Create Interprofessional “Conway Brain Injury Community” to Meet Documented Community Need

Fall 2022 Newsletter

By Emily Wish, OTD, OTR/L, PCBIS, Lorrie George Paschal, PhD, OTR, ATP, and Duston Morris, PhD, MS, CHES, ACE-HWC
Department of Occupational Therapy
University of Central Arkansas

According to the Arkansas State Plan for Traumatic Brain Injuries (UAMS, 2020), there were approximately 2,300 individuals living with a brain injury in Arkansas between 2013-2019. In the River Valley and Central Arkansas areas (including Conway, Cleburn, Johnson, Logan, Perry, Pope, Pulaski, Van Buren, White, and Yell counties) there are 685 individuals registered with the TBI registry (UAMS, 2020). As of March 2022, it is estimated that there are approximately 611 individuals hospitalized due to a TBI in the US (CDC, 2022). Stroke, which is an acquired non-traumatic brain injury, is one of the leading causes of disability in the US (Virani et al., 2020). With the risk factors for stroke increasing since 1995, it is no surprise that the prevalence of this disease has also increased in the US (Virani et al., 2020). Arkansas is one of the top 14 states in the US in rates of stroke hospitalization (CDC, 2021). According to the Brain Injury Association of America, 95% of individuals living with a brain injury do not receive the long-term treatment and support they need to be successful in their occupations (Ashley et al., 2019). Acquired brain injuries impact individuals for a lifetime, but there is a lack of local resources that address occupational and healthcare needs for this population following discharge from rehabilitation.

To address this need, recent occupational therapy doctoral students Dr. Emily Wish and Dr. Mckenzie Svebek created the Conway Brain Injury Community (CBIC) in the University of Central Arkansas’ Department of Occupational Therapy in the College of Health and Behavioral Sciences (CHBS). This community allows members, post-acquired brain injury, to come together to work on increasing their occupational performance and overall health and well-being.

The vision of the CBIC program combines Dr. Wish’s desire to facilitate occupational performance of members and Dr. Svebek’s aim to establish a supportive interprofessional approach. Together, a community-based network of community dwelling individuals post-acquired brain injury and faculty supervised occupational therapy students was established to holistically address the needs of this community. Partnership with faculty and students from a variety of CHBS disciplines enhances the program by providing a unique approach of involving professors, students, and clinicians to meet the needs of CBIC members. At this time, primary team members include occupational therapy and health coaching. Other disciplines participate based on members’ interests. For example, this semester, dietetics students provided a presentation on heart healthy food choices.

This interprofessional program was an outcome of capstone projects but has become sustainable through partnership and supervision of occupational therapy faculty member, Dr. Lorrie George-Paschal, and health sciences faculty member Dr. Duston Morris. Through an interprofessional collaborative approach, the CBIC team leads theory-based and client-centered sessions tailored to address goals the members have set for themselves.

Operating within the UCA semester schedule, the group meets weekly, with the exception of school breaks. The program is based on the theory of Occupational Adaptation which strives to improve occupational functioning by creating a change in the internal adaptation process of members through engagement in desired occupations. At the beginning of the 14-week semester-long program, participants complete Occupational-Adaptation based Instruments, developed by Dr. George-Paschal with Dr. Krusen (2019). These instruments provide structure for the program. Because the program is research-based, participants first review and sign informed consent approved by Research Compliance at UCA. If they give consent, participants complete the Occupational Adaptation Practice Guide to set meaningful goals. When goals have been set, participants evaluate their current sense of mastery on their established goal(s) using the six-item Relative Mastery Scale (George-Paschal, Krusen, & Fan, 2021). This valid and reliable instrument is used to measure individual and group outcomes. The RMS is completed again in the middle and at the end of the semester.

Example goals of current CBIC members include improvement in upper extremity tone management and range of motion, cooking with one hand, sewing with one hand, improved handwriting with the non-dominant hand, improving awareness of the left visual field, and improving community mobility. CBIC members are partnered with one to two occupational therapy students and a health coaching student to work on their goals. Occupational therapy sessions are held for two hours each week with activities focused on each member’s specific goal(s). Activities are scaffolded to increase success. For the CBIC member who wants to sew, students and faculty created opportunities that have progressed from operating functions on the sewing machine with one-hand, to sewing straight seams, to making a drawstring bag, and most recently making their own pillow case. The next step is to meet at a local fabric store to choose Christmas fabric for the member to make a quilt top. Signs of adaptation for this member have been noted through signs of initiation and generalization as the member shared that they have visited a local sewing center to try out and consider the purchase of a sewing machine for home.

