Welcome to the winter edition of the AGEC Health professions newsletter. As I mentioned last fall, I will be reviewing each of our grant’s new objectives and the related specific subobjectives and activities the GWEP will be accomplishing within each. Therefore, our first objective is the following:

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.

With this objective we will be involved in many activities. This quarter I will review an activity which we started during the last grant which has been enhanced during this grant cycle. HRSA introduced a new term, at least for the GWEPs, for this grant initiative, TTOUR sites. This stands for Tribal, Tribal Organizations, Underserved and/or Rural primary (TTOUR) healthcare sites. One AGEC subobjective for this GWEP objective is: AGEC will train the health care workforce in TTOUR primary care sites/delivery systems (and other sites such as AHEC clinics) to provide age-friendly and dementia-friendly health care for older adults and achieve and maintain Level I and/or Level II Age-Friendly Health System (AFHS) recognition from the Institute for Healthcare Improvement (IHI). 

With this objective, our first milestone is to: Implement (update if necessary) the AGEC multi-modal educational training curriculum that integrates and maintains the Age Friendly Health Systems (AFHS) 4Ms Framework while assisting TTOUR Federally Qualified Healthcare Clinics (FQHC) to become or maintain Level I and/or Level II recognition from the Institute of Healthcare Improvement (IHI) and complete associated Plan-Do-Study-Act (PDSA) quality improvement cycles. All TTOUR FQHC clinical partnered sites (10 clinics in rural/underserved areas in AR) have a goal to become recognized as AFHS certified. AGEC staff will provide resources for staff training, group case discussions, and assistance to them to identify and complete PDSA initiatives, the IHI application, and data collection/evaluations related to AFHS 4Ms Framework and required measures. During this cycle, we are introducing on-line modules to take the place of our previous face-to-face trainings and are working diligently to have these available on an easy learning platform where training and outcomes can be completed at the convenience of the learners. 

We are excited to continue our wonderful partnership with ARcare (FQHC network) to complete this objective and to enhance age and dementia-friendly care that Arkansas healthcare professionals in remote rural areas provide to thousands of older Arkansans.

I salute and thank the awesome healthcare workforce all over rural Arkansas!! Thank you!!!!

Arkansas Colleges of Health Education and Parkinson’s Support Group Through Art Program

The Arkansas Colleges of Health Education School of Occupational Therapy (OT) designed an art curriculum in collaboration with ACHE’s ongoing Parkinson’s Support Group creating the Parkinson’s Support Group Through Art program.

The initial support group was started by Dr. Reed Handlerly and Dr. Kaci Handlery with the mission to find, create, and sustain opportunities for those impacted by Parkinson’s to be empowered physically, emotionally, socially, and mentally. This mission aligns with the School of Occupational Therapy’s mission to educate highly skilled and compassionate Occupational Therapy professionals and to prepare them to advocate for those with limited opportunities for occupational engagement.

Being mindful that physical symptoms of Parkinson’s can create barriers in participating in art activities, careful consideration was given to the development of the Parkinson’s Support Group Through Art program. Dr. Whitney Garrison outlined the initial curriculum. A literature review by Occupational Therapy Doctoral (OTD) student and research assistant Ashleigh Milne informed evidence-based interventions which directed art medium choices. Sessions were designed to encourage participant engagement in the group setting for creative expression and socialization. From these efforts the School of Occupational Therapy offered a 13-week art curriculum for the Parkinson’s Support Group as part of our Productive Aging Level 1D Fieldwork during the Fall semester 2024. Information and invitations were distributed to members of the support group and to the public through flyers and ACHE social media. An ACHE instructor and four OTD students facilitated weekly sessions. These OTD students employed their knowledge of human physiology and Parkinson’s symptoms with the science of preparing for and adapting activities to create an environment for those living with Parkinson’s to more fully engage in their chosen leisure occupation of art. As the semester progressed, guest presenters and participant interests enhanced creative art expressions. Attendance varied from 7-15 individuals weekly for a total of 160 encounters and ended with an art exhibition.



