The Arkansas Geriatric Education Collaborative (AGEC), a Geriatric Workforce Enhancement Program, has reached the halfway point in our funding. We continue to achieve our goals for this program, along with our long-time partners (ASU and UCA) and our more recent partners (CareLink, Mainline Clinic in Lincoln County, McAuley Senior Center, and AARP), to educate health professionals, students, caregivers, first responders and the general public about issues and topics that affect our older population.  We are also proud of our innovative projects to improve patient care and disseminate best practices information using a variety of delivery systems.

In preparation for a new grand cycle that starts at the end of 2017, we are developing a statewide needs assessment.  We really want, need and appreciate your input and ideas.  Please think about what information or experiences you would like to have to provide better care to our older adult patients.  Then watch and listen for our notification that the needs assessment survey is available and respond to it!  The more input we have, the more valuable our future events will be for you. In the meantime, feel free to e-mail your suggestions for topics and programs to agec@uams.edu or post a note on our website page.

The AGEC funded two junior faculty fellowships during 2016 and had outstanding fellows, Drs. Jennifer Vincenzo and Elvin Price.  Dr. Vincenzo is faculty in physical therapy at UAMS Northwest and Dr. Price is faculty in pharmacy at UAMS.  We are excited to have two new fellows for 2017.  Dr. Lisa VanHoose is physical therapy faculty at UCA and Dr. Upendra Kar is research faculty in the UAMS College of Pharmacy.  We anticipate great things from both of them and are delighted to be able to offer them this opportunity.

We continue to offer video teleconferences four times/year; to sponsor Alzheimer’s disease-focused geriatric grand rounds twice yearly; offer Arkansas Geriatric Education Mentors and Scholars (AR-GEMS) for health care professionals; host the Summer Institute for faculty members who want an update on geriatric content; sponsor training for first responders, community members and others. For those interested in more education and programs in geriatrics, more information can be obtained at our website, www.agec.org.

As we plan ahead, we would love to hear from you about what you would like to know more about. Remember, we will be conducting a statewide needs assessment in the spring, 2017 and hope you will take the time to answer the questions on-line or by using a mailed survey.

We all wish you a very happy and successful new year and look forward to your participation in one or more of our programs.  Hope to see you soon!

Ronni Chernoff, Ph.D., FAND, FASPEN, Director, AGEC and Professor, Reynold’s Department of Geriatrics

By Kerry Krell, MPH

UAMS Arkansas Geriatric Education Collaborative (AGEC)

Fall is here and that means cooler weather, the holidays, and flu season are around the corner. People over the age of 65 are considered high risk for serious complications from the flu, such as pneumonia, bronchitis, sinus infections and ear infections that can quickly lead to hospitalization and sometimes death. Certain medical conditions, such as diabetes, heart disease, chronic lung disease, and people who have a weakened immune system due to chemotherapy or other immune-suppressing medications, put seniors at an even greater risk for flu and flu-related complications.

Fortunately, the flu vaccine is widely available and is the number one tool that health care providers can use to help keep their senior patients healthy. However, the best protection against flu requires a multi-faceted approach. The CDC offers some tips below to maximize older adults’ protection against the flu.

• Strongly encourage patients over the age of 65 to get a flu vaccine. There are two vaccines designed specifically for people 65 and older:
  • The high dose vaccine contains 4 times the amount of antigen as the regular flu shot.
  • The adjuvanted flu vaccine is designed to help create a stronger immune response to vaccination. This vaccine is available for the first time in the United States during the 2016-17 flu season.
• Encourage your older patient’s family and caregivers to also get vaccinated against the flu. By vaccinating the family and caregivers of your patient, you’re helping develop another layer of protection for your older patient. This is particularly important for patients in long-term care facilities. Unfortunately, long-term care personnel continue to have the lowest flu vaccination rates (69.2% compared to 91.2% in hospitals) among all health care personnel.
• Encourage older patients and their caregivers to practice good health habits. This means covering coughs, washing hands often, and avoiding those who are sick.
• Encourage older patients to seek medical advice quickly if they develop flu-like symptoms. This includes fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue.
• Advise older patients to get the pneumococcal (pneumonia) vaccine. Flu commonly causes pneumonia and pneumonia is one of the most serious flu-related complications in older adults. This vaccine can protect against pneumonia, meningitis, and bloodstream infections.

Reference:

http://www.cdc.gov/flu/about/disease/65over.htm.

