Day 2 :
Saddleback College, USA
Keynote: An evaluation of Be Strong: A nurse-led caregiver-assisted exercise program to reduce fall-risk in older adults
Time : 09:30-10:15
Cindy Gross has nursing experience for the past 40 years in various sectors of the healthcare industry including clinical practice, administration and academic environments. In working with population health, the focus has been on health and wellness for the aging adult to maximize independence and functional ability through exercise and balance
Statement of the Problem: One in three adults over age 65, fall each year sustaining an injury. Preventing falls is multifactorial inclusive of age, medical condition, comorbidity, medication use, vision, and environmental home safety factors; however a key variable to reduce falls with the aging population is exercise. Falls can be reduced with regular exercise; yet, confidence in balance and fear of falling can psychologically limit older adults from participating in mobility.
Methodology & Theoretical Orientation: A program called Be Strong, created and developed by an interdisciplinary team, was a nurse-led caregiver-assisted exercise program for fall-risk older adults. It focused on teaching older adults at-risk for falls, innovative ways to successfully exercise at home. The team created a library of 10 minute videos consisting of sitting, laying and standing exercises enabling older adults an ability to visually model tailored innovative exercises with caregivers in a safe, guarded environment. This nurse-led caregiver-assisted exercise pilot project evaluated fall-risk reduction, confidence in balance and fear of falling. Nine participants engaged in 20 minutes of daily tailored caregiver-assisted exercise over a 20 week period. Data were analyzed using descriptive and inferential statistics.
Conclusion & Significance: The Berg Balance Scale and Timed Up and Go test showed statistically significant differences in fall-risk scores. The Activities-Specific Balance Confidence Scale, Fall Efficacy Scale and Fall Efficacy International Scale showed no statistically significant difference in confidence and fear of falling. The participants, agency staff and consultants evaluative survey which showed positive feedback of this exercise experience.
Recommendations: This program continues to be offered to older adults aimed to reduce fall-risk and improve functional ability, independence, healthy living and quality of life.
Universidad Autónoma de Nuevo León, Mexico
Time : 10:15-11:00
Bertha C. Salazar is full time professor in the graduate program of the Nursing School of Universidad Autonoma de Nuevo Leon, Monterrey Mexico. Teaches Philosophy and Knowledge Construction of Nursing and serves as Chair for master and doctoral students in Nursing Science. Research interest is older adult´s functionality, particularly physical exercise and cognitive interventions to improve gait parameters and cognitive function. Currently developing an intervention aimed to improve everyday memory of older adults. She belongs to the National System of Researchers (Sistema Nacional de Investigadores), Consejo Nacional de Ciencia y Tecnología of México.
Statement of the Problem: Population aging is considered a successful of humanity by international organizations. But at the same time it is likely that older adults suffer from one more chronic diseases imposing challenges to older adults, families and society. Efforts are needed to maintain older adult’s health and active as much as possible. The purpose of this paper is to describe active aging according to sex, age and years of school in a sample of Mexican older adults from Matamoros, Mexico. The data are part of a bigger study.
Methodology & Theoretical Orientation: A descriptive design was used with 200 older adults. A non-probabilistic sampling was used. Participants were recruited through referrals of principal investigator's university colleagues. It was assured that participants with more than 14 years of education were also recruited to seek for differences by years of school. Active aging was measured by basic and instrumental activities of daily living, Yesavage depression short scale, Pffeifer mental state questionnaire and one question perceived health. Cutoff points were established for each measurement and sum to dichotomize into active aging or not. Additional questions were time spent in physical activities, and as volunteer work.
Findings: Most of participants (190; 95%) presented a chronic disease. One hundred two participants qualified in active aging (physical independent, free of depressive symptoms, good mental state and perceived their health as good or excellent. Only 21% (42) said they walked 120 minutes or more weekly, 14% (80) used a treadmill or stationary bike and 53% (106) were involved in volunteer work. Conclusion & Significance: Those with less age, women and more years of education showed higher proportions of active aging. Recommendations are made to different health professional to develop programs involving older adults in different activities to promote active aging.
