University of Central Arkansas

Telehealth: Increasing Opportunities for Student Training and Expansion of Care to Senior Adults

Fall 2020 Newsletter

By Alicia S. Landry, PhD, RD, SDN, SNS
Family and Consumer Sciences
University of Central Arkansas

Telehealth is an umbrella term that often refers to healthcare services that are delivered virtually. Examples of telehealth are telemedicine, mHealth (mobile health), and store and forward. In order to lay some groundwork, we will start with brief definitions.

Telemedicine is two-way, synchronous discussion between a patient and a healthcare provider, or between multiple providers.
Mobile health is when a patient uses an application or software to manage health. An example would be tracking dietary intake using a food log app on a smartphone and syncing it with the platform a registered dietitian monitors to give the patient feedback on diet choices.
Store and forward includes gathering patient data (like photos of a rash or an x-ray) and using the information for diagnostic decisions made by a provider at a later time.

Using accurate terminology to describe telehealth interventions becomes important when multiple providers are providing care for a single patient as well as other situations. Having a healthcare team in sync with one another is critical to positive patient outcomes.

While telehealth could potentially result in healthcare savings as well as increased safety and convenience for aging adults as well as their providers (Snoswell, Taylor, and Caffrey, 2019), concerns remain about the feasibility of telehealth use in a geriatric population. Specialties such as psychiatry and counseling, physical and occupational therapy, and medical nutrition therapy have been positively impacted by the use of telehealth and should continue to grow as demands for specialists increase and the safety of going to practitioner offices remains in question. For most Medicare patients, virtual doctor visits are covered when a doctor is not available to see the patient in person and Medicare has expanded coverage for virtual visits in the wake of COVID-19 (Medicare, 2020).

Patient acceptance, insurance reimbursement, regulatory or licensure barriers, access to high-speed broadband or wireless networks, and privacy concerns are legitimate obstacles to implementing telehealth. In Arkansas, broadband access is very poor (41st in the US), making network infrastructure in rural areas somewhat prohibitive of the use of telehealth. The Arkansas Rural Connect program is expected to use $25 million to cover underserved and rural communities, and more recently, there have been expanded efforts to make wireless and broadband coverage available in rural areas. While 26% of adults over 60 years of age reported no access to the internet, only half of 45-59-year-olds reported no access (Arkansas Broadband Report, 2019) which means age gaps do occur in the access to high-speed internet as well as in the utilization of telehealth. As always, healthcare providers communicating with senior adults must recognize challenges in hearing, sight, technology access, as well as others to ensure the best care possible.

Patients with chronic conditions like diabetes, cardiovascular disease, and obesity show favorable responses to home management via telehealth when led by an interprofessional team of healthcare providers. If it is possible that telehealth can allow seniors to remain safely at home for a longer time, ensure older adults are compliant with medication use, and reinforce support of caregivers, it may be time to take a deeper look into the possibilities for allied health professionals to grow the telehealth outlet.

During this time of physical distancing, older adults are more likely to feel socially isolated, experience food insecurity, and delay routine healthcare. In the National Poll on Healthy Aging, 45% of respondents said the pandemic made them more interested in telehealth and only 25% reported being concerned they would have difficulty seeing or hearing the provider during a video visit (Buis et al., 2020). Reduced risk of falls or decreased exposure to disease benefits the frail elderly, and telehealth can allow resource providers to maintain closer contact with older adults. In-home caregivers who may have their own families or other jobs can connect with healthcare providers which may reduce stress and improve the quality of care. Mobility (address movement and physical activity), mentation (assess cognition level), medication (identify the type, dose, supply), and what matters (determine goals, preferences, priorities) are the four M’s of age-friendly health and remembering these for telehealth visits can make these visits even more successful for the aged (Institute for Healthcare Improvement, 2019).

For registered dietitians, the expanding telehealth world has been a phenomenal way to provide integrated and patient-centered care, even with guidelines about physical distancing and preventing the spread of infectious disease. For example, a registered dietitian observing mealtimes with speech pathologists and occupational therapists allows the interprofessional team to make decisions about food consistency, swallowing risk, socialization, and other issues impacting nutrition status. For patients with at-home parenteral nutrition, registered dietitian observation along with pharmacy and medical providers reduces the risk of bloodstream infections and hospital readmission (Raphael et al., 2019). In diabetes self-management education (DSME), registered dietitians are able to teach blood glucose monitoring and follow patients in real-time as they report their blood glucose levels. Telehealth DSME has had great success and shown significant reductions in hemoglobin A1c and blood pressure in patients with diabetes (Nicoll et al., 2014). Group therapy or support groups with counselors, registered dietitians, and social workers may help alleviate distress and loneliness of isolation. The use of multidisciplinary clinics has been shown to improve outcomes in aging adults (Erskine, Griffith, & Degroat, 2013; Kozak et al., 2017) and implementing telehealth in these clinics makes scheduling less burdensome. Dietitians across the State are utilizing telehealth for DSME and dietetic interns are learning multiple telehealth platforms in order to be better equipped as they enter the dietetics profession.

During the spring of 2020, multiple hospitals and primary care provider clinics closed and only allowed medically necessary procedures. These restrictions affected dietetics education because students were no longer allowed in hospitals like during traditional internships. Turning to telehealth and working alongside registered dietitians – even at a distance – to monitor and educate patients allowed students to continue their education and graduate on time. Likewise, these opportunities often included exposure to interprofessional teams of pharmacists, physicians, and other therapists which may not have been accessible during typical rotations. Taking advantage of these technologies gave students an opportunity to participate in ground-breaking healthcare as well as provided them with the confidence to interact in a healthcare team. While we must still train healthcare professionals to have bedside manner and we need to ensure students are competent in clinical skills, considering telehealth as a significant portion of their educational experience is worthwhile.

Arkansas Department of Commerce. (2019). Arkansas State Broadband Manager’s Report. Available at: https://www.arkleg.state.ar.us/Calendars/Attachment?committee=685&agenda=3195&file=Exhibit%20F%20Arkansas%20State%20Broadband%20Manager%20Report.pdf
Buis, L., Singer, D., Solway, E., Kirch, M., Kullgren, J., & Malani, P. (2020). Telehealth use among older adults before and during COVID-19. University of Michigan National Poll on Healthy Aging. August 2020. Available at: http://hdl.handle.net/2027.42/15625
Erskine, K. E., Griffith, E., & Degroat, N. (2013). An interdisciplinary approach to personalized medicine: Case studies from a cardiogenetics clinic. Personalized Medicine, 10(1), 73–80.
Institute for Healthcare Improvement. (2019). “What Matters” to older adults? A toolkit for health systems to design better care with older adults. Retrieved from: http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Documents/IHI_Age_Friendly_What_Matters_to_Older_Adults_Toolkit.pdf
Kozak, V. N., Khorana, A. A., Amarnath, S., Glass, K. E., & Kalady, M. F. (2017). Multidisciplinary clinics for colorectal cancer care reduces treatment time. Clinical Colorectal Cancer, 16(4), 366–371.
Medicare. (2020). Available at: https://www.medicare.gov/coverage/telehealth
Nicoll, K. G., Ramser, K. L., Campbell, J. D., et al. (2014). Sustainability of improved glycemic control after diabetes self-management education. Diabetes Spectrum, 27(3), 207-211.
Raphael, B.P., Schumann, C., & Garrity-Gentille, S. (2019). Virtual telemedicine visits in pediatric home parenteral nutrition patients: A quality improvement initiative. Telemedicine Journal and E-health, 25(1), 60–65.
Snoswell, C. L., Taylor, M. L., & Caffery, L. J. (2019). The breakeven point for implementing telehealth. Journal of Telemedicine and Telecare, 25(9), 530-536. doi: 10.1177/1357633X19871403.

