by Justin Martin, OTS Doctorate Program, and M. Tracy Morrison OTD R/L, Chair, Occupational Therapy,  Arkansas State University (ASU)

Personhood is a term used to describe the actions taken by self or others for the purposes of promoting personal autonomy and quality of a life (Little, 2014). Societal conversations about personhood can be found alongside those about spirituality and human rights (Martin & Sabbagh, 2011). While US healthcare policies unanimously promote personhood concepts, the process of preserving personhood during times of personal health decline and increased dependency levels remains relatively unexplored among aging populations.

Mealtime choice is enjoyed as a ritual of personhood during the first year of postnatal development (Birch, Savage, & Ventura, 2007). Infant caregivers are encouraged to facilitate infant engagement levels in the feeding process through varied methods that include increased feeding times, environmental modifications and additional food choices. By mid-childhood, mealtime rituals become expressions of personhood and incorporated into interpersonal social dynamics. By adulthood, mealtime rituals are carried across generations between the parent and offspring. And upon late adulthood, the mealtime ritual may be one of the only remaining expressions of personhood that generalizes into institutionalized care settings (Kiser, Medoff, Black, Nurse, & Fiese, 2010).

There is a paucity of information about the influence of mealtime rituals on the quality of life and the well-being of individuals with Alzheimer’s disease (AD).
Individuals with AD commonly experience negative behaviors including feeding aversions, apathy, anxiety, disinhibition, fear and depression (Burns-Cox, 1980).

These behaviors dramatically increase the level of caregiver burden and increased risk of negative health incidences. Evidence suggests personhood rituals, for example meditation and religious ceremonies, facilitate positive behaviors and neuroprotective changes among individuals with AD (Chow, et al., 2009). Person-centered contexts remain the most appropriate therapeutic approaches for residents with AD because they stimulate positive emotional memories that facilitate cooperative actions that suggest positive developments despite the degenerative nature of AD (Chow, et al., 2009).

Occupational therapists prioritize “how” or “whether” the person served participates in meaningful activities (i.e. occupations). A fundamental principle within this profession is that the engagement in personhood activities promotes well-being and that well-being is an intrinsic state that promotes the quality of life regardless of health status (Gray, 1998). Occupational therapists (OTs) promote the person’s engagement levels through interventions that incorporate sensory, cognitive, physical and environmental factors. Most commonly, OTs focus interventional efforts around the rituals, habits and routines of the person with AD and they measure outcomes the promote well-being and ability levels pre- and post-intervention (Padilla, 2011).

Occupational therapists utilize numerous therapeutic methods theoretically supported in the cognitive neurosciences (Arbesman & Lieberman, 2011). The use of visual priming and reminiscence to promote engagement and well-being in adults with AD has been proven effective and worthwhile (Burns, Jacoby, & Levy, 1990).

The premise that negative behaviors result in feeding aversions during mealtime also suggests that increased engagement in mealtime activities may promote both feeding and well-being. The feasibility of a program developed to promote personhood during the mealtime ritual was recently explored among a cohort of individuals with AD living in memory care facilities. When residents were provided with contextual supports associated with mealtime options (versus only verbal instructions), their engagement levels in mealtime activities improved. Additionally, caregivers reported reduced burden levels associated with mealtime duties. These observations suggest that mealtime may be the ideal context for therapeutic activities and that well-being may be promoted through personalized mealtime rituals.

Institutional care does not replace the home environment, but personal rituals generalize beyond home environments because they are acts of personhood. And in likeness to the ritual of prayer, the ritual of mealtime activities may be valuable to the well-being of the individual with AD (Greenwood, et al., 2005). Therapeutic programs that reduce barriers to promote engagement in personhood rituals are important considerations during end of life care. The personalized mealtime rituals may be the last personhood ritual available in the adult with advanced AD and therefore may serve as an important therapeutic tool for healthcare professionals working in memory care facilities.

