Whitney Thomasson

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

Fall 2022 Newsletter

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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

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)

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

Preparing the Rising Generation of Healthcare Professionals

Summer 2022 Newsletter

By Denise Demers, PhD, CHES and Darshon Reed, PhD
University of Central Arkansas
Department of Health Sciences and Department of Psychology

With the recent exponential growth of the aging population (from 13.1% in 2010 to 16.9% in 2020) and the projected growth by 2050 reaching 22% of the total population in the nation (U.S. Census Bureau, 2018), focus on the aging population has become paramount. Adults over the age of 65 will likely reach and affect every aspect of our society in the coming months and years. Not only will it be imperative to have resources available to assist them, but also healthcare workers to provide such care. Strategies to improve this population’s health and quality of life are both varied and multiplicitous, ranging from community programs such as “Meals on Wheels” to local recreation center physical activity programs. From Geriatrics to Gerontology, systems and structures are being developed and put in place in order to adequately provide for the aging population. Now is the time to prepare the coming health care force to administer such programs and strategies.

To adequately prepare the rising generation of healthcare professionals, it takes a multidisciplinary approach. Not only are doctors and nurses needed, but community healthcare providers such as psychologists, health education specialists, and volunteer organizations. For decades, universities and colleges throughout the nation have begun to teach using a more experiential approach to their curriculum. Included in that curriculum are simulation labs (Coyne et al., 2021) and service learning (Furco, 1996) . Service learning has exploded in recent years, becoming the go-to teaching strategy for many higher education classrooms, whether in-person or virtually.

Recently at the University of Central Arkansas, one of the psychology courses focused on healthy aging. Everything within that class was seen through the lens of the aging population – each chapter from the text, additional articles, and blogs from the American Psychological Association Aging resources. Additionally, students spent time at two local senior care facilities interacting with the residents. During their time at the facilities, students played games, visited, and colored Easter eggs with the residents.

From this experience, over 90% of the students agreed or strongly agreed that their time at the Senior Center was a valuable experience for them. It not only helped them better connect with the content of what they were learning in class, but also helped them both increase in understanding of the problems and challenges of those residents in the facility, as well as how their work can make a difference in the world.

In order to meet the needs of the aging population, programs throughout the country need to focus on aging (Grady, 2011). Whether it be in research (Croff et al., 2020) or applying theory to application through experiential learning (Efthymiou et al., 2021; Kim et al., 2021; Niman & Chagnon, 2021) or virtual simulations (Coyne et al., 2021), such experiences like this are needed in our college classrooms and courses. To prepare the coming generation for “the impending crisis, which has been foreseen for decades, is now upon us” (Institute of Medicine, 2008), courses for the future healthcare professionals in all disciplines need to provide adequate content related to the aging population. Likewise, faculty must also prepare themselves by using multidisciplinary and interprofessional programs that give students the benefits of experiential opportunities with the aging population.

References

Coyne, E., Calleja, P., Forster, E., Lin, F. (2021). A review of virtual-simulation for assessing healthcare students’ clinical competency, Nurse Education Today, Jan;96:104623. doi: 10.1016/j.nedt.2020.104623. Epub 2020 Oct 10. PMID: 33125979.

Croff, R., Tang, W., Friedman, D. B., Balbim, G. M., Belza, B. (2022). Training the next generation of aging and cognitive health researchers, Gerontology & Geriatrics Education, 43:2, 185-201, DOI: 10.1080/02701960.2020.1824912

Efthymiou,L., Ktoridou, D. Epaminonda,E. (2021) A model for experiential learning by replicating a workplace environment in virtual classes, IEEE Global Engineering Education Conference (EDUCON), pp. 1749-1753, doi: 10.1109/EDUCON46332.2021.9453966.

Furco, A. (1996). Service-Learning: A balanced approach to experiential education. Expanding Boundaries: Service and Learning 1 (1):2–6.

Grady PA. (2011). Advancing the health of our aging population: A lead role for nursing science. Nurs Outlook. Jul-Aug;59(4):207-9. doi: 10.1016/j.outlook.2011.05.017. PMID: 21757076; PMCID: PMC3197709.