Does Age-Related Hearing Loss Worsen Cognitive Decline?

By Natalie Benafield, Au.D., CCC-A
Communication Sciences and Disorders
University of Central Arkansas

Most of us associate aging with a decline in hearing acuity, with good reason. Two-thirds of individuals over 70 years of age have a loss in hearing that would be considered clinically significant. Communication obviously suffers, causing frustration for both the person with the hearing loss and their family members. However, it is estimated that less than one-quarter of individuals with age-related hearing loss seek treatment. Evidence is mounting that ignoring hearing as you age can have detrimental effects that go beyond difficulty communicating with others.

As far back as 1989, scientists have suggested that age-related hearing loss may contribute to cognitive decline in seniors. A pivotal study published in the Journal of the American Medical Association (Uhlmann, et.al.,1989) suggested that hearing loss in older adults was associated with a higher risk of dementia. For the past several years, other researchers have been conducting research in this area and have come to similar conclusions. Dr. Frank Lin, at Johns Hopkins University, and his team followed 639 individuals from the ages of 36-90 for twelve years to investigate the link between hearing loss and dementia. After adjustment for other factors including age, gender, educational level, diabetes, smoking and hypertension, their research suggested that those with hearing loss experiences a 30-40% accelerated rate of cognitive decline (Lin, et al., 2013). More recently a large-scale review of epidemiologic studies of age-related hearing loss and cognitive function from twelve countries was conducted. The researchers found that age-related hearing loss was significantly association with a decline in all main cognitive domains, except for Alzheimer’s disease and vascular dementia. They concluded that hearing loss related to aging is a modifiable risk factor for cognitive decline and dementia in seniors (Loughrey, et al., 2018).

While the exact mechanism underlying the relationship between age-related hearing loss and cognitive decline has not been identified, there are several theories. Some have suggested that hearing loss and cognitive decline may be caused by the same general neurodegenerative process (Stahl, 2017). Neuroimaging studies have suggested that similar changes in the temporal regions of the brain have been noted in individuals with hearing loss and with cognitive decline (Lin, et al., 2014). Other researchers suggest that hearing loss (i.e., the lack of sensory input) causes individuals to use additional cognitive resources to process auditory input, resulting in chronic cognitive “multitasking” and overload. (Tun, McCoy, & Wingfield, 2009). Exacerbating the condition may be that untreated hearing loss often leads to social isolation and even depression, which in turn leads to reduced cortical input over time, hastening atrophy in certain regions of the brain.

Will hearing aid use slow cognitive decline? It makes sense that the use of hearing devices such as hearing aids could increase auditory input, lessen cognitive load, and decrease social isolation, thereby slowing cognitive decline (Sarampalis, et al., 2009). However, we need more large-scale, longitudinal studies before being confident of that claim. Current studies have failed to show a robust protective relationship between hearing aid use and cognitive function. One recent small-scale study found that individuals with evidence of auditory- to- visual cross-modal reorganization in the brain showed evidence of reversal of the re-organization in the auditory cortex, with additional gains in speech perception and cognitive performance (Glick & Sharma, 2020).

What does this mean for current clinical care of older adults? Health care providers often see hearing loss as normal part of aging as they must focus on the numerous urgent medical needs of older adults. This research suggests that clinicians should take a proactive, rather than reactive approach to hearing health in the aging population. Rather than waiting until a patient complains of difficulty hearing, encourage early hearing screening, evaluation, and treatment for those 60 and older. Most patients will not understand the importance of their hearing to brain health. While we lack the evidence to suggest that hearing aids can reduce cognitive decline, we have plenty of evidence to say that hearing loss is not good for the brain. Early hearing evaluation and treatment is risk-free, and evidence is mounting that appropriate treatment of age-related hearing loss could have a positive impact on cognitive decline.

References

Glick, H. A., & Sharma, A. (2020). Cortical Neuroplasticity and Cognitive Function in Early-Stage, Mild-Moderate Hearing Loss: Evidence of Neurocognitive Benefit From Hearing Aid Use. Frontiers in Neuroscience, 1.

Lin, F. R., Yaffe, K., Xia, J., Xue, Q.-L., Harris, T. B., Purchase-Helzner, E., Satterfield, S., Ayonayon, H. N., Ferrucci, L., & Simonsick, E. M. (2013). Hearing loss and cognitive decline in older adults. JAMA Internal Medicine, 173(4), 293–299. https://doi.org/10.1001/jamainternmed.2013.1868

Lin, F. R., & Albert, M. (2014). Hearing loss and dementia – who is listening? Aging & Mental Health, 18(6), 671–673. https://doi.org/10.1080/13607863.2014.915924

Loughrey, D. G., Kelly, M. E., Kelley, G. A., Brennan, S., & Lawlor, B. A. (2018). Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis. JAMA Otolaryngology– Head & Neck Surgery, 144(2), 115–126. https://doi-org.ucark.idm.oclc.org/10.1001/jamaoto.2017.2513

Sarampalis A, Kalluri S, Edwards B, & Hafter E. (2009). Objective measures of listening effort: effects of background noise and noise reduction. Journal of Speech, Language & Hearing Research, 52(5), 1230–1240. https://doi.org/1092-4388(2009/08-0111)

Tun PA, McCoy S, Wingfield A, Tun, P. A., McCoy, S., & Wingfield, A. (2009). Aging, hearing acuity, and the attentional costs of effortful listening. Psychology & Aging, 24(3), 761–766. https://doi.org/10.1037/a0014802

Uhlmann, R.F., Larson, E.B., Rees, R.S., Koepsell, T.D., Duckert, L.G. (1989). Relationship of hearing impairment to dementia and cognitive dysfunction in older adults. Journal of the American Medical Association 261(13), 1816-1919.

Weinstein, B.E., (2018). A primer on dementia and hearing loss. Perspectives of the ASHA Special Interest Groups, 3(6), 18-27.

