CHRONICLES AGING - Nursing Home Help

CHRONICLES in AGING Discovery, Learning, and Caring about Aging at the University of Missouri Winter 2010
An interdisciplinary approach to research that will improve the
lives of kidney transplant patients
Cynthia L. Russell, PhD, RN, ACNS-BC
Inside this issue: Retooling for an Aging
America
page 2
Center Leaders Teach
Class
page 3
Boomer Time
page 4
Meet the Fellow:
Teresa Cooney
page5
Chronicle-ing the
News
page 6
Center News
page 7
Sensory Loss and
Aging
page 8
Volume 4, Issue 1
K idney transplanta‐
tion provides a cost‐effective alternative to dialysis for those with end‐stage kidney disease resulting in an improved quality of life. Since 2000, renal transplant in those 65 years and older has increased by 80%.1 Those who receive a kid‐
ney transplant must take immunosuppressive medications for the life of the kidney. Addition‐
ally, the medication regi‐
men is complex and costly. Medication non‐
adherence is a leading cause of kidney failure with medication dosing non‐adherence (missing medications) at about 25% 2 and medication timing non‐adherence (not taking the twice daily prescribed medica‐
tion on time) at about 75%.3 At the University of Missouri, our trans‐
plant team conducts re‐
search that is focused on improving medication adherence in adult and older kidney transplant patients. Targeting patient predictors of medication non‐
adherence such as demographics (gender, ethnicity) and patient characteristics (social support, self‐efficacy, and depression) has not resulted in significant improvements in medication adherence. Intervention studies tar‐
geting adult patients have also not shown sig‐
nificant medication ad‐
herence improvements. Our team is the first to pilot an innova‐
tive intervention to im‐
prove immunosuppres‐
sive medication adher‐
ence in adult and older kidney transplant recipi‐
ents. This systems ap‐
proach moves away from blaming the patient for medication non‐
adherence and instead links medication taking with established patient habits. The patient also receives monthly reports on medication taking that are generated from an electronic medication cap that is used on the medication bottle. This electronic medication cap records the date and time of every cap open‐
ing which presumes medication ingestion. We have tested this intervention in a pi‐
lot randomized con‐
trolled trial and found a statistically significant difference between the treatment and control group (p=.03). We have submitted an R01 to the National Institutes of Continued on page 2. Page 2 Health to conduct a fully powered study with a di‐
plant. Consequently, those who receive a kidney verse sample. transplant must keep the kidney as long as possible, so that they don’t have to return to the transplant list, Assembling an Interdisciplinary
be retransplanted and use a precious kid‐
Research Team
ney that could be used by someone else. The very nature of transplant care re‐
Identifying the most effective interven‐
quires an interdisciplinary approach. Suc‐
tions for improving medication adherence cessful support of the transplant patient, in this population holds promise for main‐
and family/caregiver requires specialized taining the quality of life that a transplant skill and knowledge from the social affords, decreasing costs of morbidity and worker, clinical nurse, transplant nurse retransplant, and making more kidneys coordinator, nephrologist, transplant sur‐
available. geon, dietitian, pharmacist, financial counselor, and many others. This pro‐
References
1. Annual Report of the U.S. Organ Procuregram of research evolved from a mutual ment and Transplantation Network and the
concern of all members of the transplant Scientific Registry of Transplant Recipients:
team that we did not know how to effec‐
Transplant Data 1988-2009. Department of
Cindy Russell, PhD, RN,
Health and Human Services, Health Resources
tively change medication non‐adherence Associate Professor, Sinclair
and Services Administration, Healthcare SysSchool of Nursing
in this population. tems Bureau, Division of Transplantation, Rock ville, MD; United Network for Organ Sharing, Richmond, VA;
University Renal Research and Education Association, Ann
The Value of Interdisciplinary Research
Arbor, MI. 2009.
Each professional brings a unique prospective to the scientific thinking that is required for nurturing a stel‐
2. De Geest S, Borgermans L, Gemoets H, et al. Incidence,
determinants, and consequences of subclinical noncomplilar program of research. ance with immunosuppressive therapy in renal transplant
recipients. Transplantation. 1995;59(3):340-347.
