Day 2 :
Keynote Forum
Julianne Wright
University of Indianapolis, USA
Keynote: Valvular heart disease and the older adult
Time : 10:00- 10:30
Biography:
Julianne Wright has completed her DNP this past spring from the University of Southern Indiana. She is an Assistant Nursing Professor from the University of Indianapolis in Indiana. Her research has focused on improving assessment skills in nursing, improving the surveillance for significant findings and best patient outcomes. She has over 30-years’ experience in critical care and medical-surgical nursing at the bedside and working closely with adult patients and the older adult.
Abstract:
Valvular heart disease (VHD) constitutes a pathologic process affecting cardiac output, direction of blood flow through the heart and pooling of blood around the valves. These conditions are precursors to poor tissue perfusion, peripheral edema, pulmonary edema and emboli, all of which can cause cardiovascular and cerebrovascular complications. A gap in the care of patients with these conditions is the lack of accurate auscultation of heath sounds. Due to increasing life-expectancy in the United States and prevalence of obesity VHD is expected to become a cardiac epidemic needing early detection to evaluate and minimize adverse effects on heart function. The purpose of the discussion will be to cultivate higher expectations in healthcare for cardiovascular surveillance through cardiac auscultation and by other means, facilitating early detection and prevention of cardiovascular and cerebrovascular complications in the older adult. Data collections on cardiac murmurs and subsequent nursing documentation revealed a significant skill deficit in cardiac auscultation in nursing and readily corrected with aneducational in-service. The discussion will also include the various therapy options and the quality of life for the older adult with valvular heart disease
Keynote Forum
Elizabeth Andersen
The University of British Columbia, Canada
Keynote: Nursing home models and modes of service delivery: A review of outcomes
Time : 10:30-11:00
Biography:
Elizabeth Andersen PhD, RN, is an Assistant Professor in the School of Nursing, Faculty of Health and Social Development, University of British Columbia. Her research is focused on exploring specific components of nursing home cultural change models and their effects on residents, families, and paid caregivers. She is especially interested in the working conditions and expanding roles of more marginalized nursing home employees (care aides).
Abstract:
Within contemporary approaches to nursing home care, the staff composition and task allocation influence paidcaregiver experiences, and in turn affect the quality of care provided to residents. In this presentation, I will profile several different models of nursing home care with their associated modes of service delivery, and summarize the varied reports of effectiveness of these models and modes of service delivery. While anecdotalevidence supports the Eden Alternative® Neighbourhood or Household models, empirical support for the consistent assignment mode of service delivery within the Eden Neighbourhood or Household models is notextensive. More persuasive evidence supports the more advanced Eden Greenhouse model with its embedded flexible assignment policies and self-managed teams of care aides. Flexible assignments are a design element of the Alzheimer’s Disease and Related Disorders Society (ADARDS) model as well. Although consistentassignments for paid caregivers continue to be targeted by organizations, self-managed teams and flexibleassignments may be more ideal modes of nursing home service delivery, especially now, as the average age,frailty level, and acuity level of nursing home residents is increasing.
- Track 9: Social Gerontology, Track 11: Pharmacotherapy & Track 12: End-of-Life
Location: Salon-D
Chair
Ilene Warner-Maron
Institute for Continuing Education and Research, USA
Co-Chair
Elizabeth Andersen
University of British Columbia, Canada
Session Introduction
Lillian Mwanri
Flinders University, Australia
Title: Ageing in a foreign environment for new migrants: The case of newly arrived African migrants in South Australia
Biography:
Lillian Mwanri is a public Health Physician and a Fellow of the Australasian Faculty of Public Health Medicine. She is currently the Coordinator of the Master of Health and International Development program at Discipline of Public Health, Flinders University, South Australia. She has published more than 40 papers in reputed journals and has been serving in different committees for culturally and linguistically diverse communities in South Australia
Abstract:
Over the past few years, a large number of Africa migrants have settled in Australia. The majority of this population has been re-settled under the humanitarian program. Usually, resettlement occurs after many years of living in refugee camps, in different countries away from the country of origin. As a result of this surge in migration of Africans, ageing and frailty are gradually becoming a public health issue for Africans living in Australia. It is well understood that people from developing countries who migrate to developed countries originate from an environment where family members care for them during the old age. At the same time information about experiences of ageing and frailty of Africans in Australia is generally limited. Despite the wide variety of origins, most studies of ageing have mainly focused on experiences of old migrant populations e.g. Greeks and Italians and the mainstream Australian population. Information and discussions on new and emerging communities including the Africans is limited, yet their number and the proportion are increasingly becoming a significant part of the Australian population. The main aim of this paper is to provide some insight into the socio-cultural experiences of ageing for African migrants in South Australia and the challenges and opportunities faced by the ageing African migrants in interacting with the Australian health services. The paper provides some insights as to how some African communities relate with the provision of health care especially ageing care and calls for more research to understand the ageing challenges of the community. It also provides some points for discussion to enhance the capacity of current health services to provide more culturally competent services. The paper contributes to the knowledge of the provision of culturally competent care to African patients and their families by enabling the learning of health services and health service providers to improve the competence of ageing care services for newly arrived migrants in Australia.
Veronique Provencher
University of Sherbrooke, Canada
Title: Improving home safety in people with dementia following hospital discharge
Biography:
Véronique Provencher is an occupational therapist who has completed his PhD in geriatric rehabilitation from the University of Montreal in 2012. She is professor at the University of Sherbrooke and researcher at the Research Center on Aging (Quebec, Canada).
