The University of Toledo Department of Public Health & Preventive Medicine, Center for Successful Aging, Center for Continuing Medical Education and The Ohio Geriatrics Society (OGS)
Present the: 20TH ANNUAL GERIATRIC MEDICINE SYMPOSIUM: PresentSelf‐Care among Older Adults: Promoting their Physical, Cognitive and Mental Health
Friday, March 4, 2016 8:00 a.m. ‐ 4:15 p.m.
Hilton Garden Inn Perrysburg, Ohio Hospice of Northwest Ohio Sincera Supportive Care and Symptom Relief, A Signature Service of Hospice NWO
Please be sure to visit the exhibitor booths. Area Office on Aging of Northwest Ohio, Inc. Heartland of Waterville Kindred at Home‐ Home Health and Hospice Kingston Healthcare Orchard Villa Senior Independence Home Health & Hospice
Please be sure to visit the exhibitor booths. PLANNING COMMITTEE A special thanks to the members of our planning committee listed below who contributed their time and effort to ensure the success of this program:
Victoria Steiner, PhD Symposium Director UT Public Health and Preventive Medicine Center for Successful Aging Darlene Ault Center for Successful Aging Murthy Gokula, MD, CMD UT Family Medicine Geriatric Medicine
Barbara Hicks, MSN, RN UT Nursing Alumnus Cletus Iwuagwu, MD UT General Internal Medicine Geriatric Medicine
Gayle Kamm, PharmD, BCPS UT Pharmacy
Lisa Keaton, MSW, LSW UT Outpatient Social Work Barbara Kopp Miller, PhD UT Online Education Center for Successful Aging Michelle Masterson, PT, PhD UT Rehabilitation Science Deborah Mattin, PhD, MBA, MSN, RN UT Nursing A. John McSweeny, JD, PhD, ABPP (CN) UT Psychology Barbara J. Messinger‐Rapport, MD, PhD, FACP, CMD Geriatric Medicine Hospice of the Western Reserve Britney Molnar UT Center for CME FACULTY James B. Leverenz, MD Director, Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland Clinic Joseph Hahn MD Endowed Chair of the Neurological Institute
Heather L. Menne, PhD Senior Research Scientist Benjamin Rose Institute on Aging
Anne Mondro, MFA Associate Professor University of Michigan Stamps School of Arts & Design
THE UNIVERSITY OF TOLEDO FACULTY Victoria Steiner, PhD Associate Professor, Department of Public Health and Preventive Medicine Assistant Director, Center for Successful Aging The University of Toledo
Murthy Gokula, MD, CMD Associate Professor, Department of Family Medicine Director, Geriatric Medicine Fellowship The University of Toledo
Janet Hoy, LISW‐S, PhD Assistant Professor, College of Social Justice and Human Services The University of Toledo
Christopher Ingersoll, PhD, AT, ATC, FACSM, FNATA, FASAHP Professor & Dean, College of Health Sciences Interim Dean, College of Social Justice and Human Service The University of Toledo
Michelle Masterson, PT, PhD Associate Professor and Director, Physical Therapy Program Chair, Department of Rehabilitation Sciences The University of Toledo
Kimberly A. Schmude, PharmD, RPh Clinical Assistant Professor Department of Pharmacy Practice College of Pharmacy and Pharmaceutical Sciences The University of Toledo DISCLOSURE PAGE
PLANNING COMMITTEE DISCLOSURES None of our planning committee members have any financial interest or other relationships with any manufacturer of commercial products or service to disclose that would pose a conflict of interest with regards to the content of this activity.
FACULTY DISCLOSURES
Dr. Leverenz discloses that he recieves Grant Support from National Institute of Health, Alzheimer’s Association, Alzheimer’s Drug Discovery Foundation, Michael J Fox Foundation, Axovant, Lundbeck, and Sanofi/Genzyme. He is also a Consultant for Axovant, GE, Navidea Biopharmaceuticals, Piramal Healthcare, and Teva.
Drs. Gokula, Hoy, Ingersoll, Masterson, Menne, Schmude, and Anne Mondro do not have any financial interest or other relationships with any manufacturer of commercial products or service to disclose that would pose a conflict of interest with regards to the content of this activity.
Nursing Credit Disclosure to Learners
The presenters and the planners of this activity have declared that there is no conflict of interest to disclose. All speakers/presenters have signed a statement that says she/he will present information fairly and without bias. This activity is sponsored by the Ohio Geriatric Society. Approved Provider status does not imply endorsement by the provider, ANCC, OBN or ONA of any products displayed in conjunction with an activity. ACCREDITATION
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The University of Toledo and the Ohio Geriatrics Society. The University of Toledo is accredited by the (ACCME) to provide continuing medical education for physicians. The University of Toledo designates this live activity for the maximum of 6.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of the participation in this activity.
This Live activity, 20th Annual Geriatric Medicine Symposium: Self‐Care among Older Adults: Promoting Their Physical, Cognitive, and Mental Health, with a beginning date of 03/04/2016, has been reviewed and is acceptable for up to 6.75 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Application for Counselor/Social Work credit has been filed with the Ohio CSWMFT Board. Determination of credit is pending.
The University of Toledo, Psychiatry Department is approved by the Ohio Psychological Association ‐ MCE Program to offer continuing professional education with Provider No. 00P0‐340967014. This program has been approved for 6.75 credit hours.
The State of Ohio Board of Executives of Long Term Services & Supports (BELTSS) has approved this program for 6.5 course hours with BELTSS# 174‐C‐16
Application for has been made to the Ohio Physical Therapy Association for continuing education credits for Physical therapists. Determination of credit is pending.
Application for has been made to the State of Ohio Occupational Therapy, Physical Therapy and Athletic Trainers Board for continuing education credits for Occupational therapists. Determination of credit is pending.
The University of Toledo, College of Nursing (OH‐026 2‐1‐17) is an approved provider of continuing nursing education by the Ohio Nurses Association (OBN‐001‐91), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
6.75 Contact Hours of Continuing Nursing Education will be awarded for successful completion. Successful completion requires the learner to: Attend 80% of the session and completion and submission of an evaluation tool.
The AAPA accepts certificates of participation for educational activities certified for Category 1 credit from AOACCME, Prescribe credit from AAFP, and AMA PRA Category 1 credit(s)™ from organizations accredited by ACCME or a recognized state medical society. For information regarding The University of Toledo, CME Upcoming Events, be sure to visit our website:
cme.utoledo.edu
The UT CME Office is pleased to announce that we have received the ACCME "Accreditation with Commendation" good through 2016. TO OBTAIN YOUR CME CREDIT Your CME Program Evaluation and Certificate will be available on Tuesday, March 8, 2016
1. Go to cme.utoledo.edu. (Omit the www/http ://) 2. Click on DIRECT LINK TO LOGIN 3. Login: Username: lastnamefirstname (no commas, no spaces) Password: zip code (Your password is your zip code unless you specified another password in your profile)
4. An online forms inbox will appear with your program evaluation to complete. 5. Complete your online evaluation; be sure to answer all questions. 6. Click the submit tab. 7. You will be directed to print your certificate.
Hilton Garden Inn Wi‐Fi Code: hilton2015 20th Annual Geriatric Medicine Symposium Self‐Care among Older Adults: Promoting their Physical, Cognitive and Mental Health
7:30 am Registration & Continental Breakfast ‐ View Exhibits
8:00‐8:15 Welcome‐ Christopher Ingersoll, PhD, AT, ATC, FACSM, FNATA, FASAHP
Victoria Steiner, PhD
Moderator: Victoria Steiner, PhD 8:15‐9:00 The Aging Brain: What’s Normal, What’s Not, Next Steps James B. Leverenz, MD
9:00‐9:45 Creative Expressions: Exploring the Positive Impact of the Arts for Older Adults Anne Mondro, MFA
9:45‐10:05 Panel Discussion
10:05‐10:20 Break/View Exhibits
Moderator: Barbara Hicks, MSN, RN
10:20‐11:05 Dietary Supplements and Over‐the‐Counter Medications Kimberly A. Schmude, PharmD, RPh
11:05‐11:50 Promoting Health Through Physical Activity Michelle Masterson, PT, PhD
11:50‐12:10pm Panel Discussion
12:10‐1:15 Lunch 20th Annual Geriatric Medicine Symposium Self‐Care among Older Adults: Promoting their Physical, Cognitive and Mental Health
Moderator: A. John McSweeny, JD, PhD, ABPP (CN)
1:15‐2:00 Understanding the Therapeutic Roles of Companion Animals with Older Adults Janet Hoy, LISW‐S, PhD
2:00‐2:45 Encouraging Self‐Care among Older Adults: Examples from a Senior Center Heather L. Menne, PhD
2:45‐3:05 Panel Discussion
3:05‐3:15 Break/View Exhibits
3:15‐4:00 Using Technologies in Self‐Care Management Murthy Gokula, MD, CMD
4:00‐4:15 Q&A
4:15 pm Adjournment The Aging Brain: What’s Normal, What’s Not, Next Steps
James B. Leverenz, MD
Objectives:
1. Describe normal age associated cognitive changes and those associated with disease. 2. Review disease associated brain changes in older adults. 3. Described both pharmacologic and non‐pharmacologic approaches to treating and preventing aging‐associated cognitive change. The Aging Brain: What’s Normal, What’s Not, Next Steps
James B. Leverenz, MD
Cleveland Lou Ruvo Center for Brain Health
Neurological Institute Cleveland Clinic
Supported by National Institute of Health, Veterans Affairs, MJFF, APDA, PDF, Jane and Lee Seidman Fund
Disclosures: 1. Consulting: • Axovant • GE • Navidea Biopharmaceuticals • Piramal Healthcare • Teva 2. Grant Support: • National Institute of Health • Alzheimer’s Association • Alzheimer’s Drug Discovery Foundation • Michael J Fox Foundation • Axovant • Lundbeck • Sanofi/Genzyme
1 Objectives: 1. Describe normal age associated cognitive changes and those associated with disease. 2. Review disease associated brain changes in older adults. 3. Decribed both pharmacologic and non-pharmacologic approaches to treating and preventing aging- associated cognitive change.
