Arkansas State University

Falling Matters: What you need to know about home fall prevention for your patients

Fall 2021 Newsletter

By Kylie Murphy, OTS, BS
Occupational Therapy Student, College of Nursing & Health Professions
Arkansas State University
Edited by Jessica Camp, DNP, APRN, AGCNS-BC, NE-BC, CDP

SIGNIFICANCE OF FALLING FOR OLDER ADULTS & POSSIBLE INTERVENTIONS

According to the Centers for Disease Control and Prevention (CDC) (2020, p. 1), “around 36 million older adults fall each year, resulting in more than 32,000 deaths.” Falls in the older adult population can result in broken bones and head injuries. Falling is not a normal part of aging. Falls are a result of physical changes or poor home environmental setup. There are multiple sources available which can aid providers in having conversations with their patients to help prevent home falls.

According to the CDC (2018) and Mayo Clinic (2019), some fall prevention options for providers to discuss with patients include suggesting patients:

• schedule yearly eye and foot examinations
• add grab bars near bathtub and toilet
• have plenty of light throughout the home
• get plenty of exercise
• store items within easy reach
• use assistive devices when needed
• remove throw rugs
• keep an updated list of medications
• maintain a clutter-free home

Additional things to consider when talking with patients about preventing falls at home, should include adding their vitamins, supplements and over the counter medications to their list of home medications. Patients need to know that all their daily medications are important to include.

Patients also need to know that vision changes are a normal part of aging and that these changes can influence a person’s fall risk. Eye examinations from an optometrist are critical in identifying eye problems early on. Explain to patients that some common eye problems they will be screened for may include glaucoma, cataracts, macular degeneration, diabetic retinopathy, and conjunctivitis. All of these eye conditions can influence a person’s fall risk.
Foot examinations should be performed during a yearly check-up like a Medicare Annual Wellness Visit. Providers should check sensation, blood flow, and changes to the shape of the feet. Instruct the patient remove their shoes and socks when seating them in your exam rooms or other treatment areas.

Another intervention is the reduction of clutter and good lighting in your clinical areas, just like we would the home environment to be. Reducing clutter and having good lighting reduces tripping hazards that may cause falls when patients come to visit you. Modeling a safe environment can provide visual examples for you to use when discussing a patient’s home environment modifications.

Another critical aspect in reducing fall risk for your patients is to promote a healthy lifestyle. Exercises that promotes balance, strength, and coordination such as, Tai Chi, will help prevent falls for an aging individual in your care. Devices such as a plastic seat in the shower or a raised toilet seat can be helpful to patients who have fallen in the bathroom. These items can provide a stable surface when doing daily activities and may have some coverage by insurances.
Resources to share with your patients and families can sometimes be challenging to locate when you are busy working. Below are some online resources for family members and caregivers that provide more information on home fall prevention in older adults. Please share them with your patients and their families:

• Fall prevention resources for older adults and caregivers
https://acl.gov/FallsPrevention
• Debunking the Myths of Older Adult Falls
https://www.ncoa.org/article/debunking-the-myths-of-older-adult-falls
• Video on 6 steps to prevent falls from the National Council on Aging (NCO)
https://www.ncoa.org/article/preventing-falls-tips-for-older-adults-and-caregivers
• 18 Steps to Fall Proofing Your Home from the NCO
https://www.ncoa.org/article/18-steps-to-fall-proofing-your-home
• Evidence-Based Falls Prevention Programs from the NCO
https://www.ncoa.org/article/evidence-based-falls-prevention-programs
• Eldercare Locator
https://eldercare.acl.gov/Public/Index.aspx
• National Assistive Technology (AT) Program search
https://www.at3center.net/stateprogram#
• CDC- Adult fall prevention resources
https://www.cdc.gov/falls/resources.html

References
Centers for Disease Control and Prevention . (2018). Family caregivers: Protect your loved ones from falling . https://www.cdc.gov/steadi/pdf/STEADI-CaregiverBrochure.pdf
Centers for Disease Control and Prevention . (2020). Injury prevention & control: Keep on your feet. CDC. https://www.cdc.gov/injury/features/older-adult-falls/index.html#:~:text=About%2036%20million%20older%20adults,bones%20or%20a%20head%20injury
Mayo Clinic Staff. (2019). Fall prevention: Simple tips to prevent falls. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/fall-prevention/art-20047358

The Importance of Vitamin D in the Wintertime

Winter 2021 Newsletter

By Dr. Audrey Folsom, DHSc, MSHS, MT(ASCP), Assistant Professor of Clinical Lab Sciences, and Mr. Eric West, MBA, DTR, Assistant Professor of Dietetics
Arkansas State University

Vitamin D deficiency and insufficiency affects individuals across all ethnicities and age groups, but older adults are especially vulnerable. Vitamin D deficiency is a widespread problem, which is attributed to many different factors, including lifestyle and environmental factors.