Funding Mechanisms
3. Russell CL, Conn V, Ashbaugh C, Madsen R, Hayes K, Ross
Our research program has been funded consistently G. Medication adherence patterns in adult renal transplant
since 2002 in amounts ranging from $10,000 to recipients. Res Nurs Health. 2006;29(6):521-532.
$150,000. Sources include: the Interdisciplinary Center on Aging at the University of Missouri, John A. Hart‐
ford Center of Geriatric Nursing Excellence, Iowa Gerontological Nursing Intervention Research Center, National Kidney Foundation, the National Institute of The Transplant Research Team at MU
Nursing Research (NINR‐R15 Area Grant), American Nephrology Nurses Association, University of Mis‐
Cynthia Russell, PhD, RN, ACNS-BC, associate
souri Research Board, American Nurses Foundation/
professor, Sinclair School of Nursing, conducts
Sigma Theta Tau, and the University of Missouri Re‐
research on medication adherence in adult and
search Council. Importance of Anticipated Findings
The number of people with kidney disease continues to rise as people live longer with more co‐morbid con‐
ditions. While the number of those over 65 receiving a kidney transplant has doubled in the last 10 years, the number of kidney donors has not kept pace with the number of patients waiting for a kidney trans‐
older transplant recipients and dialysis patients with
the Transplant Research team. Other team members
include:
Andrew Webb, RN, BSN
Catherine M. Ashbaugh, MSN, ACNS-BC
Vicki Conn PhD, RN, FAAN
Mark Wakefield, MD, FACS
Deanna Coffey, MSW
Retooling for an Aging America Page 3 Readying for the coming gray storm
W inter is here. As responsi‐
ble citizens we listen to weather predictions and heed snowstorm warnings by stocking up on food, shovels, ice salt and appropriate clothing. Emergency readiness is essential for weather‐
ing the frosty winter. But have we paid adequate attention to predic‐
tions about the impact the baby boomers will have on our population? How prepared are we for the coming gray storm? The In‐
stitute of Medi‐
cine (IOM), an independent, nonprofit organization that pro‐
vides advice to decision makers and the public, formed a commit‐
tee to explore these questions. Their conclusion, detailed in the report, Retooling for an Aging Amer‐
ica: Building the Health Care Work‐
force, is that the U.S. is facing criti‐
cal health care shortages for the more than 78 million baby boomers begin‐
ning to reach age 65 in 2011. Simply put, there will be an inadequate num‐
ber of geriatricians and health care workers to meet the needs of our ag‐
ing population. “As the number of older Americans increases, so will the demand for care,” explains IOM president, Harvey V. Fineberg, MD, PhD, in a video available on Med‐
scape Today.2 What can be done to ensure the baby boomers receive appropri‐
ate health care? The IOM team advises taking immediate action and recommends a three‐step ap‐
proach:  enhancing the geriatric‐care skills of all who are involved in provid‐
ing geriatric health care. This in‐
cludes training residents and all health care professionals in set‐
tings where older adults receive care;  recruiting and retaining geriat‐
ric specialists by providing greater financial and career incentives; and  better integrating patients and their family and friends into care‐provider roles. “These changes in profes‐
sional training, recruitment of geri‐
atric specialists, and new models of care require action at many lev‐
els,” says Fineberg. “By retooling the health workforce, we can help assure that every American can look forward to a healthier fu‐
ture.”2 Retooling for America is a storm warning that we cannot af‐
ford to ignore if we are to weather the gray storm ahead. 1Institute
of Medicine. Retooling for an
Aging America: Building the Health
Care Workforce. Washington, DC: The
National Academies Press; 2008. Available at: http://www.iom.edu/
CMS/3809/40113/53452.aspx
2Fineberg H. “Retooling for an Aging
America,” The Medscape Journal of
Medicine. 16 Dec. 2009. http://
www.ncbi.nlm.nih.gov/pmc/articles/
PMC2562151
Topics in Aging
Health Interventions: Understanding and Improving
the Physical Function and Independence in Older Adults
READ Small Grants Program The Interdisciplinary Center on Aging’s Research Enrich‐
ment and Dissemination (READ) grants encourage inter‐
disciplinary aging research and collaboration among MU faculty. The annual submission deadline is April 15. For more details about eligibility and requirements, see our web site: http://www.aging.missouri.edu/research/guidelines
This fall 13 students represent‐
adults. Instructors Steven ing six disciplines enrolled in Zweig, MD, MSPH, and Health Interventions: Under‐
David Oliver, PhD, recruited standing and Improving a distinguished group of fac‐