Integrated Care: The Role of Mental Health Practitioners on the Primary Health Care Team

By Kevin Rowell, PhD
Department of Psychology and Counseling
University of Central Arkansas

As with the implementation of the Affordable Care Act in 2017, U.S. health care continues to develop the patient-centered medical home model as a way of efficiently coordinating health care delivery. Especially for older patients where complexity of health care is the norm, the weight of responsibility in providing effective, safe, and lower cost interventions rests squarely on the primary care practitioner (PCP). Now that baby boomers have reached late life, it is estimated that approximately one-fourth of patients seen in primary care clinics are over age 65. Although most are in good health, the natural decline in health with aging results in a greater presence of physical illness and dysfunction such that most older adults have at least two chronic conditions, as well as developing acute illnesses at prevalence rates similar to younger adults (CDC, 2013, as cited in Hunter et al, 2017).

While the public clearly understands that primary care is designed to be the first line of help in the case of medical illness and that most treatment is rendered therein, the majority of people do not realize that primary care practitioners are very often the first line of treatment for mental health issues as well (O’Donohue et al, 2005). People struggling with common disorders involving depression, anxiety, and substance abuse will more likely seek help from their PCP before considering intervention from a psychiatrist, psychologist, counselor, or clinical social worker. In fact, roughly one-third of the visits to PCPs is due to a mental health concern, and another one-third of visits involve a medical diagnosis that has a significant mental health component (Blount, 2003). The reasons are attributed to familiarity with the PCP, greater access to a PCP as compared to specialists (especially in rural areas), and fear of stigmatization in visiting a mental health clinic (Hunter, et al, 2017).

Research has shown that the most prevalent mental disorders are major depression, generalized anxiety, somatization, and substance abuse. Other common mental health issues include relationship conflict, stress, sleep disturbance, and fatigue. Not surprisingly, women are much more likely than men to report issues with mental health, which is a very consistent trend across most health care settings. Regarding patients over 65, other mental health issues involve cognitive decline, sexual dysfunction, grief/loss, isolation/loneliness, and lower motivation in managing chronic diseases (Hunter et al, 2007).

Whereas the PCP is able to provide appropriate intervention for many of these issues, usually through medication and perhaps brief consultation, a myriad of factors limits the effectiveness of the PCP in addressing primary mental health disorders and secondary mental health issues in chronic disease management. For example, diagnosing some mental disorders usually necessitates somewhat lengthy interviews and often a screening test, yet the high volume of patients scheduled daily in primary care clinics limits the time a PCP can spend with an individual patient. Furthermore, 60-85 percent of PCPs reported being under-trained in diagnosis and treatment of mental disorders. Additionally, when PCPs decide for a referral to a mental health specialist such as a psychiatrist or psychologist, wait times for appointments can be weeks and the likelihood of the patient following through with the appointment is less than 25 percent. Finally as previously mentioned, many people, especially older adults, with mental health concerns feel stigmatized in visiting a mental health clinic and will often refuse to seek help rather than potentially feel embarrassed or shameful (Blount, 2003, Hunter et al., 2017).

To address these issues, the fully integrated behavioral health model calls for the placement of a full-time behavioral health clinician (BHC) to be employed in primary care. Typically the BHC is a licensed psychologist, professional counselor, or clinical social worker who has received special training in integrated care behavioral health. Advantages of the behavioral health clinician are many. Of utmost importance is the presence of a mental health expert in primary care whose function is to identify primary and secondary mental health issues in patients and then to collaborate with the PCP and other staff in providing effective evidence-based interventions for patients. Through research backed behavioral interventions, BHCs can address stress reduction, mindfulness, sleep hygiene, maladaptive thoughts, as well as adaptive, healthy life style changes like exercise, relaxation, diet changes, smoking cessation, and decreased alcohol/substance use, all of which directly improve mental health and chronic disease management (Hunter et al, 2017). For the older patient, BHCs can conduct screenings for dementia and other cognitive problems, address social isolation, and help with sexual dysfunction.

Research indicates that when a full-time BHC is employed in primary care, treatment effectiveness increases, patient and staff satisfaction increase, and treatment and medication costs decrease (Blount, 2003; Ogbeide, Stermensky II, & Rolin, 2016). For example, one consistent finding is that patients with mood (depression) and anxiety disorders show significant improvement, often without medication, when they work closely with a BHC. Furthermore, when a referral to a mental health specialist is necessary, patients are much more likely to meet the appointment, particularly if the BHC can meet briefly with them during the wait time before the first appointment. The BHC is also freed from the standard 8-10 minute PCP appointment duration to better gather interview information, discuss treatment goals, and even implement brief 15-20 minute follow up appointments to reinforce interventions that are working and to make adjustments where needed.

Older adult patients should be encouraged by the addition of a BHC member to the PCP staff. Such a health care provider is able to better address so many more issues than one’s PCP, and the fact that the BHC has been called in to meet with the older patient in no implies that the patient should be embarrassed or stigmatized. It simply means that he or she will be receiving optimal holistic care that has been shown to have significant benefits.

References:

Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems, and Health, 21, 121-134.

Centers for Disease Control and Prevention (2013). The stage of aging and health in America 2013. Retrieved from http://www.cdc.gov/health/state_of_aging_and_health_in_America_2013.pdf.

Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2017). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention (2^nd ed.). Washington DC, American Psychological Association: Washington, D.C.

O’Donohue, W. T., Byrd, M. R., Cummings, N. A., & Henderson, D. A. (2005). Behavioral integrative care: Treatments that work in the primary care setting. New York: Brunner-Rutledge.

Ogbeide, S., Stermensky II, G. & Rolin, S. (2016). Integrated primary care behavioral health for the rural older adult. Practice Innovations, 1, 145-153.

Physical Activity for Older Adults

By Stacy Harris, DNP, APRN
School of Nursing
University of Central Arkansas

Being physically active is one of the most important lifestyle habits people of all ages can take to improve their health. Recently, the United States Department of Health and Human Services (2018), released new physical activity guidelines. The new guideline recommends adults try to achieve a minimum of 150 minutes (2 hours and 30 minutes) of moderate activity or 75 minutes (1 hour and 5 minutes) of intensive activity each week. The new guideline highlights special populations, including recommendations for the older adult. Older adults should try to achieve the adult recommendations along with balance training and muscle strengthening activities. In addition, the guideline states that older adults with chronic conditions or disabilities should engage in physical activity according to their abilities, explaining that any activity level is better than being sedentary.

As adults age and chronic conditions become common, patients may feel becoming physical fit and more active is unrealistic and not beneficial. However, numerous studies have shown older adults benefit from physical activity. Lövdén, Xu and Wangy (2013) published a critique of a meta analysis that linked increased aerobic physical activities with enhance cognition in sedentary adults. In a randomized control trial of Tai Chi training in adults (mean age 77) with mild cognition issues 30 minutes of Tai Chi three times a week over 12 months resulted in a 4% lower conversion to dementia compared to 17% for the control group (Lövdén, Xu and Wangy, 2013). Tai Chi is a low impact activity practiced as a graceful form of exercise involving a series of movements performed in a slow, focused manner accompanied by deep breathing.