Vitamin D is an essential component for bone health, helping stave off the development of osteomalacia (bone softening), aiding in preventing muscle weakness, and minimizing bone fractures due to falls. The absorption of vitamin D through UVB-irradiation from sun exposure becomes less efficient in older adults, therefore vitamin D deficiency has become more prevalent in this population (Boucher, 2012). Other factors such as reduced appetite, taking multiple medications, and being under stress add to the prevalence of this deficiency. (Boucher, 2012; Kweder & Eidi, 2018)

Aside from the well-known association between vitamin D and bone health, there have been studies that indicate a correlation between low levels of the vitamin and an increased risk of developing oral, gastrointestinal, urinary, and even respiratory infections (Kweder & Eidi, 2018). Vitamin D has several critical roles in immunity and a deficiency can lead to a dysfunctional immune system. Additionally, if the deficiency is sustained, it can lead to the development of autoimmune conditions or cancers (AACC, 2020). Moreover, research indicates an association between low levels of vitamin D and diseases associated with aging such as cognitive decline, depression, osteoporosis, cardiovascular disease, hypertension, type 2 diabetes, and cancer (Meehan & Penckofer, 2014). With the high prevalence of vitamin D deficiency and its underestimation from many physicians, vitamin D deficiency has become a worldwide health issue (Kweder & Eidi, 2018).

A lack of vitamin D production by the skin during the winter months has been linked to Seasonal Affective Disorder (SAD), also known as the “winter blues”. Depression is linked to lower blood levels of vitamin D (Anglin, Samaan, Walter, & McDonlad, 2018). Normally, the body can manufacture enough vitamin D during the spring, summer and fall months to last through the winter. The body can store vitamin D in the liver and in fat cells (Harvard Health Publishing, 2007), and then use it to get through a winter season. However, because we now have desk jobs or work inside, and use sunscreen when we are outside during the summer, our body struggles to make and store enough to last through the winter months.

While the deficiency is commonly seen in the older adult, there are other contributing risk factors. They include dark skin pigmentation, impaired or poor skin integrity, reduced time spent outdoors and reduced exposure to sunlight, having a body mass index (BMI) greater than 30, and impaired renal function. It is also noted that females are at higher risk than males for vitamin D deficiency (Meehan & Penckofer, 2014). This higher risk comes from differences in body composition. Females (and overweight people) naturally have a higher body fat percentage than males. Vitamin D is a fat-soluble vitamin that gets trapped in fat cells, where it can no longer be used by the body (Donnelly Michos, n.d.). Therefore, a higher body fat percentage leads to lower vitamin D levels.

The best way to know if a vitamin D deficiency is present is to get tested. A primary care provider can order a 25-hydroxyvitamin D, the most abundant and common form of vitamin D found in the blood. This blood test requires no specific preparation and can be done during a regular check up. Once the results come back, the reference ranges for normal levels are indicated on the report, but it is worth noting that the Endocrine Society defines vitamin D deficiency as a 25-hydroxyvitamin D blood level below 20 ng/mL (50 nmol/liter) and vitamin D insufficiency as a level between 21–29 ng/mL (52.5–72.5 nmol/liter) (AACC, 2020).

If the test levels come back below the normal reference range, it is possible that this is due to a lack of sun exposure or a lack of absorption from the intestines, which is common with many bowel disorders such as irritable bowel syndrome, Crohn’s disease, etc. (AACC, 2020) A primary care provider can make a recommendation for supplementing with vitamin D3, which can be easily purchased at most pharmacies and grocery stores. Blood levels can be checked again after several months of supplementation to see if the dosage is adequate, excessive, or inadequate. It is important to get tested before supplementation is started, as high levels of vitamin D in the blood can lead to an accumulation of calcium in the kidneys and blood vessels, which could cause damage (AACC, 2020).

Foods rich in vitamin D include egg yolks and oily fishes, but the amount required to get enough vitamin D is more than the average person would eat. There are fortified foods such as milk and cereals, but even those do not provide enough. The two remaining solutions are to get more sunshine or to supplement. Getting more sunshine can be tricky for those who live in the northern states due to the low angle of the sun’s rays during the winter months, which decreases UVB absorption by the skin. This doesn’t even factor the increased amount of time we spend indoors due to the winter weather. Therefore, most primary care providers will recommend a supplement to get blood levels up. (Harvard Health Publishing, 2007)

In conclusion, vitamin D is a crucial component of a healthy life, especially in older adults. Adequate levels can help keep the diseases of aging at bay. Vitamin D deficiency can be attributed to our modern lifestyle, which keeps us indoors year-round, as well as other risk factors such as being female, having a darker skin pigmentation, and being overweight. Testing is the only way to know if a deficiency is present, and supplementing with vitamin D should be undertaken under the direction of a primary care provider.