References:

1. Martin, G.A., & Sabbagh, M.N., (2011). Palliative care for advanced Alzheimer’s and dementia: guidelines and standards for evidenced-based care. New York: Springer.
2. Little, M. (2014). Theorising personhood: for better or for worse. European Journal for Person Centered Healthcare, 2(1), 57.doi:10.5750/ejpch.v2il.696.
3. Padilla, R. (2011). Effectiveness of occupational therapy services for people with Alzheimer’s disease and related dementias. The American Journal of Occupational Therapy, 65(5), 487-489.
4. Stages of Alzheimer’s. (2017). Retrieved from alz.org: Alzheimer’s Association: http://www.alz.org/alzheimers_disease_stages_og_alzhemers.asp.

by Ronni Chernoff, Ph.D., FAND, FASPEN, Director, AGEC & Professor, Department of Geriatrics

We are coming to the end of the second year of the Arkansas Geriatric Education Collaborative, a Geriatric Workforce Enhancement Program. It is an appropriate time to look back on our accomplishments during the second year and recap some of the continuing and new achievements. We continue to be proud of what we contributed to the education and training of health professionals, faculty and students who are looking forward to careers in one of the many health care disciplines in Arkansas. We are pleased that there is great interest in the new, updated AR-GEMS online self-study program and our successful summer Institute for faculty, which is scheduled for the week of May 15, 2017. For more information on either of these two programs, email Regina V. Gibson, MALS, RN, CHES at rvgibson@uams.edu. We continue to offer video teleconferences four times/year and have dates but not topics for the Fall series (Oct. 11 and Dec. 13, from 11 a.m. to 1 p.m.). Our newest option, programs available through web-streaming (Blackboard Collaborative), is becoming more popular; this means you can stay at your computer and receive the program in real time and ask questions through the chat option. We are delighted to offer you the opportunity of accessing AGEC programming more conveniently. This month we are launching a needs assessment to gain insight into what you would like to learn more about. If you receive it as paper or online, please take the few minutes needed to fill it out and return it to us. Your input is very valuable to us and we look forward to hearing from you. Feel free to email your suggestions for topics and programs to agec@uams.edu or post a note on our website page.

Look for “Save the Date” cards and announcements for the geriatrics and long-term care 18th annual conference Sept. 21-23, 2017. A Geriatric Grand Rounds on exercise and aging issues in dementia patients is scheduled for May 24 and we will be web-streaming it, video teleconferencing by interactive television, and be live in the Jo Ellen Ford Auditorium at the Donald W. Reynolds Institute on Aging, UAMS.

Along with our first responder organizations to help our law enforcement, firefighters, and emergency medical technicians (EMTs) recognize and manage people with dementia, we are developing additional partners to provide training and support materials to make them better able to help these older adults in need. We continue to collaborate with our partners to provide useful and relevant information on aging to seniors who attend AARP programs and local Arkansas Aging Initiative sites for lifestyle and educational workshops.

The new www.agec.org website has been launched and offers easier navigation and more features. Please visit the website and read all about our new features. There are two portals, one for health professionals and one for community members who are not health professionals.

Have a great spring and enjoy the beautiful weather!

by Lisa VanHoose, Ph.D., PT, MPH, Assistant Professor, Physical Therapy
University of Central Arkansas (UCA), AGEC Fellow

What is the most common cancer treatment-related side effect in senior cancer survivors?
You probably guessed it, if you are a cancer survivor or the loved one of a cancer survivor. Fatigue is the most common cancer treatment related side effect in senior cancer survivors1, 2. Senior is defined as 65 years of age or older. Cancer increases the risk and severity of fatigue in older persons2. Most senior cancer survivors report cancer related fatigue (CRF) at some time during cancer treatment1, 2. The National Comprehensive Cancer Network defines CRF as “a distressing, persistent subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual function”3. In layman’s terms, CRF the condition affects one’s ability to perform routine tasks and does not respond to typical strategies, such as rest, change in diet, or lowering stress. The disruptive symptoms can begin with the start of treatment and may continue years after treatment has ended4.5.