2 3 Prevalence of Dementia
70
60
50
40
(%) 30
Dementia 20
10
0 65 70 75 80 85 90 Age (years)
Adapted from Hebert LE, et al. JAMA. 1995;273:1354-1359.
Aging and Dementia Prevalence
5 65-74 75-84 4 85+ Number (in millions) 3 of DAT patients in the US 2
1
0 1980 19902000 2010 2020 2030 2040 2050
4 Prevalence of PD
Dorsey et al, Neurology, 68:384-6, 2007.
Dementia NIA/AA: “Dementia is diagnosed when there are cognitive or behavioral (neuropsychiatric) symptoms that: ”
• Interferes with ability to function at work or at usual activities
• …a decline from previous levels of functioning…
• …Cognition/behavior involve at least two cognitive domains:
• Memory, executive function, visuospatial, language, behavior
McKhann et al., Alzheimer’s & Dementia, 1-7, 2011.
5 Alzheimer’s Disease
NIA/AA Criteria: • Meets criteria for dementia • Insidious onset • Presentations: • Amnestic • Language • Visuospatial • Executive • Alternatives: • Stroke, Lewy body disease, medical illness, medications
McKhann et al., Alzheimer’s & Dementia, 1-7, 2011.
Not all dementia is Alzheimer’s disease
6 Mild Cognitive Impairment (MCI)
NIA-AA Core Clinical Criteria: • Concern regarding a change in cognition • Patient, informant, clinician •Impairment in one or more cognitive domains • Memory, executive, attention, language, visuospatial •Preservation of independence in functional abilities • May take more time, be less efficient, make more errors • “…generally maintain their independence of function in daily life with minimal aids or assistance”
Albert et al., Alzheimer’s & Dementia, 1-10, 2011.
What is “Normal” Aging?
• Memory • “Working” • Attention, retrieval • Short term • Encoding for storage • Long term • Retrieval
Working Short Term Long Term
7 What is Alzheimer’s Disease?
History - Alzheimer’s Disease
Auguste Deter
8 History - Alzheimer’s Disease Auguste Autopsy: “…evenly affected atrophic brain…” Bielschowsky stain: “…very characteristic changes in the neurofibrils…fibrils arranged parallel…a tangled bundle of fibrils…” “…Dispersed over the entire cortex…,miliary foci…sites of deposition of a peculiar substance…”
Alzheimer's Disease- Pathology
Silver Stain: “Neuritic Plaques”
Beta Amyloid Protein “BAP”
9 “BAP”
Alzheimer's Disease- Pathology
10 Microtubule The Tau gene binding repeats
3R 352
This image cannot currently be displayed. 2N3R 381 23N3R This image cannot currently be displayed. 410 4R 383
This image cannot currently be displayed. 2N4R 412 23N4R This image cannot currently be displayed. 441
exon 2 exon 3 exon 10
Tau genomic structure 0 1 2 3 4 4a 5 6 7 8 9 10 11 12 13 14
This image cannot currently be displayed. This image cannot This currently be imag displayed. e cann ot curre ntly be displ ayed.
This image cannot non -coding exonscurrently be displayed. non -CNS coding exons alternatively spliced exons in brain
Are you a BAPtist?
Or a TAUist?
11 Signs and Symptoms of Alzheimer’s Disease
Early Stage Middle Stage Advanced Stage (years 0-4) (years 5-8) (years 8-12) memory loss executive dysfunction executive dysfunction apathy apathy depression poor insight poor insight cortical dysfunction cortical dysfunction (aphasia/apraxia/agnosia) visual spatial visual spatial disruptive agitation disruptive agitation psychosis psychosis psychosis (delusions)
“Bedside” Testing
http://www.mocatest.org/
12 Scoring of Clock Drawing
Laboratory Testing
• Blood • CBC, chemistry, TSH • B12, folate • Syphilis serology • Genetic testing* • Cerebrospinal fluid • A, tau, p-tau, 14-3-3, infection markers, paraneoplastic markers • Imaging • Structural (CT, MRI with hippocampal volume) • SPECT, FDG-PET • Amyloid imaging
13 Laboratory Testing - Imaging
Normal Aging AD
Hippocampus - Volume
Laboratory Testing - Imaging
Glucose (FDG-PET)
Amyloid
Foster NL Neuroimaging in Weiner and Lipton., 2009: p. 105-136.
14 Alzheimer’s Disease
Laboratory Testing - CSF
15 Treating the Dementias
16 Approved Treatments for Dementia Cholinergic Therapy
•Cholinesterase inhibitors • donepezil (Aricept) • rivastigmine (Exelon) • galantamine (Razadyne)
Approved Treatments for Dementia Cholinergic Therapy
Placebo- All Patients Taking –3 * Controlled Phase Rivastigmine * † Improvement –2 * 2-12 mg/day –1 † 0 † 1 2 † 3 4 ‡ 5 †* 6 ** 7 Difference at
From Baseline Rivastigmine 6-12 8 1 year = 11 points 9 mg/day (n=47) 10 Original placebo (n=51) 11 12 Projected placebo
Mean Change in ADAS-Cog Scores ADAS-Cog in Change Mean 13 Decline 0212 186 38 44 52 Week
*P<0.001 vs placebo; †P<0.001 vs projected placebo; ‡P<0.05 vs projected placebo. Observed-case analysis. ADAS-Cog = Alzheimer’s Disease Assessment Scale-Cognitive Subscale. (MMSE 10 -17)
17 Approved Treatments for Dementia Memantine (Namenda) & Donepezil (Aricept)
3.6 Improvement P=.014 3.8 P=.032 P=.123 P=.008 4.0
† 4.2 *P=.028 P=.03
4.4 Deterioration
4.6 Memantine+Donepezil Mean CIBIC-Plus Score Placebo+Donepezil 4.8 0 4 8 12 18 24 End Point n = 198 197 190 182 180 172 198 n = 196 194 181 170 164 152 196 Treatment Week *OC analysis. †LOCF analysis. Source: Data on file, Forest Laboratories, Inc.
Non-Cognitive Therapies
Symptom Non- Medication Pharmaceutical Apathy Social and physical AChEi activity ? Psychostimulant
Irritability Caregiver education Antidepressant (sertraline) Anticonvulsant Antipsychotic Avoid Benzodiazepines Psychosis Don’t treat, caregiver Antipsychotic (quetiapine) Hallucinations/delusions education ?
Sleep Sleep Hygiene Melatonin ? Sedating medication
18 Where do we go from here?
Are you a BAPtist?
Or a TAUist?
19 Alzheimer's Disease- Pathology
Silver Stain: “Neuritic Plaques”
Beta Amyloid Protein “BAP”
“BAP”
20 “The Proof of the Pudding is in the Eating”
Alzheimer's Disease- Treatment
21 Alzheimer's Disease- Treatment
Schenk D et al, Nature, 1999
Amyloid Immunotherapy
• AN1792 (A 1-42) • Phase I, 80 subjects with no adverse events • Phase IIa • 372 AD subjects • 6% developed meningoencephalitis • Trial discontinued • “responders” with slower rates of cognitive decline, but increased brain volume loss
22 Amyloid Immunotherapy
• AN1792 (A 1-42)
Lemere & Masliah, Nature Rev Neurol, 2010
Amyloid Immunotherapy
23 Amyloid Immunotherapy
Doody et al, NEJM, 23:311-21, 2014
Amyloid Immunotherapy Prevention Trials
Trial Medication Subjects Status
Banner Vaccine or APOE4 2015 APOE4 BACE inhibitor Carriers (1200)
A4 Solanezumab + Amyloid scan Active enrollment Imaging BAP (1000)
DIAN Solanezumab or Known mutation Active enrollment PS1/PS2/APP Gantenerumab (210)
API Crenezumab Colombia Active enrollment PS1 (E280A) (300)
http://www.nia.nih.gov/alzheimers
24 Amyloid Immunotherapy Aducanumab
• Monoclonal Antibody • To aggregated A • Phase Ib • 137 subjects • Placebo or 1,3,6, or 10 mg • Significantly positive effects/Dose response • Amyloid imaging • MMSE • CDR • Side effects were dose and APOE genotype driven
Amyloid Immunotherapy Aducanumab
25 Amyloid Immunotherapy Solanezumab
Seimers ER et al, Alz Dement, In press.
Amyloid Immunotherapy Prevention Trials
Trial Medication Subjects Status
Banner Vaccine or APOE 4/4 Late 2015 APOE4 BACE inhibitor Carriers (650)
A4 Solanezumab + Amyloid scan Active enrollment Imaging BAP (1000)
DIAN Solanezumab or Known mutation Active enrollment PS1/PS2/APP Gantenerumab (210)
API Crenezumab Colombia Active enrollment PS1 (E280A) (300)
http://www.nia.nih.gov/alzheimers
26 BACE Inhibition Prevention Trials
Trial Medication Subjects Status
Banner Vaccine or APOE 4/4 Late 2015 APOE4 BACE inhibitor Carriers (650)
A4 Solanezumab + Amyloid scan Active enrollment Imaging BAP (1000)
DIAN Solanezumab or Known mutation Active enrollment PS1/PS2/APP Gantenerumab (210)
API Crenezumab Colombia Active enrollment PS1 (E280A) (300) http://www.nia.nih.gov/alzheimers
27 What if something works?
Epidemiology of AD and MS
• Alzheimer’s disease • Current US estimates – 5.3 million people • 2050 estimates - > 13 million people (US only) • Multiple Sclerosis • Current US estimates – 400,000 people • Cleveland Clinic Main Campus • Mellen Center – 12 physicians, 6 APC • CBH – 6 physicians, 2 APC
28 Alzheimer’s Disease Other therapeutic approaches
Trial Medications Subjects
Prevention Vitamin E/Selenium, Asymptomatic Estrogen, Statins, Exercise MCI/Alzheimer’s Lipoic Acid, ACEi, Symptomatic Carvedilol, Metformin, Nasal Insulin, Exercise Aging Cognitive training, Age related cognitive Omega-3, Vitamin D, decline Hormonal, Exercise Non-Cognitive L-Tryptophan, Prazosin, Delirium, Agitation home intervention
http://www.nia.nih.gov/alzheimers https://clinicaltrials.gov/
In healthy older adults: • Active vs Inactive • Fit vs Unfit • Exercise Training vs Control
• Better cognitive performance
• Preservation of cognitive function
• More extensive brain activation during executive control tasks
• Greater preservation of brain tissue volume
Deeny et al., 2008; Erickson et al., 2007, 2009, 2011; Etnier et al., 2007; Schuit et al., 2001
29 Exercise Increases the Size of the Hippocampus
Erickson et al. 2011, PNAS
Physical Activity, Genetics, and the Hippocampus
Smith et al. (2011). NeuroImage, 54, 635-644.
