2^nd International Conference on Aging & Gerontology - ICAG 2017 June 26-27,2017

Hotel Venue - Hilton San Diego Mission Valley

Biography:

Jason Diederich is the General Manager of Aged Care Regional Assessment Services at APM, Australia’s largest private provider of aged care assessments. Part of the Australian Government’s My Aged Care program, APM uses a wellness and reablement focus to identify the care needs of older Australians to allow them to remain at home for longer. His background in Occupational Therapy drives his holistic approach to the assessment process, underpinned by an understanding of the economic driv­ers of a sustainable aged care model. Based in Melbourne, Australia, he has managed a number of national assessment contracts on behalf of the Australian Government, as well as managing the operations of residential aged care and community care providers

Abstract:

In the last 2-3 years, Australia has embarked on a remarkable reform process for aged care services. The key goals are to achieve a consumer driven and market based national aged care system that is funded in a sustainable way based on need. This reform is essential to put choice and control into the hands of the aged care consumer, as well as ensuring that the limited government funds available are allocated to those who need it most. A key component of this reform process, known as My Aged Care, is the introduction of new levels of assessment. The previous high level clinical based assessments (known as ACAT) have been supplemented by entry level non-clinical assessments (known as RAS). Services are also delivered in a two-tiered system for lower level and higher level care needs. Over time the plan is to integrate the non-clinical (RAS) and clinical (ACAT) assessments, but it is unclear how this will look. Whilst the clinicians currently delivering the clinical ACAT assessments also have the skills to deliver non-clinical assessments, this is not a good use of this expensive and increasingly rare resource. The non-clinical RAS assessments meet the needs of many older people who are after basic support services such as cleaning or transport, but what happens when they encounter someone with more complex needs? This workshop will explore the Australian experience, and go in to more detail about the wellness and reablement approach used as part of the assessment itself. But, will also seek input and share information from participants about different models of aged care assessment from the USA and around the world.

Biography:

Georgina Hicks has undertaken her Post-graduate Medical degree at King’s College London. Following graduation, she has worked as Foundation Doctor in London, gaining broad experience in geriatric wards specializing in heart failure and stroke, as well as other specialties

Abstract:

Statement of the Problem: Do Not Attempt CPR (DNACPR) decisions are commonly made in UK hospitals. Recent legislation dictates that the decision be discussed with the patient or their relatives. Many patients and relatives have unrealistic expectations of CPR outcome and it is essential that this is addressed in such conversations. We undertook two investigations of the appropriateness of resuscitation decisions based on a validated tool for predicting neurologically intact survival after in-patient CPR (Good Outcome Following Attempted Resuscitation, GO-FAR score).

Methodology: All patient records from a geriatric ward were reviewed on a single day. Information was collected regarding patient age, comorbidities and DNACPR decisions, and a GO-FAR score calculated. The process was repeated on a second day two months after reporting our initial findings to clinical staff.

Findings: 48 patients with a mean age of 73 years (SD13) were included. Of the 25 patients in the initial study, 5/9 patients with a 9.4% likelihood of neurologically intact survival were DNACPR, 9/12 with a 1.7% likelihood were DNACPR, and 1/4 with a 0.9% likelihood was DNACPR. Of the 23 patients in the subsequent study, 1/9 patients with a 9.4% likelihood of neurologically intact survival was DNACPR, 3/11 with a 1.7% likelihood were DNACPR, and 2/3 with a 0.9% likelihood were DNACPR.

Conclusion & Significance: Following introduction of the GO-FAR score, a smaller proportion of patients with 9.4% and 1.7% likelihood of neurologically intact survival were made DNACPR (p=0.13 and 0.04 respectively), and a greater proportion of patients with 0.9% likelihood were made DNACPR (p=0.49). Introduction of the GO-FAR score influenced the practice of clinicians with varying significance. The score’s greatest utility may be in prompting consideration of resuscitation status for patients with <1% likelihood of neurologically intact survival, and facilitating an evidence-based discussion with the patient and their relatives.