How is cancer-related fatigue (CRF) treated?
The first step in CRF treatment focuses on reducing any personal factors that may be contributing to one’s stress. Cancer survivors may benefit from counseling regarding issues that may contribute to stress such as finances, nutrition, and behavior management including coping. Strategies such as mind-body awareness, relaxation, or sleep therapy may also be beneficial in minimizing stress. Next, the cancer survivor will need to work with his/her medical and rehabilitation team (s) to identify potential medical causes for CRF. Nutritional deficits, anemia, pain, and other conditions and diseases can contribute to the severity of fatigue. A management plan will be created, put in place, and evaluated for its impact. Fatigue is a unique symptom. The medical/rehabilitation team and the patient will work together to identify strategies that will work best for the patient. Medications will be assessed for adverse drug effects and interactions that may be responsible for CRF. Medications will include prescribed and over-the counter medications, including herbal supplements.

Physical activity has been strongly encouraged to address CRF. A customized exercise plan from a community, medical, or rehabilitative care provider can minimize the risk of injury and address the special considerations of the older cancer survivor. An exercise plan will include both endurance activities (walking, jogging, or swimming) and light weight training. Yoga has been recommended to address CRF, pain, and other side effects of cancer3. Other recommendations include scheduling activities during times when you have the most energy, limiting naps to less than one hour, focusing on one task at a time, and delegating or eliminating nonessential tasks. Cancer related fatigue (CRF) is a common side effect of cancer treatment, but it can be effectively treated for improved function and quality of life.

Disclaimer: The comments/opinions are those of the author and not necessarily those of the AGEC. All content found in this article is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this newsletter. Dr. VanHoose may be reached at lvanhoose@uams.edu if you have questions about the content.

by Gretchen Gibson, DDS, MPH, Veterans Health Administration Central Office (VHACO)

This newsletter segment is not necessarily written for your patients, but more for your “future patients” and even you and your family. Retirement planning is a process that is supposed to start long before they day you leave your job for the last time. Planning is the key word.

When this is discussed, it evolves around making sure there are adequate funds that any retirement benefits are in place that any wills or trusts are in place; that debt is taken care of as much as possible; and that you have adequate resources to take you through retirement years.

What is often not thought about are planning for issues of health, and in this case, issues regarding oral health. The average age for retirement is now around 63. Most everyone knows that dental benefits are often acquired through insurance programs through employment. When retirement begins, these benefits end. Many people do not know that Medicare does not cover dental benefits, except in very extreme cases. There has been some suggestion that dental benefits be added to Medicare Part B, but this is by no means a given and most likely a long time off, if at all. There is the possibility of private coverage in retirement, but this needs to be well thought out, to make sure the benefits will meet your needs. One website, http://www.mouthhealthy.org/en/dental-care-concerns/paying-for-dental-care, takes you through some questions and answers regarding dental care and what you may require in the way of dental benefits. However, just like planning for fiscal retirement, it is in your best interest to plan for dental health in retirement as well. Putting off extensive work till after retirement may not be wise if you have not planned for the full cost in your budget.

A great amount of research has shown that a healthy mouth is beneficial for a healthy quality of life. Eating, smiling and verbal interaction are key parts to a happy retirement and you need to do this pain free and comfortably. A frank discussion with your dentist is appropriate as you think about your date of retirement to discuss the change in your dental benefits and how best to approach this. This also brings up an important point regarding continuing dental care after retirement. Many people will put off preventive or maintenance dental care due to the cost. However, it is wise to consider the cost of repair versus the cost of maintenance.

