Hello everyone and welcome to the AGEC Newsletter for fall of 2024; the first of AGECs quarterly health professions newsletter for the new AGEC Health Resources and Services Administration (HRSA) Geriatric Workforce Enhancement Grant (GWEP) which began July 1, 2024. First of all, I want to let everyone know that we were successful in writing for the new Geriatric Workforce Enhancement Grant. We received notice in late May that we received the $5 Million - 5 year grant and we couldn’t be more excited. This grant is somewhat different than the previous grants with a few of the same components as well as some new ones. Today I will provide a bit of an overview of the entire grant. First, HRSA funded 42 grantees across 37 states as part of the 2024 GWEP call for proposals. So Arkansas is very excited to be one of the 37 states with one of these grants!

With this grant, HRSA decided that they would provide all applicants with one overall goal and three subobjectives. 

Therefore our goal (as well as the goal of the other 41 GWEPs) is:

To educate and train the primary care and geriatrics workforces and other appropriate specialties to provide age and dementia friendly care for older adults in integrated geriatrics and primary care sites/delivery systems. 

This goal is supported by three objectives:

1) Develop reciprocal partnerships between academia, primary care sites/delivery systems (including nursing homes), and community organizations, to transform clinical training environments into integrated geriatrics and primary care sites/delivery systems that are age-friendly and dementia-friendly.

2) Provide interprofessional geriatrics clinical training and education to students, residents, fellows, faculty, and preceptors in Tribal, Tribal Organizations, Underserved and/or Rural (TTOUR) primary care sites/delivery systems with the intent to have them practice in these sites upon completion of their program.

3) Establish and/or maintain education and training programs in TTOUR primary care sites/delivery systems that provide the supportive care workforce, direct care workers, and the primary care workforce with the knowledge and skills to improve the care of older adults, including persons living with dementia, by using innovative technology and methods.



In future quarters, I will be reviewing each objective and the related specific subobjectives and activities the GWEP will be accomplishing within each. We have great work planned and are excited about getting started. We are mostly in the planning phase now with all of the new activities and new partnerships. We will update you as we begin and we hope all of you will keep following us on this website and be active with our educational efforts; together will accomplish great things and help bring improved care to older adults in Arkansas!

Students from the School of Occupational Therapy at the Arkansas Colleges of Health Education (ACHE) are enrolled in a productive aging course and related fieldwork experience as part of the Doctor of Occupational Therapy curriculum. The fieldwork experience is designed to provide hands on experiences in a particular area, in this case productive aging.

In the realm of occupational therapy and accessible design, the integration of Certified Aging-in-Place Specialist (CAPS) knowledge offers vital perspectives on creating environments that support individuals as they age. Dr. Tracey Zeiner, ACHE Academic Fieldwork Coordinator, Assistant Professor, and Aging-in-Place Specialist supervised a recent Level I fieldwork experience for students in this specialized area and provided a comprehensive exploration of accessibility, from compliance with the Americans with Disabilities Act (ADA) to the nuances of universal and aging-in-place design. This fieldwork, which involved evaluating various properties, has offered students invaluable insights into how environments impact daily living and occupational performance.

The fieldwork involved a multifaceted approach to evaluating accessibility across different settings. Students visited a variety of locations, including businesses, homes currently in use, and spec homes for sale. Each setting provided unique challenges and learning opportunities:

• Businesses: Here, students assessed compliance with ADA standards, gaining an understanding of how public spaces can be adapted to meet legal requirements and support individuals with disabilities.
• Spec Homes: For these newly constructed or planned homes, the focus was on evaluating universal design principles. Universal design aims to create environments that are accessible to all people, regardless of age or ability, by incorporating features that support a wide range of needs.
• Homes-in-Use: These existing residences offered a chance to assess the specific needs of current homeowners and provide recommendations for aging-in-place modifications. The objective was to understand how changes to a home could support individuals in maintaining independence and quality of life as they age.