30 Physical Activity, Genetics, and the Hippocampus
Smith et al. (2014). Frontiers in Aging Neuroscience.
In healthy older adults: • Active vs Inactive • Fit vs Unfit • Exercise Training vs Control
• Better cognitive performance
• Preservation of cognitive function
• More extensive brain activation during executive control tasks
• Greater preservation of brain tissue volume
Deeny et al., 2008; Erickson et al., 2007, 2009, 2011; Etnier et al., 2007; Schuit et al., 2001
31 Lou Ruvo Center for Brain Health Cleveland Clinic
Trial Medications Subjects
Grifols Plasmaphoresis Alzheimer’s disease
Neuronix Transcranial Magnetic Alzheimer’s disease Stimulation
Rasagiline Rasagiline Alzheimer’s disease (ADDF)
Aducanumab Aducanumab MCI/early Alzheimer’s (Biogen) Disease CBH Biorepository None Aging and Neurodegeneration
Lou Ruvo Center for Brain Health
• Don’t forget help is available! • Clinical care • Alzheimer’s Association • We need your help! • Treatment trials • Clinical studies (no treatment) • Support
Please call us: 216-636-9467 800-223-2273 (ext 69467)
32 Thank You !
33
Creative Expressions: Exploring the Positive Impact of the Arts for Older Adults
Anne Mondro, MFA
Objectives:
1. Discuss an overview of the benefits of creativity for well‐being and highlight key research in the field of creative aging. 2. Discuss the various forms of expressive art and provide insight into how to work with local artists and musicians. 3. Illustrate the positive impact of the arts for persons with dementia and their care partners
2/16/2016
Creative Expressions Exploring the positive impact of the arts for older adults
Anne Mondro University of Michigan Penny W. Stamps School of Art & Design, Ann Arbor, MI USA
• Provide an overview of the benefits of creativity for well‐being and highlight key research in the field of creative aging
• Discuss the various forms of expressive art and provide insight into how to work with local artists and musicians
• Illustrate the positive impact of the arts for persons with dementia and their care partner
1 2/16/2016
Anne Mondro
Benefits of Creativity
• Outlet for expression • Provides joy • Enables self‐discovery • Provides a positive distraction • Builds self‐esteem • Enhances decision‐making • Helps to acquire knowledge and skills • Decreases loss of U‐M Geriatrics Silver Club Member independence • Decreases anxiety
2 2/16/2016
Benefits of Creativity • Bond socially • Develop trust • Expand the support network • Communicate with others across generations, income, abilities and cultures
Anyone Can Dance Program
Judith Sachs
www.anyonecandance.org
Memory, Aging & Expressive Arts
Students will meet with specialists in neurology, psychology, public health, social work, and the arts to learn fundamental concepts and issues facing individuals with memory loss.
Through expressive art sessions with adults living with memory loss, students will explore the potential of the arts to serve as an outlet for expression and build key life skills.
3 2/16/2016
Memory, Aging & Expressive Arts
• Gain a holistic perspective of aging and memory loss
• Explore the benefits of creativity
• Apply expressive arts to coursework to build community
U‐M Stamps School of Art & Design student and engagement skills U‐M Geriatrics Silver Club Member working together as part of Memory, Aging & Expressive Arts
Student Preparation for working with Persons with Memory Loss
Communication Creative Toolbox & Listening Skills
Dementia Confidentiality Knowledge Issues
4 2/16/2016
Expressive Arts:
Embrace the use of multiple forms of art in healthcare and wellness programs
Emphasis is placed on the creative process to improve one’s quality of life and quality of relationship with others
U‐M Stamps School of Art & Design student and U‐M Geriatrics Silver Club Member working together as part of Memory, Aging & Expressive Arts
Writing & Poetry
Theater & Music & Storytelling Singing Expressive Arts
Dance & Visual Arts movement
5 2/16/2016
Designing for a shared art experience instead of a medical intervention
U‐M Stamps School of Art & Design student and U‐M Geriatrics Silver Club Member working together as part of Memory, Aging & Expressive Arts
Florence Nightingale’s Notes for Nursing (1860)
Artwork created by U‐M Geriatric Center Mild Memory Loss Program Club Member
6 2/16/2016
U‐M Stamps School of Art & Design student and U‐M Geriatrics Silver Club Member working together as part of Memory, Aging & Expressive Arts
National Center for Creative Aging www.creativeaging.org
7 2/16/2016
Participatory Arts for Older Adults: A Review of Benefits and Challenges Noice, Noice and Kramer (2013)
Aim: Collect and describe current and past Wellness Studies and to promote future investigations with a strong evidentiary base.
31 Studies were reviewed
• Dance: 8 studies • Expressive Writing: 3 studies • Music: 10 studies • Theater: 7 studies • Visual Art: 3 studies
Source: The Gerontologist (2014) 54 (5): 741‐753
Studies revealed an overwhelmingly positive quality of life outcomes for various participatory art forms
• Art participation is intrinsically pleasurable (e.g., Gutman & Schindler, 2007; Kraus & Anderson, 2013; Stacy, Brittain & Kerr, 2002)
• Social support in group arts instruction (e.g., Cacioppo & Hawkley, 2003; Seeman, Lusignolo, Albert, & Berkman, 2001)
• Well‐researched benefits of stimulating or productive activities (e.g., Glass, de Leon, Marottoli, & Berkman, 1999; Hultsch, Hertzog, Small & Dixon, 1999; Wilson & Bennett, 2003)
Source: The Gerontologist (2014) 54 (5): 741‐753
8 2/16/2016
The Impact of Professionally Conducted Cultural Programs on the Physical Health, Mental Health, and Social Functioning of Older Adults Cohen, et al. (2006)
Aim: To measure the impact of professionally conducted community‐based cultural programs on the physical health, mental health, and social activities of individuals aged 65 and older. Intervention group outcomes: • Higher overall ratings of physical health • Fewer doctor visits • Less medication use • Fewer instances of falls
Source: The Gerontologist (2006) 46 (6): 726‐734.
Impact of TimeSlips, a Creative Expression Intervention Program, on Nursing Home Residents With Dementia and their Caregivers Fristsch, et. al. (2009) Investigated a ten‐week TimeSlips storytelling intervention on quality of care for persons with dementia residing in long‐term‐care facilities. TimeSlips is a group‐generated story program that uses open‐ended questions to create the story.
Results:
• Residents were more engaged and more alert • More frequent staff‐resident interactions, social interactions and social engagement • Staff that participated in program had more positive view of residents
9 2/16/2016
Retaining Identity: Creativity & Caregiving
A pilot study to evaluate the effectiveness of art as an intervention for caregivers and persons with memory loss
Research Team:
Anne Mondro Elaine Reed, Sponsored by: Dr. Lydia Li Mcubed and Michigan Dr. Cathleen Connell Alzheimer’s Disease Center Annie Hyrila Parisa Gharderi
Specific Aims:
1.Test the feasibility of an art intervention for caregiver and persons with memory loss
2. Enable caregivers to rediscover sense of self through the creative arts
3. Improve quality of relationship between caregiver and care recipient
4. Reduce the feelings of distress for caregiver and care recipient
10 2/16/2016
Intervention
First four sessions:
• Caregivers will learn how to use art materials, explore their creativity, develop a basic understanding of art and design principles, and build communication skills for working with persons with memory loss through art making and guided discussions.
Following four weeks:
• Caregiver teach the same projects to their care recipient. Facilitators will help guide the caregiver in how to structure the projects for their partner and aid in providing ways to communicate successfully in leading their partner through the art making. A guided discussion with the group will follow.
What do you see?
What does the artwork remind you of?
What did you discover?
What can you take away from this experience?
What title would you give this artwork?
11 2/16/2016
Variables & Measures
The measures will evaluate the art intervention based on the following caregiver constructs: distress, sense of self, caregiver self‐efficacy, creativity, and relationship to care recipient.
Survey measures include:
• Zarit Burden Scale (Skaff &Pearlin, 1992) • Caregiver competence (Pearlin et al., 1990) • Caregiver appraisal measures‐ Caregiver satisfaction • (Lawton et. al, 1989) • Behavior Symptoms Checklist (Teri et. al, 1992) • Closeness of the Relationship (Whitlatch et. al,2001) • Creative Self‐Efficacy and Creative Role (Karkowski • et. a, 2012) • Qualitative short surveys for the caregivers asking questions about meaningful activities and the art workshops
Establish Partners for Arts Programming
1. Partner with museums, arts organizations, schools and universities
1. Partner with local artists, musicians, dancers, and writers/poets
12 2/16/2016
Training for Artists to work with older adults :
• National Center for Creative Aging www.creativeaging.org
• The Creative Center at University Settlement www.thecreativecenter.org
• TimeSlips www.timeslips.org U‐M Stamps School of Art & Design student • University of Michigan and U‐M Geriatrics Silver Club Member Certificate in Advanced working together as part of Memory, Aging Clinical Dementia Practice & Expressive Arts www. ssw.umich.edu
When working with Artist & Musicians
• Provide key information about the group: strengths, challenges, interests, likes/dislikes
• Provide key information about your program’s schedule
• Offer communication tips and resources to further knowledge of working with your group
• Have volunteers or staff available to assist
• Let the artist and musician experiment with the group
• Pay the artists for their time. They are experts.
13 2/16/2016
Enhancing well‐being through Creative Expression for Persons with Memory Loss
• Maintain a sense of personhood
• Provide important meaning and purpose in daily life
• Exert a degree of control over one’s world
• Sense of pride and accomplishment U‐M Stamps School of Art & Design student and U‐M Geriatrics Silver Club Member working together as part of • Build relationships with others Memory, Aging & Expressive Arts
“We learned from one another, the young and the aged. We provided a service to one another and enjoyed it!”