As we age, there are factors that can increase the risk of dental disease, such as increased risk for dry mouth and issues associated with other systemic diseases. Discuss with your dentist what should be the most appropriate length of time between recall or preventive visits, based on your individual situation. Your dentist will take into account how well you can keep your teeth clean at home, how much dental treatment you currently have and how easy it is for you to maintain that.  As with any disease process, the earlier that a problem is caught, the easier it is to deal with.  Fluoride use has proven to reduce cavities in adults as well as children. Talk to your dentist and hygienist about the best fluoride regime for you, based on your risk for future cavities. If the dentist and hygienist are regularly evaluating the health of your gums, early intervention regarding periodontal or gum disease can help you keep your natural teeth a lot longer.

Finally, the risk of oral cancer does increase with increasing age, and having someone check your mouth at least yearly, especially if you drink moderate to heavy and/or use tobacco, is recommended. Dental care provided at your retirement will most likely not be the last dental treatment you will need, but making sure your mouth is in a healthy state at that time and then taking the steps to maintain that oral health for as long as you can will be another way of helping to assure a happy retirement.

by Besdine R et al.; American Geriatrics Society Task Force on the Future of Geriatric Medicine
submitted by Regina V. Gibson, MALS, RN, CHES, Arkansas Geriatric Education Collaborative

In response to the needs and demands of an aging population, the field of geriatric medicine has grown rapidly during the past three decades. The discipline has defined its core values as well as the knowledge base and clinical skills needed to improve the health, functioning, and well-being of older persons and to provide appropriate palliative care. Geriatric medicine has developed new models of care, advanced the treatment of common geriatric conditions, and advocated for the health and health care of older persons. Nevertheless, at the beginning of the 21st century, the health care of older persons is at a crossroads. Despite the substantial progress that geriatric medicine has made, much more remains to be done to meet the healthcare needs of our aging population. The clinical, educational, and research approaches of the 20th century are unable to keep pace and require major revisions. Maintaining the status quo will mean falling further and further behind. The healthcare delivery and financing systems need fundamental redesign to improve quality and eliminate waste. The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has identified five goals aimed at optimizing the health of older persons:

1. ensure that every older person receives high-quality, patient-centered health care
2. expand the geriatrics knowledge base
3. increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons
4. recruit physicians and other healthcare professionals into careers in geriatric medicine
5. unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors.

Geriatric medicine cannot accomplish these goals alone. Accordingly, the Task Force has articulated a set of recommendations primarily aimed at the government, organizations, agencies, foundations, and other partners whose collaboration will be essential in accomplishing these goals. The vision described in this document and the accompanying recommendations are only the broad outline of an agenda for the future. Geriatric medicine, through its professional organizations and its partners, will need to mobilize resources to identify and implement the specific steps that will make the vision a reality. Doing so will require broad participation, consensus building, creativity, and perseverance. The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician workforce is a recipe for expensive, fragmented health care that does not meet the needs of our older population.

By virtue of their unique skills and advocacy for the health of older persons, geriatricians can be key leaders of change to achieve the goals of geriatric medicine and optimize the health of our aging population. Nevertheless, the goals of geriatric medicine will be accomplished only if geriatricians and their partners work in a system that is designed to provide high-quality, efficient care and recognizes the value of geriatrics.

 

Reference:

J Am Geriatr Soc. 2005 Jun;53(6 Suppl):S245-56.

https://www.ncbi.nlm.nih.gov/pubmed/15963180

U.S. National Library of Medicine National Institutes of Health

 

by Amy Shollenbarger, Ph.D., CCC-SLP

Communication is vital to humanity. Most individuals acquire language with relative ease, yet as we age, certain changes in communication may occur as a part of the normal aging process. Normal changes that occur in our ability to communicate as we age may include language, speech, swallowing, or hearing. Understanding normal changes due to aging is important so we know when further examination by a speech-language pathologist or audiologist, due to abnormal changes, may be needed (Busacco, 1999).

