“Elderhood” Express - The University of Tennessee at Chattanooga

“Elderhood” Express
UTC School of Nursing Chosen as Member of National Hartford Center of Gerontological Nursing Excellence In light of their extensive focus in gerontology, the UTC School of Nursing has been asked to join the National Hartford Center of Gerontological Nursing Excellence (NHCGNE). The mission of the Center is to enhance and sustain “the capacity and competency of nurses to provide quality care to older adults through faculty development, advancing gerontological nursing science, facilitating adoption of best practices, fostering leadership, and designing and shaping policy.” Upon receiving this prestigious invitation, the first state university in Tennessee to be named, Dr Christine Smith, Director of the School of Nursing, says she looks forward to the wonderful opportunities this designation affords the school. “We have had a significant focus on gerontology for the last three years through the grant work of Dr. Joanie Jackson and Dr. Carolyn Schreeder. Their HRSA grants focused on educating interprofessional team members in the care of the elderly. When I was called to ask us to participate, I knew immediately it was because of the work of those associated with these two projects. As Dr. Jackson and Dr. Schreeder were in the process of submitting their HRSA grants, we were also developing a proposal to have an endowed Chair in Gerontology. The Vicky B. Gregg Chair in Gerontology was funded through the Tennessee Health Foundation. The inaugural holder of this chair, Brittany Cusack, DNP, ANP, came to the School of Nursing in April 2015. Since that time she has led the efforts to start an Adult Gerontology Acute Care Nurse Practitioner Program in the School of Nursing, and has worked with the Dean of the College of Health Education and Professional Studies, Dr. Valerie Rutledge, to create a minor in Gerontology for the campus. The Hartford Center’s focus is to ensure a strong gerontological workforce in nursing in the US and internationally through faculty development, advancing gerontological nursing science, facilitating adoption of best practices, fostering leadership and designing and shaping policy. Dr. Smith stated, “As the population ages, it is important for nursing to remain at the forefront in educating nurses. Through our association with The Hartford Center, we will have access to the best and the brightest that nursing has to offer as we look at programming and research for this specific population. I plan on getting older, so I look forward to what we learn, what the research tells us and adding to the best practices in nursing as it relates to gerontology. Our goal is to have a nationally recognized program in gerontological nursing.” Elderhood Express was developed to disseminate evidence-­‐based information to community agencies in the Chattanooga area who are intimately involved with the care of our population who are “outgrowing their youth.” Many newsletters and publications focus on childhood and adulthood, but it is rare to find one solely aimed at issues experienced in “elderhood.” Article selections will be chosen from a variety of disciplines. We will also provide listings of geriatric-­‐focused community events as available. UTC Launches New MSW Program UTC begins offering a new Master’s of Social Work (MSW) program in the fall of 2016. The program prepares students for advanced social work practice with special emphasis on serving older adults and their families throughout the Chattanooga region. Dr. Cathy Scott, Assistant Professor and University of Alabama at Birmingham Geriatric Scholar, describes the importance of the new program: Having worked as a geriatric social worker in Chattanooga for many years, I know firsthand the growing demand for aging services in our area. Chattanooga and the surrounding area are home to an increasing number of aging individuals and family caregivers who experience emotional, social and, economic burdens. I am excited for UTC and the greater Chattanooga region to have a program of study that will equip advanced practitioners to serve and meet the needs of this aging population. Students entering the two-­‐year MSW program complete 60 credit hours over two years of study. Professionals with an undergraduate degree in social work may be eligible for the Advanced Standing MSW program. Students in the Advanced Standing program complete 39 credit hours over 12 months of study. The MSW curriculum is designed to meet the needs of adult students. All required courses will be offered through personalized, face-­‐to-­‐face evening courses paired with online and hybrid delivery as appropriate for the course material. Students complete 900 hours of field education under the supervision of the Director of Field Education and assigned agency MSW field instructors. Students develop learning contracts at the beginning of their internships that outline how they will demonstrate mastery of the social work competences and practice behaviors learned in the classroom. Graduates will be prepared for employment as social workers in numerous fields and agencies, and are able to obtain licensure as clinical social workers. Admission into the program is granted on a rolling basis with courses beginning in the fall semester of each academic year. Learn more about the program online http://www.utc.edu/social-­‐work/