Abstract:
Health professionals practicing in geriatric units routinely assess their patients with dementia prior to hospital discharge for their ability to perform safely their daily living activities. The aim of this assessment is to know what type of home care services are needed when they will return in their living environment. Because of a home visit cannot usually be done prior to discharge, this assessment is performed in hospital. This situation raised two questions: 1-to what extent the risks assessed and the home care services recommended in hospital setting prior to discharge truly reflect and predict home safety; 2-how can we improve home safety in people with dementia following hospital discharge. Based on a systematic review and an international panel of experts, our data suggest that some risks (such as fire) may be overestimated, while others (such inappropriate medication intake) may be underestimated before hospital discharge. These results may be explained by: 1) characteristics of the assessment setting (unfamiliarity of the context); 2) differences in clinicians, patients and caregivers’ perceptions and values toward ethical challenges (safety vs autonomy); 3) difficulty to predict how safety issues will change in the months following hospital discharge (progression of the disease, reduction of delirium). Developing a clinical decision tool to support assessment and management of risks by health professionals as well as optimizing transitions of care (through case manager and technological aid) may help to improve home safety in people with dementia following hospital discharge.
Mirian Ueda Yamaguchi
Centro Universitário de Maringá - UniCesumar,
Brazil
Title: Sexually Transmitted Diseases in the Elderly: A Current Challenge
Biography:
Mirian Ueda Yamaguchi is a Pharmacist and Professor of Post-Graduate Course in the Promotion of Health, Centro Universitário de Maringá-UNICESUMAR–Maringá, Paraná, Brazil
Abstract:
In Brazil there are more than 20 million people aged 60 or over and estimates indicate that the number will triple in the next 40 years1. In this context, the aim of this study was to analyze the evolutionary trend of STDs among the elderly in Brazil and around the world. The study consisted of a systematic review (PRISMA)2 in LILACS, IBECS, Cochrane, MEDLINE, PubMed and SciELO. In total, 979 articles were identified, 44 of which met the inclusion criteria for this study. Among the works selected, 77% of the research related to HIV / AIDS and only 23% to other STDs. It was found that currently seniors remain sexually active into their later years, a fact related to the advent of drugs for erectile dysfunction. It was also found that a notable characteristic of this age group was the practice of sex without protection, which is reflected in the increase in STDs in this population. Other relevant data found in this review refers to the failure to diagnose STDs in elderly patients due to the fact that health professionals are unaware of, or ignore, the sexual practices of the elderly population, confusing the symptoms with comorbidities associated with old age. Furthermore, it was found that the elderly are generally excluded from public policy promoting health and the prevention of STDs. It is concluded that there is a need for awareness among health professionals of STD and geriatric services about changes in the behavior and epidemiological profile of this population. KEYWORDS: Sexually Transmitted Diseases; HIV/AIDS; Public Policy.
Biography:
Margaret Decker is a Clinical Assistant Professor for the Decker School of Nursing and is a Certified Nurse Educator. She is currently pursuing her PhD from the Decker School of Nursing. Her areas of specialty are leadership and management, geriatrics and orthopedics. She is a 2015-2016 Faculty Fellow for Community Engagment at Binghamton University. She engages students through flipped classroom style learning. She advises students from the Watson School of Engineering with interests in bioengineering. For the Decker School of Nursing, she serves as a board member for the Broome County Community Organizations Active in Disaster.
Abstract:
Community Engaged Learning (CEL) at Binghamton University is a course designation in which students are involved in community partnerships and through these engagments and experiential learning meet course objectives. The purpose is to enrich learning and provide a service learning opportunity for the student. In this presentation, the students in the introductory nursing course, Socialization to the Professional Role I are meeting the course objectives of communication and interviewing elders for their introduction into a health history. Their primary objective for their assignment is to gather data for demographic information. However, in realizing the valuable information in social gerontology, the rich history to be shared through oral histories is realized when the student interviews the residents of the facility to gather an oral history. The Veterans of the United States shared their experiences with the nursing students through oral histories of their lives. In return, the nursing students gathered demographic information for the purposes of their nursing assignment and later wrote their own reflections of the interviews. When reflecting upon the community engagement, we felt it was important to give back to the Veterans so in return they spent time writing poetry, trascribing the interviews, preparing memory boxes and giving momentoes of the interview to the Veterans to keep as a remembrance of their history they shared. This presentation will discuss the experience of social gerontology and the benefit to the health care team through oral histories.
Briony Jane Murphy
Monash University, Australia
Title: Investigating intentional cause deaths among nursing home residents
Biography:
Briony Jane Murphy is a PhD scholar (March 2014) with the Department of Forensic Medicine, Monash University. She is using existing medico-legal death investigation information to describe the frequency, nature and potential risk or protective factors of intentional deaths among nursing home residents in Australia. The expected completion date is March 2017. She has a background in criminal justice administration and injury prevention research after graduating from RMIT in 2013 with first class honours in Criminal Justice Administration (BA) completing a thesis titled ‘Service contacts proximate to intimate partner homicide’. Her research interests include Epidemiology, Injury Prevention, Public Health and Aged Care.