Kim, M. J., Kang, H. S., De Gagne, J. C. (2021). Nursing students’ perceptions and experiences of using virtual simulation during the COVID-19 pandemic. Clinical Simulation in Nursing, 60, 11-17.

Niman, N. B., & Chagnon, J. R. (2021). Redesigning the Future of Experiential Learning. Journal of Higher Education Theory and Practice, 21(8). https://doi.org/10.33423/jhetp.v21i8.4507

U.S. Census Bureau, Current Population Reports, Estimates of the population of the United States by single years of age, color, and sex: 1900 to 1959 (Series P-25, No. 311); Estimates of the population of the United States, by age, sex, and race: April 1, 1960, to July 1, 1973 (Series P-25, No. 519); Preliminary estimates of the population of the United States by age, sex, and race: 1970 to 1981 (Series P-25, No. 917); and Intercensal estimates for 1980–1989, 1990–1999, and 2000–2009. The data for 2010 to 2020 are based on the population estimates released for July 1, 2020. Data beyond 2020 are derived from the national population projections released in September 2018. Some estimates have been revised since previous publication in America’s Children.

Verkuyl, M., Oona St-Amant, O., Lynda Atack, L., Diane MacEachern, D., Amanda Laird, A., Paula Mastrilli, P., Germayne Flores, G., Harper Soul Hamilton Gunn, H. P. S. (2022). Virtual simulations’ impact on clinical practice: A qualitative study, Clinical Simulation in Nursing, 68, 19-27. https://doi.org/10.1016/j.ecns.2022.04.001.

Choosing Wisely: Focused Recommendations to Improve Deprescribing Practices

Summer 2022 Newsletter

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

Older patients are at a higher risk of being prescribed multiple medications increasing their risk of negative effects from polypharmacy. Polypharmacy and inappropriate use of medications can increase the patient’s risk of falls, delirium, and hospitalizations. Deprescribing can help reduce polypharmacy and minimize any use of inappropriate medications³. Choosing Wisely is a tool developed by the American Board of Internal Medicine to promote conversations between patients and clinicians. Working closely with the American Society of Consultant Pharmacists, Choosing Wisely has outlined ten recommendations targeting appropriate prescribing practices.²It can be hard to keep so many recommendations in mind, so here is an easy way to organize them for use with patient care—4-3-2-1.

It’s no surprise that older adults have polypharmacy. There are four recommendations that highlight the problems with drug-drug interactions—particularly issues with bleeding and cognition, so each area has two recommendations.

Avoid use of two or more medications that can increase a patient’s bleed risk. Direct oral anticoagulants (DOACs), warfarin, aspirin, selective serotonin reuptake inhibitors (SSRIs), antiplatelet agents, nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can all increase the patient’s risk of bleeding. Carefully decide if the benefits outweigh the risk when combining these agents, and if yes, provide education and frequent monitoring.
Avoid the use of strong CYP3A4 and P-glycoprotein (p-gp) inhibitors or inducers with DOACs. DOACs (i.e., rivaroxaban, dabigatran, apixaban) combined with inhibitors of p-gp and CYP3A4 can lead to an increased risk of bleeding or therapeutic failure due to changes in metabolism.
Avoid prescribing three or more CNS-active medications. Combining antidepressants, benzodiazepines, Z-drugs (e.g., zolpidem), opioids, gabapentinoids, antipsychotics, and antiepileptics can lead to an increased risk of falls and fractures. Use non-pharmacologic options and the lowest effective dose as viable options for medication management.
Avoid combining opioids with benzodiazepines or gabapentinoids to treat pain in older adults. An increased risk of serious breathing difficulties may occur and can lead to death in those with chronic obstructive pulmonary disease or the elderly.

Three recommendations focus on reviewing the complete medication list with patient factors in mind to prevent adding/continuing drugs that are not needed.

Before prescribing medications for new symptoms, ensure that it is not an adverse drug reaction (ADR) from a current medication. Prescribing cascades can occur when new medications are added to treat ADRs from a patient’s current medication.
Perform a complete medication review prior to continuing medications at transitions of care. Negative outcomes are associated with continuing medications that are no longer indicated for the patient.
Assess goals of care, time-to-benefit for medications, and the presence of comorbidities for older adults with limited life expectancy. Many drugs (e.g., cholinesterase inhibitors, memantine, and statins) have questionable benefit when a patient is near the end of life.