Key Student Insights and Learnings

Student feedback from this fieldwork highlighted several key themes and learning outcomes:

• The Environment is Everything: A recurring theme was the profound impact that environment has on an individual's ability to engage in daily activities. Students recognized that accessibility isn’t just about meeting minimum standards but also about creating supportive, functional spaces that enhance quality of life.
• Documenting Home Assessments: Students noted the importance of learning to document home assessments meticulously. This skill is crucial not only for professional development but also for providing actionable recommendations that can significantly improve clients' living conditions.
• Education and Application of Design Principles: The fieldwork underscored the importance of understanding and applying certified aging-in-place and universal design principles. Students observed these principles in action, gaining practical experience in both personal homes and public spaces within the community.
• Increased Confidence in Home Evaluation: Through hands-on evaluations, students reported a boost in their confidence to conduct thorough home assessments. This experience is vital for their future roles as occupational therapists, where they will need to assess and recommend modifications based on individual needs.
• Collaboration with Builders: The fieldwork also illuminated the potential for occupational therapists to collaborate with builders. By working together, OTs and builders can ensure that new constructions and remodels meet accessibility needs effectively from the outset.
• Real-World Observations: Students appreciated the opportunity to visit multiple locations, including a remodeled home intended to be more accessible. This experience provided a firsthand look at the discrepancies between advertised accessibility and actual functionality from an occupational therapy perspective.
• Impact of Environment on Well-being: A critical takeaway was the realization of how thoroughly evaluating the design and accessibility of both personal and community environments can affect a person’s well-being. Implementing accessible design requires a nuanced approach that considers individual needs, while universal design focuses on accommodating a broad range of requirements.

Conclusion

The CAPS fieldwork has proven to be a transformative learning experience for students, bridging theoretical knowledge with real-world application. By exploring various aspects of accessibility and design, students have gained a deeper understanding of how environments influence occupational performance and quality of life. This hands-on experience not only enhances their practical skills but also prepares them to advocate for and implement designs that support productive aging and universal accessibility. As they move forward in their careers, these insights will be instrumental in their ability to contribute to more inclusive and supportive living environments.

By: Leah Tobey-Moore, PT, DPT, MBA

Assistant Professor, Clinical Coordinator; Arkansas Geriatric Education Collaborative 

The aging population in the United States, including Arkansas, is increasing rapidly, yet the supply of healthcare professionals specializing in geriatrics is not keeping pace. From 2010 to 2020, the U.S. population aged 65 and older grew significantly, with the number rising from approximately 52.8 million to 54.6 million. Despite this surge, only 315 new Medical Geriatric Subspecialty Certificates were issued during this period. Projections indicate that by 2040, the percentage of people aged 65+ will reach 21.6%, underscoring an urgent need for more specialized care.

In Arkansas, this demographic shift is evident as well. The state’s older adult population increased from 15% to 17% of the total population between 2010 and 2019, adding over 60,000 individuals. Arkansas, which ranks 42nd in overall health, faces significant challenges in providing adequate healthcare, particularly in rural areas where resources are sparse.

The Arkansas Geriatric Education Collaborative (AGEC) aims to improve health outcomes for older adults by integrating geriatric best practices into primary care and enhancing patient and caregiver engagement. Our clinical partner, ARcare, is the largest Federally Qualified Healthcare Center in AR. Founded in 1986 as a single rural clinic in Augusta, ARcare now serves over 100,000 patients annually. ARcare’s commitment to comprehensive care includes specialized providers in medication assisted therapy and diabetes self-management, benefitting older adults who need these services.

Central to the AGEC and ARcare collaboration is the Age-Friendly Health Systems (AFHS) framework, which incorporates the age-friendly "4Ms": What Matters, Medications, Mentation, and Mobility. This framework was developed by major health systems and geriatric experts to improve care for older adults, and is promoted by the Institute for Healthcare Improvement (IHI). The AFHS approach prioritizes individual needs and goals, promotes safe and effective medication management, screens for cognitive and mental health issues, and assesses mobility to prevent falls and enhance safety.

In ARcare’s rural clinics, this framework is being integrated into everyday practice to better serve older adults. The focus on “What Matters” involves understanding and respecting the patient’s choices and goals. Mobility assessments aim to prevent falls and keep people safe in their environment, while Mentation screenings address issues such as dementia and depression. The evaluation of Medications ensures that prescribed treatments do not interfere with the patient's overall well-being and care goals.