Abstract:
With an ageing global population, there is an increasing demand for health and aged care services including nursing homes. As such, improving the quality of care and quality of life for residents in these settings is an internationally recognised imperative. Despite the vast amount of research and prevention initiatives for suicide and violence-related deaths among younger populations, little is known about how older adults die in nursing homes from intentional causes including suicide and resident-to-resident aggression. Medico-legal death investigation information is a highly valuable yet underused data source for public health research which can help to further our understanding of intentional deaths in this vulnerable population. To address this gap, doctoral research is currently examining the frequency, nature and potential risk (or protective factors) of intentional cause deaths among nursing home residents using existing medico-legal death investigation information. Systematic reviews conducted in 2014, reveal a paucity of research on intentional deaths in nursing homes and highlight gaps in our understanding of these deaths, providing a guide for future research in this area. Preliminary data collection commenced in 2015 has encountered a number of methodological issues associated with the use of existing medico-legal death investigation informationas a data source for research on intentional deaths among nursing home residents. Despite this, early evidence suggests that the analysis of this information has the potential to address many of the gaps in knowledge identified by the systematic reviews. It is anticipated this research will help to build a greater knowledge base and improve current understanding of these deaths to inform prevention strategies and alter attitudes towards intentional deaths among nursing home residents to equal those afforded to similar deaths in younger populations. A truly ageless era is one where each individual’s life is valued equally and irrespective of age.
Ilene Warner-Maron
Institute for Continuing Education and Research
USA
Title: Preventing Medication Errors in Long-Term Care Facilities
Biography:
Ilene Warner-Maron completed her PhD in health policy in 2007 at the University of the Sciences in Philadelphia, where her dissertation focused on HIV and aging. She holds masters degrees in gerontology from the University of Pennsylvania (1985), health care administration from St. Joseph’s University (1989) and law and social policy from Bryn Mawr College (1995); a bachelors in sociology from Philadelphia University (1983) and a diploma in nursing from the Albert Einstein Medical Center School of Nursing in 1980. She is the president of the Institute for Continuing Education and Research, a federal monitor of nursing homes in the US, a member of the board of directors of the Alzheimer’s Association and a Fellow in the College of Physicians in Philadelphia.
Abstract:
Medication errors are frequent occurrences in hospitals and long-term care settings, estimated in one out of every five doses administered in an institutional setting. Issues of medication errors have been highlighted and studied since the Institute of Medicine’s 1999 report, To Err is Human was released, however medication administration has become increasingly complex and prone to errors despite advances in the electronic medical record and automated dispensing systems. Errors frequently include administration failures (wrong dose, drug, time, route, patient); pharmacy dispensing and delivery issues; technique errors and monitoring problems. A review of citations for medical errors by the Pennsylvania Department of Health from 2009-2012 identified specific categories of errors in medication administration. This presentation will use a systems approach to address the patterns of deficiencies and offer recommendations to decrease errors in all areas of identified deficient practice.
- Track 1: Biogerontology, Track 2: Management of Ageing & Track 3: Sleep & Ageing Related Disorders
Location: Salon-D
Chair
Girish J Kotwal
University of Massachusetts, USA
Session Introduction
Elizabeth Andersen
The University of British Columbia, Canada
Title: The Impact of Mode of Assignment on Relational Care in Nursing Homes
Time : 11:45-12:10
Biography:
Elizabeth Andersen PhD, RN, is an Assistant Professor in the School of Nursing, Faculty of Health and Social Development, University of British Columbia. Her research is focused on exploring specific components of nursing home cultural change models and their effects on residents, families, and paid caregivers. She is especially interested in the working conditions and expanding roles of more marginalized nursing home employees (care aides).
Abstract:
In Canada, over the past decade, care aides’ assistive and caring roles have expanded considerably due to dramatic shifts in staffing patterns in nursing homes. These shifts are due in part to tremendous health care cost pressures faced by federal and provincial governments and in part to new approaches to health care delivery. In contemporary approaches, the presence of Registered Nurses in long-term care facilities has diminished, while care aides are employed in escalating numbers. Care aides have become the most central or the most accessible/available service providers to residents. In many facilities, teams of care aides who used provided care to all residents have been abolished. Newer approaches favor consistent (non-rotating) assignment of residents to care aides. In theory, consistent assignments foster closer, more intimate relationships between care aides and nursing home residents and facilitate familiarity between care aides and families of residents. This ethnographic study is a portrayal of care aides’ thoughts and feelings about their consistent assignments. Experiential data were collected from 22 care aides working in five nursing homes in a western Canadian city. The data were analyzed utilizing constant comparison to identify common themes. Care aides who were consistently assigned to residents described working without reference to each other. Some described losing contact with residents/families not assigned to them. Others described feeling overwhelmed, isolated, and confined by this mode of assignment and described a strong need for collegial fellowship and friendship. Experienced care aides stressed the importance of shared tasks, interchangeable tasks, and joint decisions, and indicated that a return to teamwork would help them to moderate or buffer the effects of stressful events and/or work environments.
Cassandra Warner Frieson
University of Alabama in Huntsville
USA
Title: Evidence-based Components of an Effective Fall Prevention Program for Older Adults and the Elderly
Time : 12:10-12:35
Biography:
Cassandra Warner Frieson, DNP, MSN, BSN, NP-C, FNP-BC has completed her doctoral studies from the University of Alabama in Huntsville College of Nursing in Alabama. Professional memberships include United Who’s Who for empowering executives and professionals; Who’s Who among American Women; the National Association for Female Executives; and the Alabama Society of Health, Education, and Training. She has served as Speaker at various professional organizations. She currently practices at Long Term Care physician Services of Alabama, Inc. as a nurse practitioner for over 18 years. She is an Adjunct Faculty and published author.