- Aging Case Studies | Cognitive Aging |Psychiatric Disorders | Elderly Care
Location: South Park
Saddleback College, USA
Time : 11:20-12:30
Jordan Tishler is a leading expert in the field of Medical Cannabis therapeutics. As an Emergency Physician, he has treated countless alcoholics and drug users. His observation that he had never seen a Cannabis overdose lead Tishler to delve deeply into the science of Cannabis safety and treatment. After years of research and learning, he brings his knowledge, reason, and caring to patients here at Inhale Medical Consulting, and through his advocacy work at the local and national levels. He graduated from both Harvard College and then Harvard Medical School (affectionately known together as Preparation H), trained in Internal Medicine at the esteemed Brigham and Women’s Hospital, and has spent many years working with the underserved, particularly our Veterans. He is also a parallel entrepreneur working for patients’ well-being in the corporate space, helping to elevate dosing and safety profiles of medication, and helping to establish best practice for bringing new Cannabis products to market.
Tishler is a frequent speaker and author on a variety of topics related to the medical applications of cannabis. He is also a Massachusetts spokesperson for Doctors for Cannabis Regulation(DFCR).
Sexuality is a fundamental part of the lifecycle for most people and difficulties can lead to loss of self-esteem, depression, anxiety and interpersonal strife. Despite its normality, half of men and nearly half of women are troubled by some form of difficulties with sexuality at some point in their life. Difficulties go far beyond erectile dysfunction in men and low libido in women and arise in 4 phases: Interest, Arousal, Orgasm, and Satisfaction. Interestingly, few people ever address these issues with their care team, despite evidence that three quarters of their providers are willing and able to be helpful. Part of this stems from the assumption by both patients and providers that beyond the phosphodiesterase inhibitors, which work only for erectile dysfunction in men, there is little to be gained from therapeutics. Cannabis therapy can provide a more effective, cross-gender solution to a broad range of these sexual difficulties. In a largely dose-dependent manner Cannabis has been shown to improve function in all 4 of the domains mentioned above. We will discuss data, clinical scenarios, and practice of treating sexual dysfunction with cannabis. We will also briefly discuss how Cannabis can be used to improve sexual relations in people for whom dysfunction is not currently a problem.
Zefat Academic College, Israel
Title: Depression statuses and related predictors in later life: A 10-year follow-up study in Israel
Time : 12:30-13:00
Rabia Khalaila is an expert in critical care nursing, worked for years in intensive care at Hadassah Medical Center in Ein Kerem. He is also an expertise in Gerontology and is considered as one of the leading experts and researchers in Israel in gerontology, particularly, in the study of the Arab elderly population and their family caregivers. To this day he published more than 30 articles in leading journals in his fields. Today, he is a senior lecturer and head of the Department of Nursing Zefat Academic College, Israel.
The aim of the current study was to investigate the factors associated with depression statuses in a ten-year follow-up of community-dwelling older adults in Israel. Longitudinal data were used from the Israeli sample of the Survey of Health, Aging and Retirement in Europe, assessing the depressive symptoms in 1,042 respondents, aged 50 or above, at three time points: 2004/2005 (Wave I); 2009/2010 (Wave II); and 2014/2015 (Wave III). Multinomial logistic regression was used to determine the relationships among explanatory variables and depression statuses (no depression, intermittent depression, or persistent depression). Some 46.5% of the participants suffered from intermittent or persistent depression. Five factors were associated with increasing the probability of both intermittent and persistent depression: being female, unemployed, less educated, physically disabled, and in poor health. Five other explanatory variables were associated only with a higher risk for persistent depression: low family income, widowhood, physical inactivity, more than two chronic diseases, and cognitive dysfunction. According to these findings, depression is common among older people in Israel.