Physical Function and Inde‐
ulty from varied disciplines to pendence in Older Adults. take part. “It’s fascinating to The graduate‐level course hear the perspectives of so takes an interdisciplinary ap‐
many disciplines in one class‐
proach to understanding and room,” said Maegan O’Lough‐
improving physical function lin, a Human Development and independence in older and Family Studies major. BOOMER Time
Look out! Numbers have University of Missouri’s power, and when the largest Interdisciplinary Center on demographic group in the Aging fellows and associates for world’s history, the baby their reflections on what it will boomers, begin to turn 65 in be like as the baby boomers 2011, they are going to put their move down the life course. We stamp on aging. We asked the share their responses here. I t is estimated that there were 36 million seniors in the United States eligible for retirement in 2004. Among this group of Americans there is a minority; approximately 7% are gay and lesbian. Further, estimations indicate that by the year 2030, 20% of Americans will be more than 65 years of age making approxi‐
mately 72 million Americans age 65 and older. This 7% translates into more than 5 million gays and lesbians age 65 and over at that time. The current baby boomer generation of gays and lesbians experienced the Stonewall Riots that lead to the sexual revolution of the 1960’s, that resulted in the political stance of “coming out”. This new aging cohort will be in sharp contrast with the current generation of gay and lesbian older persons living in long‐term care (LTC). All previous and current aging homosexuals have feared arrest, loss of jobs, dis‐
crimination in housing, and placement in mental hospitals solely because of their sexual orientation. This takes on particular importance relative to the LTC of baby boom individuals, especially the upcoming gays and lesbians who are expected to be open about their sexual orientation, and demand the right of ex‐
pression and consideration as they go into LTC institutions. Geraldine Dickey PhD, LCSW T he cost of health care, unless significant reform is achieved, will become prohibitive, even for those with Medicare. Caregivers in the
home will become “doctors” and older persons living alone will selfdiagnose and self-medicate as they are able. Suicides, already the highest
among the elderly, will increase. Younger generations, particularly the one
once removed, will resist paying taxes to cover the needs of the elderly.
Inadequately financed nursing homes will continue to be filled primarily by
poor older people who have exhausted their resources. Baby boomers will
refuse to live in semi-private small cubicles with a stranger, and while resources last, will select instead to move to upscale expensive assisted living
alternatives. Here too they will eventually grow frail, exhaust their funds,
and spiral down the slippery slope of life. The only hope is some sort of universal health care coverage from cradle to grave, and a universal health
care identifier (number) that tracks all health care interventions along the
trajectory. This would include medications, physician visits, hospitalizations,
and any other useful historical information for a care provider, regardless
of type of service and location on the planet.
David B. Oliver, PhD
D emographers estimate that by 2030
20% of the American population will
be persons who are over sixty years of age.
One half of these persons will have one or
more disabling condition. This means that
there will be 30 million persons who are
learning to live with a disability, while at
the same time experiencing aging. The
success which we have in providing health
care and social services will depend to a
large degree upon our skill in meeting the
challenges of a population of persons with
disabilities.
Health care and social services
providers must encourage persons who are
aging with a disability to develop positive
attitudes toward their disabilities, learn
new adaptive skills, use assistive technology, and locate peer support networks.
We must advocate for more accessible
environments, more accessible transportation options, and more accepting community activities. As baby boomers age, there
will be larger numbers of persons who
have vision and hearing impairments,
physical disabilities, and cognitive and
affective disorders. They will need to remain active in their community and social
networks, and maximize their ability to
live independently.
We can learn much from the
disability rights and independent living
movements of the last forty years, as we
seek to meet the challenges of our aging
population. Health care professionals and
social service providers will need to examine their own attitudes and knowledge.