Abstract:
Falls among the elderly aged 65 years and older can lead to serious injuries such as hip fractures, trauma-related hospital admissions, and even death. Falls can occur in various settings to include nursing homes, hospitals, and in the community. Fall risk assessments, pharmacy consultation and medication review, laboratory review to include vitamin D levels, Tai Chi exercises, and a comprehensive falls education program are primary factors to reduce fall rates. Although significant, an appreciable change in fall rates may still not occur. According to the literature, an estimated 90 million Americans will experience dizziness in their lifetime; dizziness can lead to loss of balance and falls. Health care professionals are often unaware of falls in patients with undiagnosed inner ear dysfunction when there is no prior injury or report of a recent fall. Therefore, the author, after in-depth research and consultation with fall prevention specialists,critically evaluated the need for an evidence-based protocol to include visual, vestibular, proprioception; as well as muscular and psychological components. The expanded protocol identifies individuals at-risk for falls as well as screen for those individuals who have not fallen and have not been identified as a fall risk. The author discusses in detail the protocol shift that not only focuses on remediation of falls but also fall prevention through medical diagnostics of balance and vestibular disorders, balance and vestibular rehabilitation training, sensory-processing techniques, and psychological screening for fear of falling.
Leslie Gillies
Norfolk General Hospital, Canada
Title: Sustainability of an innovation to support and respond to persons with behaviors related to Dementia and Delirium
Time : 12:35-13:00
Biography:
Leslie Gillies is Director of the Perioperative Services, Critical Care Program, Respiratory Therapy Service and Haldimand Norfolk Diabetes Program at Norfolk General Hospital, Simcoe Ontario, Canada. She completed her BScN at McMaster University and MEd (Administration) at Brock University. She serves as an Assistant Clinical Professor at McMaster University, School of Nursing since 1990 and previously worked at Hamilton Health Sciences as a Chief of Nursing and Chief of Interprofessional Practice
Abstract:
Gentle Persuasive Approaches (GPA) in Dementia Care, a program designed for staff caring for patients in long term care who exhibit challenging behaviors was implemented and has been sustained in an acute care setting. Outcomes include fewer codes indicating violent situations, a reduction in physical restraint and sitter use, and fewer reports of safety incidents involving agitated patients. GPA in Dementia Care, a person-centered curriculum designed to improve staff confidence when working with patients who exhibit behavioral symptoms was successfully implemented in multiple acute care units and departments. This was the first time that this program, designed for long-term care, was implemented for staff in acute care setting across a large multi-site organization. Key factors that affected ability to sustain the program included adopting and adapting a previously well received, established curriculum (at present > 200,000 staff in settings in Canada have participated); relevance for staff, managers, other stakeholders, and senior leadership; engaging teams and groups to facilitate sustainability; involving leaders; integrating knowledge into policies; and pursuing sources of 1-time funding to demonstrate the benefit of dedicating operating funding to ongoing sustainability efforts. GPA is a tangible and effective intervention to support improvement of the patient experience in the acute care hospital setting.
Atul Sunny Luthra
Homewood Health Centre
Canada
Title: Workshop
Classification of behaviors in Dementia based in impairment in theories based upon information processing pathways
Time : 14:00-16:00
Biography:
A.S.Luthra is presently an associate clinical professor at McMaster University, Hamilton, Ontario, in the faculty of health sciences, Department of Behavioural Neuroscience. He is also affiliated as a research scientist with the Research Institute for Aging, Schlegel, University of Waterloo, Ontario. He is currently working as medical coordinator in the Program for Older Adults at Homewood Health Centre, Guelph, Ontario. He is affiliated in the same capacity with the St. Peter's site of Hamilton Health Science, Hamilton, Ontario. His clinical and research focus is on developing safe pharmacological and affordable non-pharmacological treatment interventions for behaviors in moderate to advanced dementia.
Abstract:
Objectives: There is vast heterogeneity in use of terminology and classification of behaviors in dementia with no universally accepted classification system. Methods: Criteria proposed by Davis, Buckwalter and Burgio (1997) were identified as the basis for classification of behaviors in dementia. A review of the literature was done to identify the “Specification of the Theoretical Construct” (STC) to justify aggregation of similar behavioral symptoms into clinically meaningful categories. Results: STC identified for these behavioral categories are those based in theories on information processing (TIP). Two behavioral categories emanating from pathological changes in TIP are: Disorganized Behaviors (DOB), and Misidentification Behaviors (MiB). Discussion: DOB is the result of an alteration in the physiological status of the patient. This result in changes in arousal and attentiveness and this, in turn, leads to impairment of the sequential organization of information processing thereby giving way to fragmentation of the process at many different levels of the brain. MiB are the result of a specific breakdown in two specific steps of TIP; schema identification and pattern recognition. This result in the failure of the usual pairing of old and new information with an altered sense of relatedness between self and persons, places, objects and events.
Siyaram Pandey
University of Windsor, Canada
Title: Workshop
Water soluble Nano-miceller formulation of Ubisol Q10 halts progression of neurodegenerative diseases and cellular aging
Time : 16:15-17:00
Biography:
Siyaram Pandey is a Professor in the Department of Chemistry & Biochemistry at the University of Windsor. He received his MSc from Banaras Hindu University (1986),Varansi, India and his PhD from Jawaharlal Nehru University/CCMB (1992), New Delhi,India. He did is postdoctoral training at McGill and joined NRC, Ottawa as a researchofficer (1993-2000). He joined the University of Windsor in 2000.