Two recommendations are specific to avoiding use of anticholinergic medications.

Avoid use of highly anticholinergic medications in older adults without considering safer alternatives or non-pharmacological options. Anticholinergic medications include first generation antihistamines (diphenhydramine, doxylamine), tricyclic antidepressants, gastrointestinal antispasmodics, antiemetics, urinary incontinence medications, and medications for Parkinson’s disease. These medications are associated with an increased risk of dementia, cognitive impairment, and excess sedation.
Avoid concomitant use of anticholinergic medications with cholinesterase inhibitors for treatment of dementia. The two medication classes exhibit opposing actions; therefore, anticholinergics will decrease the efficacy of cholinesterase inhibitors.

The last recommendation focuses on tramadol in particular.

Avoid prescribing tramadol for older adults without consideration of fall risk, serotonergic excess, seizures, and drug-drug interactions. Potential for serotonin syndrome, hyponatremia, tramadol-induced seizures, and hypoglycemia are all possible side effects that are harmful for older adults contributing to falls and fractures. The risk of these effects is increased with a decrease in renal function.

Conversations about medications between pharmacists, prescribers, other health care professionals with patients and their caregivers provides awareness of the benefits and harms of medications. Shared decision-making is imperative when optimizing a patient’s medication regimen to improve outcomes, avoid unnecessary adverse effects, and better manage chronic conditions¹.

References:

Liacos M, Page AT, Etherton-Beer C. Deprescribing in older people. Aust Prescr. 2020;43(4):114-120. Published 2020 August 03.
Ten Things Physicians and Patients Should Question. Choosing Wisely. American Society of Consultant Pharmacists, American Board of Internal Medicine. Published 2022 June 04.
Wu H, Kouladjian O’Donnell L, Fujita K, Masnoon N, Hilmer SN. Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions. Int J Gen Med. 2021;14:3793-3807. Published 2021 Jul 24.

Managing a Healthy Dietary Pattern with Inflation and Rising Food Costs

Summer 2022 Newsletter

By Laura Stilwell, M.Ed.
Education Coordinator
UAMS Arkansas Geriatric Education Collaborative (AGEC)

The Arkansas Geriatric Educational Collaborative (AGEC) provides nutrition education and cooking tips for older adults in our monthly Facebook Live program, “From Our Kitchen to Yours.” Two AGEC community programs provide healthy nutritional information as well: Eat Well, Live Well, and Healthy Brain, Healthy Heart. These two programs can be presented either in person or via zoom. They’re also available on-demand online at patientslearn.uams.edu/agec. The program content follow the recommendations outlined in the Dietary Guidelines for Americans 2020-2025 published by the USDA. The Guidelines outline a dietary pattern for older adults that is predominately plant-based and follows the Mediterranean Dietary pattern. (USDA, 2021)

The USDA has published the April 2022 forecasts of the consumer price index. As summarized by the United States Department of Agriculture (USDA) food inflation is reported in two categories: food-away-from-home (restaurant purchases) and food-at-home (grocery store purchases). Restaurant purchases were 6.9% higher in March 2022 than March 2021. Grocery purchases were 10% higher in March, 2022 than one year ago. Meat groups were the grocery category experiencing the highest increases, (predominately beef), with fresh vegetables having the least increase in pricing. Many factors contribute to rising prices in food purchasing, one of which being the impact of the Ukrainian conflict. Increased fuel costs for transportation of goods and supply chain disruptions also play a major role in higher food costs. (USDA, 2022) The COVID-19 pandemic also disrupted the supply chain for supermarkets, making dietary staples difficult to find. Additionally, job losses due to the COVID-19 pandemic decreased spendable income for older adults. (USDA, 2022) Indirectly, the increase in interest rates by the Federal Reserve is also expected to negatively impact spendable income. (USDA, 2022)