U‐M Geriatrics Silver Club Member in response to Memory, Aging & Expressive Art shared art experience
14 2/16/2016
Music
U‐M Geriatrics Silver Club members
Music
U‐M Geriatrics Silver Club Member and U‐M Stamps School of Art & Design working on creating custom playlists as part of Memory, Aging & Expressive Arts
15 2/16/2016
http://newhorizonsmusic.org
Dance
Anyone Can Dance Program by Judith Sachs
16 2/16/2016
University of Michigan Health System
Story writing
TimeSlips www.timeslips.org
17 2/16/2016
Poetry
Alzheimer’s Poetry Project www.alzpoetry.com
Visual Art (Abstract)
• Introduce new techniques • Use good quality art materials • Inspired by art history • Avoid children’s crafts
Artwork created by U‐M Geriatric Center Mild Memory Loss Program Club Member
18 2/16/2016
Artwork created by U‐M Geriatric Center Mild Memory Loss Program Club Member
Visual Art (Reminiscing)
U‐M Stamps School of Art & Design student and U‐M Geriatrics Silver Club Member working together as part of Memory, Aging & Expressive Arts
19 2/16/2016
The Cleveland Museum of Art Distance Learning Program
Distance Learning (DL) @ the CMA consists of live, real time videoconferencing that allows participants to interact with the museum from their own locations
MoMA Meet me at MoMA www.moma.org/meetme/practice/index
20 2/16/2016
University of Michigan Museum of Art Meet me at UMMA
Impact of the Arts on Care Partners:
• Opportunity to engage in meaningful activities with family member
• Opportunity to engage in conversation
• Opportunity to contribute to community and advocate for awareness
• Enable care partner to feel a sense of pride in their family members
21 2/16/2016
Memory, Aging & Expressive Arts Art Exhibition and Performance 2013
Meet Me at MoMA
22 2/16/2016
My wife was diagnosed with Alzheimer's disease 3 years ago. Over time, her mood became increasing depressed as her memory declined. She withdrew socially. Little stimulated her internally or externally. As her caregiver, my outlook was negatively affected. The Memory, Aging & Expressive Arts program significantly brightened her spirits as she enjoyed the camaraderie of her student partner and the creative challenges the class presented. She looked forward to attending every class and took delight in her art. As her life‐ long partner and caregiver, my spirits were also lifted by the positive impact the program had.
23
Dietary Supplements and Over‐the‐Counter Medications
Kimberly A. Schmude, PharmD, RPh
Objectives:
1. Discuss categories of Over‐the‐Counter products commonly used by older adults with thoughts on appropriate selection. 2. Describe safety issues with Over‐the‐Counter products used by older adults in order to avoid a negative impact on health. 3. Discuss a general approach for thinking about dietary supplements and their use by older adults. 2/16/2016
DIETARY SUPPLEMENTS AND OVER-THE-COUNTER MEDICATIONS Kimberly A. Schmude PharmD, RPh March 4th, 2016
OBJECTIVES
Discuss categories of OTC products commonly used by older adults with thoughts on appropriate selection
Describe safety issues with OTC products used by older adults in order to avoid a negative impact on heath
Discuss a general approach for thinking about dietary supplements (herbals, vitamins...) and their use by older adults
1 2/16/2016
OVERVIEW
NSAIDs / Acetaminophen Antihistamines Decongestants Dietary supplements Legislation Safety issues Approach to the patient
NSAIDS / ACETAMINOPHEN
2 2/16/2016
NSAIDS (NON-STEROIDAL ANTI-INFLAMMATORY DRUGS)
Reason for use Fever Pain relief *
OTC ingredients Ibuprofen 200mg max = 6 tabs daily Naproxen 220mg max = 2 tabs daily if ≥ 65yrs
Safety Issues GI bleeding Acute kidney injury
*OTC doses have NO anti-inflammatory activity; analgesic activity only
NSAIDS / GI BLEEDING RISK
High risk patients Increased age History of GI bleed Low dose aspirin Anticoagulant use Alcohol intake
3 2/16/2016
NSAIDS / ACUTE KIDNEY INJURY
High risk patients Impaired renal function Diabetes mellitus Hypertension Heart failure Cirrhosis Volume depletion (vomiting, diarrhea, aggressive diuresis) ACE inhibitors (i.e. lisinopril...) Angiotensin receptor blockers (i.e. losartan...)
Pai AB; Pharm Today 2014;20:54-64.
4 2/16/2016
ACETAMINOPHEN
Reason for use Fever Pain relief
OTC dosing Single ingredient: 325mg, 500mg, 650mg tablets Included in many multi-ingredient products Maximum daily dose = 4000mg daily
Safety Concern Hepatotoxicity
ACETAMINOPHEN / SAFETY CONCERN
Hepatotoxicity ↑ risk at doses > 4000mg daily FDA required warnings
5 2/16/2016
ANTIHISTAMINES
ANTIHISTAMINES / SECOND GENERATION
Uses: hives / relief of allergy symptoms Characteristics Little penetration into the CNS Anticholinergic activity (minimal to none)
“Non-sedating” Claritin (loratadine)10mg Adult dosing: 1 tablet daily; no age restrictions Allegra (fexofenadine)180mg Adult dosing: 1 tablet daily OTC labeling for patients ≥ 65yrs: “ask a doctor” *Geriatric dosing: use caution; CrCl < 80ml/min: 60mg daily
“Low-sedating” Zyrtec (cetirizine)10mg Adult dosing: 1 tablet day OTC labeling for patients ≥ 65yrs: “ask a doctor”
*Geriatric dosing: 5mg daily Children’s Zyrtec (cetirizine) 5mg/5ml syrup OTC labeling for patients ≥ 65yrs: 5ml daily
*Lexi-Drugs. Accessed Feb 6th, 2016.
6 2/16/2016
ANTIHISTAMINES / FIRST GENERATION
Characteristics CNS penetration / sedation Anticholinergic activity (significant)
Anticholinergic drugs / ↑ risk in the elderly: Constipation Sleep disturbance Cognitive decline Vision changes Falls / hip fractures BPH symptoms / urinary retention Hallucinations / delirium / seizures Cardiac arrhythmias
ANTIHISTAMINES / FIRST GENERATION
Approved for allergy Clemastine (Tavist) Diphenhydramine (Benadryl) Brompheniramine (Children’s Dimetapp) Chlorpheniramine (Chlor-Trimeton)*
Approved for insomnia Doxylamine Diphenhydramine
Approved for common cold (runny nose) Doxylamine (Nyquil; other multi-ingredient products) Diphenhydramine (multi-ingredient products) Brompheniramine (Children’s Dimetapp) Chlorpheniramine (multi-ingredient products)*
Krinsky DL, et al. APhA, 2015.
7 2/16/2016
NASAL DECONGESTANTS
ORAL DECONGESTANTS
Use: common cold, allergy
Pseudoephedrine Usual adult dose = 240mg /day Sustained release tabs: 120mg q12h or 240mg q24h Immediate release 30mg tablets: 60mg q 4-6 hours
Phenylephrine10mg tablets Adult dose: 1 tablet q 4 hours (max 6 per day)
8 2/16/2016
ORAL DECONGESTANTS
Safety issues
↑ BPH symptoms / urinary retention
Cardiovascular
CNS stimulation
Hypertension
ORAL DECONGESTANTS
Use: common cold, allergy
Pseudoephedrine Usual adult dose = 240mg /day Sustained release tabs: 120mg q12h or 240mg q24h Immediate release 30mg tablets: 60mg q 4-6 hours
*Geriatric dose: Use with caution; initiate with IR tablets; 30-60mg q6hrs prn
Phenylephrine10mg tablets Adult dose: 1 tablet q 4 hours (max 6 per day)
*Lexi-Drugs. Accessed Feb 6th, 2016.
9 2/16/2016
TOPICAL DECONGESTANTS
Nasal sprays Nasal vapor inhalers oxymetazoline levmetamfetamine administered q10-12hrs may use q2hours phenylephrine 3 month expiration date administered q4hrs
Rebound congestion Rebound congestion max use = 3 days max use = 7 days
Absorbed systemically IF overused Not absorbed No required safety Same safety concerns as the warnings oral decongestants
DIETARY SUPPLEMENTS
10 2/16/2016
LEGISLATION
Dietary Supplement Health & Education Act (DSHEA) 1994 Products intended to supplement the diet containing 1 or more: Vitamin or Mineral Amino acid Herb or other botanical Intended to supplement the diet by ↑ total dietary intake Concentrate, metabolite, constituent or combination of the above...
Label claims Disease claims are NOT allowed Nutrient content and health claims are allowed Structure / Function claims are allowed (with disclaimer)
“New Dietary Ingredient” A dietary ingredient that was NOT marketed in the USA in a dietary supplement before Oct 15th 1994
LEGISLATION
Dietary Supplement & Nonprescription Drug Consumer Act
2006
Mandatory reporting of serious ADRs to MedWatch
Final rule for current good manufacturing practices
2007
Product must contain what the label claims it does
Product may not be contaminated
11 2/16/2016
2014 TOP 20 HERBAL SALES (~$ IN MILLIONS) IN FOOD, DRUG, AND MASS MARKET CHANNELS Horehound Cranberry Echinacea Black cohosh Flaxseed Valerian Yohimbe Bioflavinoids Saw palmetto Ginger Aloe Vera Milk Thistle Garlic Cinnamon Rhodiola Horny Goat Weed Ginkgo Plant sterols Red Yeast Rice Elderberry 0 102030405060708090100110
2013 2014 ↓from 2013 adapted from Smith, T. Herbalgram. 2015:107;52-59.