Hearing is most negatively affected as we age, with approximately 35% of individuals over the age of 65 having some type of hearing loss (Bance, 2007). Articulation, or the way we produce speech sounds, remains adequate as we age (Hooper & Cralidis, 2009) although significant tooth loss may impact articulation skills (Busacco, 1999). Changes in voice skills may include more tremor, breathiness, roughness, or pitch changes, but intelligibility is not usually affected (Ryu et al., 2015). Receptive language ability may decrease due to slower auditory processing, but expressive language is usually not affected other than minor word finding difficulties (Yorkston, Bourgeois, & Baylor, 2010). Swallowing may require greater effort or time as one ages, which may lead to weight loss (Busacco, 1999).

Communication skills stay relatively intact and improve throughout childhood and the adult years. Let’s examine normal aging and communication from the 20’s and beyond (adapted from Loudermill, Lowry, & McCullough, 2010). Long term memory, complex reasoning, and creativity are greatest in your 20’s. In the 30’s minimal changes begin to occur, but performance on functional, everyday tasks is not affected. As individuals move into their 40’s, slight word finding difficulties may occur. More effort is required to do things like remember phone numbers, do mental calculations, or play challenging card games. Reduced short term memory begins to be noticeable. In your 50’s, processing speed slows down, and it takes longer to learn new things. Problems with visuospatial skills occur. For example, you may occasionally forget where you parked or have more difficulty copying a three-dimensional design. It is more difficult to multitask and harder to maintain attention and remember details. For example, you may remember fewer details of a novel or movie than a younger person would. Placing an event in time and place becomes more difficult. You may remember the event but not exactly when or where it occurred. Word finding difficulties occur, but do not interfere with everyday tasks. In your 60’s, decreased attention, memory, and slower processing of information occurs. It becomes more difficult to tune out distractions. You may have difficulty remembering names or retrieving well-known words, which can be frustrating at times. However, performance on daily tasks should not be negatively affected. In your 70’s, cognitive abilities vary greatly due to various factors such as education, nutrition, and genetics. Those with other health problems – hypertension, diabetes, and heavy alcohol use – show a decline in memory and general cognitive ability. However, individuals in their 70’s and beyond who are aging normally and in good health, should maintain adequate communication skills.

There are several things individuals can do to preserve communication and cognitive abilities as discussed by Calvagna (2016). Continue learning – pick up a new hobby, try a new recipe, learn a new language. Stay physically active by exercising. Keep your mind active by reading, doing crossword puzzles, and engaging in crafts. Eat healthily and avoid tobacco. Engage in social interaction and communicate with family and friends regularly. Volunteer for a cause or a charity, join clubs and/or participate in religious activities. All of these things will keep your brain healthy and active, and contribute to good communication skills as one ages.

References
Bance, M. (2007). Hearing and aging. Canadian Medical Association Journal, 176(7), 925-927, doi: 10.1503/cmaj.070007

Busacco, D. (1999). Normal communication changes in older adults. Let’s Talk, 72, 49-50.

Calvagna, M. (2016). Ten tips for healthy aging. Health Library: Evidence-Based Information.

Hooper, C. R., & Cralidis, A. (2009). Normal changes in the speech of older adults. You’ve still got what it takes, it just takes a little longer! Perspectives on Gerontology, 14(2), 47-56.

Loudermill, C., Lowry, M., & McCullough, K.C. (2010). The aging brain: What’s normal and what’s not. Presentation at the Arkansas Speech-Language-Hearing Association annual convention, Little Rock, AR.