Music Therapy for Agitation Reduction in Dementia Dr. Brittany Cusack, DNP Alzheimer’s Disease International (2015) has predicted that by 2030 there will be 75.6 million people affected by the disease; by 2050, they are estimating a staggering 135.5 million persons afflicted. Alzheimer’s disease and related dementias (ADRD) is characterized by cognitive impairment that is often accompanied by agitation in 70-­‐90% of those with advanced cases (Teri et al, 1999). Agitation is a significant behavioral problem that increases the incidence of hospitalization in this population and also can provide a significant burden on caregivers (Sourial et al, 2001). Several studies have been conducted to determine ways to reduce the agitation associated with ADRD, one of which was conducted by Heeok Park who studied 26 people with a mean MMSE score of 8.08 who resided in the home setting. Park (2013) examined the effect of individualized music that began playing for 30 minutes prior to these individuals’ peak agitation times. Using the modified Cohen-­‐Mansfield Agitation Inventory, agitation was measured at three different intervals during twice weekly sessions: 30 minutes before peak agitation time, 30 minutes while listening to the music, and after listening to the music. A paired t-­‐test was used to statistically analyze the results, and it was determined that agitation levels decreased while listening to the music as compared to the baseline data (t = 3.70, p < .001). While further research should be conducted on the subject, Park’s research supports the utilization of individualized music therapy in the treatment plans for those suffering from dementia-­‐associated agitation. “Individualized music is defined as music that has been integrated into the person’s life and is based on personal preference” (Gerdner, 1992). Individualized music may be able to be used as an alternative intervention for the management of agitation in persons with Alzheimer’s disease and related dementias (Gernder, 2012). References • • • Alzheimer’s Disease International. (2015). Dementia Statistics. Retrieved fromhttp://www.alz.co.uk/researc
h/statistics Gerdner, L. (2012). Individualized music for dementia: Evolution and application of evidence-­‐based protocol. World Journal of Psychiatry, 2(2), 26-­‐32. Park, H. (2013). The effect of individualized music on agitation for home-­‐dwelling persons with dementia. Open Journal of Nursing, 3, 453-­‐459. Sourial, R., McCusker, J., Cole, M., & Abrahamowicz, M. (2001). Agitation in demented patients in an acute care hospital: Prevalence, disruptiveness, and staff burden. International Psychogeriatrics, 13, 183-­‐197. Teri, L., Ferretti, L., Gibbons, L., Logsdon, R., McCurry, S., Kukull, W., McCormick, W., Bowen, J., & Larson, E. (1999). Anxiety and Alzheimer’s disease: prevalence and comorbidity. The Journals of Gerontology, Series A, Biological Sciences and M edical Sciences, 54, M348-­‐M352. PACT 4 Grant Dr. Joanie Jackson, DNP The University of Tennessee at Chattanooga School of Nursing received the Providing Advanced, Culturally Competent Care through Clinical Training (PACT 4) Advanced Nursing Education (ANE), Health Resources and Service Administration (HRSA) grant in September of 2012 funded at $1.2 (over the 3 year life of the grant) to develop and implement interprofessional (IP) geriatric care into curricula for graduate programs in Nursing, Physical Therapy (PT), and Athletic Training (AT). The PACT 4 grant was awarded a one-­‐year no-­‐