The implementation of the AFHS framework at ARcare clinics represents a significant step forward in enhancing geriatric care in rural Arkansas. By fostering interprofessional, patient-centered approaches, this model shows early potential and offers a promising blueprint for improving healthcare for the aging population. As the older adult demographic grows, expanding Age-Friendly practices will be crucial in meeting their evolving needs.

References

1.     Advisory Committee on Interdisciplinary Community-Based Linkages. Preparing the Current and Future Health Care Workforce for Interprofessional Practice in Sustainable, Age-Friendly Health Systems: 17th Annual Report to the Secretary of Health and Human Services and the U.S. Congress. Published online August 2019.

2.        U.S. Census Bureau. Older Population and Aging. Census.gov. Accessed July 24, 2023. https://www.census.gov/topics/population/older-aging.html

3.        U.S. Census Bureau. The Older Population in the United States: 2020. Census.gov. Published 2020. Accessed July 27, 2023. https://www.census.gov/data/tables/2020/demo/age-and-sex/2020-older-population.html

4.        American Board of Medical Specialties. ABMS Board Certification Report. American Board of Medical Specialties. Published 2023. Accessed July 26, 2023. https://www.abms.org/abms-board-certification-report/

5.        Administration on Aging. 2020 Profile of Older Americans. Published online May 2021. https://acl.gov/sites/default/files/Profile%20of%20OA/2021%20Profile%20of%20OA/2021ProfileOlderAmericans_508.pdf

6.        Miller W, Wheeler E. Rural Profile of Arkansas | Social & Economic Trends Affecting Rural Arkansas. Published online 2021. Accessed July 26, 2023. https://www.uaex.uada.edu/publications/pdf/MP564.pdf



7.        Mumford QP, Miller W, Wheeler E, Christenberry P, Howell R. Primary Care Needs Assessment of Arkansas. Published online 2020.

8.        American Geriatrics Society. GWEP Coordinating Center. Programs. Published July 27, 2023. Accessed July 27, 2023.

https://www.americangeriatrics.org/programs/gwep-coordinating-center

9.        National Association for Geriatric Education. Geriatric Workforce Enhancement Programs (GWEPs). Eldercare Workforce. Published 2018. Accessed July 26, 2023. https://eldercareworkforce.org/wpcontent/uploads/2018/03/NAGE_GWEP_Overview.pdf

Incorporating the 4Ms Framework of Age-Friendly Care into Baccalaureate Nursing Education

According to the 2020 Census, 16.8% of the United States population is 65 and over. Growth in this population is expected to continue into the next decade (Caplan, 2023). Of the older population in the United States., over one million people reside in nursing homes (Centers for Disease Control, 2023). This number is expected to increase along with the growing older population.

Nursing is the largest discipline in nursing facilities, 12% of which are staffed by registered nurses, who significantly impact the quality of life for residents in these facilities. Despite the potential impact of nurses in these facilities, many nursing students do not favor working with older adults in general, particularly in long-term care settings (Hebditch et al., 2020; King, Roberts & Bower, 2013). Some negative attitudes cited by nursing students include the perception that older adult care settings are uninspiring and only require rudimentary nursing skills (Robinson & Cubit, 2007). These attitudes are often influenced strongly by the experiences students have during their nursing education (Adewuyi, Morales & Lindsey, 2022; Neils-Strunjas et al., 2020). In our project, we sought to positively influence baccalaureate nursing students' knowledge and attitudes toward older adults and long-term care settings by using the 4Ms model of care to structure our older adult didactic and clinical content.

According to Edelman et al. (2021), the Age-Friendly Health System initiative was established to increase quality, person-centered care for older adults. This initiative developed the evidence-based 4Ms of age-friendly care. It consists of four core components: what matters, medication, mentation, and mobility. “What Matters” centers around patient-centered care. This is individualized care around the older adults' care preferences and goals. “Medications” involves medication management with medication reconciliation and deprescribing high-risk medications that will support the other 4Ms of care. “Mobility” is “explored by an interdisciplinary team (IDT), with a holistic perspective that addresses all of the 4Ms” (Edelman et al., 2021, p. 143). This also includes creating an environment that enables mobility. “Mentation” is addressed in the age-friendly setting by supporting cognitive function. Activities and routines should be individualized based on the level of cognition. Independence and dignity should be maximized. It also involves identifying and treating dementia, depression, and delirium. The 4Ms framework can play a significant role in encouraging nursing students to pursue a career in long-term care. By focusing on the age-friendly care components, the framework demonstrates nurses' impact on improving the quality of life for older adults.