References

AACC. (2020, December 4). Vitamin D Tests. Retrieved from Lab Tests Online: https://labtestsonline.org/tests/vitamin-d-tests

Anglin, R., Samaan, Z., Walter, S., & McDonlad, S. (2018, January 2). Vitamin D Deficiency and Depression in Adults: Systematic Review and Meta-Analysis. Retrieved from Cambridge University Press: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/vitamin-d-deficiency-and-depression-in-adults-systematic-review-and-metaanalysis/F4E7DFBE5A7B99C9E6430AF472286860

Boucher, B. J. (2012). The Problems of Vitamin D Insufficiency in Older People. Aging and Disease, 313–329. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3501367/

Donnelly Michos, E. (n.d.). How Does Vitamin D Affect Women’s Health? Retrieved January 7, 2020, from Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/wellness-and-prevention/how-does-vitamin-d-affect-womens-health

Harvard Health Publishing. (2007, February). Vitamin D and Your Health: Breaking Old Rules, Raising New Hopes. Retrieved from Harvard Health Publishing : https://www.health.harvard.edu/staying-healthy/vitamin-d-and-your-health-breaking-old-rules-raising-new-hopes

Kweder, H., & Eidi, H. (2018). Vitamin D Deficiency in Elderly: Risk Factors and Drugs Impact on Vitamin D Status. Avicenna Journal of Medicine, 139–146. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178567/

Meehan, M., & Penckofer, S. (2014). The Role of Vitamin D in the Aging Adult. Journal of Aging and Gerontology, 60–71. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399494/

Ways to improve health in your geriatric patients

By Dalton Smith, ATC, 1st Year SPT
College of Nursing and Health Professions
Arkansas State University

In 2015 the world population of adults over the age of 60 was at 900 million but by 2050 that number is projected to be at 2 billion¹! With this we should expect our patient population demographics to shift towards these older adults, and with it our treatment strategies. The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”². Older adults are plagued with added stressors that accompany aging such as losing mental capacities and a decrease in functional ability. This leads to isolation, loneliness or even psychological distress and then add chronic illness or acute injuries and you’ve got the formula for a health disaster.

Healthy people 2020 objectives identify multiple areas to improve older adult health as a priority. But are we doing the best we can to help? Over the next few decades we will see these cases more and more. According to the CDC, Arkansans 50 years and over are among the leaders in the nation who report they rarely or never receive the social support they need³. So, the question is how can our healthcare professionals have a positive impact on health in our older patient population?

The first thing that can be done to help is to listen to our patients. Many of us know already that our patients want to talk about their lives, but did you know that adequate emotional and social support is associated with a reduced risk of mental illness, physical illness and mortality⁴? So talk to your patients, actually listen and support them. This is a very easy, yet effective, way to have a positive influence on your patients.

Another way to help is to offer encouragement! Encourage them to eat healthy diets, get involved in their community and get at least 30 minutes of physical activity a day. Studies have shown that having better physical health has a large effect on mental health and having better mental health has a stronger effect on current physical health⁵. Therefore encouraging older adults and providing resources about the importance of physical health will have a positive effect on their overall health.

Sometimes a little education is all that is needed. Many patients aren’t aware of the resources they have access to. Here are some things you can educate them about:

For patients interested in becoming more physically active, there are many locations that offer Silver Sneaker⁶ programs throughout the state.
Maybe they want to become more involved in the community but don’t know how. There are many opportunities to be found on volunteerar.org⁷ that they could explore or you could recommend based on their interests.
If transportation is an issue, there are services throughout the state that could help get them to and from healthcare visits.
Using ChooseMyPlate.org⁹ or referring to a registered dietitian, you would be able to give them the information they need to start them on a path toward a healthy diet. And AGEC offers a diabetes empowerment education program¹⁰ that is extremely beneficial to older patients living with diabetes.
There is an abundant amount of resources available to older adults in Arkansas ranging from abuse hotlines to foster grandparent programs. They can be found on humanservices.arkansas.gov¹¹ or even on the AGEC website under free community programs¹⁰.

At the end of the day it’s about finding ways to help people. Sure, we can inform them that eating well, participating in regular physical activity and not using tobacco will increase their well-being, but through listening we offer the support our patients need and can direct them to additional resources.

WHO (2019). Mental health of older adults. Available at: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults .
World Health Organization (1948). Constitution of the World Health Organization. Available at: http://www.who.int/governance/eb/who_constitution_en.pdf (Accessed 17 Jul. 2019).
Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Atlanta, GA: National Association of Chronic Disease Directors; 2008.
Strine TW, Chapman DP, Balluz L, Mokdad AH (2008). Health-related quality of life and health behaviors by social and emotional support: Their relevance to psychiatry and medicine. Soc Psychiatry Psychiatr Epidemiol 43:151-159.
Ohrnberger J, Fichera E, Sutton M. The dynamics of physical and mental health in the older population. J Econ Ageing. 2017;9:52–62. doi:10.1016/j.jeoa.2016.07.002
https://tools.silversneakers.com/LocationSearch
https://www.volunteerar.org/organization
https://www.care.com/c/stories/5841/arkansas-transportation-resources/
https://www.choosemyplate.gov/older-adults
https://agec.uams.edu/communityprograms/
https://humanservices.arkansas.gov/programs-services/services-by-group/senior