cost extension in July, 2015 for analysis, evaluation, and dissemination of grant work. During the span of the grant, 10 interprofessional modules were developed to include: • Introduction to IP practice • IP Core Competencies • Safety and Falls • Advanced Safety and Falls • End of Life • Special Concerns in the Older Adult • Pharmacology in the Older Adult • Care of the Older Adult • Mental Health Issues in the Older Adult • Nutrition in the Older Adult In addition to curricula development, grant staff/faculty/students: • Conducted health fairs in local housing authority establishments • Participated in community awareness events for fall prevention • Students collaborated with the Chattanooga Hamilton County Health Department (CHCHD) to develop the Fall Prevention Chattanooga Partnership, which offered a Fall Prevention Summit and offered a Matter of Balance Master Trainer workshop, in conjunction with an additional Community Foundation of Greater Chattanooga (CFGC) $15,000 grant • Participated in the Minority Health Fair • Presented posters at local, regional, and national conferences regarding grant work • Created and implemented an IP Cadaver Lab experience for PT and Nursing students To Weight or Not to Weight? Adaptive Equipment for Clients with PD Dr. Jessica Crowe, OTD, OTR/L PD is a chronic, neurodegenerative disease characterized by impairments in coordination, motor control, and muscle tone (Melnick, 2013). It impacts approximately one-­‐million individuals in the United States (US) over the age of sixty (Melnick, 2013; Van Den Eeden et al., 2003). One of the distinguishing features of PD is the presence of extraneous movement, or a tremor, and this symptom may limit quality of life and independence in activities of daily living (ADLs) for individuals with PD (American Occupational Therapy Association [AOTA], 2014). As such, these individuals require increased assistance with ADLs. In the US alone, it costs approximately 10.8 billion dollars each year to provide ADL care for individuals with PD (Chen, 2010). With a projected increase in the numbers of individuals with PD in the US due to the aging baby-­‐boomer population, these costs are expected to sky rocket. To mitigate the expense associated with caring for persons with PD and to increase quality of life, clients may be referred to rehabilitation services to facilitate improved independence and participation in ADLs (AOTA, 2008). Rehabilitation professionals may offer a variety of interventions to improve ADL independence for clients with PD, including the use of adaptive equipment (AOTA, 2014). It is hypothesized that adaptive equipment may compensate for impaired movement, ultimately resulting in improved ADL independence. One of the most common recommendations for clients with PD is to use weight in adaptive equipment (Meshack & Norman, 2002). Yet, there is limited evidence to support this claim. With recent health care reform, rehabilitation professionals are challenged to provide evidence-­‐based interventions, which will produce measureable, functional outcomes. As such, it behooves rehabilitation professionals to examine the research to determine the most appropriate adaptive equipment to be used to improve ADL outcomes for clients with PD and to ask the question if weight is appropriate with this population. Movement Kinematics of Reach and Grasp in PD Reaching and grasping actions are often required during the performance of an ADL task. Movement kinematics during reaching and grasping have been studied extensively in clients with PD (Maitra & Dasgupta, 2005; Schettino et al., 2003; Wenzelburger et al., 2000). This research may help understand why rehabilitation professionals use adaptive equipment to compensate for impaired movement during ADL. Using a three-­‐dimensional camera system to evaluate movement kinematics during simulated reach tasks, Wenzelburger et al. (2000) found significant impairment in movement quality in clients with PD. These participants exhibited increased tremor in the final phase of reaching to grasp (Wenzelburger et al., 2000). Schettino et al. (2003) examined the movement kinematics of hand pre-­‐shaping in response to various object sizes prior to grasp in clients with PD. This study found that clients with PD exhibited delayed grasp of an object regardless of the object’s shape (Schettino et al., 2003). Finally, Maitra and Dasgupta (2005) examined the coordination of proximal and distal upper limb movements during reach to grasp in clients with PD. The authors concluded that individuals with PD exhibit incoordination of individual joint movements needed to execute the task of reaching and grasping (Maitra & Dasgupta, 2005). While the research methodologies of these studies are not rigorous, they provide limited evidence that movement kinematics are impaired in clients with PD (Maitra & Dasgupta, 2005; Schettino et al., 2003; Wenzelburger et al., 2000). As a result of impaired or uncoordinated movement patterns, it is hypothesized that clients with PD may have deficits in the functional reach and grasp patterns required for successful ADL performance. Adaptive Equipment and Movement Kinematics Adaptive equipment may change various characteristics of an object or tool to increase an