Ryu, C. H., Han, S., Lee, M., Kim, S. Y., Nam, S. Y., Roh, J., & … Choi, S. (2015). Voice changes in elderly adults: Prevalence and the effect of social, behavioral, and health status on voice quality. Journal of The American Geriatrics Society, 63(8), 1608-1614. doi:10.1111/jgs.13559

Yorkston, K. M., Bourgeois, M. S. & Baylor, C. R. (2010). Communication and aging. Physical Medicine and Rehabilitation Clinics of North America, 21(2), 309-319.

by Towino Paramby  CScD, CCC-SLP, Veronica Rowe Ph.D., OTR/L, Nina Roofe Ph.D., RDN, LDN, and SLP Graduate Students Kirsten Kubinski, and Laura Jones

Graduate students at the University of Central Arkansas teamed up for a two-day collaboration focusing on interprofessional education (IPE) on September 16th and 19^th of 2016. Interprofessional education is defined by two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010).  The speech-language pathology, occupational therapy, and dietetics programs came together for a combined lecture led by Dr. Towino Paramby, Dr. Veronica Rowe, and Dr. Nina Roofe.  The lecture emphasized the importance of interprofessional collaboration in the healthcare setting.  Topics covered included dysphagia, adaptive devices used for eating, specific modified diets, scope of practice, and interprofessional collaboration.  These three professions, when working together, can implement a successful treatment plan for the overall health of patients, often those of the geriatric population.   

The second day of the interprofessional collaboration allowed students to work together in a hands-on learning experience through a two-part lab. Observations of hands-on learning have shown that students demonstrate strong communication tied to working in teams (Bass et al, 2011). Through this lab, students experienced the use of adaptive eating equipment, prepared and tasted thickened liquids, assisted feeding, and observed a linespread demonstration. The linespread is a quick and inexpensive viscosity test, which allows practitioners to compare the effect of a particular food or ingredient. This information is useful when thickening liquids to certain consistencies for safe swallowing. Adaptive equipment used for eating are helpful tools for promoting independence to patients with physical disabilities such as arthritis, stroke, Parkinson’s disease, poor vision, etc. The graduate students were assigned random case studies and were responsible for selecting the most appropriate adaptive equipment for their “patient”. Goggles and other devices were provided to simulate different impairments such as decreased vision, strength, and poor fine motor coordination that are often found in the geriatric population. Students were able to assess how their selected pieces of adaptive equipment worked while simulating these common disabilities to gain further insight on the potential benefits of the equipment occupational therapists can provide for clients with a range of difficulties. On the left, speech-language pathology and occupational therapy graduate students work together on their case study.

The second part of the lab focused on the use of thickened liquids with patients affected by swallowing disorders, also known as dysphagia. Presbyphagia, which is swallowing difficulty associated with aging, is the second most common reported symptom in geriatric medicine (Charpied, 2009). Thickened liquids are often recommended by speech-language pathologists to patients as a way to adjust consistencies for easier swallowing. This lab allowed students to test both pre-thickened liquids as well as prepare their own liquids at varying consistencies. This lab not only gave students the opportunity to practice preparing thickened liquids, and modified diets, but more importantly, they gained first-hand experience which will allow them to better empathize with future patients. On the left, Dr. Paramby explains the use of thickened liquids to a group of graduate students.

Through this two-day collaboration, graduate students from three different fields of study expanded their knowledge of each profession’s scope of practice. More importantly, these students learned how interprofessional collaboration can result in the maximum benefit for a patient in the healthcare setting (WHO, 2010).

 

 

References:

Bass, Kristin M., Danielle Yumol, and Julia Hazer. “The Effect of Raft Hands-on Activities on

Student Learning, Engagement, and 21st Century Skills.” RAFT Student Impact Study. Rockman et al, 2011. Web. 24 Jan 2012.

 Charpied, George. “Presbyphagia: Hidden Risk in the Geriatric Population.” American Speech-    Language Hearing Association (2009): 1-6. 2009. Web. 17 Oct. 2016.

World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization. See http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf.

 

by Regina Gibson, MALS, CHES, CCRP,
Arkansas Geriatric Education Collaborative (AGEC)

Pictured above are Dr. Ronni Chernoff and Dr. Jeanne Wei

Recently at the College of Medicine Annual Faculty Dinner, Ronni Chernoff, Ph.D., professor in the Department of Geriatrics at the Donald W. Reynolds Institute on Aging and Director of the Arkansas Geriatric Education Collaborative, received an award of admiration and appreciation for her commitment to excellence in education programs. She was thanked for her vision, dedication, and inspiration.