Older adults may be overwhelmed or intimidated when a health care provider uses the word “exercise.” The word exercise suggests a level of activity that may be unattainable for older adults. Patients may be more likely to relate to leisure activities such as gardening, dancing or walking. Evidence suggests that leisure activities are beneficial to cardiovascular health. Mensink, Ziese and Kok (2009) found older adults who participated in leisure activities at 1-2 hours per week, had lower systolic blood pressure, heart rate and body mass than sedentary adults.

Besides improving cardiovascular health, physical activity is also proven to improve orthopedic issues. Half of all older adults have knee and hip pain and may worry that increasing physical activity will worsen already achy joints (Peterson, Osterloh and Graff, 2019). The good news is that this idea has been disproven by multiple scientific trials. The American College of Rheumatology and the Osteoarthritis Research Society International recommends activity as first line treatment for knee and hip pain. Activities such as water aerobics, land-based (i.e. walking) and Tai Chi are appropriate activities.

At the University of Central Arkansas (UCA), the Department of Exercise and Sport Science, developed an exercise program for older adults who reside at College Square Apartments, a retirement community on the UCA campus. A faculty member and students meet with participating residents who have been cleared by their primary care provider. Before exercise begins, the students conduct a motivational interview with the participant and create mutual agreed upon goals. The students administer the Senior Fit Test, interpret the results, then prepare and lead the participants through 6-8 weeks of exercise. At the end of the program students administer the Senior Fit Test again, and then review and debrief with the participant.

Older adults may think participating in a fitness program or purchasing expensive equipment is needed to improve fitness. Home-based items such as lifting full milk gallon jugs or carrying laundry baskets up steps are ways to increase strength. Stretch bands are low-cost items that can be used to help with flexibility and strength, too. Any physical activity is worthwhile and helps cardiovascular, joint and mental health. Just move!

References

Lövdén, M., Xu, W. & Wangy, H. X. (2013). Lifestyle change and the prevention of cognitive decline and dementia. Current Opinions in Psychiatry 26 (3): 239-243.

Mesink, B. M., Ziese, T. & Kok, F.J. (2009). Benefits of leisure-time physical activity on the cardiovascular risk profile at older age. International Journal of Epidemiology (28): 659-666.

Peterson, N. E., Osterloh, K. D., & Graff, M. N. (2019). Exercises for older adults with knee and hip pain. The Journal for Nurse Practitioners, (15) 263-267.

S. Department of Health and Human Services (2018). Physical activity guidelines advisory committee scientific report, 2ⁿ^d Ed. Retrieved from https://health.gov/paguidelines/second-edition/report/

Involving Students in Holistic Wellness for Seniors

By Alicia S. Landry, PhD, RDN, LDN, SNS
Lydia Sartain, MS, RD, LD, CDE
Nina Roofe, PhD, RDN, LDN, FAND, CNWE

College of Health and Behavioral Sciences, University of Central Arkansas

Making the aging process fulfilling and enjoyable should be the goal of healthcare providers working with older adults. While indicators of wellness have been assessed to see how they may interrelate in aging, there is still some work to be done to get the message out that holistic wellness in older adults can positively impact quality of life. For example, in patients diagnosed with Parkinson’s and Alzheimer’s disease, declines in functional status have been related to declines in cognition¹. In frail and cognitively impaired elderly people, strength and balance training showed improvements in functional and cognitive abilities². Finally, older adults who report social isolation, also show delayed recovery of systolic blood pressure in response to stress³. A focus on holistic health and wellness in the senior population is a complex, yet much-needed objective.

In order to approach aging holistically, there are a few key recommendations healthcare providers can encourage older adults to do:

Stay active and engaged in social relationships
Spend time mentoring others
Eat a healthy diet
Exercise body and mind
Find healthcare providers they trust

With these in mind, faculty at the University of Central Arkansas (UCA) developed an interprofessional learning opportunity for students and local older adults. Through our ongoing partnership with Faulkner County Center on Aging, we were able to enhance our theme meal by involving students from nutrition and dietetics, interior design, and family and consumer sciences (FACS) education. The goal was to provide a service to the elderly participants while encouraging interprofessional interactions outside of the classroom environment. The theme meal encouraged all the students to assess quickly and think critically during the event, a valuable skill for their future careers.

FACS majors who needed to assess growth and development milestones asked participants to bring in grandchildren. Interior design students observed the building and activities to work with mobility and design issues, then make recommendations. Nutrition students developed and produced a healthy, safe meal with any leftovers going to homebound seniors. The student-produced menu was based on the theme, A Night at the Drive-In, and included grilled hamburgers, oven roasted potatoes, tossed salad, ambrosia salad, and chocolate chip cookies.

The theme meal was successful, and students learned valuable lessons, including planning, organizing, budgeting, and ensuring customer satisfaction. Students also had the opportunity to develop higher level skills, including effective management and decision making. The interprofessional aspect provided students the opportunity to learn textbook concepts while interacting with others to meet numerous objectives for their classes.

Student reflections included quotes like:

“During the theme meal project I learned how to better work with others and share ideas to come up with one main idea. This helped me learn how to come up with the main idea collaboratively and emphasized the importance of communication. This can be applied to learning because it is important to listen to other ideas and consider what is the best one and maybe even putting more than one idea together to find the best outcome. Part of learning is collaborating with others and being willing to put your idea aside if someone has a better one.”

“Accountability is an interesting subject we covered this semester. I honestly thought we would have a problem with someone not doing their part for the theme meal. I was so wrong! I was so proud of how responsible every single person was the day of the theme meal. Everyone arrived on time and did the part they were assigned. There was no withdrawal, aggression, regression, or projection. The reason why I thought back to this topic is that I experience problems with accountability from my staff at work. I guess I assumed that more college students act like this than I thought, and is why I was worried about it from our class. I am so pleased with the maturity of our class’s theme meal. Everyone was accountable for a task and completed it with no complaints”.

“I would have liked to spend more time talking to those who frequent the center in order to get a better understanding of what a normal day looks like to them.”

“My favorite thing was seeing all of the seniors enjoy the theme of the meal and the meal itself. I think that this theme was great because it was something everyone, despite many differences, could enjoy!”

After evaluating student reflections and surveys from the meal participants, we began to consider other ways in which holistic senior wellness could be addressed. Our search led us to consider a fascinating study done to assess seniors’ wellness using e-health applications⁴. These researchers used technology to ask seniors questions, look at physical and functional health, as well as spend time with them in an assisted living facility. The takeaway message was that this method provided immediate feedback and education opportunities to promote holistic well-being in seniors. In future collaborations, we would like to integrate technology applications to assess cognitive performance, physiological and functional variables, as well as other components of wellness like social and financial aspects. With these added components, healthcare providers in communication and speech, psychology and counseling, health education, physical and occupational therapy, as well as kinesiology could be seamlessly integrated into a community preventative health model that is beneficial and scalable. Using something like a theme meal to get students serving in our community has been a fantastic way to introduce them to interprofessional care as well as teach critical components in our disciplines. Getting students involved in interprofessional discussions and regularly assessing the domains of wellness alongside senior adults could redefine holistic wellness in aging.