In simple terms, food prices are on the rise in 2022. Supply for many products is low. Transportation costs are high. Income available for grocery expenses is trending down due to higher interest rates, higher energy costs, and overall inflation. In the current economic market, planning ahead and shopping wisely can allow older adults to maintain a healthy dietary pattern and a manageable food budget. Using tools outlined in MyPlate.gov and utilizing community food resources, older adults can save money and find supplemental food sources in the community. (USDA, 2022)(NCOA, 2022)
The USDA provides shopping and budgeting tools in the MyPlate plan at MyPlate.gov. Menu plans, recipes, shopping lists, and strategies for saving are all outlined under the Tools section at Myplate.gov. While shoppers are faced with high meat prices, a shift toward a more plant-based dietary pattern may be beneficial. Realigning food choices to plant protein sources is recommended in the Dietary Guidelines for Americans as well as the Mediterranean and DASH Dietary models. (USDA, 2021) By choosing vegetables and fruits that are sourced locally and are in season, it’s easier to enjoy fresh fruits and vegetables at a more comfortable price point than buying foods that are imported or transported long distances. Foods that are transported long distances and have lengthy storage reflect the high cost of fuel and storage energy. (USDA, 2022)

For older adults who may be on a fixed income, food price inflation causes concern about day-to-day expenses. In addition to planning carefully and spending food dollars wisely, there are programs designed to help older adults with their food needs. Beyond the rapidly rising costs of food, many older adults have other financial or social factors such as fixed incomes or a lack of food accessibility that make them especially vulnerable to food insecurity. There are a variety of local and national agencies available to older adults to combat food insecurity. One such agency is the National Council on Aging. The (NCOA) provides information for food assistance for older adults; eligibility for food assistance may be determined by visiting BenefitsCheckup.org and entering a local zip code. (NCOA, 2022) Food banks are located across the United States and provide over sixty thousand meal programs that serve all fifty states as well as Washington D.C. and Puerto Rico. While the NCOA outlines federal benefits, Area Agencies on Aging coordinate the benefits at the local level. Arkansas Agencies on Aging administer the benefits for older adults in Arkansas. All seventy-five counties in Arkansas are divided into eight regions that receive nutritional support from the Arkansas Agencies on Aging. (Arkansas DHS, 2018)

The Meals on Wheels program provides in-home meal distribution to qualifying older adults. Supplemental Nutrition Assistance Program (SNAP) provides benefits to be used at retailers, farmers markets, roadside stands and Community Supported Agricultural programs (CSAs). Another program called the Senior Farmers’ Market Nutrition Program (SFMNP) also provides access to fresh locally grown produce. These benefits enable older adults to buy fresh fruits and vegetable and other nutritious foods. Another supplemental program is the senior food box program, officially called the Commodity Supplemental Food Program. This program, administered locally by Area Agencies on Aging, allows older adults to improve their daily dietary pattern with healthy surplus food from the USDA commodity food list. An individual senior food box contains staple items such as pasta, rice, canned fruits and vegetables, cheese, milk and cereal. In addition to Meals on Wheels and retail benefits through SNAP programs, local senior centers with administration through the Arkansas Area Agencies on Aging provide nutritional congregate meals, as well as transportation to these centers to allow older adults access to hot, nutritious meals in a group setting. These meals may be free, or available for a minimal cost. (NCOA)

The rising costs of food can be concerning, especially older adults. Through diligent planning and utilization of food resources, a healthy dietary pattern can be maintained through this economic cycle of high food prices. (USDA, 2022) Using planning tools from myplate.gov, along with resources available through the Arkansas Area Agencies on Aging, can allow eligible seniors to supplement food sources and reduce overall food expenses while on a fixed budget. Following the basic tips of planning meals for home dining, keeping healthy snacks on hand, and utilizing supplemental resources can help consumers navigate food inflation. Keeping a healthy dietary pattern on track and alleviating anxiety about finances is possible by having resources available for older adults for food purchase and accessibility. (NCOA)

References

Area Agencies on Aging 2018 – Arkansas department of human services. humansevices.arkansas.gov. (2018). Retrieved June 6, 2022, from https://humanservices.arkansas.gov/wp-content/uploads/2017_Senior_Benefits_Resource_Guide.pd_5-1.pdf