Weekly health coaching sessions are held on a separate day and last one hour. Students from occupational therapy and health coaching work together and often attend the sessions led by the other discipline. Participants feel an accountability to their health coaching goals as evidenced by one member pushing to finish a project during an occupational therapy session because they had set a goal to complete it with their health coaching student.

In addition to the individual activities, the program includes informational and support group activities. This semester, activities have included a presentation on nutrition for heart health (provided by UCA nutrition students) and various activities to promote self-worth and group connection. This supportive community provides a safe space for CBIC members to identify, establish and achieve personal and/or health-related goals throughout their rehabilitation journey. While this is not therapy, it does provide CBIC members an opportunity to reflect on their strengths through recovery and to maintain and improve their long-term occupational performance.

Starting with four members in June 2022, the program has expanded to seven members this fall and will continue to reach more individuals in the Central Arkansas area.
The goal is to provide a sustainable interprofessional program that can serve the needs of the members post-acquired brain injury while simultaneously providing opportunities for CHBS students to learn and engage in meaningful healthcare community services. UCA OT Doctoral Capstone student Kassidy Sawyer will provide program management and direction in 2023. For more information about the CBIC, please contact Dr. Emily Wish, CBIC program director at ewishotd@gmail.com.

George-Paschal, L. & Krusen, N. (2019). Occupational Adaptation Practice Guide. Copyrighted
2019.
George-Paschal, L. & Krusen, N. (2019). Relative Mastery Scale. Copyrighted 2019.
George-Paschal., L, Krusen, N.E., Fan, C.W. (2021). Psychometric evaluation of the Relative
Mastery Scale: An Occupational Adaptation instrument. OTJR: Occupation, Participation and Health. [online first 12.31.2021 Sage Journals. https://doi.org/10.1177%2F15394492211060877

From the Director’s Desk

Summer 2022 Newsletter

Wow, what a “hot” summer we are all experiencing. Therefore, I want to send out a special “thank you” to all of you who are out there serving and caring for our older adults! This is dangerous weather for anyone, especially for our vulnerable older adults. So, “thank you” to all healthcare professionals who continue to serve!

Our academic partners have been very persistent in their work throughout the spring and summer and are working diligently to fulfill summer obligations while preparing for a new academic year. So “thank you” also to our collaborators at ASU, UCA, Hendrix, and the Arkansas College of Health Education, we are looking forward to another exciting academic year with you and your students.

The AGEC has also been busy over the past few months. We are very excited to reintroduce the hands-on Alzheimer’s & Dementia Experience which has been on hold since the beginning of the pandemic, early in 2020. We had our first program in May with Saline Memorial Behavioral Health and we had 30 healthcare participants. Another program is schedule for August! Community programs were also busy in the spring and have continued this summer, both virtually and in-person. With a new collaboration with Arkansas Colleges of Health Education in Fort Smith, we have begun releasing a series on social media of 26 short videos in partnership their School of Occupational Therapy students and faculty, covering a variety of adaptive equipment for older adults around the home and their communities – click here to visit our Facebook page and see. We have also been very successful in the continuation of dementia support groups via phone, Zoom, and in-person where more than 130 caregivers were reached over the past quarter. AGEC Learn from Home Series continues where a different AGEC community program is presented every month via Zoom. We also continue our regular activities such as Ageless Grace, Tai Chi, and many evidence-based programs with our partners including UAMS Centers on Aging, CareLink AAA, and multiple senior centers.

Try to stay cool the rest of the summer!!

Nutritional Biomarkers of Age-Related Muscle Loss

Summer 2022 Newsletter

By David Church, PhD, CSCS*D
Department of Geriatrics, College of Medicine
University of Arkansas for Medical Sciences

Skeletal muscle mass, function, and strength decline with increasing age, a condition that has been coined “sarcopenia”¹. Sarcopenia increases the risk of deleterious health conditions and represents a major financial cost to healthcare systems. Among older adults who are hospitalized, those with sarcopenia on admission are 5-fold more likely to incur higher hospital costs than those who do not.² The economic burden of sarcopenia on the US healthcare system is considerable, with one estimate of the total annual cost of hospitalization for sarcopenic individuals being USD $40.4 billion³. From a clinical practice perspective, individuals with sarcopenia are at a greater risk of falling, reduced mobility and independence, and 95% more likely to be hospitalized as compared to those without sarcopenia³.