HERBAL SUPPLEMENTS / SAFETY CONCERNS
Surgical complications due to herbals Anesthesia Bleeding Common recommendation: Discontinue herbal supplements 2 weeks before surgery
Allergic reactions ↑ risk Asteraceae cross-reactivity ragweed, marigold, chrysanthemum, daisy, dandelion… echinacea, milk thistle, valerian, feverfew, butterbur…
Contamination / Adulteration “Weight loss” supplements “Male enhancement” supplements
FDA . www.fda.gov accessed Feb 10, 2016 Leak JA. Internet J Anesthesiol 2000;4(3) ISSN:1092-406X
12 2/16/2016
RESOURCES / PRODUCT QUALITY
ConsumerLab Newsletter / e-mail alerts Product evaluations (subscription only) Product seal (licensed or voluntary program)
United States Pharmacopeia (USP) Product seal (voluntary program)
EMERGENCY DEPARTMENT VISITS / ADVERSE EVENTS DUE TO DIETARY SUPPLEMENTS
Geller AI; N Engl J Med 2015;373:1531-40
13 2/16/2016
METHODS
Surveillance data (2004-2013) 63 emergency departments (nationally representative) Emergency department visits: 3667 cases identified
Estimated average annual occurrence: 23,005 ED visits 2154 hospitalizations
Characterized patients / products / type of ADR
Geller AI; 2015
RESULTS / PATIENTS ≥ 65YRS
62.7% visits due to vitamin / mineral products
29.9% visits due to calcium, iron, or potassium Calcium (54.1% swallowing problems) Iron / Potassium (abdominal complaints)
Other vitamin / mineral products Swallowing problems 41% Mild-moderate allergic reactions 40.6%
Geller AI; 2015
14 2/16/2016
RESULTS / PATIENTS ≥ 65YRS
“Swallowing problems” Choking Pill-induced dysphagia Globus
Visits due to supplement induced swallowing problems ≥ 65yrs 37.6% versus 6-64yrs 9.4% ≥ 65yrs 83.1% due to vitamin / mineral products
↑ hospitalization ≥ 65yrs 16% versus <65yrs 8.4% (p=0.003)
Geller AI; 2015
DIETARY SUPPLEMENTS APPROACH TO THE PATIENT
15 2/16/2016
Be mindful of projecting any negative attitude
Use inquiries about herbals as an opportunity
Gather / Use information specifically Intake forms, medication history Info / Inquiry posters in the waiting / examination rooms
Aggressive case finding Narrow therapeutic index drugs Immune compromised patients Patients anticipating surgery Explain risk to patient versus their perceived benefit
Encourage the patient to be an informed consumer
REFERENCES
Anastasi JK, et al. Herbal Supplements: Talking with your patients. J Nurse Pract. 2011;7:29-35.
Ang-Lee Mk, et al. Herbal medicines and perioperative care. JAMA. 2001;286:208-16.
ConsumerLab. com LLC. White Plains, NY. www.consumerlab.com
Geller AI, et al. Emergency department visits for adverse events related to dietary supplements. N Engl J Med. 2015;373:1531-40.
Kachru N, et al. . Potentially inappropriate anticholinergic medication use in community-dwelling older adults: a nation cross-sectional study. Drugs Aging. 2015;32:379-89.
Krinsky DL, et al. editors. Handbook of Nonprescription Drugs, 18th ed. Washington DC: American Pharmacists Association; 2015.
Leak JA. Herbal Medicines: What do we need to know? The Internet Journal of Anesthesiology 2000;4(3) ISSN: 1092-406X
Lexi-Drugs. Lexicomp [database online]. Hudson, OH: Wolters Kluwer Health Inc; February 2016.
Mehta RL et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.
Messina BA. Herbal supplements: Facts and myths – talking to your patients about herbal supplements. J Perianesth Nurs. 2006;21:268-78.
National Kidney Foundation. KDOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 suppl 1):S1-S266.
Natural Medicines Comprehensive Database. Stockton, CA: Therapeutic Research Faculty. http://naturaldatabase.therapeuticresearch.com
Pai AB. Keeping kidneys safe: The pharmacist’s role in NSAID avoidance in high-risk patients. PharmToday. 2014;20:54-64.
16 2/16/2016
REFERENCES
Salerno SM et al. Effect of oral pseudoephedrine on blood pressure and heart rate.. A meta-analysis. Arch Intern Med. 2005;165:1686-94.
Schmiedl S, et al. Self-medication with over-the-counter and prescribed drugs causing adverse drug reaction related hospital admissions: results of a prospective long term multi-centre study. Drug Saf. 2014;37(4):225-35.
Shi S, Klotz U. Drug interactions with Herbal Medicines. Clin Pharmacokinet 2012;51(2):77-104
Smith T, et al. Herbal dietary supplement sales in US rise 6.8% in 2014. HerbalGram. 2015:107;52-9.
U.S. Food and Drug Administration. www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud
West T, et al. Evaluation of anticholinergic burden of medications in older adults. J Am Pharm Assoc. 2013;53:496- 504.
Vaes, LP, et al. Interactions of warfarin with garlic, ginger, ginkgo, or ginseng: nature of the evidence. Ann Pharmacother 2000;34:1478-82.
Zia A, et al. Anticholinergic burden is associated with recurrent and injurious falls in older individuals. Maturitas. 2016 ;84:32-7.
17
Promoting Health Through Physical Activity
Michelle Masterson, PT, PhD
Objectives:
1. Discuss excersize and physical activity strategies that promote health and wellness for older adults. PROMOTING HEALTH THROUGH PHYSICAL ACTIVITY
Michelle Masterson, PT, PhD Chair, Department of Rehabilitation Sciences Director, Doctor of Physical Therapy Program College of Health Sciences
Let’s Look at the Big Picture
Changes Changes associated with associated inactivity (and other lifestyle/ with typical environmental factors) aging
Frailty
common chronic medical conditions and the causes of death among older individuals
1 Being healthy or well…
Is more than just “not getting or being sick” Is influenced by knowledge, attitudes, behaviors, and environment Requires active participation and responsibility
WELLNESS DOESN’T JUST HAPPEN, ONE MUST WORK FOR IT!
Benefits of Physical Activity
myocardial O2 cost BP and HR at submax resting SBP and DBP insulin needs LDL’s and triglycerides total BF intra-abdominal BF BMI (kg/m2)
2 Benefits of Physical Activity
VO2 due to central and peripheral adaptations lactate threshold exercise threshold for onset of symptoms HDL’s glucose tolerance muscle capillarity musculoskeletal function
Benefits of Physical Activity
morbidity and mortality obesity anxiety and depression feeling of well-being functional independence performance of work, recreational, and sports activities quality of life
3 Physical Activity
So what’s the problem??
...easier said than done!!!
Physical INactivity
• Participation in leisure activity: -65-74 y.o. 49% -75+ y.o. 35%
• Participation in moderate-level physical activity: -65-74 y.o. 31% -75+ y.o. 23%
• Participation in strengthening exercises: -65-74 y.o. 11% -75+ y.o. 8%
Healthy People 2010, US Dept. HHS
4 Causes of INactivity
Acute / accidental inactivity: induced by bed rest, acute illness
Chronic inactivity: induced by sedentary lifestyle or chronic disease
Environmental factors: bed rails, restraints, improper chair/bed height, stairs, doors community and neighborhood accessibility and safety lack of assistance social isolation
Barriers
. The older adult: . The HCP: -health status -time and productivity -social and cultural factors -reimbursement -FEAR -ageism -lack of knowledge -interpersonal and -misconceptions about physical communication skills activity (pain, boring, no -lack of knowledge (under- results, cost) estimate and under-treat)
Rasinaho et al., 2006; Haber, 2007; Hilton, 2008; DiGiacomo, 2009 Wasserman 2008
5 So What Do We Do?
Role of Health Care Professionals 1. Understand Models of Change 2. Use appropriate interventions 3. Use behavioral change strategies
Health Belief Model
A person must believe: . He/she is susceptible to health problems . The health problems can be prevented or minimized . He/she can be successful in strategies to prevent or minimize the problems
The older adult’s PERCEPTION is the key! We must address his/her perceptions AND...address our OWN misperceptions!
6 So What Do We Do?
Role of Health Care Professionals 1. Understand Models of Change 2. Use appropriate interventions 3. Use behavioral change strategies
Interventions
“We have been too careful and too conservative with our geriatric patients, attempting to strengthen them by putting them on an exercise machine for 3 minutes. We have committed the inexcusable sin of under-dosing our interventions.”
Whetten & Studer, 2011
7 Interventions
“There is an abundance of evidence to support the use of high intensity training to improve gait, balance, and strength, yet we are unwilling to apply this evidence to our older adults.” Whetten & Studer, 2011
Interventions . Endurance . Train for 6MW test (functional = 1200-1750’) . Gait Speed . Train with treadmill (functional = 2.24 mph) . Strength . Should feel physically challenged . Balance . Should be successful with task 75% of the time . Dual Tasking . Task should be meaningful Whetten and Studer, 2011
8 Interventions
“Physical Activity and Public Health in Older Adults: Recommendations from the American College of Sports Medicine and the American Heart Association”
Nelson et al. Medicine & Science in Sports and Exercise. 39(8): 1435-1445; 2007.
Interventions
. Aerobic . Flexibility . 30 minutes, moderate . 10 minutes of intensity, 5 days/wk OR flexibility activities, . 20 minutes, vigorous 2 days/wk intensity, 3 days/wk . Balance . Strengthening . “for those at risk for . 8-10 exercises, 10-15 a fall” reps, 2 days/wk, . Activity Plan nonconsecutive . Should include how, where, and when
Nelson et al., 2007
9 Activity Plan!?
Ask the questions: Level of activity, leisure interests, occupation, perceived barriers, knowledge level What do you like to do, but can’t, why? Use measureable goals: Normative data to compare, motivate, monitor EXAMPLES for each domain? Next slide…
Examples (Let’s do them!)
Aerobic 2 or 6 minute walk test; #steps/day; total distance or time/day Strength Grip strength; time for 5x sit to stand; # reps sit to stand in 30 seconds Flexibility Back scratch test; sitting reach test Balance Single leg stand; tandem or semi-tandem stand; functional reach test
10 So let’s put a plan together!!!
Considerations
. F.I.T.T. Principle . Frequency, Intensity, Type, Time
. How to monitor intensity . Rate of Perceived Exertion (RPE) . 1-10 (4 = moderately hard) . Talk Test
11 Aerobic (Endurance)
. “Accumulate 30 minutes (T) of moderate intensity (I) activity on most, preferably all, days of the week (F)”
. Type (T) . rhythmic, aerobic . large muscle groups . Consider functional activities that can help maintain/improve aerobic capacity: . EXAMPLES?