Chernoff is a graduate of Cornell University. She earned two master’s degrees from Columbia University and a doctorate in health professions education from the University of Pennsylvania. The author or editor of numerous widely used textbooks including Geriatric Nutrition: The Health Professional’s Handbook (Jones & Bartlett), Chernoff has published dozens of research studies, book chapters and other publications on geriatric nutrition, nutrition support, and clinical nutrition. Chernoff has held leadership positions in the American Society for Parenteral and Enteral Nutrition; the Gerontological Society of America; the National Association of Geriatric Education Centers and the National Association for Geriatric Education. Her service at the national level includes the White House Conference on Aging; Medicare Coverage Advisory Committee; the Institute of Medicine’s Committee to Review Child and Adult Care Food Program Meal Requirements; and has served as a member of the Cornell University Board of Trustees. Dr. Chernoff is also the former president of the Academy of Nutrition and Dietetics.

by Cynthia C. Mercado, EMBA, M.A. and Stanley K. Ellis, Ed.D.

Evidence–based outcomes have become the by-word of research organizations, especially to document accountability for use of scarce resources in government-funded research. The Arkansas Geriatric Education Collaborative (AGEC), a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, is a case in point. Currently, in its second year of implementation, AGEC’s goal is to educate Arkansas’ health care professionals, students, caregivers, first responders and the general public about issues and topics that affect the older population. Advancing such goals requires AGEC to offer a whole host of initiatives such as video teleconferences, Alzheimer’s Dementia training, Geriatric Grand Rounds, Arkansas Geriatric Mentors and Scholars (AR-GEMS), evidence-based self-management programs for older adults, caregiver classes, first responder classes, and Summer Institute for Faculty, among others.

How does AGEC track the progress of these endeavors? How does AGEC know whether these initiatives reach their intended end-users? How can AGEC best respond to the current needs of Arkansas healthcare professionals? Answering such questions provides AGEC valuable feedback to guide planning and policy directives.

To answer these questions AGEC, in collaboration with the UAMS Office of Educational Development Evaluation (OED) Team, has designed a process to help assess and evaluate the outcomes of their numerous educational endeavors. Both quantitative and qualitative data are collected from participants using mailed and online survey questionnaires. To date, OED has created and administered Survey Monkey questionnaires to evaluate the program’s impact on the practice/job of the participants and knowledge shared with friends and co-workers (90-day evaluation); evaluated programs and speakers related to content delivery, and strengths of the educational activity; gathered participants’ feedback about the tour in the Alzheimer’s/Dementia Experience: Take a Walk in Their Shoes; and caregivers’ view of the Geriatric-focused program presentations. These questionnaires include demographic variables such as age, race or ethnicity, gender and professional affiliations. A comprehensive participant database is continuously updated through the use of the Participant Profile surveys. For some participants (e.g., MD, DO, RN, PT), the Program Sign-in Sheet for Contact Credit Hours documents their professional activities to fulfill their mandatory CE/CPE hours.

A program as dynamic as AGEC will continue to evaluate its offerings to help guide the future directions and address the educational needs of the participants. Plans are underway to conduct a statewide needs assessment in the spring of 2017.

We urge you, the participants in these activities, to complete these evaluations because policy makers and researchers rely on your feedback to make policy decisions and provide activities that will help you, your clients and loved ones receive quality services they deserve.

by Laura Smith-Olinde, Ph.D., CCC/A, and Steven E. Boone, Ph.D.