Suicide Prevention in the Older Adult Population

By Alex Henry, BS-CD & Hannah Speer, OTD/S
College of Nursing and Health Professions
Arkansas State University

Every day 10,000 people turn 65 years old (Heimlich & Heimlich, 2014). Because of this, the elderly adult population is increasing rapidly. Of this elderly population, 40% will need some form of long term care whether it be an assisted living facility or a nursing home (Mezuk, Lohman, Leslie, & Powell, 2015). The rapid growth of this cohort makes one percent of elderly adults who commit suicide extremely alarming (Mills, Gallimore, Watts, & Hemphill, 2016). Adults 65 years and older, specifically men, have a suicide rate of 30 per 100,000 (Mezuk, Lohman, Leslie, & Powell, 2015). Forma et al. (2017) found that of elderly adults who committed suicide, 70% had been admitted to the hospital within the last two years. Of the 70% who committed suicide, 36.8% had been discharged from the hospital within the previous month. There are many factors to consider in looking at suicide in the elderly population. The elements can be as personal as social isolation, feeling like a burden to the family, depression as well as facility issues such as high staff turnover and the number of beds (Mezuk, Lohman, Leslie, & Powell, 2015). This significant number of factors coincides with an alarming rate of suicide in the elderly population. These factors should be taken into consideration by the facility staff both in the hospital and in long term care facilities. Staff, especially nurses, should be educated to identify risk factors of depression and suicide and to monitor the mental health of the patients.

A research study conducted by Mospan, Hess, Blackwelder, Grover, & Dula (2017) recognized the role of the primary care provider in taking properly monitoring patients at risk for suicide. The researchers found that nurses rarely used their knowledge of suicide prevention (p. 537). They suggested an educational intervention which provided a variety of online, live, and asynchronous learning activities (for example) to help bridge the gap. Cheryl et al. (2013) conducted a study involving the competencies for educating advanced practice and general psychiatric mental health nurses. The researchers found that there are no standard competencies for teaching or assessing suicide risk. However, the American Psychiatric Nurses Association’s position on this topic is that it is the individual nurse’s responsibility to complete research for his or her evidence-based practice to treat patients with mental illness (Cheryl et al., 2013). Based on these studies, student nurses and nurses already in the field should both be able to detect signs of suicide in their elderly patients and to learn about suicide prevention. All facility staff, nurses especially, should take the initiative in developing their skills to understand the risk of suicide in their patients better.

References

Mospan, C., Hess, R., Blackwelder, R., Grover, S., & Dula, C. (2017). A two-year review of suicide ideation assessments among medical, nursing, and pharmacy students. Journal of Interprofessional Care, 31(4), 537-539. doi: 10.1080/13561820.2017.1301900

Cheryl, P., Janet, Y., Barbara, L., Pamela, G., Eric, A., & Deborah, H. (2013). Competency-based training for PMH nurse generalists: Inpatient intervention and prevention of suicide. Journal of the American Psychiatric Nurses Association, (4), 205. Retrieved from https://doi.org/10.1177/1078390313496275

Heimlich, R., & Heimlich, R. (2014, February 07). Baby boomers retire. Retrieved from http://www.pewresearch.org/fact-tank/2010/12/29/baby-boomers-retire/

Forma, L., Aaltonen, M., Pulkki, J., Raitanen, J., Rissanen, P., & Jylha, M. (2017). Care service use in 2 years preceding suicide among older adults: Comparison with those who died a natural death and those who lived longer. European Journal of Ageing, 2, 143. Retrieved from https://doi.org/10.1007/s10433-016-0397-9

Mills, P. D., Gallimore, B. I., Watts, B. V., & Hemphill, R. R. (2016). Suicide attempts and completions in Veterans Affairs nursing home care units and long-term care facilities: a review of root-cause analysis reports. International Journal of Geriatric Psychiatry, 31(5), 518. Retrieved from https://ezproxy.library.astate.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=114190206&site=eds-live&scope=site

Mezuk, B., Lohman, M., Leslie, M., & Powell, V. (2015). Suicide risk in nursing homes and assisted living facilities: 2003-2011. American Journal of Public Health, 105(7), 1495–1502. https://doi.org/10.2105/AJPH.2015.302573

World Health Organization. (2014). Preventing suicide: A global imperative. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/131056/9789241564779_eng.pdf;jsessionid=61FB77728ABF43079DC58810EFB7F8B0?sequence=1

Tech and Aging

Arkansas State logo

By Jessica Camp, MSN, APRN, AGCNS-BC
College of Nursing & Health Professions, Arkansas State University