Dietary Guidelines Advisory Committee.(2020). Scientific Report of the 2020 Dietary Guidelines committee: Advisory Report to the Secretary of Agriculture and Secreary of Health and Human Services. U.S. Department of Agriculture, Agriculture Research Service, Washington, D.C. p 16-22, p.122-130.
https://www.dietaryguidelines.gov

Dong, D., Stewart, H., Don, X., & Hahn W., (2022, April). Quantifying Consumer Welfare of Impacts of Higher Meat Prices During Covid-19 Pandemic ERR 306. www.ers.usda.gov. Retrieved June 6, 2022 from
https://ers.usda.gov/webdocs/publications/103813/err-306.pdf?v21283

MacLachlan, M., & Sweitzer, M. (2022, April). Summary Findings food Price Outlook 2022.
www.ers.usda.gov. Retrieved May 25, 2022, from
https://www.ers.usda.gov/data- products/food-price-outlook/summary-findings

National Council On Aging. (2022, April 18). Food assistance for Older Adults Help to Gain Access to Healthy Food: Resources for Older Adults. www.ncoa.org. Retrieved May 25, 2022, from https://www.ncoa.org/article/help-to-gain-access-to-healthy-food-resources-for-older-adults

From the Director’s Desk

Spring 2022 Newsletter

Thank you to all of our AGEC health professional friends and peers for continuing to support AGEC programs and activities. We started off this year with more depressing COVID-19 Omicron news and a huge uptick in positive cases. However, we marched on and now as spring is emerging, we are once again having face-to-face programs and attending in-person events. Hooray! Our community participants have been very excited about getting back together face-to-face for evidence-based programs and activities and attendance has been great. The social isolation over the past two years has certainly taken its toll, but we are doing what we can to limit or even reverse its effect.

Over the past 3 months we have worked diligently to maintain programming and activities and our outcomes are great. For the clinical activities in March, we were excited to partner with Opioid Prevention for Aging and Longevity (OPAL) and UAMS’s Academic Detailing program at the Psychiatric Research Institute to provide 2 hours of continuing education on Naloxone to AGEC’s clinical partners at ARcare in England, Augusta, Cabot West, Bald Knob, Wynne and Benton. OPAL is also securing Naloxone kits which will be distributed to these clinics when available.

We continued to also provide many programs virtually. Highlights included several events via Zoom such as: Eat Well Live Well at the Benton Senior Center; Mental Health, Food, & Exercise with partners AARP & AR-Connect; Internet Safety via Zoom in partnership with the Central Arkansas Library System; Caregiver Resources with partner AARP; Kidney Health at the Bryant Senior Center; and Preventing Isolation in partnership with UCA students. The AGEC Age Wise podcast continues to be popular along with AGEC’s Facebook page where we now have over 2,400 followers. The program “Understanding Dementia & Alzheimer’s Disease” was presented for 28 UCA Consumer Science students in February, and a video caregiver story entitled “Dealing with Hardships While Caring for Parents” was released online for National Caregivers Day on 2/18/22, with over 2,800 views.

Health Professional trainings have also been active with over 200 attendees this past quarter. Webinars included: Immunization 2022: Communication & Science Update (1/12/22); and The Importance of Hearing in Healthy Cognitive Aging (2/16/22). On 2/8/22, The Challenges and Opportunities: Working with Rural CBOs, was presented to a national audience during a GWEP-CC Peer Sharing Webinar, and the AGEC webinar for March was in partnership with OPAL with Kirk Lane, AR Drug Director, titled Arkansas Naloxone Project.

AGEC has also been excited to get back out in the community presenting evidence-based programs and activities face-to-face at local communities of faith and senior centers. Older adults are attending these programs and enjoying meeting again with their peers! We at the AGEC thank all of you for your loyalty and partnerships; we could not reach all the healthcare professionals, students, or older adults without all of you! Thank you!!!

Weight Loss in Older Adults: Can We Stop the Losing Battle?

Spring 2022 Newsletter

By Haylee Whitehurst, Occupational Therapy Doctorate Student
College of Nursing & Health Professions
Arkansas State University
Edited by Jessica Camp, DNP, APRN, AGCNS-BC, NE-BC, CDP

Did you know?

Unintentional weight loss occurs in 15%- 20% of older adults and is associated with increased morbidity and mortality.