Only if they are able to learn from persons
with disabilities and sincerely encourage a
positive approach to living with a disability, can they provide quality services to
their patients and clients who are aging
with a disability.
Homer Page, PhD
The future looks very bleak
to me. I don’t expect that
in late life I will be able to
afford health care, or
even decent assistedliving quarters. My father
says that longevity is a
curse, hopefully I will not
see the day when I feel
that way too.
Greg Petroski, PhD
Page 5 Stop. Look. Listen.
A n aging population, the pre‐
diction that approximately 40% of elderly Americans will die in a nursing home by the year 2020, and a paucity of nursing homes designed to meet the needs of dying residents is creating the perfect storm. Nursing home social workers are in a unique position to dramatically impact the dying ex‐
perience for residents and their families by challenging the status quo and by advocating for changes in the physical environment to en‐
hance end‐of‐life care. Although a designated hospice room that promotes pri‐
vacy and dignity at end‐of life may well be the gold standard, there are numerous other adaptations that can be incorporated into the physical environment of nursing homes with little or no additional cost. Can the resident’s bed be moved close to a window to pro‐
vide a view of nature? If not, can a picture of the resident’s favorite season be hung within eyesight? Are there shelves or counter tops available so the room can be per‐
sonalized with keepsakes and fam‐
ily photos? Does the resident have easy access to the thermostat, tele‐
vision remote, and telephone? Is there comfortable seating available for family members? As staff and family leave a resident’s room, it is imperative that they, “Stop, look, and listen,” to ensure that the resi‐
dent is comfortable and that the environment promotes autonomy and tranquility. Denise Swenson, PhD Meet the Fellow Teresa Cooney,PhD I’m a Minnesota native and earned my bache‐
lor’s in Psychology from the University of North Dakota. I completed graduate study in Human Development, emphasizing adulthood and aging, at Penn State, where I was an NIA pre‐doctoral trainee. From there, I did a two‐
year post‐doc in demography of aging at UNC‐
Chapel Hill, followed by a faculty position at University of Delaware (UD), where I spent 8 years. At UD I started the Adult Health and Development Program, pairing college stu‐
dents and older adults in recreational, social and educational activities. I also received a National Institute of Mental Health FIRST award, which funded a 5‐year study on the impact of later‐life parental di‐
vorce for adult offspring. In 1997, I came to the MU. I’ve served as department chair for 4 years, and now direct undergraduate studies in HDFS. Currently, I’m a Fac‐
ulty Fellow in the Graduate School. What led you to pursue research in aging? I’ve always enjoyed conversing with and helping older people. In high school I worked in a nursing home for three years and that really got me interested in their lives, and issues of concern regarding aging. Then, as an undergrad, I worked for a year on a memory study where I adminis‐
tered protocol to older adults. What is your current research project? I’m actively engaged with two projects right now. One involves secon‐
dary data and I started it while on leave in The Netherlands three years ago. This project compares family support and relationships in aging families in the US and the Netherlands, attributing many of the differ‐
ences we see to culture and social welfare system differences in the two countries. A primary data collection I’ve just started with a faculty col‐
league and 2 graduate students involves interviews with women who are caregiving for ex‐husbands. We’ve enrolled eightcaregivers thus far in the pilot project and already are obtaining some fascinating information about this increasingly common phenomenon. What are some of your favorite hobbies? I have two teenage sons, so in recent years my free time is usually spent going to their activities, which for one is music (attending lots of con‐
certs, marching band competitions) and the other is football. My husband and I cook regularly with a group of friends (which also means my hob‐
bies are good food and drink!) and I like to read, garden, and exercise. Chronicle-ing the News
1
Too many patients, two few
geriatricians
By 2030, there will be an estimated 8,000
geriatricians, but the nation will need 36,000 to
care for 78 million baby boomers who will begin
to turn age 65 in 2011. The American Medical
Association is one of several medical organizations
supporting greater training in geriatrics. All
physicians, regardless of specialty, will need to
become proficient in geriatric care. http://www.amaassn.org/amednews/2008/05/05/prl10505.htm
Healthy lifestyle, attitude, keep seniors on
track
2
Scientists are finding that a rich and active
social life combined with exercise are key
factors in “resilient aging.” Some seniors dodge
life-threatening diseases, while others have excellent
coping skills to live with disease and disability and
then move on, claims Marie Bernard, Deputy
Director of the National Institute on Aging. Dr.