Biography:

Ken Stern is the President and Founder of Ken Stern & Associates, a comprehensive wealth manager. Mr. Stern is also a Managing Director of Lido Advisors, LLC where he manages Lido’s wealth planning strategies and family office services. Mr. Stern developed the Alpha System in response to a need for a customized wealth plan, comprehensive estate protection as well as a personalized legacy component. He has earned the title of Certified Financial Planner from the College of Financial Planning in Denver, Colorado.

Abstract:

ECONOMY & OUTLOOK

Trumpenomics: What Are Your Next Steps?

Tsunami: How The Graying of the Baby Boomers Will Drive the Next Economic Decade

2017 Market Outlook: Is it Time to Take the Road Less Travelled?

ADVANCED WEALTH PLANNING

Your Trilogy: Wealth, Protection & Legacy

Retirement Rules: The Five Biggest Threats to Your Retirement and How to Avoid Them

Beneficiary Audit: What You Planned vs. What Will Actually Occur

INSTRUCTOR

Ken Stern & Associates (KSA) is an investment manager and family office. KSA is committed to providing high-quality, effective financial education. Our mission is to enrich, strengthen and empower our trainees to be savvy consumers and astute investors. We present on a variety of financial topics and can customize our education to fit your needs.

OVERVIEW

We aim to discuss, bring clarity, and provide solutions to the key financial issues facing consumers, investors, retirees, small businesses and executives today. With a dynamic economy and the complexities regarding tax, pensions, retirement and legacy planning, we can all benefit from advanced opportunities and solutions for our families and company. Our presentations focus on coaching your employees on some of our strategies designed to help them grow their assets, minimize their tax burden, and preserve their financial legacy. In these busy times, it can be difficult for employees to find time to seek out the information necessary to understand their financial options.

Biography:

Shailaja Moodithaya has her research interest in Physiology of Aging and Autonomic Neural activity. She developed interest in this field as a teacher of medical physiology, since 1990. She has worked on projects from agencies like Indian Council of Medical Research, Board of Research on Nuclear Science etc. Her works on health issues relating to autonomic dysfunctions are well published and presented in National and International Conferences.

Abstract:

Diabetes mellitus and ageing share common symptoms like stiffness and loss of functioning of tissues due to cross-liked proteins and free radicals. Glycated Haemoglobin (HbA1c) is often used as a stable cumulative index of glycemic control and has shown that even in non diabetic adults, there is a steady increase in HbA1c levels with age.

Aim of the study is to evaluate the strength of association of HbA1c with metabolic and cardiovascular ageing indices in subjects between the age group of 40 to 60 yrs. A total of 220 subjects, with (n=110) and without (n=110) diabetes were assessed for the metabolic and cardiovascular ageing biomarkers. BMI, waist hip ratio, fat percentage, Fasting blood sugar and HbA1c were assessed as metabolic ageing biomarkers. The cardiovascular ageing indices measured were resting heart rate, blood pressure and Heart rate Variability.

Ageing biomarkers were compared between subjects with and without diabetes using independent‘t’ test and showed that the T2DM group exhibit significant accelerated ageing as compared to that of the controls. Pearson’s and partial correlation coefficient was used to assess the association of Glycated Haemoglobin with the ageing biomarkers without and with controlling for chronological age, indicated that, strength of association of levels of HBA1c with cardiovascular and other metabolic biomarkers of ageing is statistically significant. Therefore, the study concludes that the tightness of glycemic control has a significant impact on the biological ageing process.

Biography:

Élodie Vandenbergh is a Neuropsychologist. She is currently writing a thesis on the cognitive processes involved in prescription comprehension in older adults and patients with Parkinson’s disease. By adopting an experimental approach, she aims two objectives: to enrich existing models of procedural document’s processing by taking into account user’s characteristics and to identify the prescription designs that are the most adapted for different older adult cognitive profiles.