Art is broad in scope. This program included paints and canvas, dance, ceramics, crafts, and music. Mediums of acrylic and watercolor paints, paper and canvas, seated dance, 3-dimensional hand building with clay, a drum circle, and participant led dream catcher fabrication were explored.

The individuals who make up this group demonstrate a range of physical abilities. Therefore, presenting a variety of ways to interact with the art media was important for participation in the creative process. Students practiced using their clinical reasoning skills to guide skilled interventions and compassionate interactions with program participants. The intent of this learning focus is for OTD students to translate clinical reasoning skills and compassion to interactions with their future clients.



Here is an example of the clinical reasoning process. Fine motor tasks can be challenging, especially if hand tremors are present. One session allowed participants the opportunity to select the shape and size of canvas along with color of pourable acrylic paints. A variety of options for gross to fine motor actions were offered. Paint in squeeze-bottles allowed a gross grasp slinging approach. Mallets allowed for a smash and splash approach. Large to very small brushes were within reach too. This helped each participant choose their level of challenge.

The program concluded by honoring our artists with an art gallery show and reception at the ACHE Research Institute Health and Wellness Center. Exhibitions included individual and group art projects. One large canvas, a group project titled Parkinson’s: In this Together, represents the Parkinson’s tulip and the impact support from those around us offers. The art piece is a textured mixed media work of acrylic, watercolor and spackle. Everyone in the picture had a hand in sculpting, painting and or hand printing this work of art.

Another project embedded in the program tasked the OTD students with curating a photo slideshow of participants weekly endeavors. During the art exhibition a big screen slideshow displayed on loop. What developed was an opportunity for participants and visitors to sit, talk and laugh. 

Additionally, OTD students measured pre and post grip strengths. Though the group sample was small, results indicated the majority of participants demonstrated some increase in dominant hand grip. However, this was a secondary finding. The social, emotional and mental gains reported by participants were experientially significant. Comments noted by one included that this art program was the first time out of the house in years to participate in a peer group social event. One referred to the toll that Parkinson’s related fatigue takes when attempting art at home. In this program he was able to create art without the associated fatigue of set up and clean up. Others brought family members, an adult child or grandchild, and were able to share interests in a way both could participate. One requested to lead a session and taught the group how to make a dreamcatcher. A caregiver said they needed this time.

ACHE’s Parkinson’s Support Group and the School of Occupational Therapy accomplished aspects of both missions. Individuals in the support group were empowered physically, emotionally, socially, and mentally through the arts. This Parkinson’s community graciously welcomed our students allowing them to achieve a greater awareness of real people with real issues related to Parkinson’s. This also furthered the mission of ACHE’s Occupational Therapy School for skilled and compassionate professionals to enhance occupational engagement. This collaboration created more than art.

 For more information about the Parkinson’s Support Group Through Art program, please contact Cynthia Mathis. Cynthia.Mathis@achehealth.edu

CM 

Exploring the Effect of Immersive Virtual Reality on Empathy and Bias in Doctor of Physical Therapy Students Toward Individuals with Alzheimer’s Disease and Related Dementias

 As the prevalence of Alzheimer's Disease and Related Dementias (ADRD) continues to rise, it is imperative that healthcare professionals are equipped with knowledge and skills to effectively address the unique complexities of this condition. However, evidence has found student health professionals across various disciplines often lack knowledge of best practices in dementia care, may lack self confidence, and may develop negative attitudes toward individuals with ADRD.^1–3 Students frequently believe that care for individuals with ADRD is unlikely to be effective, that communication with these individuals is overly challenging, and that providing care is excessively complex.¹ Such attitudes are partly shaped by limited opportunities to engage with individuals with ADRD and their caregivers in mentored, educational environments. As a result, few students pursue careers in dementia care, despite the growing demand for professionals in this field.^4,5