The term sarcopenia, coined in 1989, refers to the loss of muscle mass¹. Since then, greater insights into muscle strength, mass, and function have developed. It has been demonstrated that low muscle mass is associated with weakness, and that weakness is strongly associated with function and disability. However, low muscle mass alone is weakly or not associated with function and disability^2–5. As a result, current sarcopenia definitions incorporate measures aimed at muscle mass, strength, and function. The majority of sarcopenia research focuses on prevention and treatment. Of this work, there is even less attention given to the standardization of assessment and diagnostic criteria. Multiple working groups of experts have weighed in, including those previously mentioned^2,6,7; however, there are also the National Institute on Aging (NIA), the Foundation for the National Institutes of Health funded Sarcopenia Definitions and Outcomes Consortium (SDOC)⁴, and the Asian Working Group for Sarcopenia (AWGS)⁵. While important initiatives, the results have led to different definitions and clinical assessments for the same disease. Further, when looking into one working group, SDOC, the level of agreement amongst 13 different position statements varies widely⁴. Thus, uncertainty surrounding the definition and outcomes of sarcopenia is high even amongst international experts. Most striking is the fact that current diagnostic criteria and cutoffs only identify individuals with sarcopenia, NOT those “at risk” for sarcopenia. This is an important failing of the current diagnostic tests as these cut off points indicate the patient’s increased risk for falls, while independence, quality of life, and longevity are decreased^2–4,8,9. Further, the regression and management of sarcopenia becomes a major economic burden to the healthcare system³. At this point, the best possible outcome is to slow the progression of the disease. In fact, the recent Sarcopenia Definitions and Outcomes Consortium (SDOC) states that since low grip strength and usual gait speed are independent predictors of falls, mobility limitations, hip fractures, and mortality in community-dwelling older adults, they should be included in the definition of sarcopenia⁴. Thus, current techniques and diagnostic criteria can only identify sarcopenia after a physical/functional impairment has occurred. As a result, clinicians must treat and manage the disease, as opposed to identifying susceptible individuals and taking preventative steps. Stated differently, clinicians are hoping to slow the rate of decline rather than maintain or improve muscle health.

Skeletal muscle amino acid metabolism dictates muscle health and functionality. Altered amino acid metabolism lead to decrements in muscle mass, quality, and performance⁸. Our laboratory, as well as others, have documented that the circulating essential amino acids (EAA) response to protein ingestion determines muscle amino acid metabolism^10,11. This well-established phenomenon allows us characterize potential nutritional biomarkers following an EAA challenge in order to determine the state of muscle health. As no additional equipment will be required the proposed EAA challenge represents a potential low-cost solution to classifying patients’ skeletal muscle health. This initiative will leverage the well-established physiological role EAA play in muscle metabolism and health within the existing clinical infrastructure (i.e., basic phlebotomy procedures). The extrapolation of this work will be the development of a simple analytical tool that would provide clinicians the ability to discern alterations in muscle metabolism and health prior to a loss of function or overt development of sarcopenia.

References

1. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997 May;127(5 Suppl):990S-991S. PMID: 9164280

2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M, Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16–31. PMCID: PMC6322506

3. Goates S, Du K, Arensberg MB, Gaillard T, Guralnik J, Pereira SL. Economic Impact of Hospitalizations in US Adults with Sarcopenia. J Frailty Aging. 2019;8(2):93–99. PMID: 30997923

4. Bhasin S, Travison TG, Manini TM, Patel S, Pencina KM, Fielding RA, Magaziner JM, Newman AB, Kiel DP, Cooper C, Guralnik JM, Cauley JA, Arai H, Clark BC, Landi F, Schaap LA, Pereira SL, Rooks D, Woo J, Woodhouse LJ, Binder E, Brown T, Shardell M, Xue QL, DʼAgostino RB, Orwig D, Gorsicki G, Correa-De-Araujo R, Cawthon PM. Sarcopenia Definition: The Position Statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatr Soc. 2020 Jul;68(7):1410–1418. PMID: 32150289

5. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020 Mar;21(3):300-307.e2. PMID: 32033882

6. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010 Jul;39(4):412–423. PMCID: PMC2886201

7. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, Compher C, Correia I, Higashiguchi T, Holst M, Jensen GL, Malone A, Muscaritoli M, Nyulasi I, Pirlich M, Rothenberg E, Schindler K, Schneider SM, de van der Schueren M a. E, Sieber C, Valentini L, Yu JC, Van Gossum A, Singer P. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017 Feb;36(1):49–64. PMID: 27642056

8. Moore DR. Keeping Older Muscle “Young” through Dietary Protein and Physical Activity12. Adv Nutr. 2014 Sep 1;5(5):599S-607S. PMCID: PMC4188243

9. Mitchell WK, Williams J, Atherton P, Larvin M, Lund J, Narici M. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Front Physiol. 2012;3:260. PMCID: PMC3429036

10. Church DD, Hirsch KR, Park S, Kim IY, Gwin JA, Pasiakos SM, Wolfe RR, Ferrando AA. Essential Amino Acids and Protein Synthesis: Insights into Maximizing the Muscle and Whole-Body Response to Feeding. Nutrients. 2020 Dec 2;12(12). PMCID: PMC7760188

11. Pennings B, Boirie Y, Senden JMG, Gijsen AP, Kuipers H, van Loon LJC. Whey protein stimulates postprandial muscle protein accretion more effectively than do casein and casein hydrolysate in older men. Am J Clin Nutr. 2011 May;93(5):997–1005. PMID: 21367943

Do you know the signs of elder abuse?