By  Jill S. Detty Oswaks, DNSc, CRNA, and Lorena Thompson, DNP, CRNA

Over the years, anesthesia care and safety has improved, expanding anesthesia delivery to all age groups with a wide range of health needs. Parallel to the increased safety using newer anesthetic agents and technology, scientific knowledge is emerging on the effects of stress and anesthesia on long term health.  The baby boom generation will enter retirement with a greater projected lifespan than their parents and with greater health issues.⁴ Anesthesia providers and patients, aged 60 and older, must be aware of the potential effects of anesthesia on long term health.

Age, which affects almost every organ system, is strongly correlated with diseases, need for hospitalization and length of stay, injuries, and adverse reactions to medications¹. The associated risks for increased morbidity and mortality parallel an increase in surgeries in the aging population.

A major public health concern is post-operative cognitive decline (POCD) in the elderly. The study of POCD is to determine if a link between perioperative care and POCD exists and strategies to prevent its development.  Postoperative cognitive decline is defined as a drop in cognitive performance on neuropsychological tests postoperatively as compared to preoperative performance². Unfortunately, diagnosis can only occur in individuals who have undergone preoperative neuropsychological testing.   The implications of POCD are greater than just cognitive decline and include increased morbidity and mortality, decreased quality of life, and earlier exit from the workforce².

Like any public health concern there are modifiable and non-modifiable risk factors for POCD.   The non-modifiable risk factors include increased age, fewer years of previous education, type of surgery, genetic risk, preoperative renal insufficiency, previous stroke, and lower performance on preoperative neuropsychological tests². Patients’ and anesthesia’s focus is on the modifiable risk factors.

Individuals can contribute to improved postoperative outcomes through smoking cessation, controlling diabetes, and physical exercise^2,3. While aging is associated with decreased physiologic reserve, this is worsened by sedentary lifestyles³. Physical exercise is associated with increasing physiologic reserve and adaptation to stress. Improved physical reserve is associated with decreased psychological stress, better healing, faster return to preoperative physiologic baseline and decreased postoperative pain³.

Anesthesia providers have an ever increasing awareness of monitoring anesthetic depth, medications and adverse effects in the elderly and anesthetic management strategies to improve outcomes. Concerted efforts between the aging patient and anesthesia can decrease modifiable risks and decrease the risk of POCD.

References:

1. Alvis, B.D., & Hughes, C.G. (2015). Physiology considerations in geriatric patients.  Anesthesiology Clinics, 33, 447–456. doi: 10.1016/j.anclin.2015.05.003.
2. Berger, M., Nadler, J., Browndyke, J., Terrando, N., Ponnusamy, V., Cohen, H.J., Whitson, H.E., & Mathew, J.P. (2015). Postoperative cognitive dysfunction: Minding the gaps in our knowledge of a common postoperative complication in the elderly. Anesthesiology Clinics, 33, 517–550. doi: 10.1016/j.anclin.2015.05.008
3. Carli, F. & Scheede-Bergdahl (2015). Prehabilitation to enhance perioperative care.  Anesthesiology Clinics 33, 17–33. doi:10.1016/j.anclin.2014.11.002
4. King, D. E., Matheson, E., Chirina, S., & Shankar, A. (2013). The status of baby boomer’s health in the United States: The healthiest generation? JAMA Internal Medicine, 173(5), 385-386. Jill S. Detty Oswaks, DNSc, CRNA, Lorena Thompson, DNP, CRNA

By Nick Grunewald, PharmD candidate and Lisa Hutchison, PharmD, MPH

Dabigatran is a twice a day oral anticoagulant indicated for stroke prevention in patients having atrial fibrillation and deep vein thrombosis/pulmonary embolism treatment and prevention. These conditions are more prevalent in older and frail adults. Dosage ranges from 110mg twice a day to 150mg twice a day, with 150mg doses noted as having a higher incidence of bleeding.1 Dabigatran becomes therapeutic within 24 hours of administration with continuation of therapy. Studies show that dabigatran is an acceptable alternative to warfarin and has a similar adverse effect profile.2 Dabigatran acts as a direct thrombin inhibitor, and in comparison to warfarin, it does not require frequent monitoring, has a more rapid effect, and fewer drug-drug interactions.

Until now, if a patient on dabigatran had a major bleed, there was no way to quickly reverse its effects. Clinicians (and patients) had to wait until the drug was eliminated from the body for its effect on bleeding to dissipate or sometimes in extreme bleeding situations clinicians might try prothrombin complex concentrate to reverse dabigatran effects. Not having a reversal agent was considered a disadvantage for use of the dabigatran, and clinicians worried about its overall safety in older adults.