Stella F, Banzato CEM, Quagliato EMAB, Viana MA, Christofoletti G. Dementia and functional decline in patients with Parkinson’s disease. Dement Neuropsychol. 2008;2(2):96–101. doi:10.1590/S1980-57642009DN20200004
Dorner T, Kranz A, Zettl-Wiedner K, Ludwig C, Rieder A, Gisinger C. The effect of structured strength and balance training on cognitive function in frail, cognitive impaired elderly long-term care residents. Aging Clin Exp Res. 2007 Oct;19(5):400-5.PMID: 18007119
Xia N, Li H. Loneliness, Social Isolation, and Cardiovascular Health. Antioxid Redox Signal. 2018;28(9):837–851. doi:10.1089/ars.2017.7312
Thompson HJ, Demiris G, Rue T, et al. A Holistic approach to assess older adults’ wellness using e-health technologies. Telemed J E Health. 2011;17(10):794–800. doi:10.1089/tmj.2011.0059

Communicating with patients. What is the best strategy?

By Jacquie Rainey, DrPH, MCHES
College of Health and Behavioral Sciences, University of Central Arkansas

Effective communication with patients is integral to a patient and family-centered approach to care. Effective communication contains elements such as establishing rapport, gaining trust, determining readiness to learn (change), considering the patient’s perspective and asking the right questions. The question is: How we do this in the limited amount of time we have to see a patient? Techniques talked about often involve paying attention to the patient’s concerns, asking them about their motivations, talking about their fears, and listening carefully to their concerns and core beliefs. Two approaches to communication that have gained popularity are motivational interviewing (MI),¹and health literacy.

Motivational Interviewing

Motivational interviewing is a communication method that can aid in the development of the patient-provider relationship and thus enhance adherence to medical regimens and behavior change, as well as increase patient satisfaction. Motivational interviewing has been defined as “.. a collaborative, person-centered form of guiding to elicit and strengthen motivation for change.” ²

MI has been described as a complex set of client-centered skills of reflective listening and not a technique that can be learned from a few hours of training. It involves the use of specific communication strategies that are designed to get to the heart of a person’s motivation to change. Miller and Rollnick believe that some clinicians may intuitively practice elements of MI. The use of ‘guiding’ someone to a decision when they are dealing with a problem is a mix of asking, listening and providing information. This type of communication is a common practice among many clinicians. However, MI is true reflective listening in the face of ambivalence from the patient or even irrational and contradictory motives. The purpose of MI is to help the patient recognize their own thoughts and goals and facilitate change. It is a true collaboration between the patient and the provider. The provider uses interviewing to draw out the patient’s ideas and motivations rather than telling them what they should do, and thus empowering the individual to take responsibility for their actions. MI has shown to be effective with older adults in influencing change related to weight loss, medication management and exercise.³ Although MI has a lot to offer in effective patient communication, most healthcare providers are not effectively trained in this technique and do not have enough time with the patient to appropriately employ this method.

Health Literacy

Other suggestions for effectively communicating with patients come from the field of Health Literacy. Health Literacy involves communicating with a patient in a manner that ensures the patient understands and is able to utilize the information provided to make an informed decision. Teach back is one technique that requires the healthcare provider to listen to the patient explain their understanding of the desired action or information. If the patient can’t explain the desired action then the provider attempts to convey the message in another way. The Ask Me 3 approach from Health Literacy requires the patient to ask the healthcare provider three questions: What is my main problem? What do I need to do? Why is it important for me to do this? These are all very important questions but they are clinician-centered rather than patient-centered. The questions may lead to more knowledge and understanding but they do not encourage shared decision making and goal setting and thus patient empowerment. ⁴

Effective Listening

Effective listening is often described as a lost art in medicine. In one study, family practice and internal medicine residents spent an average of 12 seconds letting the patient speak before interrupting them during primary care visits, often interrupting before the patient had finished explaining an issue.⁵

To be an effective advocate for the patient and partner in their healthcare the provider needs to find out who the patient really is, where they are in their healthcare, and how they want to proceed. Ronald Epstein M.D. discusses healthcare providers being present in the moment when communicating with patients in his book Attending: Medicine, Mindfulness and Humanity. He describes being present as listening deeply, without interruption, judgement or preconceptions.^.6 The provider needs to learn whether the patient understands the diagnosis and also the patient’s perspective of her health status and options.

Suneel Dhand believes the one question doctors utilize the least is asking the patient, “What are your goals?” This question gets at what the patient would like to see as an outcome of the encounter. It is particularly important to ask this of older adults who may be dealing with multiple health challenges. It elicits the patient’s expectations for their care and shows that the provider cares about them and their health. It engages the patient in their own healthcare and fosters the patient-provider relationship.⁷

The core element of MI, health literacy and effective patient education/communication is listening. By exploring the patient’s goals and values and determining what they want from their care, the provider can determine if the desired behavior or treatment fits in with the person’s values. Does the behavior change or healthcare plan help to accomplish an important goal or does it interfere with the goal?

Questions that could be used to help elicit goals are:

What specifically would you like to work on to manage your condition?

How important do you think it is to manage/treat your condition?

What is the most important thing for you to accomplish with your care?

Then just listen………

Markides states, “We don’t have to talk all of the time. When someone tell us her problem we healthcare professionals tend to want to give her a solution or say something to cheer her up because we feel uncomfortable watching her suffering. That’s not always the right thing to do. There are times that we need to learn to say nothing and just listen to the other person.”⁸

Martin, L. Communicating with patients. Medline Plus, US. National Library of Medicine. https://medlineplus.gov/ency/patientinstructions/000456.htm review date 11/20/17. Accessed March 1, 2019.
Miller WR, Rollnick S. Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 2009; 37, 129-140.
Beagley D, Bonifas R. Motivational interviewing with older adults. Eder care: a resource for interprofessional providers. University of Arizona College of Medicine Tucson; 2016.
Beyond AskMe3. http://www.ihi.org/education/Documents/ProgramMaterials/CDCMillionHeartsBloodPressureProject/BeyondAskMe3.pdf. Accessed March 1, 2019.
Rhoades DR, McFarland KF, Finch WH, Johnson AO. Speaking and interruptions during primary care office visits. Family Medicine.2001;33(7,) 528-32.
Mindful Practice. http://www.ronaldepstein.com/mindful-practice. Accessed March 1, 2019.
The simple powerful question doctors should ask their patients. https://www.kevinmd.com/blog/2018/07/the-simple-powerful-question-doctors-should-ask-their-patients.html. Accessed March 1, 2019.
Markides M. The importance of good communication between patient and health professionals. Journal of Pediatric Hematology Oncology. 2011;33, S123-S125.