Therefore, healthcare programs are incorporating simulation and experiential learning opportunities to increase student exposure to and engagement with persons with ADRD to combat these barriers to care. Immersive virtual reality (VR) simulations bring to life the multi-faceted challenges and lived experiences of persons with dementia and their care partners beyond what can be conveyed through traditional, didactic instruction. Research shows that participation in VR simulations may increase empathy and positive attitudes towards people with ADRD.^6–10 Increasing empathy in health-care students may ultimately lead to better-informed care decisions, improved interactions, and improved quality of life for people with ADRD and their care partners.^6,10

The University of Central Arkansas has begun pilot utilization of Embodied Labs^®  Alzheimer’s Disease simulation with Doctor of Physical Therapy (DPT) students. The immersive VR experience offers a firsthand perspective of the challenges of memory loss, sensory changes, and communication barriers experienced by a person with ADRD. The current project aims to assess how this simulation may enhance students' empathy, improve their understanding of the disease, and refine their person-centered care strategies.

Five, second year Doctor of Physical Therapy students enrolled in a directed research practicum course participated in a pilot study to explore the effect of participation in immersive VR on measures of empathy, understanding, and bias toward older adults with ADRD. Prior to participation in the VR simulation, students completed a literature review and participated in a journal club discussion of current evidence related to utilization of low-fidelity and immersive virtual reality simulation in dementia education. Additionally, prior to participation in the simulation, students completed the Dementia Attitudes Scale (DAS). The DAS is frequently used to assess a person’s knowledge and perceptions toward working with persons with ADRD. The DAS consists of 20 items, answered on a seven-point likert scale, to determine if a person has supportive, accepting, or exclusionary attitudes toward working with persons with ADRD.^11–14 Additionally, the DAS assesses subcategories of dementia knowledge and social comfort toward persons with ADRD.

During the simulation, students were individually equipped with a virtual reality headset to view three modules that allowed them to follow the journey of ‘Beatriz’, a middle aged Latina woman, as she progressed through mild, moderate, and late stages of Alzheimer’s Disease. Each of the three modules highlighted the cognitive and physical changes Beatriz experienced, and allowed students to observe interactions with family and health professions involved in her care. After each module, all students participated in a group debriefing session to reflect on the experience. After completing all three modules and debriefing sessions, students completed the DAS a second time for post-participation assessment.

Effectiveness of the simulation on student attitudes and perceptions of ADRD was assessed through quantitative and qualitative means. A paired samples t-test found significant increases in the overall score on the DAS (t=-9.207, p<.001) as well as increases in both the dementia knowledge and social comfort subscales (t=-8.050, p=.001; t=-4.679, p=.009 respectively). In addition to notable quantifiable improvements, students provided rich insights into their learning experience during the debriefing sessions. Students noted the profound impact of seeing life through the eyes of someone with ADRD. They reported gaining a deeper understanding of the cognitive, sensory, and emotional challenges faced by persons with ADRD. Sensory distortions that appeared during the modules (such as hearing changes, dimming vision, and conflicting auditory and visual information) emphasized the complex challenges persons with ADRD experience that impact their ability to communicate and navigate within their environments.

Students also frequently discussed the psychosocial dynamics that were brought to light during the simulation. They noted emotional moments from Beatriz's perspective including feelings of isolation, fear, and sadness. Students noted the family’s reactions throughout the modules ranged from concern to agitation, which underscored the emotional toll of caregiving relationships. Exposure to Beatriz and her family helped students understand the need for empathy, patience, active listening, adapted communication, and tailored approaches to assist persons with dementia in processing and responding to their environment.

The students acknowledged the VR simulation is an effective tool for enhancing their understanding of dementia. They described the experience as transformative in helping them grasp the person’s perspective in a way that traditional learning methods cannot. Overall, the pilot study found implementation of immersive virtual reality simulation to be feasible and beneficial at improving students perceptions and attitudes toward persons with Alzheimer’s Disease and Related Dementias. UCA has plans to expand implementation of the Beatriz Lab^® to include the entire second year DPT cohort as well as students from the departments of Exercise and Sport Sciences and Communication Sciences and Disorders in future semesters.