It appears that more older adults are using technology in their daily lives (Davis, 2019). According to a study by AARP, mobile devices and computers are the primary technology used by this population (Anderson, 2017, p. 3). To a lesser extent, older adults reported managing their healthcare and learning with this technology. Another study by PEW Research Center Older Adults and Technology Use (Smith, 2014) found that:

Six in ten seniors now go online
Just under half are broadband adopters
Younger, higher-income, and more highly educated seniors use the internet and broadband at rates approaching—or even exceeding—the general population
Internet use and broadband adoption each drop off dramatically around age 75
27% of older adults use social networking sites such as Facebook, but these users socialize more frequently with others compared with non-SNS users
E-readers are as popular as smartphones

Sadly, however, Davis (2019) points out that the design of technology used by older adults rarely focuses on them. This article aims to shed a bit of light on some of the technology that may be useful or even helpful for older adults and technology that is actually designed for the older adult.

Interestingly enough, these are not the only technology-based items, nor services, available to older adults. Currently, there is a multitude of technological products marketed specifically for older adults. Nextavenue contributing write Patricia Corrigan shared an overview on several tech items that can help older adults who serve to maintain their independence, such as:

Wearable battery-operated emergency alert systems (such as Philips Lifeline), which detect falls and summon help
The Apple watch (Series 4), which monitors your heart rhythm and detects falls
Some cell phones (such as GreatCalla), which offer emergency response buttons
Voice-controlled devices (such as LifePod), which work with “smart” speakers to remind you when to take your medication or head to a medical appointment
Cameras, microphones and motion sensors (Evermind makes one version), which monitor your regular activity — or signal a lack of it to your caregiver (2018, para. 2)Surprising to this author, there is a company offering transportation normally available through the use of technology to older adults. One company provides transportation for older adults by turning traditional on-demand transportation systems (like Uber, for example) already in place into senior-friendly transportation. Older adults can call an eight-hundred-number and press a few buttons once registered, to obtain a ride, and even return home all the while sharing information with the family about their activity through messaging communication. This service charges twenty-seven cents per minute currently in addition to the service rate charged by the transportation company for the travel. Unfortunately, it is not yet available in all parts of Arkansas. However, the zip code 72002 for Little Rock provided the following rates (from their website):
Not surprising, there is more than one company that markets cell phones, including smartphones, to our older adults. One such company touts that they are the home of the “original easy-to-use cell phone” (Greatcall, 2019a, para. 1). They also offer a family caregiving device that includes a wearable communicator designed for two-way communication, fall detection, and GPS locating features that are reportedly waterproof. Further, they offer a version of this that tracks fitness and looks similar to the traditional wearable device providing the same features (Greatcall, 2019b). Another company offers more conventional cell phones with some additional services designed for urgent and emergent communication around the clock (Snapfon, 2019, para. 1-3).

Ride Fare:
$3.60 base fare + $0.76 per mile + $0.15 per minute (with a minimum fare of $7.60)

and
Concierge Fee:
$0.27 per minute

* Please note that during periods of high demand, our vendors may include a surge charge (gogograndparent.com, 2018)

Despite older adults still reporting skepticism regarding technology, the trend is up on use for most aspects. This article shows that there is no shortage of new ways technology is being garnered to help out older adults. Let this article encourage you to learn more about how technology can assist your older adult patients, your family or even yourself.

Smith, (2014). PEW report. Older Adults and Technology Use. PEW Research Center. Retrieved on January 14^th, 2019 from http://www.pewinternet.org/2014/04/03/older-adults-and-technology-use/

Anderson, M., & Perrin, A. (2017). PEW Report. Technology Use Among Seniors. PEW Research Center. Retrieved on January 14^th, 2019 from http://www.pewinternet.org/2017/05/17/technology-use-among-seniors/

Abrahms, S. (2015). 3 Must-have cell phones for seniors. Retrieved on January 17^th, 2019 from https://www.forbes.com/sites/nextavenue/2015/06/17/3-must-have-cell-phones-for-seniors/#238490ce6cce

Greatcall. (2019a). About us. Retrieved on January 17^th, 2019 from https://www.greatcall.com/about-us

Greatcall. (2019b). Feel safer on the go. Retrieved on January 17, 2019 from https://www.greatcall.com/devices/lively-mobile-medical-alert-system

Snapfon & Excellcious Communications LLC. (2019). Easy to use features. Retrieved on January 17, 2019 from https://www.snapfon.com/big-button-cell-phone/

Snapfon & Excellus Communications LLC. (2019). sosPlus mobile emergency management services. Retrieved on January 17, 2019 from https://www.snapfon.com/sos-plus/

GoGoGrandparent. (2018). How it works. Retrieved on January 17, 2019 from https://gogograndparent.com/

Corrigan, P. (2017). Technology can help us age in place, if we let it. Nextavenue: Where Grown-ups Keep Growing. Retrieved on January 14^th, 2019 from https://www.nextavenue.org/technology-age-in-place/