Strengthening
. Often neglected in older adults . Work out with a partner . Monitor breathing patterns . F.I.T.T. . Consider functional activities that can help maintain/improve strength: . EXAMPLES?
12 Flexibility
. Always warm-up . Don’t bounce . Move just beyond end-ROM . Hold each 10-30 seconds . Consider functional activities that can help maintain/improve flexibility: . EXAMPLES?
Balance
. Must be challenging . Incorporate with strengthening and flexibility exercises . Consider functional activities that can help maintain/improve balance: . EXAMPLES?
. SAFETY is critical for all physical activity!
13 So What Do We Do?
Role of Health Care Professionals 1. Understand Models of Change 2. Use appropriate interventions 3. Use behavioral change strategies
Behavioral Change
. Identify target behaviors . behaviors to avoid or stop . behaviors to adopt or begin . Identify barriers . Problem-solving to remove or bypass barriers . Goal setting . Reinforcement
14 Behavioral Change
. Schedule activity . join organized group classes and activities . Self-monitoring and feedback . daily logs, charts showing change (use several variables)
Behavioral Change
. Individualize program . consider lifestyle, occupation, hobbies, time constraints, etc. (the whole person) . Support system . get family, friends, co- workers involved . support groups
15 Behavioral Change
MORE IDEAS . Emphasize functional activity . Increase physical activity in every day chores, ADL’s, shopping, etc. . Modify the activity vs. not doing it all (modify rules) . Encourage independence (do for self) . Participate in local events (charity walks…) . Volunteer
Resources
. FREE 86 page booklet . www.nia.nih.gov . Geared toward older adult . Chapters include: . benefits of exercise . safety issues with exercise . sample exercises . personal stories and testimonials . nutritional guide . charts and logs
16 In Summary
Physical activity as a continuum Physical activity as everyday life BENEFITS of physical activity… SO JUST DO IT!
THANK YOU!
17
Understanding the Therapeutic Roles of Companion Animals with Older Adults
Janet Hoy, LISW‐S, PhD
Objectives:
1. Identify at least one of each of the following types of benefits of human‐ animal interaction for older adults: physical benefits; social benefit; emotional/psychological benefits. 2. Define and differentiate between the following designations: “companion animal”; “service dog”; “emotional support animal”; “animal assisted activities”; and animal assisted therapy” 3. Identify and differentiate which kinds of patient health benefits can be facilitated by each the different animal role designations; and types of resources to support older adults with companion animals.
2/16/2016
Understanding the Therapeutic Roles of Companion Animals with Older Adults
Janet Hoy, LISW‐S, PhD, Associate Professor
University of Toledo Social Work Program Toledo, Ohio
Objectives
‐ Objective 1: Attendees will be able to identify at least one of each of the following types of benefits of human‐animal interaction for older adults: physical benefits; social benefit; emotional/psychological benefits.
‐ Objective 2: Attendees will be able to define and differentiate between the following designations: “companion animal”; “service dog”; “emotional support animal”; “animal assisted activities”; and animal assisted therapy”
‐ Objective 3: Attendees will be able to identify and differentiate a) which kinds of patient health benefits can be facilitated by each the different animal role designations; and b) types of resources to support older adults with companion animals.
1 2/16/2016
Human‐animal interaction (HAI)
Human‐animal bond (HAB)
2 2/16/2016
Overview of benefits • Physical: contact‐related (oxytocin release; lower blood pressure; decreased cortisol; decreased respiration rate; decreased heart rate); increased activity level (e.g., walking dog, playing with cat) • Psychological: roles; meaning; self‐efficacy and connection • Emotional: reduced feelings of loneliness; increased feelings of well‐being • Social: direct (companionship) and indirect (stimulation of interactions with other revolving around animal) • Functional: increased independence; ‘working’ dogs (e.g., service/assistance dogs)
3 2/16/2016
American Heart Association: Statement on Pet Ownership and Cardiovascular Risk Conclusions • Pet ownership, particularly dog ownership, is probably associated with decreased CVD risk (Level of Evidence: B). • Pet ownership, particularly dog ownership, may have some causal role in reducing CVD risk (Level of Evidence: B). Recommendations • Pet ownership, particularly dog ownership, may be reasonable for reduction in CVD risk (Class IIb; Level of Evidence B). • Pet adoption, rescue, or purchase should not be done for the primary purpose of reducing CVD risk (Class III; Level of Evidence C). http://circ.ahajournals.org/content/127/23/2353.long#sec‐9
“Stress‐mediation effect”
• Decreased blood pressure (Friedmann et al., 1983b; Katcher, 1983; Slovenko, 1983; Haggerty Davis, 1991; Manor, 1991; Glickman, 1992; Hart, 1995; Allen, Blascovich, & Mendes, 2002; Allen, Blascovich, Tomaka, & Kelsey, 1991); • Slowed heart and respiration rates (Manor, 1991; Allen, Blascovich, & Mendes, 2002; Allen, Blascovich, Tomaka, & Kelsey, 1991); • “Feel‐good” effect of the bonding hormone oxytocin released into both the person’s body (Odendaal & Meintjes, 2003).
4 2/16/2016
Stress‐mediation effect (cont.)
• In addition to subjective feelings of fear and distress, human experiences of stress and anxiety encompass many physical symptoms such as heart palpitations, shortness of breath, and release of cortisol. • Physical act of stroking and holding an animal can have immediate mitigating effects on such physical symptoms related to stress and anxiety, contributing to the subjective sense of feeling good when holding an animal
Overview of liabilities
• Grief and loss: often disenfranchised • Bites and other acute injuries • Zoonosis ‐ http://www.cdc.gov/healthypets/ • Animal abuse and neglect • Hoarding • Anthropomorphizing
5 2/16/2016
Therapeutic roles: terms used……
• “therapy animal” • “comfort dog” • “pet” • “companion animal” • “emotional support pet” • “service animal” • “assistance dog” • “guide dog” • “seeing eye dog” • “skilled companion animal” • others?????
Brief history
• Animal medicine • 1800’s therapeutic animals • Psychodynamic • Guide dogs –World War I in Germany • Emerging evidence‐base; lack of conceptual clarity makes research in these areas difficult
6 2/16/2016
Therapeutic roles (Least to most training)
Companion Animals/ “Pets”
Emotional Support Animals
Therapy Animals
Assistance/Service Animals
Companion animals • May be part of person’s family, eco‐system, and natural support system • Naturally offers benefits of human‐animal bond and human‐animal interaction • Also entails liabilities: grief and loss, etc. • The import of this role needs to be intentionally included in health‐related assessments and interventions! • Examples????
7 2/16/2016
Common issues for older adults with companion animals (Anderson, Lord, Hill & McClune, 2015) • Medical issues associated with aging have potential to be mitigated by HAI/HAB due to reduced social isolation and enhanced physical activity • Illnesses associated with aging, e.g., arthritis, diabetes, etc., also make it more difficult for older adults to provide routine care for animals, particularly for those living alone • Financial barriers may also be problematic
Developing supports for older adults with companion animals (Anderson, Lord, Hill & McClune, 2015) • Pet‐friendly senior living facilities –on‐site supports such as dog walking assistance and dog parks Example: http://www.aplaceformom.com/blog/2013‐4‐18‐ best‐pet‐friendly‐assisted‐living‐columbus/ • Partnerships with humane societies and shelters that provide: reduced adoption fees; ongoing support through adoption and ownership process Example: Toledo Area Humane Society –provides reduced adoption fees, mobile food delivery for elderly and/or housebound residents; MSW internships • Partnerships with veterinary clinics Example: Ohio State Veterinary Outreach Program ‐ provides mobile care for pets of older adults and/or housebound residents); veterinary social workers on staff and MSW internships
8 2/16/2016
Emotional Support Animal (ESA) • A companion animal who is deemed by a licensed mental health professional, in writing, to be therapeutically beneficial to a client and part of that client’s treatment • Conveys a legal status with some legal protections (housing accommodation, air travel) • Not trained to assist/compensate for specific disability impairments • Typically not registered as therapy animal • Example: Hope and Recovery Pets (HARP) program at Toledo Area Humane Society
Sample letter designating ESA [Date] To Whom It May Concern: [Full Name of Patient] is my client and has been under my care since [date]. I am very familiar with his/her history and with the functional limitations imposed by his/her emotional/mental health‐related issue.
Due to this emotional disability, [client first name] has certain limitations coping twith wha would otherwise be considered normal, but significant day to day situations. To help alleviate these challenges and to enhance his/her day to day functionality, I have recommended that [client first name] obtain an emotional support animal as part of his/her treatment plan. The presence of this emotional support animal is necessary for the emotional/mental health of [client name] because his/her presence will mitigate the symptoms he/she is currently experiencing. Sincerely,
(Licensed mental health professional’s name and title)
9 2/16/2016
Housing accommodation for ESA
Dear [HOUSING AUTHORITY/LANDLORD]:
[NAME OF TENANT] is my client, and has been under my care since [DATE]. I am very familiar with his/her history and with the functional limitations imposed by his/her disability. He/She meets the definition of disability under the Americans with Disabilities Act, the Fair Housing Act, and the Rehabilitation Act of 1973.
Due to mental illness, [FIRST NAME] has certain limitations regarding [LIST LIMITATIONS, E.G., SOCIAL INTERACTION/COPING WITH STRESS/ANXIETY, ETC]. To help alleviate these difficulties, and to enhance his/her ability to living independently and full use and enjoy the dwelling unit you own and/or administer, I recommended an emotional support animal as part of [FIRST NAME’s] ongoing treatment. The presence of the emotional support animal is necessary for the mental health of [FIRST NAME] because the animal’s presence will alleviate symptoms of [FIRST NAME’s] disability [LIST BENEFITS].
[NAME OF TENANT] is therefore requesting a reasonable accommodation for his/her emotional support animal at [NAME OF FACILITY], under the federal Fair Housing Amendments Act of 1988 (42 U.S.C. 3601, et seq.).