Screening for Dementia

UCA.edu logo

By Kevin Rowell, Ph.D.
Department of Psychology and Counseling, University of Central Arkansas

It seemed to Karen that her 78 year-old mother was having more trouble remembering people’s names, recalling the right words to use in a conversation, and driving with some confusion about which routes to take. Karen noted that her mother’s difficulties began occurring gradually over the past two years, and now she wondered if this is a part of normal aging or if it could be signs of Alzheimer’s disease. On two different occasions, Karen addressed her concern with her mother but was met both times with her mother’s refusal to discuss the matter.

Such a scenario is quite common in families, and with the Baby Boomer generation now in their 60’s and 70’s, it is becoming a reality to millions of Americans. When an elderly person begins to experience noticeable decline in memory, sense of direction, and other cognitive abilities, the concern is whether these are due to normal, age-related changes or due to a disease process like Alzheimer’s, the most common type of dementia. Receiving a diagnosis of dementia is certainly troubling and disconcerting, much like a cancer diagnosis, because some forms have no cure and are fatal within a few years of onset. As with most diseases, early detection leads to early intervention which even if not curable, can at least slow down the progression or assist in preserving cognitive function for a longer period of time.

While most of us are familiar with the terms Alzheimer’s disease and dementia, there is some confusion about their meaning. Dementia is a class of disorders that usually occurs after age 60 with abnormal decline in memory being the first symptom to be noticed. Other cognitive deficits include difficulty recalling names of people or objects, carrying out multiple step tasks, solving complex problems, and maintaining visual-spatial accuracy. Alzheimer’s disease is by far the most common type of dementia and represents approximately 60-70% of cases. Other common types include vascular dementia, dementia due to Parkinson’s disease, and Lewy Body dementia (American Psychiatric Association, 2013).

Determining whether or not an elderly family member has dementia usually involves some type of cognitive exam to measure the degree of function that is lost and may also include a brain scan such as a CT scan or MRI to evaluate the brain’s structural changes that have occurred. In both types of examination, the results from the current patient are compared to a large sample of people his or her age to determine if the changes are significantly below average, that is, if these changes are much greater than expected for the patient’s age group.

Cognitive examinations vary in terms of complexity and time: very brief scales have only a few items and take less than five minutes, intermediate tests require 30 minutes to an hour, and more comprehensive neuropsychological assessments involve several hours of testing. The kind of test administered depends upon the health care provider who is seen. Their choice of assessment will be based upon how much time they can allocate for the testing and the kind of assessment training that they have received.

Most people will make an initial appointment with their primary care provider (PCP) rather than with a psychiatrist, neurologist, or psychologist. PCP’s typically have very limited time to conduct an assessment, and they usually receive training on administering brief screening tests instead of more complex scales. If results of the screening test indicate a problem with memory or other kinds of cognitive functioning, the PCP may give a tentative dementia diagnosis but will typically refer the patient for more in-depth assessment by a psychiatrist, neurologist, or psychologist in order to confirm the diagnosis (Yokomizo, Simon, & de Campos Bottino, 2014).

Because of their common medical education and training, psychiatrists and neurologists often provide similar kinds of assessments. These tests usually require approximately 30 minutes to complete and involve several cognitive tasks such as memory, attention span, naming common objects, copying geometric figures, verbal ability, and orientation to time/date, place, and person. Each task is assigned a very limited number of points, usually ranging 0-3, and a total score is derived by summing all of the points. This total score is then compared to a normal range of scores expected for someone with the same age, and in some cases, with similar education. Psychiatrists and neurologists very often refer the patient for a CT scan or MRI which will help determine the specific type of dementia given that the cognitive testing indicates a significant level of impairment and warrants a diagnosis of dementia (Del Sole, Malaspina, & Biasina, 2016; Tsoi, Chan, Hirai, Wong, & Kwok, 2015).

Psychologists who specialize in geriatric assessment, typically receive the greatest amount of training in test administration. Whereas they often utilize the kinds of intermediate tests used by psychiatrists and neurologists, neuropsychologists may want to use more in-depth, more complex tests to precisely evaluate a person’s memory, attention span, and the other cognitive abilities measured in the intermediate tests. Similar to the other tests mentioned, the results are compared to a normative sample to determine the severity of impairment (Fields, Ferman, Boeve, & Smith, 2011).

If a family member begins to experience noticeable memory loss or problems in other kinds of cognitive tasks, it is advisable to seek a cognitive examination because it is critical to have this kind of information in determining whether or not the individual has dementia. These results can then be used to track changes in their cognitive abilities as they age which will be highly useful in determining the optimal type of intervention for them.

References.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5^th ed.). Washington, DC: Author.

Del Sole, A., Malaspina, S., & Biasina, A. (2016). Magnetic resonance imaging and positron emission tomography in the diagnosis of neurodegenerative dementias. Functional Neurology, 31, 205-215.

Fields, J. A., Ferman, T. J., Boeve, B. F., & Smith, G. E. (2011). Neuropsychological assessment of patients with dementing illness. Nature Reviews. Neurology, 7, 677-687. doi: 10.1038/nrneurol.2011.173.

Tsoi, K. F., Chan, J. C., Hirai, H. W., Wong, S. S. & Kwok, T. Y. (2015). Cognitive tests to detect dementia. A systematic review and meta-analysis. JAMA Internal Medicine, 175, 1450-1458. doi: 10.1001/jamainternmed.2015.2152.

Yokomizo, J. E., Simon, S. S., & de Campos Bottino, C. M. (2014). Cognitive screening for dementia in primary care: A systematic review. International Psychogeriatrics, 26, 1783-1804. doi: 10.1017/S1041610214001082.

Opioid Abuse Among Older Adults: A Growing Concern

By Stephanie Rose, MSW
Department of Health Sciences, University of Central Arkansas

With the increase among the aging Baby-Boomer population, there has been an overall increase of prescription drug use. Many older adults struggle with co-morbid diagnoses, contributing to multiple prescriptions being consumed at one time (Dowell, 2016). Older adults are also more likely to be victims of medication theft (Collins, 2018). With the rising amounts of opioid overdoses, the use of opioids for pain-management among older adults is a growing concern (Dowell, 2016). Historically, there has been more of a focus on younger adults and opioid misuse; however, the average age (50 or older) of treatment admissions for opioid abuse is rising. One in four older adults have used a prescription drug that has the potential for addiction (Carew, 2018). The U.S. Department of Health and Human Services found that while 500,000 older adults were prescribed higher than recommended amounts of opioids, 90,000 of these individuals were identified as high risk for abuse and/or overdose (Collins, 2018).