Summer 2022 Newsletter

By Matthew Harmon, MSN, RN, CNE
School of Nursing
Arkansas State University

Older adults (over the age of 65) are commonly a target of abuse. In fact, one in six older adults are affected by some type of elder abuse. When one thinks of abuse, one may think of physical violence. In fact, the National Center on Elder Abuse notes seven different types including; physical abuse, sexual abuse, emotional abuse, financial/material exploitation, neglect, abandonment, and self-neglect.

Physical abuse encompasses bodily injury, impairment, or physical pain caused by physical force (NCEA, 2022). Noticing multiple bruises in different stages of healing is an important sign of abuse because it indicates separate instances of trauma at different times. Other worrisome signs would be bruises, black eyes, welts, broken bones, sudden change in behavior, broken eyeglasses, and broken hearing aids. It is not uncommon for an older adult to experience a couple of these signs after an accidental event like a fall. However, it would be more suggestive of abuse if several of these signs were noticed at different times, as it suggests recurring incidents related to abuse.

Sexual abuse is sexual contact of any kind that is not-consensual (NCEA, 2022). Signs of sexual abuse in older adults include the report of sexual abuse from the individual, or sudden change in emotional status (NCEA, 2022). This type of abuse is harder to notice for some due to the lack of observable symptoms in the abused.

Emotional abuse or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts (NCEA, 2022). This type of abuse consists of signs that are more behavioral-based. Signs that may suggest emotional abuse include irritability, isolating oneself, sudden change in emotional status, or report of emotional abuse.

Financial/material exploitation refers to the illegal or improper use of an elder’s funds, property, or assets (NCEA, 2022). This type of abuse may also be difficult to identify in other individuals. The main identifiers of this type of abuse would be sudden change in financial status, addition of names to bank cards and credit cards, and abrupt changes to will or other financial documents. According to Dominguez et al. (2022), recognizing this type of abuse should show special consideration to those who may live alone or who already have a degree of isolation.

Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder(NCEA, 2022). Being so, this type of abuse is found in individuals who require aid/caregiver for some aspect of their care. This can be an individual who is being taken care of by family, or even those being cared for in a facility. Signs of neglect include unsafe living arrangements, dehydration, starvation, poor hygiene, bed sores, among any other sign of abuse mentioned above.

Self-neglect characterized as the behavior of an elderly person that threatens his/her own health or safety(NCEA, 2022). The signs of this type of abuse mimic that of neglect as mentioned previously. The main difference of self-neglect to the other types of abuse is that this type of abuse has no identified abuser. Self-neglect is also different from neglect in that an individual who is a victim of neglect typically requires some type of supervision with their care while those who exhibit self-neglect do not.

Abandonment is the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder (NCEA, 2022). Abandonment may include the individual being abandoned at their home, or being abandoned at a medical facility. In some cases individuals may be abandoned at a public facility such as a supermarket, restaurant, or recreational area (NCEA, 2022).

If you or any older adults you know shows signs of elder abuse, several resources are available to help. First and foremost, if the matter is life-threatening, call 911 for immediate assistance. If the suspected abuse is occurring within a facility that the abused is housed at, contact administration of that facility. If you feel uncomfortable doing so, and wish to remain anonymous, you may call the Arkansas Department of Human Services, Office of Long-Term care at 1-800-582-4887 for residents in long-term care facilities. Victims of abuse are not always individuals in long-term care facilities, so if the person is not in a long-term care facility, and you suspect abuse call the Arkansas Department of Human Services, Adult Protective Services at 1-800-482-8049.

References

Fraga Dominguez, S., Ozguler, B., Storey, J. E., & Rogers, M. (2022). Elder abuse vulnerability and risk factors: Is financial abuse different from other subtypes? Journal of Applied Gerontology, 41(4), 928-939. https://doi.org/10.1177/07334648211036402

National Center on Elder Abuse. (n.d.). Types of abuse. NCEA. Retrieved July 12, 2022, from https://ncea.acl.gov/Suspect-Abuse/Abuse-Types.aspx