Idarucizumab (Praxbind®) has been recently marketed as a reversal agent for dabigatran. It is a humanized monoclonal antibody fragment (Fab) that binds to dabigatran and its metabolites with higher affinity than that of dabigatran’s binding to thrombin, neutralizing its anticoagulant effect. The recommended dose of idarucizumab is 5 g, provided as two doses separated by 15 minutes. Idarucizumab is supplied in vials containing 2.5 g/50 mL.3

In studies of normal volunteers taking dabigatran, after infusion of idarucizumab, immediate and complete reversal of the dabigatran-induced increase in dilute thrombin time (dTT) was reported for all idarucizumab dose groups . Reversal was sustained (i.e., mean dTT values remained at <ULN for 72 h) with the 2 g, 4 g, and 5 g plus 2·5 g doses. In addition to complete reversal of dabigatran, study data showed that 24 hours after administration of idarucizumb, anticoagulation with dabigatran can be restarted with full therapeutic effect.⁴ ⁵ In summation, study data show that complete reversal of dabigatran is obtained in minutes after administering 2 doses of 2.5mg of idarucizumab.

At present, idarucizumab’s place in therapy as a reversal agent for dabigatran is limited to emergent situations. This may decrease the occurrence of major bleeds due to trauma or surgical intervention. However, careful consideration for its use should be made. The average wholesale price (AWP) cost of idarucizumab is $42/mL, equaling $4200 per administration. Casual use of this agent could cause undue expense to patients and institutions. Therefore, risk benefit should be evaluated in every patient that would be considered for administration of idarucizumab.

References:

1. Boehringer Ingelheim. Pradaxa Full Prescribing Information. Last Accessed on 6/25/16. Available at http://docs.boehringer-ingelheim.com/Prescribing%20Information/PIs/Pradaxa/Pradaxa.pdf
2. Dabigatran Versus Warfarin In Patients With Atrial Fibrillation, Connolly SJ, N Engl J Med, 2009, 361(12):1139-51

3. Boehringer Ingelheim. FDA Approves Praxbind® (idarucizumab), Specific Reversal Agent for Pradaxa® (dabigatran etexilate mesylate). PRAXBIND Full Prescribing Information. Last Accessed on 10/27/15. Available at: http://us.boehringer-ingelheim.com/content/dam/internet/opu/us_EN/documents/Media_Press_Releases/2015/Praxbind.pdf

4. S Glund, J Stangier, M Schmohl, et al. Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers: a randomised, placebo-controlled, double-blind phase 1 trial Lancet (2015) published online June 16. Last Accessed on 10/27/15. Available at: http://dx.doi.org/10.1016/S0140-6736(15)60732-2

5. Pollack CV, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, Dubiel R, Huisman MV, Hylek EM, Kapmhusien PW, Kreuzer J, Levy JH, Sellke FW, Stangier J, Steiner T, Wang B, Kam CW, Weitz JI 2015) Idarucizumab for dabigatran reversal. N Engl J Med 373:511–520

Applicable CE documents will be posted soon.

Unable to attend in person? Live Streaming link here: AGEC Collaborate Channel or attend at a participating remote location.

Topic: Communication Impairment with Persons with Alzheimer’s Disease
Speaker: Richard Zraick, PhD
Professor and Chair of Department of Communication and Disorders, University of Central Florida

Objectives: After attending this presentation, the learner should

• be able to describe tools to assess language deficits, and facilitate communication in persons with Alzheimer’s disease

• be able to cite general communication tips for communicating with persons with Alzheimer’s disease.

• be able to describe some dementia-related impairments that compound language deficits in persons with Alzheimer’s disease.

Date: November 2, 2016
Time: 8:00 a.m. – 9:00 a.m.
Location: Donald W. Reynolds Institute on Aging, Jo Ellen Ford Auditorium

Accreditation: The University of Arkansas for Medical Sciences (UAMS) College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation: The UAMS College of Medicine designates this live activity for a maximum of one AMA PRA Category 1 credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

1.0 contact hour for pharmacists, physical therapists, dietitians and health educators have been approved.  Nursing, social workers, long-term care providers have been filed with the appropriate accrediting organizations. Determination is pending.

Faculty Disclosure of Financial Relationships: The planner, Dr. Ronni Chernoff, of this RSS have no financial relationships with commercial interests to disclose

The speaker(s) of this RSS has no financial relationships with commercial interests to disclose.

Commercial Support Acknowledgement: This CME activity receives no commercial support.