Anderson, G.O. (2017). Technology Use and Attitudes Among Mid-life and Older Adults. AARP Research. Retrieved on January 14^th, 2019 from https://www.aarp.org/content/dam/aarp/research/surveys_statistics/technology/info-2018/atom-nov-2017-tech-module.doi.10.26419%252Fres.00210.001.pdf

Interdisciplinary Collaboration in Simulation Education

By Dr. Patricia Guy-Walls, LMSW; Dr. Evi Taylor, LCSW and Sarah Eberwein, BSW
Arkansas State University

Simulation, particularly in healthcare, is becoming a popular modality for clinical education and training (Davies & Alinier, 2011). Through the creation of realistic scenarios and the use of innovative equipment, students are able to practice skills in real life like-settings until they are mastered (Green, Tariq, & Green, 2016). Simulation education enables students to gain the necessary skill sets needed for successful careers that cannot be acquired solely from textbooks and lectures. Simulation creates an opportunity for orientation to new procedures, exposure to rare clinical situations, assessment of knowledge, and evaluation of skills (Green et al., 2016). When providing optimal care, healthcare providers must be able to communicate with patients, their families, and other treatment team members. Therefore, interdisciplinary collaboration is an important factor in simulation education as it allows students to experience teamwork with students from other professions (Manning, Skiff, Santiago, & Irish, 2016). The Department of Social Work’s Simulation Training and Research (STAR) House is a new innovative approach in the College of Nursing and Health Professions at Arkansas State University. The STAR house was developed to “mimic” the conditions and tasks professionals may encounter while in a community setting. This article will provide a discussion of the STAR House and discuss how simulation training across disciplines can enhance students’ learning.

STAR House

Research consistently shows the effectiveness of simulation education in allowing students to practice their skills in real life-like situations. The benefits of simulation and interdisciplinary collaboration are well established in the literature (DiVall, Dolbig, Carney, Kirwin, Letzeiser, & Mohammed, 2014, 2014; Ertmer et al., 2010; Manning et al., Lateef, 2010 2016; Mooradian, 2008). The success of simulation education played a key role in the development of Arkansas State University’s Simulation Training and Research (STAR) House, the newest addition to the College of Nursing and Health Professions.

The STAR house is a furnished 2 bedroom, 1 bath house on Arkansas State University’s campus that can be staged to create a wide range of realistic experiences. For instance, social work students will practice family therapy skills in a real house, with a family, role-played by other students. The house can be staged with drugs, foul smells, bugs, loud noises, etc. and students will practice how to respond and provide services in these real-life like situations. The house can also be staged for students to assess safety for child welfare classes. There are video cameras throughout the house that record the students. This allows them to be evaluated by professors, classmates, as well as themselves. Watching the recordings provides valuable feedback as it enables students to see the techniques they need to improve.

The STAR House can be used by a variety of students including, social work, child advocacy, counseling, psychology, sociology, criminology, occupational therapy, physical therapy, nursing, and disaster preparedness. Community agencies such as the Division of Children and Family Services (DCFS) and law enforcement officials will also utilize the STAR house to conduct trainings. Each discipline can stage the house accordingly to provide an environment allowing students/workers and a team of individuals to practice and strengthen their skill sets.

The STAR House will utilize approaches that correspond with the way most adults learn: inductively, from specific to general, and through practice and feedback. This environment will provide an opportunity for students and professionals to improve their knowledge while assessing their skills. Participants will have the opportunity to develop skills for gathering and evaluating data, environmental assessment, effective interviewing and problem-solving. Students from multiple disciplines will participate in real-life situations where they can apply skills learned in the classroom and garner knowledge while dealing with real problems in a controlled, collaborative, learning environment. This new tool will add an essential component of professional practice through case studies and examples that present challenges that arise in everyday professional practice.

In conclusion, simulation education has been proven to be an effective and preferred method for learning among interdisciplinary teams. Research shows simulation has been instrumental and effective in demonstrating health care situations across the life span from how to handle emergency situations in labor and delivery (Davies & Alinier, 2011) to providing safe practices in home health care for seniors (MacDonald, Galbraith, Halliday, Smith, & Willett, 2013). Students and professionals utilizing simulation education experienced improvement in many areas including confidence, critical thinking, contextual perspective, logical reasoning, reflection, and communication (Ertmer et al., 2010). They also gained knowledge of their own roles and the roles of students from other professions (DiVall et al., 2014). As the first simulation house in Arkansas to be connected to a college campus, the Social Work Department housed in the College of Nursing and Health Professions has been given an extraordinary opportunity as a trailblazer to provide students with simulation experiences. Based on the current literature, it is anticipated that the students utilizing the STAR House will enhance their knowledge base (Lateef, 2019), improve retention of material learned (Oliva & Compton, 2009), and improve their communication and interactions with various healthcare professions (DiVall et al., 2014; Manning et al., 2016) which should allow them to provide more effective services to patients/clients.