Abstract:
Risk of neurodegenerative diseases increase as we age. There has been an exponential increase in the number patients diagnosed with Alzheimer’s and Parkinson’s disease as number of elderly increases. Although the etiological factors triggering AD and PD are very different, they ultimately bring about neuronal death which is, most likely, executed by a common mechanism(s). Currently, there are no effective treatments to halt the progression of these diseases and assist in their management. We have used cellular, and animal models (both rat and transgenic mice) of PD and AD to evaluate neuroprotective effects of water soluble Coq10. Recently we have reported unprecedented effectiveness of Ubisol-Q10,(US Patent No. 6,045,826, developed at NRC) at a very low dose of 6 mg/kg/day as an inhibitor of progressive Parkinsonian neurodegeneration in rodent models of disease. Oral intake of Ubisol-Q10 blocked the neurodegenerative processes activated by either MPTP or Paraquat. The formulation contains CoQ10 and PEG-α-tocopherol forming jointly water- soluble nanomicelles. We have confirmed bioavailability of this formulation in brain. A comprehensive behavioral analysis of transgenic animals fed with this formulation indicated significant improvement in motor activity in PD and long term memory and emotional reactivity in AD models compared to untreated animals. These results were complemented with histochemical analysis that indicated significant protection of neurons in substantia niagra region and lower amyloid beta burden in respective models. This treatment leads to the stabilization mitochondrial functions, decrease of oxidative stress in neuronal cells and triggers an increase in neurotrophic factors from surrounding supporting cells such as microglia and astroglial cells. Thus Ubisol Q10 could offers a treatment that could halt the progression of disease in AD and PD patients. This work was supported by CIHR and Michael J. Fox Foundation and a donation from Szecsei Family in Windsor
Purti Papneja
Sunnybrook Health Sciences Center, Canada
Title: Obstructive sleep apnea: A burden on the aging brain
Time : 17:00-17:25
Biography:
Purti Papneja is a Clinician Teacher and Lecturer at the University of Toronto, Department of Family and Community Medicine. She received her MD from the McMaster University and completed her Family Medicine Training at the University of Toronto. She received Clinical Training in Sleep Medicine at Sunnybrook Health Sciences. Her practice in Sleep Medicine is focused on post-stroke patients at the North Toronto Sleep Center. She is an Active Staff and Post graduate Program Co-Director in Department of Family Medicine at Sunnybrook Health Sciences and involved in undergraduate medical education.
Abstract:
Obstructive Sleep Apnea (OSA) is now recognized as an important risk factor for stroke, cognitive impairment and dementia. Moreover, OSA is a common clinical outcome after stroke directly influencing the patient's recovery. This talk will review current evidence linking OSA with stroke and cognitive impairment. It will highlight the importance of early recognition and treatment of obstructive sleep apnea in elderly patients especially during the post-stroke period to improve the neurological outcomes. In addition, physicians will learn about the novel approaches that have emerged in the last few years to treat OSA including Adaptive Servo ventilators and Nasal Expiratory Positive Airway Pressure device.
Swati Bajpai
All India Institute of Medical Sciences, India
Title: Effectiveness of a cognitive rehabilitation intervention as an adjunct to acetylcholinesterase inhibitor (AChE-I) treatment on patients with mild Alzheimer's disease: A preliminary study
Biography:
Swati Bajpai has completed her Post graduation in Clinical Psychology and currently pursuing PhD in Clinical Neuropsychology from All India Institute of Medical Science, 2013. (Development and Validation of Cognitive Rehabilitation Intervention (RECREATE) on Memory, Language, Attention and Quality of Life in Patients with Mild Alzheimer Disease.) Recently, she has been awarded Gandhi Scholar of the year 2015 for neuro-rehabilitation work and has 6 international publications. She has also worked as Psychologist in National Institute of Health (NIH) funded multi-centric project for 2 years and later worked as Senior Research Fellow (SRF) in project entitled “Preclinical Predictors of progression of cognitive decline in MCI and AD Using a Multitasking paradigm.
Abstract:
Objective: To study the efficacy of cognitive rehabilitation intervention as an adjunct to acetylcholinesterase inhibitor (AChE-I) treatment as compared to AChE-I group alone in patients with mild Alzheimer's disease. Method: Nine patients with mild Alzheimer's disease treated with Standard pharmacological treatment (‘cholinesterase inhibitors’ (Donezepil-10 mg and Rivastigmine-12 mg as capsule or 10 units as patches for more than two months) were randomly allocated to study group (n=5) and control group (n=4). All the patients in both the groups were pre and post assessed through cognitive tests which included remote memory, recent memory, attention/concentration, new learning ability and recognition ability along with activities of daily living scale, social support and quality of life domains. Institute ethical clearance was obtained and the informed written consent was taken from the patients. Results: Due to small sample size, median values between the groups were compared using Wilcoxon rank-sum test post intervention. Median values of MMSE [study group:19 (18 to 27); Control Group:15 (10 to 20)]; Remote Memory [Study group:-3.3 (-3.4 to 0.24); Control Group: -4.7 (-4.7 to -4.7)]; Simple Memory [Study group:-0.7 (-2.61 to 1.1); Control Group: -3.4 (-4.2 to -2.6)]; New learning ability [Study group:-0.7 (-1.1 to 0.07); Control Group: -1.2 (-1.52 to -0.23)]; Performance ability [Study group: 76 (20 to 126); Control group: 29 (26 to 124)]; IQ [study group:82 (56 to 139); Control group: 67 (57 to 117)]; Category fluency [Study group:10 (5 to 40); Control group: 5 (5 to 10)]; Social support [Study group: 57 (42 to 60); Control group: 55 (44 to 57)]; and Qol- Psychological domain [Study group: 0.54 (-3.39 to 1.92); Control group: -1.27 (-1.71to -0.76)] were higher in the study group as compared to the control group suggesting improvement in the above mentioned domains, however, statistically non significant (p=0.05). Similarly, post intervention, median values of ADLs [Study group: 30.9 (15 to 60); Control group: 7 (5 to 75)] were lower in the study group as compared to the control group indicating clinically significance, however statistically non-significant (p=0.05). Conclusion: The combined treatment group showed potential to positive treatment effect on cognitive/neuropsychological tests applied to patients suggesting that cognitive rehabilitation associated with AChE-I treatment can potentially be useful to stabilize or improve cognitive and functional performance of patients with mild Alzheimer's disease and can improve their quality of life. However, an adequate sample size is required to confirm it.