References:

1.   Stojic J, Petrosanec M, Milosevic M, Boban M. The attitude and knowledge of medical students regarding dementia. Acta Neurol Belg. 2022;122(3):625-630. doi:10.1007/s13760-022-01939-8

2.   Scerri A, Scerri C. Nursing students’ knowledge and attitudes towards dementia - a questionnaire survey. Nurse Educ Today. 2013;33(9):962-968. doi:10.1016/j.nedt.2012.11.001

3.   Quick SM, Snowdon DA, Lawler K, McGinley JL, Soh SE, Callisaya ML. Physical Therapist and Physical Therapist Student Knowledge, Confidence, Attitudes, and Beliefs About Providing Care for People With Dementia: A Mixed-Methods Systematic Review. Phys Ther. 2022;102(5):pzac010. doi:10.1093/ptj/pzac010

4.   Akifusa S, Izumi M, Isobe A. Dental Hygiene Students’ Attitudes and Knowledge Regarding People with Dementia: A Four-Year Prospective Study. J Dent Educ. 2019;83(6):624-629. doi:10.21815/JDE.019.076

5.   Hebditch M, Daley S, Wright J, Sherlock G, Scott J, Banerjee S. Preferences of nursing and medical students for working with older adults and people with dementia: a systematic review. BMC Med Educ. 2020;20(1):92. doi:10.1186/s12909-020-02000-z

6.   Kimzey M, Patterson J, Mastel-Smith B. Effects of Simulation on Nursing Students’ Dementia Knowledge and Empathy: A Mixed Method Study. Issues Ment Health Nurs. 2021;42(3):274-279. doi:10.1080/01612840.2020.1797252

7.   Wijma EM, Veerbeek MA, Prins M, Pot AM, Willemse BM. A virtual reality intervention to improve the understanding and empathy for people with dementia in informal caregivers: results of a pilot study. Aging Ment Health. 2018;22(9):1121-1129. doi:10.1080/13607863.2017.1348470

8.   Karana Z, Paun O. Dementia Simulation for Family Caregivers of Persons With Dementia: A Scoping Review. West J Nurs Res. 2023;45(11):1053-1062. doi:10.1177/01939459231201085

9.   Raposo R, Vairinhos M, Laska-Leśniewicz A, Sztobryn-Giercuszkiewicz J. Increasing awareness and empathy among university students through immersive exercises – testing of the virtual reality application: A pilot study. Med Pr. Published online August 21, 2023. doi:10.13075/mp.5893.01391

10. Huang Y, Ho KHM, Christensen M, et al. Virtual reality‐based simulation intervention for enhancing the empathy of informal caregivers of people with dementia: A mixed‐methods systematic review. Int J Ment Health Nurs. 2024;33(2):241-258. doi:10.1111/inm.13240

11. Banerjee S, Jones C, Wright J, et al. A comparative study of the effect of the Time for Dementia programme on medical students. Int J Geriatr Psychiatry. 2021;36(7):1011-1019. doi:10.1002/gps.5532

12. Mastel-Smith B, Kimzey M, Garner J, Shoair OA, Stocks E, Wallace T. Dementia care boot camp: interprofessional education for healthcare students. J Interprof Care. 2020;34(6):799-811. doi:10.1080/13561820.2019.1696287

13. Sari DW, Igarashi A, Takaoka M, et al. Virtual reality program to develop dementia‐friendly communities in Japan. Australas J Ageing. 2020;39(3). doi:10.1111/ajag.12797

14.      Hunter SW, Armstrong J, Silva M, Divine A. Physiotherapy Students’ Attitudes Toward Working With People With Dementia: A Cross-Sectional Survey. Phys Occup Ther Geriatr. 2020;38(1):56-66. doi:10.1080/02703181.2019.1690088