References

Davies, J. & Alinier, G. The emergence of simulation-based clinical training outside of the Westernworld. Retrieved from https://www.researchgate.net/publication/275599317_The_growing_trend_of_simulation_as_a_form_of_clinical_education_a_global_perspective

DiVall, M. V., Kolbig, L., Carney, M., Kirwin, J., Letzeiser, C., & Mohammed, S. (2014). Interprofessional socialization as a way to introduce collaborative competencies to first-year health science students. Journal of Interprofessional Care, 28(6): 576-578. doi: 10.3109/13561820.2014.917403

Ertmer, P. A., Strobel, J., Cheng, X., Chen, X., Kim, H., Olesova, L., . . . Tomory, A. (2010). Expressions of critical thinking in role-playing simulations: Comparisons across roles. Journal of Computing in Higher Education, 22(2): 73-94. doi: 10.1007/s12528-010-9030-7

Green, M., Tariq, R., & Green, P. (2016). Improving patient safety through simulation training in anesthesiology: Where are we? Anesthesiology Research and Practice, retrieved from http://dx.doi.org.10.1155/2016/4237523

Lateef, F. (2010). Simulation-based learning: Just like the real thing. Journal of Emergencies, trauma, and shock. 3(4), 348-352

Manning, S. J., Skiff, D. M., Santiago, L. P., & Irish, A. (2016). Nursing and social work trauma simulation: Exploring an interprofessional approach. Clinical Simulation in Nursing, 12(12): 555-564. doi: 10.1016/j.ecns.2016.07.004

MacDonald, K., Galbraith, Y., Halliday, K., Smith, K., & Willett, T. (2013). Simulation for at-home care for seniors: An environmental scan. Toronto, ON: SIM-one; 2013

Mooridian, J. K. (2008). Using simulated sessions to enhance clinical social work education. Journal of Social Work Education, 44(3): 21-35. Retrieved from https://search.proquest.com/docview/209795274/fulltextPDF/560CE290E39347E4PQ/1?accountid=8363

Oliva, J. R., & Compton, M. T. (2009). What do police officers value in the classroom? A qualitative study of the classroom social environment in law enforcement education. Policing: An International Journal of Police Strategies & Management, 33(2): 321-338. doi: 10.1108/13639511011044911

Taghva, A., Rasoulian, M., Bolhari, J., Zarghami, M., Esfahani, M.N., & Panaghi, L. (2010). Evaluation of reliability and validity of the psychiatry OSCE in Iran. Academic Psychiatry, 34(2): 154-7

Watters, C., Reedy, G., Ross, A., Morgan, N. J., Handslip, R., & Jaye, P. (2015). Does interprofessional simulation increase self-efficacy: A comparative study. BMJ Open, 5(1): 1-7. doi: 10.1136/bmjopen-2014-005472

Creating a Gerontology-focused Health Fair

New CNHP ASU Logo

by Jessica E. Camp, MSN, APRN, AGCNS; Addie N. Fleming, MNSc, RN, CCRN; Valerie Fielder, BS, CDP, and Samantha M. Hollis, BSN, RN, CDP
Edited by Dr. Susan Hanrahan and Dr. Linda Tate
Arkansas State University, UAMS Center on Aging Northeast & Schmieding Home Caregvier Training Program, St. Bernards Medical Center

The committee designed a health screening event for older adults, their caregivers, and professionals that provide care to older adults. Northeast Arkansas has a large number of elderly, care givers, and a large variety of professional services. The event was designed to bring everyone together. It was planned for November to increase attendance by avoiding other area events and in conjunction with National Family Caregiver Month. The Fair gathered more than 200 patients and 90 vendors from the community. This article shares the successes of the event and the opportunities for next year.

Advisory Panel
The Center on Aging had a vision for the event. The mission and vision were shared with the team during recruitment and revisited at the initial meeting. An advisory panel consisted of the many health professionals, community members, university faculty and leaders from services for older adults in the area was invited to participate.

Health Screenings
The local university, ASU, provided a great foundation for creating a health screening event.

The physical therapy department provided “timed up and go” (TUG) screenings aimed at identifying balance issues and risk for falling. Social work faculty provided anxiety and depression screenings. Communication Disorders students provided hearing screens in a private room. Nursing students provided blood pressure checks, height, and weight and body mass index screenings. Dietary Approaches to Stop Hypertension (DASH) diet education was given verbally and in writing to persons at risk for or currently experiencing hypertension. Exercise, weight loss and the DASH diet can help control chronic illnesses, such as heart disease and diabetes, making it important information to share with older adults and their caregivers (Cash & Glass, 2015, p. 1047).