Biography:
Carnes received a B.S. in biology from the University of Utah in 1973. He received a M.S. in population biology from the University of Houston in 1975. He received an M.A. in statistics and a Ph.D. in ecology from the University of Kansas in 1980. He spent 19 years in the Biomedical Research Division as a staff scientist at Argonne National Laboratory. He then spent 4 years at the Center on Aging at the University of Chicago. In 2003, he was recruited to his current position at the Oklahoma Health Sciences Center
Abstract:
Species are defined by biological criteria. This characterization, however, misses the most unique aspect of our species;namely, an ability to invent technologies that reduce mortality risks. Old animals are rare in nature, but survival to old age has become common place in humans. Science now asks how long can humans live, but we suggest a more appropriate question is: How long must humans live? Three lines of evidence are used to identify the biological equivalent of a warranty period for humans and why it exists. The effective end of reproduction, the age when the sex ratio is unity and the acceleration of mortality reveals that approximately 50–55 years is sufficient time for our species to achieve its biologicalmandate-Darwinian fitness. Identifying this boundary is biomedically important because it represents a transition from expected health and vigor to a period when health and vigor become progressively harder to maintain.
Rebecca Vargas-Jackson
George Mason University
USA
Title: Stigma, Discrimination, and Mental Disorders in Aging Populations
Biography:
Vargas-Jackson is a bi-lingual, bi-cultural physician and International and Health division lead at WRMA with nearly 30-years of working experience in the U.S. and overseas. She is also one of the lead designers and organizers in the proposed Center for Human Rights in Health at Howard University. She is currently affiliated with George Mason University, and has been affiliated with George Washington University at their Global Health division. Dr. Vargas–Jackson is an expert lecturer on Cultural Competence in Health Care, CLAS–Standards, health literacy and similar topics.
Abstract:
Stigma in the elderly is generally health related. The elderly may not be able to walk as fast as they did when they were young. Hearing decreases. Eye sight diminishes. Digestive problems are common. Teeth do not work at full capacity to complete a perfect mastication process; some seniors need to wear dentures. Diabetes, hypertension, obesity, are signs of a more sedentary life style, in addition to genetic and low health literacy skills related to healthy eating habits. HIV does not respect age. Finally, seniors may need to deal with mental and behavioral disorders while aging. Stigma in mental disorders can be extrapolated to all above mentioned health related issues. The World Health Organization recognized that the stigma and discrimination attached to mental disorders are strongly associated with suffering, disability and economic losses. Constant social, economic, cultural, technological and demographic changes have brought a series of challenges to the elderly population worldwide, which jeopardize their role in society. A Technical Consensus Statement to address this particular issue was produced in a collaborative, multidisciplinary way, involving several organizations such as: World Psychiatric Association and the World Health Organization, Alzheimer’s disease International, and International Association of Gerontology. This technical consensus statement highlights the nature, causes and consequences of this stigmatization, and promotes and suggests policies, programs and actions to combat it. 2001 was the tenth anniversary of the adoption of the “Rights of the Mentally Ill to Protection and Care” by the United Nations General Assembly. 40% of member countries of the United Nations do not adhere to this policy. Additionally care for the elderly is not considered a priority in the majority of countries in the world. Stigma is a fact for the elderly population worldwide. Stigma remains a major obstacle to ensuring access to good care for older populations with mental disorders, and any kind of communicable and non-communicable diseases. Social stigma is the disapproval of a person because they do not fit the required social norms that are given in society. Stigma is typically a social process, experienced or anticipated, characterized by exclusion, rejection, blame or devaluation that result from experience, perception or reasonable anticipation of an adverse social judgment about a person or group. Elderly populations are heavily stigmatized. Unless we address stigma as the major gap in the system that prevents access to knowledge and services to the stigmatized aging population and take some global actions to eliminate it, there is going to be very little progress in health as a human right. The elderly are going to continue being a sector of the population isolated and unreachable by any kind of social or health related intervention.
Sylvia L.F. Pender
University of Southampton, UK
Title: The importance of immune response during healthy ageing
Biography:
Sylvia Pender has completed her PhD and postdoctoral studies at St Bartholomew School of Medicine University of London, She is the Associate Professor in Mucosal Immunology and the Associate Director International atthe University of Southampton. She is also an Adjunct Associate Professor at International Medical University in Malaysia. She has published more than 45 peer-reviewed papers in reputed journals and has been serving as an editorial board member of World Journal of Gastroenterology
Abstract:
Our body’s immune defense system deteriorates with time and as a result, one is more prone to have infections which induce systemic low grade inflammation in multiple organs. As such, ‘healthy’ ageing is accompanied by the development of age-related diseases such as cancer, atherosclerosis, scarcopenia and osteoporosis. The mechanisms by which successful ageing occurs is the preservation of a good population of functional immune and non-immune cells which are immunologically characterized by preserved lympho-proliferative responses and natural killer (NK) cell cytotoxicity, as well as conserved antigen presentation to delay or prevent age-related diseases. A decline in immune function with age is supported by many epidemiological and clinical observations, with a decrease in T-cell mediated function being responsible for a large part of this change. The pathophysiological mechanisms are only partially understood. Timp-3 is the natural inhibitor of matrix metalloproteinase (MMP). Timp-3 knock-out mice, in general, have low grade inflammation in the gut. We observed that the female animals die of wasting diseases at the age of ~50 weeks compared to age matched males and WT which remain healthy. The females only, show signs of premature ageing phenotypes. We hypothesise that low grade systemic inflammation accelerate senescence. In this presentation, we will discuss the role of NK cells, the immune components of the genetic knock-out Timp3 mice during ageing.