University of North Carolina at Greensboro, USA
Time : 14:00-14:30
Deborah A Lekan is a board certified gerontological nurse with a research focus on frailty in middle aged and older adults and the use of big data and data science to use the abundant already collected, data from the electronic health record to examine problems such as frailty. She is particularly interested in how health disparities and social determinants of health, especially psychosocial factors, impact health status and risk for frailty and associated adverse health outcomes and risk-reduction interventions to promote patient recovery and how novel data analytics can illuminate some of these complex issues.
Introduction: Frailty is a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems that are associated with increased risk for adverse outcomes.
Purpose: The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and adverse outcomes including time to in-hospital mortality and 30-day rehospitalization.
Methods: The sample included medical inpatients ≥55 years at a tertiary care hospital (N=278) in the U.S. Frailty was determined using existing clinical data from the electronic health record for symptoms, syndromes, conditions, and laboratory data for four serum biomarkers. A Frailty Risk Score was created from 16 risk factors and relationships between Frailty Risk Score and outcomes were examined.
Results: The mean age was 70.2 years and mean Frailty Risk Score was 9.4 (SD, 2.2). Increased Frailty Risk Scores were significantly associated with increased risk of death (HR=1.77 to 2.27 for 3 days ≤ LOS ≤ 7 days) but depended upon length of stay (p < 0.001). Frailty was marginally associated with rehospitalization for those who did not die in-hospital (AOR=1.18, p=0.086, AUC=0.66, 95% CI for AUC= (0.57, 0.76)). The Frailty Risk Score may reflect complexity more than individual assessments of symptoms, diseases, or age; age was significantly associated with Frailty Risk Score (β= 0.039, t= 3.16, p = 0.002) but no longer significant in regression controlling for other variables, and higher risk of death was associated with increased Frailty Risk Scores, controlling for age, gender, race.
Discussion: Readily available data in electronic health records can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions to achieve optimal patient outcomes.
University of Florida, USA
Time : 14:30-15:00
Philip F. Daniels is a doctoral student in counseling and counselor education, and earning a certificate in gerontology. He has a Masters in professional counseling with a specialization in marriage and family therapy. National and international teaching experiences include college and career planning, drug and alcohol, introduction to counseling theories, lifespan development, group counseling, play therapy with children, introduction to family therapy, advance family therapy, and human rights and social justice. Clinical experiences include working with clients in hospice, memory disorder units, mental health and rehabilitation units, pediatric clinics, and community agencies conducting individual or family counseling. Specific expertise's include clinical practice and counselor education in the following areas: marriage and family therapy, dementia, caregivers of individuals with dementia, death and dying, end-of-life issues, grief and variations e.g. anticipatory & complicated, trauma, LGBT, substance abuse, and transcultural counselor competencies, play therapy, and working with children.
Neurocognitive disorders (NCD) affected approximately 46 million individuals worldwide in 2015. It is estimated that this will double every 20 years with 65.7 million in 2030 and 115.4 million in 2050. Additionally, medicinal non-compliance within the elderly is a major issue due to adverse side effects and neurocognitive disorders. Therefore, there is a need to be aware of different treatment modalities and options to increase the quality of life of the patient. From an interdisciplinary systems approach to nonpharmacological interventions for individuals with neurocognitive disorders, this presentation will provide a current review of the literature and best practices to help an individual with a NCD. Treatment options such as aromatherapy, music, holding, doll, and sand tray will be explored via their benefits and risks, as well as the feasibility. Finally, an integration of the wellness model and medical model will be utilized to view different treatment options for individuals with a NCD.