Background/Significance of Unintentional Weight Loss in Older Adults

It can be difficult to notice gradual changes in a loved one when family members see them frequently. That’s why, as professionals, we must keep an eye out for weight changes over time. Weight loss can be due to inadequate food intake as well as other contributing factors that may indicate an underlying health, behavioral, or emotional issue. Some overweight aging adults can benefit from healthy weight loss to relieve pressure on joints and heart function. In these cases, it is important that weight loss is controlled and on purpose so the individual is losing fat and not valuable muscle mass. However, when weight begins to drop off unintentionally, whether the aging adult could benefit from some weight loss or not, medically speaking the risks to their health can be very serious. Following unintentional weight loss, the immune system can deteriorate, leaving an older adult more vulnerable to infection and illness with a weakened ability to recover. An aging adult may experience fatigue as weight and overall health decline, which can prevent activity, exercise, and social participation. If they do lose weight in muscle mass, the aging adult will weaken and may be at greater risk of falls and injuries, which can be very dangerous for older adults (Gaddey & Holder, 2014).

Share These Tips with Families to Help Prevent Unintentional Weight Loss in Older Adult Patients

Add spices and color to food
1. If your family member has lost the sense of taste, then they might not be excited about eating. Consider incorporating some hot pepper, mustard, sage or other spices and flavorings in your loved one’s next meal.
Consider supplements
1. Supplements can nourish your loved one’s body and prevent malnutrition. Ask your family member’s doctor or registered dietitian what supplements would be the most appropriate.
Exercise with your loved one
1. Physical activity can improve appetite, so encourage your family member to exercise a few times a week. For example, you can go on a walk or take an aerobics class. Regular exercise will also improve bone strength and boost the immune system.
Prepare snacks
1. If your family member isn’t consuming enough calories during meal times then prepare some healthy snacks. For example, cauliflower, broccoli, and carrots, are packed with vitamins and minerals older adults need to thrive. Almonds, fresh fruit, and boiled eggs are other great snacks. For additional calories, peanut butter, cheese, puddings and other easy-to-eat foods may be suggested.
Check medications
1. If your family member takes medication that causes swallowing difficulties, nausea, or dry mouth, it can negatively affect his or her appetite (Gaddey & Holder, 2014). Voice your concerns to your loved one’s doctor and have that doctor reevaluate these medications to see if adjustments can be made.

Treatment Options

Determining the specific cause of weight loss can lead to a clearer course of action for us as professionals, whether it be a medical, dental, psychological, financial, or lifestyle solution. Treatment often involves a multidisciplinary team, including dentists; dietitians; speech, occupational, or physical therapists; and social service workers (Gaddey & Holder, 2014). Do your part by recognizing unintentional weight loss and assessing the cause, bringing attention to the treatment team, or making appropriate referrals when needed.

Everyone’s metabolism naturally slows down as they age, so it makes sense that an older adult will eat less food than they used to. It’s important to give extra attention to the nutrient quality and caloric density of food to ensure that they get adequate vitamins and minerals, especially if they may have digestive difficulties. There are ways to make meals more appealing to older adults with declining appetites and ways to make meals more accessible even for those with dental problems. It can also be a significant advantage, if you can encourage friends and family to sit down for meals together with the older adult so they have companionship and encouragement to eat whenever possible.

Common Strategies to Address Unintentional Weight Loss in Older Adults:

Dietary changes
Environmental modifications
Nutritional supplements
Flavor enhancers
Appetite stimulants

Resources for Professionals to give to Family Members

Areas Agencies on Aging (AAA)
- Meals on Wheels
- Senior Centers
- Transportation options
Division of Aging, Adult, & Behavioral Health Services (DAABHS)
Program of All-Inclusive Care for the Elderly (PACE)
Senior Community Service Employment Program

References

Gaddey, H. L., & Holder, K. (2014). Unintentional weight loss in older adults. American Family Physician, 89(9), 718–722. https://www.aafp.org/afp/2014/0501/p718.html

Programs for Adults & Seniors. (n.d.). Arkansas Department of Human Services. Retrieved November 3, 2021, from https://humanservices.arkansas.gov/learn-about-programs/programs-for-adults-seniors/

Home Medication Management

Spring 2022 Newsletter

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

Many older adults have difficulty taking their medications every day at home. With chronic health conditions, daily medications are an important part of staying healthy just like eating a balanced diet and exercising regularly. Forgetting to take medications that are needed increases the risk of disease flare-up, hospitalization, and nursing home admission. Clinicians need to stay current on the options to help older adults stay independent in their homes or reduce the burden on caregivers.