Abstract:

Statement of the Problem: Medication non-adherence in older adults is frequent. The fact that they don’t take drugs as prescribed is partly caused by age-related, prescription-related, and communication-related factors. If acting on age-related and prescription-related factors is not easy, in contrast, it is possible to modulate communication-related factors by adopting a patient-centered approach. For instance, some recent studies suggest that communicating prescriptions to elderly patients is facilitated when pictorial and table formats are used in comparison with classical ones. Surprisingly, most of the available data have been collected in studies using classical supports (paper or computers), but very few with tablets or touch-screen devices. Our main objective was to analyze experimentally the impact of two presentation formats (table vs. sheet) on older and young adult’s behavior while studying a medication prescription on a tablet, and when filling a pillbox afterwards. A facilitating effect of the table format was hypothesized.

Methodology & Results: 64 young and older adults studied two fictive week drug prescriptions at their own rhythm, and then filled a pillbox from memory. For each prescription, the pillbox filling occurred immediately after the study phase, then after a 30 minute delay. One prescription was displayed in a tabular format and the other in a sheet format. Medication studying time and pillbox filling scores were measured. As predicted, results showed that in the table format condition, prescription studying time was significantly shorter, and pillbox filling score higher, than in the sheet format condition.

Conclusion & Significance: The results of this study with older and young adults corroborate the findings of cognitive psychology on procedural document processing: when procedural information presentation is isomorphic to the structure of the procedure to execute, processing is then facilitated.

Biography:

Olga Matysiak has graduated with a Master Degree in Cognitive Neuroscience with the highest distinction from the University of Social Sciences and Humanities in Poland. Now she is continuing her education as the PhD Student in Laboratory of Psychophysiological Experiments at the same University. Since the early beginnings of her scientific career ,she was involved in the neuro-cognitive projects focused on exploring and enhancing mental functioning, especially among older adults. Currently, with the usage of the latest EEG signal processing methods, she is analysing the benefits of working memory cognitive trainings designed for elders.

Abstract:

Statement of the Problem: Aging, even in the absence of pathological conditions, is associated with cognitive decline. Executive functions and memory seem to be most affected. Deterioration is related to structural and connectivity changes in the brain and observed mostly in prefrontal cortex, hippocampus, and basal ganglia.

To remediate age-related deficits cognitive training programs have been developed. The prosperous branch of computer-based training also serves this purpose. Some of these interventions show a great potential for improving older adults’ cognition. Others infrequently generalize to tasks that were not specifically trained. Of particular interest are working memory (WM) interventions. Although working memory capacity has conventionally been conceptualized as a fixed trait, there is evidence that WMC can be augmented even in older age. These statements are reflected in recent neuroimaging studies focused on integrating cognitive plasticity with its neural mechanisms. In intervention research on WM, practice has been associated with both decreases and increases of brain activity in task-relevant brain regions. Methodology & Theoretical Orientation: In the present study we attempted to verify the effectiveness of a 5-week-long WM training using dual version of the N-back Task. Six tests (e.g. Sternberg Task, OSPAN, Syllogisms Task) served as cognitive assessment at baseline and post training sessions. Two tests were additionally accompanied by EEG recording. Findings: Data analysis provided moderate support for the efficacy of our intervention in healthy elders. We discuss this result, among others, in terms of too high complexity and requirements of a training task. We also looked for changes in electrophysiological activation patterns during the EEG recording. Our analysis reveals that, irrespective of the absence of vivid behavioral intervention’s effects, there are changes in psychophysiological mechanisms that underlie cognitive performance. We conclude that, although electroencephalographic data has provided us with information about the mechanisms of WM training to a certain extent, more research is needed to understand its neural impact.

Biography:

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).

Abstract:

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.

Biography:

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.

Abstract:

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.

Biography:

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.

Abstract:

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.

Biography:

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.

Abstract:

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.

Biography:

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.

Abstract:

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.

Biography:

Jayoung Han has her expertise and passion in improving the health care system with an emphasis on pharmaceutical policy.

Abstract:

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.