Roughly 15%, ~37.5 million people, of the entire adult U.S. population has hearing loss, but the percentages increase with age. In adults aged 55 to 64, 17% have significant hearing loss; that number goes up to 25% for adults aged 65 to 74 and is over 50% in adults older than 75 years.¹

When we talk with someone who has hearing loss, we usually know it, even though we cannot see the loss directly. Studies have linked untreated hearing loss to dementia, cognitive decline, and increases in social isolation, and depression.^2-6 Recent studies show that older adults using hearing aids or cochlear implants have better communication. They also have slower cognitive decline, and fewer social isolation and depression symptoms.^7-10 With such positive results, urging older adults to seek healthcare for diagnosis and treatment of hearing loss makes sense.

The best hearing healthcare starts with seeing an audiologist for hearing and communication needs assessments. Assessments include listening needs for face-to-face, media (TV, radio, movies), telecommunications (phone, computer), and alerting signals (alarm clock, smoke alarm) situations.¹¹ Audiologists should also help their clients figure out if they need any hearing assistive technologies to meet these needs and what kinds of devices may work best for them and their families. Right now, no medicine or surgery can cure age-related hearing loss. The best treatments remain aural rehabilitation and sound amplifying devices, the most well known being hearing aids. Digital hearing aids provide great sound quality, but digital technology keeps hearing aids costly ($400-$3000 per aid) and many people cannot afford them.¹² Medicare does not cover hearing aids, but some Medicare Advantage plans and other insurers offer partial coverage.

It happens that there are other, lower-cost amplification choices than hearing aids: handheld devices and personal sound amplifying products (PSAPs). Handheld devices have a microphone to place near the sound source and send the sound directly to earphones either wirelessly or through a wire. Sending the sound straight to the listener bypasses other sounds in the area and makes speech easier to comprehend. One example of a handheld device is “TVEars” ($60.00 -$160.00).¹³ Housemates without hearing loss often complain the TV is too loud; using TVEars the person with normal hearing can set the TV volume, while the person with hearing loss adjusts the TVEars volume. Another example is the “Pocketalker Ultra 2.0” (~$175.00).¹³  Unlike the wireless TV Ears, the Pocketalker has a wire that plugs into the microphone and carries sound directly to the earphones. The 2.0 version also has a “telecoil” that can pick up sounds in any setting that is “looped”, for example churches and theaters. The Pocketalker microphone/amplifier is about the size of a TV remote and can be used anywhere, for example in a pharmacy, a doctor’s office, or a nursing home. A sound amplifier could help ensure that patrons with hearing loss can hear and comprehend what is said and not just nodding and smiling.

The second choice, Personal Sound Amplification Products (PSAPs), costs $10 – $400 each, making them more attractive than hearing aids. The Food and Drug Administration (FDA) classifies hearing aids as Class 1 medical devices but does not regulate PSAPs. The FDA issued guidance in 2013 on PSAPs: (1) PSAPs should not be used to treat hearing loss;⁽²⁾ PSAPs should be used by those with normal hearing who need a boost in some settings; and ⁽³⁾ no professional fitting is needed.¹⁴  PSAPs look like hearing aids and amplify sound, but they are not designed to fit a specific hearing loss. In terms of function, a recent study ¹⁵ showed that two low-cost PSAPs (Woodland Whisper; CyberScience Amplifier) and one low-end hearing aid (MD Hearing Aid Pro) did not give enough amplification at the high pitches needed by most people with age-related hearing loss, and generated a lot of internal noise, which may interfere with listening. For all PSAPs, as hearing loss increased, none gave enough amplification for listeners. Even so, some PSAPs may be a good choice for someone with a mild hearing loss who needs “just a little help sometimes.”

In summary, there are less costly options to hearing aids available over the counter, are less expensive than hearing aids, and do not require a visit to a professional. Devices such as TVEars and Pocketalker have been available for many years and work well. PSAPs are newer, may not give enough amplification if a hearing loss is greater than “mild” and, unlike hearing aids, are not programmable. The best course of action, if possible, is to start with a hearing test and consider hearing aids. Medicare will pay for a hearing evaluation. Test results can help people understand how much hearing loss they have, and will serve as a baseline for future hearing tests.

References

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