Sincerely, (Licensed mental health professional’s name and title)
Assistance animals
• Entails training to assist via doing specific tasks (services) that compensate for specific disability‐related impairment (at least two tasks) • Hearing, mobility, vision, psychiatric, seizure alert, diabetic alert, sleep apnea, psychiatric • Typically protected under accessibility law • Assistance dogs are “certified” (Assistance Dogs International)
10 2/16/2016
Assistance Dogs for Achieving Independence • http://www.abilitycenter.org/we‐can‐ help/programs/assistance‐dogs/about‐adai
• http://www.assistancedogsinternational.org/
Example: Mobility Assistance Dog
• https://www.youtube.com/watch?v=MYywraE FY70 • Note specific tasks that the dog completed in this video, to mitigate effect of mobility‐ related disability
11 2/16/2016
Example: PTSD Service Dog https://www.youtube.com/watch?v=WIlPFRsse Q8
How many specific tasks did the service dog complete in this video, to mitigate the effect of specific PTSD symptoms? http://www.servicedogcentral.org/content/nod e/464
Registered therapy animals • Pass basic obedience and advanced test (e.g. – Canine Good Citizen) • Pass evaluation and become registered: – Therapy Dogs International: http://www.tdi‐ dog.org/About.aspx?Page=Getting+Started – Pet Partners (formerly Delta): http://www.petpartners.org/TAPinfo – ADI‐designated registration – http://www.agilityangels.org/introducing‐new‐ therapy‐dogs‐and‐handlers/
12 2/16/2016
Types of settings therapy dogs serve in
• Facility therapy dogs • Visitation therapy dogs • Therapy dogs that work in conjunction with human professions to augment effectiveness of professional practice, e.g., animal‐assisted therapy
“Animal‐assisted activity” (AAA) • Typically registered therapy dog and volunteer handler • Visit facilities and informally interact with individuals and groups to convey benefits of human‐animal interaction (without specific goals) – Examples: pet visitation programs at hospitals, nursing homes, etc. – Toledo Area Humane Society Pet Visitation Program – https://www.youtube.com/watch?v=7bUng9pTWBk
13 2/16/2016
“Animal‐assisted therapy” (AAT)
• AAT = licensed professional intentionally utilizing/incorporating human‐animal benefits in a goal‐directed fashion, within scope of professional practice/treatment • May involve registered therapy dogs, companion animals, ‘farmed’ animals, ‘exotic’ animals, others
Example: AAT with individuals with dementia • Goals of AAT typically pertain to improving a patient’s social, emotional, and/or cognitive functioning • E.g., strategies to trigger memory recollection: – hands‐on interaction (sensory stimulation); – discussion and reminiscing (emotional and cognitive stimulation); – positive social interaction (decreasing loneliness, agitation)
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Resources • Pets for the Elderly Foundation: http://www.petsfortheelderly.org/index.html https://www.toledohumane.org/ • Animal Assisted Interventions International: http://www.animalassistedintervention.org/Ani malAssistedIntervention.aspx • Assistance Dogs International: http://www.assistancedogsinternational.org/
References
• See list provided in conference materials
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Questions/comments?
[email protected] 419.530.4208
16 HOY REFERENCES
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Encouraging Self‐Care among Older Adults: Examples from a Senior Center
Heather L. Menne, PhD
Objectives:
1. Explain why education, support, and behavior activation are important elements to encouraging self‐care among older adults. 2. Discuss examples of actions older adults can take to support their self‐care. 2/16/2016
Encouraging Self‐Care Among Older Adults: Examples from a Senior Center
Heather L. Menne, PhD Benjamin Rose Institute on Aging
4 March 2016 20th Annual Geriatric Medicine Symposium Perrysburg, Ohio
Objectives
• Explain why education, support, and behavior activation are important elements to encouraging self‐care among older adults • Discuss examples of actions older adults can take to support their self‐care
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Self‐Care
All the actions and decisions that an individual takes to prevent, diagnose, and treat personal ill health and decisions to access and use both informal support systems and formal medical services (Kart & Dunkle, 1989)
Education
• Using the Health Belief Model • Best Practices of Education Programs • Applying the Health Belief Model to Osteoporosis • Women and Heart Disease Information
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Support
• Self Support: – Health Contracts – Accountability
• Peer Support: – Group Education – Social Interaction
• Professional Support: – Tailoring – Feedback – Positive Reinforcement
Behavior Change
• Benefits of an Active Lifestyle • Ways Older Adults Adapt their Behaviors and Increase their Self‐ Care • Lifestyle Interventions and Older Adults with Type 2 Diabetes
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Aging Mastery Program (AMP) • Developed by the National Council on Aging (NCOA) • Older adults • Meets weekly • Module Topics – M1: Navigating Long Lives: The Basics of Aging Mastery – M2: Exercise and You – M3: Sleep – M4: Healthy Eating and Hydration – M5: Falls Prevention – M6: Medication Management – M7: Financial Fitness – M8: Advance Planning – M9: Healthy Relationships – M10: Community Engagement
Initial AMP Outcomes from NCOA
• 235 participants enrolled in the program at 5 sites • 66% of all participants graduated • 86% of participants provided positive feedback • Attendance at the senior center increased • 50% of participants: – Became more physically active – Improved healthy eating habits – Improved communication with their health care team • 40% reported improved medication adherence • The creation of an advanced care plan increased from 50% to 70%
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Heart Health Program
• Developed by the Benjamin Rose Institute on Aging • Older adults • Meets every other week for 12 weeks • Session Topics – S1: Introduction to the Program – S2: Basics of Heart Health – S3: Problems, Signs, and Symptoms – S4: Lifestyle Choices – S5: Proper Care and Heart‐Related Conditions – S6: Stress, Coping, and Support
Outcomes of Heart Health Pilot Study • 16 of 25 participants graduated (64%) • Mean satisfaction was 9.18/10 • All participants said they would recommend the program • Participants individually created 88 action steps • 55/88 (63%) action steps were accomplished by the end of the program • 64/88 (73%) action steps involved altering participants’ nutrition and exercise behavior
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Elements of Self‐Care in Programs AMP Heart Health Facilitator introduces a topic for Session leader (professional nurse) lecture (often given by a guest discusses heart health using pictures speaker), some sessions have an and vocabulary from the American Education accompanying video, and the topic is Heart Association, as well as tactile reinforced with an in‐class activity activities (e.g., measuring one’s pulse) Participants are encouraged to Session leader facilitates as engage in discussion about the topic participants share past experiences, Support as well as ask questions and share illnesses, and help each other tips for engaging in healthy behaviors develop action steps. Participants do homework after Participants create action steps sessions which encourages them to toward healthy behavior that are think about the session topic and specific to their own needs and Behavior Change ways to incorporate its message into abilities (e.g., maintain a food their daily lives (e.g., writing a letter journal, ask my daughter to go on a of gratitude, creating a food plan) walk with me)
Conclusion
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Many thanks to…
• YOU for listening and participating today! • University of Toledo for coordinating and hosting this great event • Lauren Borato for helping get these slides and talk organized • The Benjamin Rose Institute on Aging, University Hospitals Community Benefit Program, and The Cleveland Foundation for funding the work presented in this session
Contact Information
Heather Menne [email protected] 216‐373‐1627
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References • Beverly, E., Fitzgerald, S., Sitnkov, L., Ganda, O., Cabellero, A., & Weinger, K. (2013). Do older adults aged 60 to 75 years benefit from diabetes behavioral interventions? Diabetes Care, 36(6), 1‐6. • Brokaw, S., Carpenedo, D., Campbell, P. , Butcher, M., Furshong, G., Helgerson, S. et al. (2015). Effectiveness of an adapted diabetes prevention program lifestyle intervention in older and younger adults. Journal of the American Geriatrics Society, 63(1), 1067‐1074. • Cress, M., Buchner, D., Prohaska, T., Rimmer, J., Brown, M., Macera, C., et al. (2005). Best practices for physical activity programs and behavior counseling in older adult populations. Journal of Aging and Physical Activity, 13(1), 61‐64. • Frewen, S., Schomer, H., & Dunne, t. (1994). Health belief model interpretation of compliance factors in a weight loss and cardiac rehabilitation programme. South African Journal of Psychology, 24(1), 39‐43. • Kart, C. & Dunkle, R. (1989). Assessing capacity for self‐care among the aged. Journal of Aging and Health, 1(4), 430‐450. • Kahana, E., Kahana, B., & Kercher, K. (2003). Emerging lifestyles and proactive options for successful ageing. Ageing International, 28(2), 155‐180. • Mosca, L., Mochari, H., Christian, A., Berra, K., Taubert, K., Mills, T. et al. (2006). National study of women’s awareness, preventive action, and barriers to cardiovascular health. American Heart Association, 113(1), 525‐534. • Plawecki K. & Champman‐Novakofski, K. (2013). Effectiveness of community intervention in improving bone health behaviors in older adults. Journal of Nutrition in Gerontology and Geriatrics, 32(1), 145‐160. • Pratt, C., Wilson, W., Leklem, J., & Kingsley, L. (2008). Peer support and nutrition education for older adults with diabetes. Journal of Nutrition for the Elderly, 6(4), 31‐43.
8
Using Technologies in Self‐Care Management
Murthy Gokula, MD, CMD
Objectives:
1. Define role of technology in aging. 2. Decribe varies applications available in technology. 3. Apply technology into clinical practice.