Girish J Kotwal
University of Massachusetts
USA
Title: Prompt management of Ageing based on disease risk analysis of Genotype and lifestyle can contribute to Longevity and improved health
Biography:
Girish J. Kotwal has completed his Ph.D in Biochemistry from McMaster University in Hamilton, Canada and postdoctoral studies from National Institutes of Health, Bethesda, MD, USA. He has held academic appoints in the USA and elsewhere. He is the Adjunct Professor of Medicine at UMass, medical school and President of a biotech company involved in finding solutions to inflammatory CNS diseases. He is also president of a bioconsulting company. He has published more than 100 papers in high impact International journals, has had a dozen or more US and International patents, serves as an editorial board member of several high caliber journals and is member of seientific societies.
Abstract:
BACKGROND: At the beginning of this century, the sequence of the entire human genome has been determined, Subsequently the influence of single nucleotide polymorphisms (SNP) has been studied and the risk for diseases like Alzheimer’s Disease, type 2 diabetes, Parkinson’s disease that occur in later years of life can be predicted by alleles that predisposes a person to ageing related diseases. APPROACH: DNA is isolated from Saliva and SNP analysis is performed for several specific disease related genes. The level of risk for predisposition to certain diseases which have been previously established was then determined and placed in the context of phenotypic findings RESULTS: SNP analysis of over 50 genes in a father and son pair was conducted and the results will be presented, CONCLUSION : Genes play a key role in Longevity and in gaining insights on how life style changes can over come gene defects and understanding the interplay of genes, one can better manage Ageing and reduce cost of hospitalization and falls that occur due to defective vision or balance.
Patricia A. Fletcher
Union Institute & University
USA
Title: The Cultural Meaning of the Wheelchair Symbol for the Aging Population
Biography:
Patricia A. Fletcher is a Ph.D.student in Interdisciplinary Studies – Public Policy and Social Change with an Aging Studies Specialization at Union Institute & University. She is a Credentialed Professional Gerontologist with a M.A. in Communications Arts, as well as a M.S. in Gerontology. She is the Founder of ElderCare Buddy, an assessment organization for older adults. Her involvement included social justice issues that globally affect the older population. She has served on various corporate boards and frequently guest lectures at national industry conferences addressing age-related issues.
Abstract:
The demographic shift of the aging population will affect all aspects of society. Therefore, it is important for this group to interpret the meaning of a symbol, which is critical in helping them improve hearing, vision, and literacy as the mobility-impaired individual increases. The purpose of this paper is to identify the role of the disability placard and plate artifact. Specially addressing, how this visual communication will help, older adults use signage to provide daily application and acceptance, and seeks to understand the cultural indicators that can affect the delivery of meaning. The negotiated artifact (Wenger, 1998, p.89) used to enhance a shared meaning among all age groups, making it easy to identify the symbol of the wheelchair. As it widens the range of meaning for placard/plate and demonstrates the necessity for the symbol. In fact, this community interaction is essential for creating policies that will help everyone improve the translation and acceptance of symbols in any language. This accommodation is a stored pictorial content found on license plates, maps, parking signs for designated spots, located outside a restroom needed to clarify instructions. This example of Wenger, 1998, p.107) standardization will show a wheelchair on every disability placard and plate, for a universal understanding of a policy that interprets someone needs of mobility assistance. The author explains the important for the public’s visual recognition and understanding of this symbol will lead to additional discoveries of how visual language can improve cognitive function with memory loss. Keywords: handicap, signs, disability placard, aging, elderly, wheelchair, international symbols, handicap, icon, mobility, visual literacy, pictograms, mobility
Biography:
Marios Kyriazis is an internationally known anti-aging physician, gerontologist and theorist on longevity. He has several medical or gerontological qualifications, and nearly 1000 articles, lectures, books and scientific papers about health and aging, both for scientists, physicians and the public. He is medical director of the ELPIs Foundation for Indefinite Lifespans which aims to develop ways to virtually abolish aging and age-related degeneration. He is also the founder of the British Longevity society, and affiliated with the Evolution, Complexity and Cognition group at the University of Brussels. He is a member of the Editorial Boar of several scientific peer-reviewed journals related to aging.
Abstract:
It is now well appreciated that the process of aging is related to a progressive reduction of biological functional complexity, which results in an increased probability of degeneration, illness, and eventual death. All aging organisms and organs display such a loss of complex function and the reasons are embedded in evolutionary strategies aiming to optimise survival. Recent research has unveiled the benefits of hormesis in delaying or reversing some of this age-related loss of function. It is now possible to retard the rate of loss of biological complexity by introducing an increased amount of nonlinear, repetitive external stimulation that challenges the organism and forces it to up-regulate its biological processes. Hormesis may exert a benefit based on a wide range of challenges such as physical, nutritional, mental, social, and biological stress. Examples of hormetic techniques include intermittent fasting, dietary restriction and calorie restriction mimetics, general environmental enrichment, cognitive and sense stimulation, sexuality-enhancing strategies, exposure to mild metabolic poisons, low or to high temperatures, exercise-mimetics, and other physicochemical challenges. These are based upon a dose-response phenomenon (low dose stimulation, high dose inhibition) which has been found in many studies to positively influence several signalling pathways or biological control mechanisms. Therefore, it is possible to offer specific practical suggestions which can be applied in everyday life, and are based upon solid science, in order to ameliorate age-related degeneration and reduce the impact of disease.