Bernard adds, “Only one of every four individuals
age 85 and over is suffering from severe
impairment.” http://www.usatoday.com/news/health/2009-11
men. As men age, their testosterone levels drop off.
In addition to its effects on sex drive, the hormone
promotes muscle and bone strength, energy level
and memory. The National Institute on Aging’s
Division of Geriatrics and Clinical Gerontology is the
primary funder of the nationwide trial. http://
www.gainesville.com/article/20091118/ARTICLES/911181010/1002
5
Boomers see views relaxing on
marijuana
A recent government survey showed that the
share of marijuana users ages 50-59 increased
from 5.1 percent in 2002 to almost 10 percent in
2007. “Doctors need to be more sensitive to it,” says
Peter Delany who heads the office of Substance
Abuse and Mental Health Services Administration. In
California and 13 other states, some form of pot use
for medicinal purposes is allowed, and recently the
Obama administration announced that federal
prosecutors would no longer go after medical users
in those states. The American Medical Association
has called for a review of marijuana’s status as a
Schedule 1 hard drug. http://www.washingtonpost.com/wp
-dyn/content/article/2009/11/15/AR2009111503007.html
-09-Resilience09_ST_N.htm
3
Age-based road tests make sense
Elderly may cry discrimination, but reflexes and
vision inarguably diminish over time. In
Massachusetts and other states, legislatures are
drafting laws to ensure that unsafe drivers be
kept off the road. Resistance is common and bills
often get watered down to achieve passage.
Increasingly, doctors and health care workers are
being brought into the picture to report individuals
who should be tested or denied the keys to their car.
http://www.boston.com/news/local/massachusetts/
articles/2009/11/22/age_based_road_tests_make_sense
Men sought for testosterone trials
4
University of Florida researchers will be
conducting “The T Trial,” recruiting 800 men
over the age of 65 at 12 sites around the
country, to determine the potential benefits
and safety of testosterone hormone therapy in older
Should mentally ill be admitted to nursing
homes?
6
In Illinois, as in most states, there are two
separate sets of state laws regarding nursing
homes and the mentally ill, and these often
become confused. For example, under state law,
voluntary nursing home residents may leave
whenever they want, but if they are seriously
mentally ill, the situation becomes more
complicated. Cases in which residents and disabled
residents have been assaulted, raped, and even
murdered have been documented. Four hearings
have been held in Illinois which houses more
psychiatric patients than any other state. http://
www.chicagotribune.com/news/watchdog/chi-091119-nursinghome-law-story,0,6356175.story
Page 7 Center Fellows
News and Honors
David Fleming, MD, Professor of Internal Medicine and Health Management and Informatics and founding director of the MU Center for Health Ethics, was named chair of the department of internal medicine. He will oversee the growth and development of internal medicine’s nine divisions while continuing to serve as center director. Puncky Paul Heppner, PhD, Professor, Department of Educational, School and Counseling Psychology, was honored with the Leona Tyler Award from the Society of Counseling Psychology; this is the highest award given by the organization and recognizes lifetime achievement in research. He also received a Chair Professorship at Beijing Normal University in the School of Psychology. Kyle Moylan, MD, Assistant Professor of Clinical Medicine, was named associate program director for the internal medicine residency program at the University of Missouri. He will also head the newly created section of geriatrics within general internal medicine. Richard Oliver, PhD, Dean, School of Health Professions, received the Darrell Mase Presidential Citation for 2009 for outstanding service on behalf of the Association of Schools of Allied Health Professions. Cindy Russell, PhD, RN, Associate Professor, Sinclair School of Nursing, received a lifetime membership from the International Transplant Nurses Society for chairing the task force for development of the Scope and Standards for Transplant Nursing Practice. Bonnie Wakefield, PhD, RN, Associate Research Professor, Sinclair School of Nursing, was inducted as a Fellow into the American Academy of Nursing. The Interdisciplinary Center on
Aging hits the airwaves!