The Arkansas Department of Health provided vaccinations based on the Center for Disease Control and Prevention (CDC) recommendations for adults and older adults (Cash & Glass, 2015, pp.18-21). Hilltop Eye Care and Southern Eye Associates provided vision screenings and education on cataracts and glaucoma. St. Bernard’s Imaging Center conducted bone density screenings as well as total cholesterol, anemia, and glucose laboratory screenings. Higginbotham Family Dental provided dental screenings. Additional professionals were invited and provided services or information about services.

Transportation
Transportation for the public was not available to the event. This was noted by some persons unable to attend as a barrier. Requests to public transportation and local churches to enlist transportation assistance were not met. For the 2018 event, negotiations are in process.

Communication
Some screening groups left before the event ended which participants complained about. Critical conversations with the voluntary service professional groups will need to take place early in the planning of the 2018 event to ensure the professionals stay for the whole event, which could include shortening the event.

A secondary communication issue was not being able to hear announcements made at the event stage. With exciting activities such as the mayor’s appearance and a physician’s panel, it was difficult for the audience to hear anywhere past the first row of vendors. This is an opportunity that can be corrected for the 2018 Senior Expo (Larsen, 2018).

Professionals
Health professionals, caregivers, and patients were targeted to receive education during the event. Several vendors voiced a desire to attend the planned educational sessions, but were unable because they were also manning a booth at the event. In post-event discussions, it was decided that a separate educational event targeting health professionals could be a solution.

Vendors
While the volume of local vendors involved in the first annual event surpassed the goal, there were still challenges. Discussions with leaders of another local annual health fair shared tactics that prevented vendors from leaving their event early, such as imposing fines or not inviting them to future events.

In summary, these services met the needs of many older adults. Senior Health Fairs bring value to the intended audience. Targeted health fairs, such as this one, provide more opportunities for older adults to interact with health professionals in the community. With the success of the first event, the 2^nd Annual UAMS Center on Aging Northeast’s Senior Expo is scheduled for November 9, 2018.

References:

Cash, J. C. & Glass, C. A. (2016). Adult-gerontology practice guidelines. New York: Springer Publishing Company.

Larsen, P. (2018). Lubkin’s chronic illness: Impact and illness. Burlington, MA: Jones & Bartlett Publishing.

Rhoads, J. & Peterson, P. S. (2018). Advanced health assessment and diagnostic reasoning (3^rd ed.). Burlington, MA: Jones & Bartlett Publishers.

Does the use of hearing aids improve balance — fact or fiction?

by D. Mike McDaniel, Professor of Communication Disorders / Arkansas State University

Recently, a team of researchers from a prestigious medical school published the results of a study in which they reported that hearing aid use apparently resulted in improved balance within an elderly sample of hearing impaired individuals (Rumalla, Karim, and Hullar, 2015). These findings were subsequently summarized in a second tier publication favored by, and directed at those, who dispense hearing aids. A recent internet search using “hearing aids” and “improved balance” as key words resulted in an alarming number of sites across the country that dispense hearing aids citing the article and its claims as a marketing tool. Given the fact that the elderly have the greatest risks for falls, which are the leading cause of injury and death in the elderly, and the elderly exhibit the largest incidence for hearing impairment, if the use of hearing aids do improve balance then certainly this information should be disseminated from within the scientific community following extensive clinical trials.

The method by which the medical school chose to assess and report balance was primitive and did not represent current state-of-the-art technology. Fortunately, the Arkansas State University Physical Therapy Department does have computerized posturography which is assessed via a sensory organization testing device. The device is a NeuroCom Balance Master. Through the combined effort of the Communication Disorders and Physical Therapy Departments, researchers were able to replicate the original study. Researchers used a similar population of adult experienced hearing aid users, the same research design, and the more sophisticated NeuroCom Balance Master.

The recent abstract of the AState replication project is as follows:
“The purpose of this study was to evaluate the balance of experienced adult hearing aid users with and without their hearing aids via Computerized Posturography (CP). CP was accomplished by employing the Sensory Organization Test (SOT) on the NeuroCom Balance Master. The SOT assessed each participant’s balance and the strategy used to maintain balance in six progressively challenging conditions. Twenty two adults using bilateral at-the-ear hearing aids participated in the study. All participants completed all SOT protocols with and without their hearing aids. No statistically significant differences in participants’ balance were identified regardless of the presence or absence of their hearing aids during SOT. These results failed to support previous research, which indicated that amplification of auditory input could benefit balance in individuals with hearing and balance disorders. Further research utilizing randomized controlled trials is needed to resolve the disparity between the current results and those of previous studies.”

Clearly, the results of this replication study did not support those from the original research report. In short, researchers were unable to demonstrate any statistical relationship between balance and the use of hearing aids from this group of participants. Findings do support the need for a comprehensive clinical trial before claims of improved balance from hearing aid use can be made.

References:

Rumalla, K., Karim, A. M., & Hullar, T. E. (2015). The effect of hearing aids on postural stability.
The Laryngoscope, 125, 720-723. doi: 10.1002/lary.24974