It is projected that the amount of older adults who abuse illicit substances will double by 2020 (Carew, 2018). Misuse and abuse of prescription opioids in older adults is associated with higher levels of pain, depression and low-level physical disabilities. In 2012, 2.9 million adults, age 50 or older reported using their prescription medications for reasons other than prescribed. Pain-medication accounted for almost half of drug-toxicity related visits to the emergency room for those ages 50 or older (Chang, 2018). This highlights the need for increased attention on older adults and opioid misuse/abuse.

There are a number of initiatives being developed and implemented in order to address these concerns. The CDC has developed guidelines regarding better management of chronic pain (Loreck, 2016). These guidelines address pain management strategies including the oversight of prescription and opioid use, appropriate opioid selection, patient education, when to cease opioid prescriptions, as well as appropriate follow-up (Dowell, 2016). Additional risks and concerns are associated with ceasing opioid prescription-management too quickly, particularly if the person is not provided adequate follow-up and resources for pain-management (Collins, 2018). This is especially concerning due to the rise of heroin use among older adults, as well as, an increase in those who are ages 50-70 receiving methadone treatment (Carew, 2018).

Interventions

Knowing the warning signs of substance abuse can assist with intervention that may save lives. It is important to increase awareness of what interventions are available and what to do should there be a concern. Some helpful tips include:

Knowing what resources exist to assist older adults is important. Proper treatment is essential, particularly since higher rates of depression and anxiety were reported among those ages 50 and older and who misused/abused their opioid prescriptions. Factors that can affect the rates of abuse may include use of opioids as an attempt to cope with the multiple changes that occur in this life-stage, as well as perceived greater pain (Chang, 2018).
Look for warning signs of substance abuse. Several warning signs include slurred speech, hostile and/or depressed mood, memory loss, confusion, and increased isolation. (Hazelden, 2018).
Increasing social engagement can be helpful, particularly since increased opioid use is associated with increased isolation (Chang, 2018).
Identifying supportive resources, including housing and food assistance, as well as addiction education that addresses issues of empowerment, decreasing stressors and enhancing coping skills. (Hazelden, 2018).

It is of further importance to select the right treatment. Due to the complex needs of an individual struggling with addiction, it is important for treatment to seek appropriate practitioners with expertise. Addiction is influenced by a variety of issues, including genetics, mental health, environmental and health factors. An array of practitioners with special skills and training who can appropriately address substance use disorders are available. Some examples of special certifications in Arkansas include Licensed Alcoholism and Drug Abuse Counselor (LADAC), Licensed Associate Alcoholism and Drug Abuse Counselor (LAADAC), Advanced Alcohol and Drug Counselor (AADC) and Certified Alcohol and Drug Counselor (ADC). These credentials require years of additional experience and education focused on addiction. Many times, these are additional credentials and education that general licensed mental health providers (LPC, LCSW, PsyD, PhD, etc.) acquire in order to provide adequate treatment to those struggling with addiction. Being well versed on the treatment options available can be especially beneficial.

The rise of opioid misuse and abuse among older adults continues to be a growing concern and challenge. There are a number of related dangers and outcomes on the rise, particularly since the population of older adults continues to increase. Many of the needs and risk factors of older adults using opioid prescriptions are unique and require well-informed interventions. The UCA Addiction Studies Program prepares students to work in the addiction field by providing comprehensive education in the field of addiction. Students obtain knowledge of addiction including mental health, counseling skills, prevention, as well as, epidemiology and etiology of addiction. The program also requires an internship experience within the field of addiction treatment. UCA Addiction Studies Program continues to prepare students with a special skill-set to address this ever-growing need.

References

Carew, A. M., & Comiskey, C. (2018). Treatment for opioid use and outcomes in older adults: A systematic literature review doi:https://doi-org.library.capella.edu/10.1016/j.drugalcdep.2017.10.007

Chang, Y. (2018). Factors associated with prescription opioid misuse in adults aged 50 or older doi:https://doi-org.library.capella.edu/10.1016/j.outlook.2017.10.007

Collins, S. (2018). Older Americans and opioid misuse: supporting an often overlooked populations in the opioid crisis. Retrieved August 29, 2018

Dowell, D., Haegerich, T., & Roger, C. (2016). CDC guidelines for prescribing opioids for chronic pain-United States. Retrieved August 27, 2018 from: https://www.collins.senate.gov/newsroom/older-americans-and-opioid-misuse-supporting-often-overlooked-population-opioid-crisishttps://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm

Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10-15. doi:http://dx.doi.org.library.capella.edu/10.3928/00989134-20160314-04

Hazelden Betty Ford Foundation. (2018). Older adults deserve recovery from alcoholism, addiction to prescription drugs. Retrieved August 29^th, 2018 from: http://www.hazelden.org/web/public/ade60306.page

Substance Abuse and Mental Health Services Administration. (2017). Opioid use in the older adult population. Retrieved August 27, 2018 from: https://www.samhsa.gov/capt/sites/default/files/resources/resources-opiod-use-older-adult-pop.pdf

Food Insecurity Among Seniors In Arkansas

By Jacquie Rainey, DrPH, MCHES
Department of Health Sciences, University of Central Arkansas

Students from the Nutritional Services Administration class in the Department of Family and Consumer Sciences at the University of Central Arkansas are learning how to plan and serve a meal for clients at the Faulkner County Senior Center. The Faulkner County Senior Center is part of the Faulkner County council on Aging, Inc. Its mission is to meet the social, nutrition and transportation needs of seniors. The partnership between the senior center and UCA students is a win for both groups. The students get real world practice in meal preparation and delivery, the seniors are fed a nutritious meal, and everyone has a good time. Any food that is not eaten the night of the theme meal is portioned for use the next day to serve to home delivered meal participants throughout Faulkner County. The event in April was centered on the theme of a 1950’s diner and included bingo and ‘50’s attire.

The Faulkner County Senior Center is one of the many organizations in the state that is working to combat food insecurity among older adults. Food insecurity is when someone is unable to acquire nutritionally adequate food in sufficient quantities and in socially-acceptable ways.¹ Arkansas ranks in the top tier nationally in the proportion of older adults (currently about 20% of all Arkansans over the age of 60) who are living with food insecurity.² Food insecurity is associated with many negative health effects, including nutritional inadequacy, poor overall health, extended hospital stays, cardiovascular disease, and worsening of chronic conditions. These health consequences have significant costs in terms of quality of life and financial impact.¹

For older adults, food insecurity is primarily an issue of access. Many areas of Arkansas, especially rural areas, are considered ‘food deserts’ where a large portion of the population does not live near a grocery store. Financial hardship is another common cause of food insecurity among seniors. People on fixed incomes have a difficult time purchasing the amount of healthful food that they need. Reduced mobility may produce barriers to older adults shopping for food or leaving home to secure a meal. In Arkansas, 21% of older adults have a health problem that requires the use of specialized equipment such as a wheelchair or walker. ¹ Additionally, lack of access to transportation or the inability to drive due to physical limitations can significantly contribute to food insecurity.