Rural Programs RSS Survey: http://learnondemand.org

Applicable CE documents will be posted soon.

Unable to attend in person? Live Streaming link here: AGEC Collaborate Channel or attend at a participating remote location.

Topic: How the Caregiver Experience can Positively Impact The Patient Experience
Speaker: John Schall, CEO of Caregiver Action Network

Objectives: After attending this presentation, the learner should

• be able to describe who family caregivers are and what they do in terms of ADLs and IADLs

• be able to list the interests and needs of family caregivers in a hospital setting

• be able to recall practical steps to more fully engage family caregivers in the hospital stay and in discharge planning

Date: November 9, 2016
Time: 8:00 a.m. – 9:00 a.m.
Location: Donald W. Reynolds Institute on Aging, Jo Ellen Ford Auditorium

Register at Eventbrite for this free event: Eventbrite registration

Accreditation: The University of Arkansas for Medical Sciences (UAMS) College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation: The UAMS College of Medicine designates this live activity for a maximum of one AMA PRA Category 1 credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

FREE Continuing Education

1.0 contact hour for pharmacists, physical therapists, dietitians and health educators have been approved.  Nursing, social workers, long-term care providers have been filed with the appropriate accrediting organizations. Determination is pending.

Faculty Disclosure of Financial Relationships: The planner, Dr. Ronni Chernoff, of this RSS have no financial relationships with commercial interests to disclose

The speaker(s) of this RSS has no financial relationships with commercial interests to disclose.

Commercial Support Acknowledgement: This CME activity receives no commercial support.

Rural Programs RSS Survey: http://learnondemand.org

Ageless Grace® Events for Personal Practice and Certification

Location: UAMS Institute on Aging, 629 Jack Stephens Dr. /  Little Rock, AR 72205, First Floor

PART I: Personal Practice Seminar – Learn to include Ageless Grace in your daily life (4 hours of *CE)  –  (required for Educator certification)

• Thursday, Dec. 1, 8 a.m. to noon, $55.00

PART I & II: Educator Certification – Become certified to teach Ageless Grace (includes DVDs, book & cards) (14 hours required for certification)

• Thursday, Dec. 1, AND Friday, Dec. 2, 8 a.m. to 4:30 p.m. each day, $380

FREE Public Class: Thursday, Dec. 1, 11 a.m. to 11:30 a.m., UAMS Institute on Aging

REGISTER: http://agelessgrace.com/training-events/little-rock-ar-december-1-2-2016/

The Center for Distance Health is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Participation in this educational activity provides up to 14.0 hours of continuing nursing education credit. Attendance at the entire class and completion of an evaluation is required to receive contact hours.

All other accreditations managed by the Arkanss Geriatric Education Collaborative. Determination is pending

SEE our flyer below for more details:

Schmeiding Home Caregiver Training

By Sherry White, MNSc, RN-BC, Project Director, Schmieding Home Caregiver Training Replication Project

Robin Mcatee, PhD, RN, FACHE, Associate Director of the Arkansas Aging Insttitute at UAMS announces that November is National Family Caregivers Month. The theme selected by the Caregiver Action Network (CAN) is “Take Care to Give Care”.  In celebration and recognition of Family Caregivers across Arkansas a variety of events are planned throughout the state in Little Rock and at each of the UAMS Regional Centers on Aging.

Statewide activities will begin with Geriatric Grand Rounds on November 9th at the Jo Ellen Ford Auditorium on the topic of Caregiver Health.  The presenter is John Schall, President and CEO of the National Caregiver Action Network.  Following Mr. Schall will be presentations from other distinguished guests including Joel Hopper with the Kimberly Clark Corporation.  Kimberly Clark is recognized worldwide for their work and contributions in support of working caregivers.  Mr. Hopper will provide information on their new employee education program called Caregiver Ally.  The Governor and his wife have been invited to participate and have been asked to proclaim November National Family Caregivers Month in Arkansas.  A tour of the Reynolds Institutes’ Schmieding Care house will follow.

On November 10th and 12th, Gary Barg, author and publisher of Today’s Caregiver Magazine will present “Become a Fearless Caregiver” Workshops in Hot Springs and Little Rock.  Mr. Barg will engage families in discussions about issues surrounding caregiving and a panel of local experts will field questions from attendees.

Additional details on dates and times and a full list of statewide events will be available soon.  For additional information on Schmieding Home Caregiver programs and offerings go to www.uamscaregiving.org

Questions may be directed to Sherry White, MNSc, RN-BC Project Director, Schmieding Home Caregiver Training Replication Project.