A key factor in managing medications at home is to maintain a current list. This list should include all prescription medications as well as any medications a patient is taking without a prescription including over-the-counter medications, dietary supplements, vitamins, and herbal remedies. The medication name, dose, and directions should be included. The patient or caregiver should be educated on what each medication is for as well as how to take it and what should be expected, both therapeutic and adverse effects. It may be helpful to write this information on the medication list as a reminder or a reference. The patient/caregiver should keep this list in a convenient location such as a wallet or purse for when they have a doctor’s visit or an emergency. (Zonsius 2022)

The second factor in managing medications at home is to have a way to keep track of administration. Simple options include a calendar to mark off when medications are taken, or a daily administration record. They are available from some pharmacies, doctors’ offices, and the Internet, or a person can create their own. These charts can be posted on the refrigerator or other convenient location. Another option is a talking alarm which can be set to provide a reminder of when it is time to take your medication. See Figure 1 for examples of charts and alarms. People with smart phones can download an app which will provide reminders and allow tracking of when medications are taken. Some examples include MediSafe and DoseCast. (Treichler 2022)

Pill containers are another option that help a patient that just needs to see if they have taken their medications (or not) each day to help keep track. Also, they can be filled ahead of time by caregivers so a person can maintain independence with taking medications each day. These containers come in a wide variety. Most recognized are weekly containers with openings for 7, 14, or 30 days. These can be filled with medications that are needed for each day. Other pill containers are arranged with 4 administration times for each day of the week. (Figure 2)

Some high-tech products provide automatic dispensing of the medications when it is administration time. Alarms sound when it is time to take the medication so the patient can press a button for the tablet(s) to be dispensed. In this way, they prevent a person from opening up the containers when it isn’t time to take their medication. In addition, some can be connected to the Internet to allow monitoring of medication dispensed remotely by caregivers who can’t be present for each administration time. (Figure 3)

Individuals with low vision may benefit from larger print prescription labels. These can be request from most pharmacies. Pill containers as discussed above are often labeled in Braille for the days of the week or administration times. Other options are gadgets have been developed which are attached to prescription bottles or use a reading device programmed to provide talking prescription instructions.

Many pharmacies provide services that can be helpful in managing medications at home. Pill packing services involve preparing a blister pack for each administration time for medications. Often these are provided without additional charge. Pill packing services can be arranged by some local community pharmacies, particularly stores that are independently owned. Some mail order pharmacies also provide this service.

Another important service that community pharmacies provide is medication reconciliation and comprehensive medication review. As the number of prescriptions and over-the-counter medications a patient takes increases, it becomes more likely that a medication is continued that is no longer needed, a drug-drug interaction is occurring, or administration instructions get confused between different medications. Pharmacists are trained to review each medication to determine if any of these concerns are occurring and can work with providers to assure a patient is on an optimal medication regimen. Having fewer medications to take is another way to help with managing medications at home. A medication reconciliation and review is recommended for all older adults each time a medication is prescribed. (LeBlanc 2015)

In conclusion, health care professionals need to be aware of the many options for helping patients manage medications at home. Medication education and reconciliation go hand-in-hand with tools and devices designed to keep medication administration safe and convenient for our older patients.

Figure 1: Examples of Alarms and Charts

Figure 2: Pill Container Examples

Figure 2: Automatic Pill Dispenser Examples

References:

LeBlanc RG, Choi J. Optimizing medication safety in the home. Home Healthcare Now, 2015; 33:313-9

Treichler C. The 10 best medication reminder apps for 2022. Onlinedoctor January 16. 2022. https://www.onlinedoctor.com/best-medicine-reminder-apps/ . Accessed April 12, 2022.

Zonsius MC, Myftari K, Newman M, Emery-Tiburcio EE. Optimizing older adults’ medication use. AJN, 2022; 122:38-43.