individual’s ability to grasp or reach an object or tool during ADL performance. A common change is to increase the handle size to improve grasp patterns. Ma, Hwang, Chen-­‐Shea, and Sheu (2008) examined the effect of adapted handle width on movement kinematics during a simulated feeding task for clients with PD. Results from this study found that clients with PD exhibited faster and smoother movements using spoons with small-­‐ or medium-­‐sized handles when compared to spoons that had larger handles (Ma et al., 2008). Another common adaptation for individuals with PD is to add weight to an object or tool to improve reach and movement during ADL tasks. It is hypothesized that the application of weight may reduce the presence of tremor and increase ADL independence (Ma, Hwang, Tsai, & Hsu, 2009; Meshack & Norman, 2002). Ma et al. (2009) investigated the impact of handle weight on object movement in clients with PD and found that light-­‐weight utensils produced smoother and faster movement patterns when compared to weighted utensils in clients with PD (Ma et al., 2009). Weight significantly impacted the movement of a tool in space for clients with PD, such that heavier tools produced greater movement impairments (Ma et al., 2009). Meshack and Norman (2002) examined the impact of weight on tremor amplitude for individuals with PD. Upon data analysis, the authors concluded that weighted wrist cuffs or weighted utensils did not improve movement kinematics or impact hand tremor in clients with PD (Meshack & Norman, 2002). These studies suggest that light-­‐weight tools with small-­‐ or medium-­‐sized handles may improve tool use during ADLs for clients with PD (Ma et al., 2008; Ma et al., 2009). The impact of the adaptive equipment on ADL outcomes was not evaluated, and it is unknown if improving movement kinematics would increase ADL outcomes for clients with PD. Implications for Adaptive Equipment Recommendations So, the question was asked: To weight or not to weight? At this time, there is limited research examining the effectiveness of weighted adaptive equipment on ADL outcomes for clients with PD. Current research has investigated movement kinematics during reaching and grasping patterns in individuals with PD and the impact of object “Evidence suggests that light-­‐weight tools with shape and weight on the movement small-­‐ or medium-­‐handles may be effective at kinematics of clients with PD. While this review does not provide improving movement kinematics and may evidence or specific recommendations for types of result in improved ADL outcomes (Ma et al., adaptive equipment that may be used to facilitate improved ADL 2008; Ma et al., 2009; Meshack & Norman, independence for clients with PD, 2008).” inferences may be drawn and utilized with caution. There appears to be no basis for the use of weighted adaptive equipment or weighted wrist cuffs in clinical practice for individuals with PD, and the use of this equipment should either be discontinued or implemented with extreme caution. Evidence suggests that light-­‐weight tools with small-­‐ or medium-­‐
handles may be effective at improving movement kinematics References
and may result in • • • improved ADL American Occupational Therapy Association. (2014). Occupational therapy practice outcomes (Ma et al., framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68, S1-­‐S48. 2008; Ma et al., 2009; Meshack & Norman, American Occupational Therapy Association. (2007). Specialized k nowledge and skills 2008). These in feeding, eating, and swallowing for occupational therapy practice. American recommendations are Journal of Occupational Therapy, 61, 686-­‐700. made with caution as an objective ADL Chen, J. J. (2010). Parkinson’s disease: Health-­‐related quality of life, economic cost, and outcome measure was implications of early treatment. American Journal of Managed Care, 16, S87-­‐
not used (Ma et al., S93. 2008; Ma et al., 2009; Meshack & Norman, Ma, H. I., Hwang, W. J., Chen-­‐Sea, M. J., & Sheu C. F. (2008). Handle size as a task 2008). constraint in spoon-­‐use m ovement in patients with Parkinson’s disease. Clinical Rehabilitation, 22, 520-­‐528. Conclusion Ma, H. I., Hwang, W. J., Tsai, P. L., & Hsu, Y. W . (2009). The effect of eating utensil With the increased weight on functional arm movement in people with Parkinson’s disease: A focused in the current controlled clinical trial. Clinical Rehabilitation, 23, 1086-­‐1092. healthcare market on interventions that Maitra, K. K., & Dasgupta A. K. (2005). Incoordination of a sequential motor task in produce measureable, Parkinson’s disease. Occupational Therapy International, 12, 218-­‐233. functional outcomes, rehabilitation Meshack, R. P., & N orman, K. E. (2002). A randomized controlled trial of the effects of professionals should weights on amplitude and frequency of postural hand tremor in people with be concerned about Parkinson’s disease. Clinical Rehabilitation, 16, 481-­‐492. research that Melnick, M. E. (2013). Basal ganglia disorders. In D. Umphred, R. T. Lazaro, M. L. Roller, supports clinical & G. U. Burton (Eds.), Umphred’s neurological rehabilitation (6th ed., pp. 601-­‐