November 13, 2009, the Interdisciplinary Center on
Aging made its radio broadcast debut on KFRU.
ICOA director, Steven Zweig, and David Oliver, assistant Director,
joined Columbia radio host David Lile on his popular morning talk
show about older drivers. Their appearance was a success, and
the ICOA was invited back for a repeat performance. On December 11,Marilyn Rantz, ICOA Associate Director, discussed how
seniors can adjust and thrive during transitions in care.
Future ICOA performance are being planned, and you can listen
live on the internet: http://www.kfru.com, or, in the Columbia
area, tune your radio to 1400 AM .
Tune in to upcoming Radio Shows:
8:35 a.m., Friday, January 15, 2010
8:35 a.m., Friday, February 12, 2010
2009 Seminars in Aging:
An Interdisciplinary Line-up
During the 2009 fall semester there have been outstanding monthly seminars on aging. A truly interdiscpliary line‐up of physicians, health policy and literacy advocates, art historians and psychologists have provided four seminars: an innovative “medical foster home” model of care (Thomas Edes, Washington DC), a comprehensive view of health literacy and aging (Stanley Hudson and Nickolas Bulter, Center for Health Policy), hidden meanings on life and aging (Mary Pixley and Arthur Merhoff, Museum of Art and Archaelogy, and David Oliver, Center on Aging), and innovative imaging of the brain in research (Nelson Cowan, Steve Hackley, Keith Schneider, and Shawn Christ, Psychological Sciences, and David Beversdorf, Radiology). Chronicles in Aging is published by the Univer‐
sity of Missouri Interdisciplinary Center on Aging. For a free electronic subscription, please e‐mail [email protected]. Phone: 573‐884‐3337 Fax:573‐882‐096 E‐mail: [email protected] Web site: www.aging.missouri.edu Editor Editorial Board Steven Zweig, MD, MSPH David Oliver, PhD Managing Editor Peggy Gray Colleen Pruett Marilyn Rantz, PhD, RN Guest Editorial Page 8 Sensory Loss and Aging
—Homer Page, PhD
I daily living. Estimates predict that as people age, one in five am will experience substantial vision loss. What I would blind. like to share with those new to vision loss is that losing Although I your sight does not mean losing your intelligence, your have lived suc‐
character or you ability to do valuable and productive cessfully with work. You are the same person. Now is the time to de‐
blindness since cide what it is you want to do and learn new ways to birth, many accomplish your goals. When you resolve to be a self‐
directed problem solver, you take responsibility for c Homer Page enjoys himself durcannot imagine ing a vacation trip to St. Maarten. liv‐
a tragedy. Blindness becomes a challenge ing well without being able to see. Once, while I was riding on a city bus, a stranger volun‐
teered that he would rather be dead than blind. The comment, though unexpected, did not surprise me. While I realize that I cannot drive a car, see printed material or look at my grandchildren—one must accept some limitations—I can still travel round the world, use technology to read, and give your life, and your loss of sight stops being “As people
age, one in
five will
experience
substantial
vision loss.”
that can even grow into a source of pride as you learn to cope. As you adapt to your new situation, realize that some well‐intentioned medical professionals, social service providers, fam‐
ily members and friends may be overprotec‐
tive and suggest unneeded limits. That’s why I encourage you and anyone who works with seniors losing their sight to tap and receive love. My strategy for living into the support and knowledge of peers well with my condition has been to confront who are blind. In them you will find a tre‐
each, “You can’t,” with an “I can.” I have found alter‐
mendous source of support and knowledge. The blind native ways to perform the large and small tasks of person who has mastered the tasks of independent liv‐
ing can be a valuable guide to needed skills and re‐
c sources, providing living proof that it is possible to live well with significant vision loss. For the professional care giver, peer resources can be among the most valu‐
The American Foundation for the
Blind has developed a web site for
seniors experiencing vision loss and
the medical professionals, family
and friends who care for them:
http://www.afb.org/seniorsite
able tools available. Homer Page, PhD, is the executive director of
Disability Media Inc. He earned a BA and MA
degree from the University of Missouri and two
PhDs, one from MU and one from the University
of Chicago. He is an author, consultant and
publisher.