Food insecurity is more common among women, minorities, individuals without a spouse, those who use alcohol or tobacco, have high blood pressure, diabetes or depression, those who have been hospitalized or visited an emergency room in the previous year, and grandparents caring for grandchildren. ^3,1 Efforts should be made to recognize the risk factors for food insecurity and to connect older adults with resources within the community. Resources include but are not limited to: the Older American Act Meal Program that provides meals at sites administered by the Area Agencies on Aging (AAA), local nonprofit organizations such as the Arkansas Hunger Relief Alliance, the Arkansas Foodbank Network, and the Arkansas Rice Depot, and the federally-funded Supplemental Nutrition Assistance Program (SNAP). One example of how Arkansans can make a difference is letting seniors in Northwest Arkansas know about the Double Your Dollars (DYD) Programs at Farmers’ Markets. Senior Farmers’ Market Nutrition Program participants may receive a ‘match’ for purchases made at participating NWA farmers’ markets with their vouchers. Participants receive market coupons that are to be used like cash to purchase fruits, vegetables, meats, eggs, dairy, jam/jelly, honey and food-producing plants. If the market is participating in the DYD project, participants can receive a 1:1 match in market coupons.

The Supplemental Nutrition Assistance Program benefits are reported to be underutilized by older adults.¹ The recommendation from the Senior Hunger in Arkansas report was to increase the number of seniors who participate in the SNAP program thus providing access to sufficient amounts of healthful foods for Arkansas seniors.¹ The Arkansas Hunger Relief Alliance quoted Tomiko Townly, SNAP outreach director as saying, “We often see eligible seniors who don’t know they can receive food assistance or believe they will be taking food from those who are worse off than they are, so they are opting instead to cut back on medications to afford food.” ²

The threat of hunger among seniors in Arkansas is a continuing challenge. Food insecurity is associated with numerous poor health outcomes that can lead to additional challenges for the individual and the healthcare system. An avenue to potentially reduce the burden of disease on these individuals and the healthcare system is to ameliorate the problem of food insecurity in America.⁴UCA is happy to have a small part in helping to do this.

Division of Aging and Adult Services, Arkansas Department of Human Services. Senior Hunger in Arkansas. https://arhungeralliance.org/wp-content/uploads/2014/12/Senior-Hunger-in-Arkansas-2014-FINAL.pdf. Accessed June 5, 2018.
Arkansas Hunger Relief Alliance. (2018). Senior Hunger. https://www.arhungeralliance.org/programs/senior-hunger/. Published 2018. Accessed June 5, 2018.
American Geriatrics Society (2018) How common is food insecurity among older adults? https://www.eurekalert.org/pub_releases/2018-03/ags-hci030818.php. Published March 8, 2018. Accessed June 5, 2018.
Ziliak J, Gunderson G. The state of senior hunger in America 2015: An Annual report. Feeding America and the National Foundation to End Senior Hunger. http://www.feedingamerica.org/research/senior-hunger-research/state-of-senior-hunger-2015.pdf. Published August 16, 2017. Accessed June 5, 2018.

Speech Entrainment: A Promising Approach for Aphasia

by Richelle Weese, M.S. CCC-SLP, University of Central Arkansas, Department of Communication Sciences and Disorders

Conversational partners naturally adapt their verbal and nonverbal communicative actions to mimic, or more closely resemble each other. This is called speech, or rhythmic, entrainment (Borrie & Liss, 2014). Speech entrainment (SE) is important for understanding normal speech production, but can also be used as a rehabilitative technique for those individuals who need help with their communicative functions. Speech Entrainment (SE), is a therapeutic technique being utilized to improve communication with patients suffering from aphasia and is showing promise in other neurologic conditions.

The premise of SE is an audiovisual speech model, in which patients are exposed to audio-visual speech stimuli and instructed to mimic the stimuli, enabling them to produce fluent speech in real time (Fridriksson, J., Hubbard, H. I., Hudspeth, S. G., Holland, A. L., Bonilha, L., Fromm, D., & Rorden, C., 2012). Entrainment is evident in various aspects of speech, including speaking rate, utterance durations, pitch properties, voice intensity, voice quality, and dialectal features (Borrie & Liss, 2014).

With entrainment being a natural feature of human communication, the question is being raised regarding the likelihood that SE would be successful if used as a therapeutic tool in other neurologic communicative disorders. UCA Speech-Language Hearing Center is conducting a study in SE. Currently four clients have undergone therapy sessions utilizing SE. Although results are in the early stages of analyzation for specifics, preliminary findings are promising. Two patients with both expressive aphasia and verbal apraxia have increased their overall phrase length, reduced “robotic” prosody features, and improved articulatory precision. Two clients completed SE that focused on improving cognitive-linguistic skills for memory, targeting recall of family and friend names, with one client showing an improved ability to now recall all five children, their spouses, and grandchildren names.

The applications for SE are encouraging. Socializing and independence are deeply rooted in successful communication. We are seeing some of those results in our participants as they engage in group activities with other participants, play games with their grandchildren, or independently order a meal at a restaurant. SE tasks have been personally chosen to target goals chosen by each participant. Speech entrainment, regardless of the precipitating event leading to the communication issue, is a promising tool that is leading to communication effectiveness and improved quality of life.

References:
Borrie, S.A., Liss, J.M. (2014). Rhythm as a Coordinating Device: Entrainment With Disordered Speech Journal of Speech, Language, and Hearing Research, June 2014, Vol. 57, 815-824. doi:10.1044/2014_JSLHR-S-13-0149

Fridriksson, J., Hubbard, H.I., Hudspeth, S.G., Holland, A.L., Bonilha, L., Fromm, D., & Rorden, C. (2012). Speech entrainment enables patients with Broca’s aphasia to produce fluent speech. Brain, 135 (12), 3815-2829.

University of Central Arkansas

Division of Aging and Adult Services, Arkansas Department of Human Services. Senior Hunger in Arkansas. https://arhungeralliance.org/wp-content/uploads/2014/12/Senior-Hunger-in-Arkansas-2014-FINAL.pdf. Accessed June 5, 2018.

Arkansas Hunger Relief Alliance. (2018). Senior Hunger. https://www.arhungeralliance.org/programs/senior-hunger/. Published 2018. Accessed June 5, 2018.

American Geriatrics Society (2018) How common is food insecurity among older adults? https://www.eurekalert.org/pub_releases/2018-03/ags-hci030818.php. Published March 8, 2018. Accessed June 5, 2018.

Ziliak J, Gunderson G. The state of senior hunger in America 2015: An Annual report. Feeding America and the National Foundation to End Senior Hunger. http://www.feedingamerica.org/research/senior-hunger-research/state-of-senior-hunger-2015.pdf. Published August 16, 2017. Accessed June 5, 2018.