2/16/2016
MURTHY GOKULA,MD,CMD Associate Professor/Program Director UT Family Medicine/Geriatrics Fellowship Program
• It takes an average 20 years to bring a new drug • A mobile app takes lesser time to build and verify the utility. • Technology use helps to increase wellness and resilience in individuals and organizations. • Communication and information technologies are in people’s daily lives. • Business opportunity: easy to develop, test, modify and prove utility for software. • We will discuss technology use to improve self care
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Patient Engagement critical to improve health outcome and reduce costs Frequent, real-time communication and feedback are essential in supporting health behavior change and empowering patient engagement 40% of deaths in the US caused by modifiable behavioral issues ◦ smoking, obesity, poor blood sugar control, ◦ poor blood pressure control, inadequate exercise, medication non-adherence ◦ neglect in follow-up medical appointments
IT platforms used to motivate patient engagement ◦ short message service (SMS)-capable mobile devices, ◦ Internet-based interventions ◦ social media ◦ online communication tools A recent systematic review : IT platform on self-management among diabetic patient; Positive effects in 74% of studies
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Patient participation in condition self- management correlates with greater improvement in health outcomes Patient engagement is interaction and participation to manage one’s health to achieve desired goals Achieved by Internet, Social media, medical apps, Text messages
Topics discussed in this presentation: • Digital therapeutic • Positive Technology • Health Behavior Therapy in Physical Activity Game Apps • iPhone and iPad apps for Senior Citizens • Mobile exercise apps and increased leisure time exercise activity • The Effectiveness of Mobile‐Health Technology‐Based Health Behavior Change • Physical activity apps for senior citizens
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EVERY DAY HEALTH ◦ Geared for patient with similar interests in health PATIENTS LIKE ME ◦ Forums, Can clarify questions & share experiences HEALTH VAULT ◦ Users record PHI and medical records: Access to authorized users and health systems SERMO ◦ Health professionals for finding new procedures and exchange experiences in disease management
Asthma MD Epocrates Couch to 5k Smokefree Loseweight Myfitnesspal Change4life healthier recipes Calorie checker Strength and flex podcasts Fitocracy Alcohol unit calculators
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DOCTLE ◦ Help patients for second opinion from specialists ◦ Paid service, needs registration ◦ Can get opinion or advice ◦ User has to forward information to physician
Help improve wellbeing based on scientific reasoning, tools and frame works: HOMEVMI ◦ Advice & alerts to users by sensors connected to patient on life style Wei & Yang ◦ Access to hospital server for patient education Benavides et al ◦ Users with similar interest and their proximity Ramos et al ◦ Doctor and patient communication app in remote areas MobiClique: Mobile social networking
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• Its an era of digital therapeutics • This program takes the face to face effective behavior change programs and brings them to digital era • Upcoming examples demonstrate that how this concept can thrive in the marketplace
• In March 2015, CDC recognized 3 digital programs • 3 digital therapeutic programs are: Omada Health’s Prevent for National Diabetes Prevention Program Welldoc: A Mobile Prescription Therapy Twine: A Collaborative Care Platform
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Omada Health’s Prevent • Omada Health’s Prevent • 16 week lifestyle intervention online program • Targets prediabetes • Can also be used for other chronic conditions like obesity • Trained health coaches for weekly nutrition and fitness guidance • Digital tools used like pedometer and cellular enables scale • Available to participant via laptop, smartphone or tablet • Tricks like motivational package to engage people
Omada Health’s Prevent
• Directed to employers, health plans, and payers • Reimbursement based on achievement of people and goals maintenance
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Welldoc: A Mobile Prescription Therapy
• First mobile prescription therapy approved by FDA • Built on automated clinical coaching and behavioral algorithms • Example: Software helps the diabetic patient in learning the optimal time for checking blood sugar for controlling blood sugar
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Twine: A Collaborative Care Platform • Team has providers, family and friends • Human coach • Integral part of the Twine experience • Shares screen with the user • Patients share data with coach as well as family and friends • Requires prescription by healthcare provider and follows the same privacy rules as providers
Twine: A Collaborative Care Platform • More efficient and scalable model of care • Significantly reduces the annual cost of management of patient with chronic conditions by: • Improving medication adherence • Reducing the number of follow up visits
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• In European Union, 83% of total money spent on healthcare is used in management of chronic diseases • Elderly with chronic diseases must be encouraged to take part in caring for their health • Positive technology is relevant for active ageing and healthy living • Positive technology • by improving the quality of personal experience • by generating motivation
Tools and strategies allows • Patient engagement in their management of care • Allows expansion of healthcare beyond traditional doctor's office and hospital • Brings change from “disease‐centered” to “citizen/client model” • Benefits elderly people who are not as mobile as others • Benefits those who cannot easily obtain care from a doctor’s office or hospital • Decrease in economic burden on our stressed healthcare system
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Use of positive technology and strategies includes advanced simulation technologies: • Virtual reality • Serious gaming or augmented reality • Spontaneous peer networks • Blogs and online communities, that are main features of 21st century living
Positive technologies are classified as • Hedonic • Induce positive and pleasant experiences • Eudaimonic • Help individuals in reaching self actualizing experiences • Social/ Interpersonal technologies • Support connectedness between individuals, groups and organizations
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Critical variables for each level are: • At hedonic level • Regulation of affect • At eudaimonic level • Flow and presence • At Social/ Interpersonal level • Collective intentions and networked flow
• Mobile phone health interventions can help in incorporating health behavior elements • The simplest of mobile phone interventions, such as a text message reminder for medical appointments can help in increasing attendance
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• Of the wide variety of mobile health apps, exercise and fitness apps are the most popular, accounting for 39% of health‐related apps • Physical activity health games developed for mobile phones are a viable option for health interventions
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Pillboxie ($0.99) • Easy way to remember meds • Available on App store • For iPhone and iPod touch
WebMD (free) • For android, iPhone, iPad • Gives trusted health information • Available in android market, and app store
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HeartWise Blood Pressure Tracker ($0.99) • Requires iOS 3.2 or later • For iPad and iPhone
Motion Doctor ($6.99) • For iPad and iPhone • Available on App store
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Lively
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WalkJoy
Respondesign
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Independa And LG
Pocketfinder • Compatible with iOS & Android • Helps in Locating and Monitoring
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Guardian Medical Monitoring: Provides safety and Security to seniors, their families and caregivers with the industry's best Central Monitoring Station, Hardware and system
MC10’S BioStamp
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• A study was conducted to determine the presence of health behavior therapy in physical activity games that were developed for mobile phone apps • The following elements were analyzed: • Prevalence of specific health behavior constructs • Association between the price and presence of health behavior therapy • Association between gamification elements and health behavior therapy in the same apps
• Many of physical activity apps contained low levels of health behavior therapy(HBT) • Average HBT levels were higher than non‐game health apps • An App, SuperBetter, used for achieving non‐specific health goals, yielded the highest HBT score
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• Content analysis of non game health and fitness apps, like smoking cessation and weight loss apps demonstrated low levels of health behavior change techniques • Further research is needed to determine whether these health games are efficacious in health interventions • There is a need to assess extent to which educational and gamification elements impact efficacy
• App developers come from different backgrounds and sometimes they do not have adequate training • Research and evaluation of health apps by both industries and independent researchers needs to be done
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• To promote a behavior change, there is a need of collaboration between app designers and behavioral specialists • It is important to assess whether these app games for health can improve community health in the long run
• Online game and IPhone app • Compatibility: • Requires iOS 8.0 or later. • Compatible with iPhone, iPad, and iPod touch • Increases resilience among people with social and physical difficulties • Access: • SuperBetter website • iTunes store
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• Mobile exercise apps have range of features that include tracking of the exercise activity and providing motivational messages • A study was conducted to find out whether the use of exercise apps is associated with increased level of exercise and improved health outcomes
• It was found out that exercise app users were more likely to exercise during their leisure time, compared to those who do not use exercise apps, fulfilling the role that many of these apps were designed to accomplish • Exercise apps make it easier for users to overcome barriers to exercise, leading to increased self‐efficacy • Exercise apps can be viewed as intervention delivery systems consisting of features that help users overcome specific barriers
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Some of the common barriers to exercise are: • Lack of time • Lack of access to exercise facilities • Lack of enjoyment of exercise, and/or lack of energy to exercise • Frequent travel
An exercise app can provide following tools to overcome these barriers: • A GPS that tracks user location and helps him in locating nearby places to run or exercise • Information or video tutorials on exercise techniques • Special exercise techniques for individuals with disabilities or pregnant women
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• Special features that motivates a user to increase physical activity levels • Motivation provided by Gamification apps to provide overall enjoyment of running • Motivational messages to improve motivation, like the messages based on tracking of individual performance
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• Mobile technologies could be a powerful media for providing individual level support to health care consumers
• A systematic review was conducted to assess the effectiveness of these interventions • Nearly all trials were conducted in high‐income countries • Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services
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• Advancements in information technology (IT) expand the ability to engage patients in the health care process and motivate health behavior change • An assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements
Measurements include those related to : • Motivation for health behavior change • Long‐standing adherence • Expenditure • Satisfaction • Health outcomes
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Impact of IT Platforms on Health Outcomes • IT platforms have been shown to improve health behavior among different disease categories, majority of the positive impact has been shown among hormonal disorders • Use of Internet‐based tailored weight control programs was correlated with significant increases in weight loss and walking distance
Impact of IT Platforms on Health Outcomes • A study examined use of text messages among patients with diabetes and found a significant decrease in HbA1C level, improved medication adherence, and decreased in emergency service use • Social media showed a positive impact on health outcomes. • Twitter usage among cancer patients was a valuable medium for sharing information, discussing treatments, and also acted as a psychological support
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Impact of IT Platforms on Health Outcomes • The use of Facebook has also been found to help improve asthma care • Video games can be implemented successfully among hyperfunctional voice disorder as a “voice therapeutic protocol”, a voice and speech therapy program
Impact of IT Platforms on Health Outcomes • One telemonitoring‐based study assessed the effects of a glucose monitoring system on HbA1c levels in diabetic patients and found that usage of this system was correlated with a significant decrease in HbA1c
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Impact of IT Platforms on Health Outcomes • Another study evaluated the impact of home‐based telemonitoring on patients with heart failure and showed a significant correlative improvement in patients’ health outcomes
• Some studies have showed undesirable effects from using social media • Kaplan et al found that psychiatric patients who participated in Internet peer support reported higher levels of distress compared to those who did not participate
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• Patient engagement is interaction and participation in managing one’s health to achieve desired goals. • Higher patient participation in self management was associated with improved health outcomes
• Social networks can be helpful for individuals with lower patient activation • Further research is needed to determine best ways to determine patient engagement in healthcare using IT platforms
31 2/16/2016
http://www.welcomehomecare.ca/27‐best‐ipad‐ and‐iphone‐apps‐for‐senior‐citizens/ http://www.lifehealthpro.com/2014/02/11/7‐apps‐ your‐senior‐clients‐should‐know‐ about?t=ltci&slreturn=1455294630&page=2
32 2/16/2016
33
NOTES ______