PhytoQuest Limited, UK
Title: Effectiveness of cucumis sativus extract (CSE) versus glucosamine-chondroitin (GC) in the management of osteoarthritis: A randomized control trial
Time : 15:00-15:30
Professor Robert J. Nash is CEO of PhytoQuest Limited, a natural products discovery and development company based in Aberystwyth. He has published over 200 papers and is inventor on several granted patents. The company focuses on small molecules called iminosugars that have many effects in animals via sugar receptors. He started his career working on anti-viral compounds with the UK Medical Research Council and then became Head of Chemistry at a government research laboratory (IGER) from where he formed multiple companies developing new pharmaceutical compounds based on immunologically active iminosugars.
Statement of the Problem: The global prevalence of osteoarthritis (OA) is escalating worldwide, primarily because of the aging of populations and an increase in the prevalence of obesity. This study aimed to evaluate the ability of Q-Actin™, a proprietary Cucumis sativus extract (CSE) to improve knee symptoms in OA.
Methodology & Theoretical Orientation: A six-month (180 days) randomized, double-blind study was conducted with two groups of patients diagnosed with primary OA of the knee to compare the effects of CSE with that of a combination of glucosamine hydrochloride and chondroitin sulphate (GC). One hundred and twenty-two (122) OA patients aged 40-75 years with a body-mass index (BMI) of 18-30 kg/m2 were evaluated. The patients received either 10 mg of CSE or 1350 mg of GC (control) twice a day for 180 days. Pain, stiffness and physical function were assessed in each patient using standard tools including: Visual Analog Scale (VAS), Lequesne's Functional Index (LFI), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline (Day 0) and at Days 30, 60, 90, 120, 150 and 180. The results were expressed as relative scores in percentages.
Findings: The CSE (Q-Actin™) treatment significantly (p<0.05) reduced the WOMAC, VAS, and LFI scores throughout the study. The CSE WOMAC score decreased by 22.44% at Day 30 and 70.29% at Day 180. The GC group results also decreased throughout the study, however, the reductions in the CSE group were significantly (p<0.05) greater than those of the GC group at all-time points. No Adverse Events (AEs) were recorded.
Conclusion & Significance: Our results indicate the efficacy and potential use of CSE (Q-Actin™) as an anti-OA, joint support therapy which can help bring about an improvement in knee pain, stiffness, and physical functions
Jayoung Han has her expertise and passion in improving the health care system with an emphasis on pharmaceutical policy.
Statement of the Problem: Medicare Part D beneficiaries’ tendency to stay with their initially chosen plan has been reported in many studies. Previous studies have focused on identifying factors associated with plan switching and little attention has been given to consequences of plan switching. This study aims to explore whether beneficiaries’ switching decisions are aligned with their preferences and how much beneficiaries benefit from plan switching. Methodology & Theoretical Orientation: The Health Retirement Study 2009 Health and Well-Being Study (HWB) and 2007 Prescription Drug Study (PDS) were used. The analysis included subjects who responded to both 2007 and 2009 surveys, and who continued to enroll in Part D. Descriptive statistics were obtained focusing on the differences in premium, out-of-pocket (OOP) costs. T-test and chi-square test were used to examine statistical significance of the difference.
Findings: Of 5,333 2009 survey respondents, 599 Part D enrollees were included in the analysis. Only a few beneficiaries (7.9%) switched plan for 2009, even though half of them answered to 2007 survey they considered switching. Regardless of whether to switch, majority of beneficiaries (75%) paid higher premium in 2009 compared to 2007. However, a larger percentage of switchers (50%) than non-switchers (44%) paid lower OOP in 2009 compared to 2007. Eleven % of switchers answered that their plans did not pay for some drugs as opposed to 29% of non-switchers. The percentage of switchers who did not take medication properly because of the cost slightly went down (from 23.4% to 21.28%) while that of non-switchers slightly increased (from 20.55% to 22.36%).
Conclusion & Significance: It appears that there is little benefit of plan switching in premium but some benefit in OOP costs. Lower cost-related non-adherence and OOP costs among the switchers suggest that plan switching improves the beneficiaries’ medication taking behavior and spending in medications.