practice. At this time, 61.). St. Louis, MO: Elsevier Mosby. there is limited evidence supporting Schettino, L. F., Rajaraman, V., Jack, D., Adamovich, S. V., Sage, J., & Poizner, H. (2003). the use of adaptive Deficits in the evolution of hand preshaping in Parkinson’s disease. equipment to improve Neuropsychologia, 42, 82-­‐94. ADL outcomes for clients with PD. Van Den Eeden, S. K., Tanner, C. M., Bernstein, A. L., Fross, R. D., Leimpeter, A., …Nelson, Current clinical L. M. (2003). Incidence of Parkinson’s disease: Variation by age, gender, and practices should be race/ethnicity. American Journal of Epidemiology, 157, 1015-­‐1022. scrutinized and evaluated, and further Wenzelburger, R., Raethjen, J., Löffler, K., Stolze, H., Illert, M., & Deuschl, G. (2000). Kinetic tremor in a reach-­‐to-­‐grasp movement in Parkinson’s disease. quantitative research Movement Disorders, 15, 1084-­‐1094. examining the effectiveness of adaptive equipment during ADL should be conducted. To ride the tidal wave of healthcare reform, rehabilitation professionals will need more research supporting the use of evaluations and interventions in clinical practice. The answer to the question, to weight or not to weight, is inclusive. At this time, it appears that weight is not an effective intervention for use for clients with PD. ASK TO HAVE YOUR LARGEST ORGAN EXAMINED Shirleen D. Chase, PhD(c), MSN, APRN, ACNS-­‐BC The incidence of skin cancer is increasing at an alarming rate, and there is currently no consensus by major health policy organizations regarding skin cancer screening. Unlike other types of skin cancers, the Centers for Disease Control (CDC, 2012) report that melanoma incidence has been steadily increasing for the last 30 years. Melanoma is the deadliest type of skin cancer causing approximately ten thousand deaths each year. While accounting for only 4% of all skin cancers, melanoma is responsible for 80% of all skin cancer-­‐
related deaths each year. While newer discoveries have recently been investigated for advanced melanoma, a significant number of patients continue to be diagnosed with thicker lesions, an increased risk of metastasis, and death. What can you do? Request a gown when seen in the clinic by your healthcare provider to ensure that your skin is easily viewable during your examination. Be aware of your risk factors: large numbers of moles, burn easily or never tan, natural blond or red hair color, history of intense sunburns, extensive amounts of freckles, or use of a tanning bed. Early detection not only leads to improved survival rates, it also significantly increases cure rates. Look for the “ugly duckling” or the one mole that looks different from the others. Regular exams of the skin by both you and your healthcare provider will increase the chance of finding skin cancer in its early stages. One way to participate in caring for your largest organ, the skin, is to examine it often. I recently went to the dermatologist with my now 71 year-­‐old mother; she had two new areas of concern on her face. I am an advanced practice nurse and I have cared for many patients with skin and soft tissue cancers including melanoma. The areas on her face did not look to be melanoma, but I had a suspicion they were another type of skin cancer. He looked at one area and said it was nothing to worry about; the other area he said would need a biopsy. I thought, “That’s it? No skin exam? No suggestion to remove her clothes for a complete exam? No need to touch the skin?” At subsequent visits to both her dermatologist and primary care provider, she did not receive a complete skin exam. You cannot wait for the invitation; ask for a gown and have all of your skin examined. It could save your life. Shirleen Chase is an Assistant Professor in the School of N ursing at the University of Tennessee at Chattanooga. Email: Shirleen-­‐Chase@utc.edu 615 McCallie Avenue, Dept. 1051 Chattanooga, TN 37401 For more information, please contact Brittany Cusack, Vicki Gregg Chair of Gerontology, at Brittany-­‐
Cusack@utc.edu or visit us online at www.utc.edu/nursing. Publication Number: E040950-­‐001-­‐16. UTC is an EEO/AA/Titles VI & IX/Section 504/ADA/ADEA institution. UTC is a comprehensive, community-­‐engaged campus of the University of Tennessee System.