The University of Central Arkansas School of Nursing Older Adult Nursing Course team created a workbook that guides students through the assessment and analysis of each of the 4Ms, including a post-clinical portion that asks students to prioritize problems, set goals, and plan nursing interventions that align with each of the four components of the 4Ms framework. A self-reflection question asks students about their experience with nursing home residents. The 13-page workbook consists of a pre-clinical reading assignment, a list of all activities to be completed using the electronic medical record (EMR) and assessing a resident, a section for each of the 4Ms, and a post-clinical section. 

The “What Matters” section includes an assessment of resident preferences. Then, students interview the resident using a guide that includes questions that range from preferences to routines and life experiences, followed by questions about how the staff can help the resident achieve more good days.

The medication section includes a medication table, including dose, indication, pharmacological class, and drug interactions. This table is followed by nine questions that analyze the appropriateness and safety of the drugs. Students evaluate the medication list for safety and appropriateness and then recommend medications to be deprescribed.

Mobility is assessed using the current EMR documentation. Then, the student assesses the resident and their environment to determine limitations and evaluate the implementation of the fall precautions.

Mentation begins with assessing the latest mental status and depression assessment in the EMR. Then, the student conducts screening assessments for both mental status and depression using the tools the nursing home routinely uses. The student then assesses the resident’s environment for factors that help or harm cognition. Each student also attends one activity session over the two-day clinical experience to evaluate participants’ change in cognition during and after the activity.



Thus far, 131 students have completed this clinical experience with many positive remarks about enjoying their time with the residents. Of these students, 47.33% stated they could see themselves working as a Registered Nurse in long-term care one day.

References

Adewuyi, M., Morales, K., & Lindsey, A. (2022). Impact of experiential dementia care learning on knowledge, skills and attitudes of nursing students: A systematic literature review. Nurse Education Practice, 62. doi:10.1016/j.nepr.2022.10335

Caplan, Z. (2023). U.S. older population grew from 2010-2020 at fastest rate since 1880 - 1890. The United States Census Bureau. https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html

Center for Disease Control. (2023).Nursing home care. National Center for Health Statistics.  https://www.cdc.gov/nchs/fastats/nursing-home-care.htm

Edelman, L. S., Drost, J., Moone, R. P., Owens, K., Towsley, G. L., Tucker-Roghi, G., & Morley, J. E. (2021). Applying the age-friendly health system framework to long term  care settings. The Journal of Nutrition, Health & Aging, 25(2), 141-145.

Hebditch, M., Daley, S., Wright, J., Sherlock, G., Scott, J., & Banerjee, S. (2020). Preferences of nursing and medical students for working with older adults and people with dementia: A

systematic review. BMC Medical Education, 20(92). https://doi.org/10.1186/s12909-020-02000-z.

King B.J., Roberts T.J., & Bowers B.J. (2013). Nursing student attitudes toward and

preferences for working with older adults. Gerontology & Geriatrics Education, 34(3), 272–91.

Meiner, S. E., &Yeager, J. J. (2019). Gerontological Nursing (6th ed.) Elseivier.

Neils-Strunjas, J., Crandall, K.J., Shackelford, J., Dispennette, K., Stevens, L. R., Glascock, A. (2020). Students report more positive attitudes toward older adults following an interprofessional service-learning course. Gerontological Geriatriatic Educaation, 41(2), 175-185. doi:10.1080/02701960.2018.1479262

Robinson, C., & Cubit, K. (2007). Caring for older people with dementia

in residential care: Nursing students’ experiences. Journal of Advanced

Nursing, 59, 255-263.

Van Dis, K. (2023). Nursing homes: A comprehensive guide. National Council on Aging

Adviser. https://www.ncoa.org/adviser/local-care/nursing-homes/