Vered Raz
Leiden University Medical Center, The Netherlands
Title: Studying onset and progression of molecular aging in RNA expression profiles
Biography:
V. Raz has completed her PhD at the Weizmann institute of Science in Israel and followed postdoctoral studies in Penn University, Philadelphia, US and Leiden University Medical Center, The Netherlands, where she is leading a multi-disciplinary research group focusing on muscle aging. She has published more than 25 papers inpeer-reviewed journals.She received several recognitions for her research including
Abstract:
Genome-wide expression profiles are altered during biological aging and can describe an age-associated molecular regulation of tissue degeneration. Using a time-dependent regression models in transcriptome datasets we can extract onset and progression of aging. Currently, onset and progression of aging in humans is poorly understood. We developed a novel methodology to study the progression of molecular aging by studying age-associated trends of RNA expression profiles. The methodology is robust and overcomes technical variations between datasets. Moreover, with this methodology the critical age from which most changes initiate can be extracted. By analyzing 8 independent cross-sectional transcriptome studies from various human tissues, we show that molecular aging is significant in only a subset of tissues while others are spared. Within the tissues with significant molecular aging, the earlier critical age, at the forth decade, was found in skeletal muscles and brain cortex, whereas in blood and kidney cortex a critical age is found only at the sixth decade. Moreover, molecular signatures also differ between tissues. Our data suggests that the complex architecture of molecular aging in humans is in part owed to the initially affected molecular pathways differ between tissues and different progression between tissues.
Sunil Godse
Radical Solutions Group
Canada
Title: Tele-Health Use in Long Term Care Facilities = Drastic Reduction in Wait Times for Specialists
Biography:
Sunil brings over 20 years of experience as a business mentor to a large number of firms ranging from start-ups to multinational organization in a variety of industries. He provides firms with sound advice, giving them the proper tools and techniques to overcome their business challenges. His highly sought after palette of services has always resulted in increased satisfaction, better productivity and stronger growth for every client he mentors. Sunil has an MBA from the Richard Ivey School of Business as well as a Bachelor of Engineering from the University of Manitoba. He has served as board member, mentor and advisor to a number of business and social ventures.
Abstract:
It is no secret that access to medical specialists for residents of long term care facilities require a painfully long wait. Worse, the further deterioration of a resident’s medical condition is often coupled with a deleterious psychological effect because of this queue, affecting the patient and the family and the health professionals working in the long term care facility. Using Ministry of Health and Long Term Care-approved equipment supplied by Ontario Telemedicine Network, eCare Partners Inc. has undergone a pilot project demonstrating the effectiveness of using a tele-health system in a number of Ontario long term care facilities. This study demonstrates that using this system has many benefits. Primarily, it will significantly reduce the wait time for specialists required for the appropriate medical care. It curtails the worsening of the medical condition and preventsthe onset of secondary medical issues. The resident’s family benefits from a reduction in stress. The long term care facility greatly benefits from healthier residents and more content staff, positively impacting its overall culture. Finally, the overall medical system benefits from a vast reduction in unnecessary visits to walk-in clinics, urgent care facilities, or hospital emergency departments,triggering a reduction in unnecessary referrals. Clearly, using a tele-health system for long term facilities presents significant benefits, both direct and indirect.
Biography:
Sara Clemens is currently completing her PhD at University of Toronto’s Institute of Health Policy, Management and Evaluation. She has previously served as a Director of Nursing and Personal Care, Director of Nursing and Health Policy at the Registered Nurse’s Association of Ontario and Nursing Lecturer at the University of Toronto. Recently, Sara participated as an expert advisor to the Ontario Seniors’Secretariat in the development of their Retirement Home Regulations
Abstract:
Recently, the Canadian Institutes for Health Research (CIHR) funded a systematic review of long-term care (LTC) that concluded “future Canadian research exploring the relationship between nurse staffing and outcomes in LTC settings is an urgent priority.” This research study seeks to understand this relationship in the Ontario context by employing a rigorous mixed-methods research design. A quantitative cross-sectional descriptive study of Ontario’s LTC population will be conducted first, using hierarchical linear regression to determine the relationship between four home-level nursing and personal care staffing characteristics and four resident-level risk-adjusted nursing and personal care sensitive quality indicators. The four home-level nursing and personal care staffing characteristics used in this study are staffing level, staff mix, skills and competencies as well as roles and responsibilities. The four resident-level quality indicators, obtained from a province-wide Resident Assessment Instrument Minimum Data Set (RAI MDS) are incidents of pain, falls, incontinence and pressure ulcers. A subsequent qualitative case study of Ontario’s five highest and five lowest performing LTCHs will provide insights into how LTCHs may successfully modify nursing and personal care staffing characteristics to best meet the ever-increasing and complex care needs of LTC residents.
Hady Khaddaj Mallat
University of Sherbrooke, Canada
Title: Risk factors affecting elderly people in outdoor daily life activities: A review
Biography:
Hady Khaddaj Mallat is currently a research student in the faculty of Sciences at the University of Sherbrooke. His research interests are Gerontology, Assistive Technology for Elderly People, and Ambient Intelligence & Smart Environment
Abstract:
Elderly people are a demographic sector which has been rapidly increasing during recent years in most countries. In this paper, a risk represents the probability of an unwanted event or danger situation which may occur and cause a possible loss, injury or other unwelcome circumstance, and an outdoor environment is considered to be outside home or any open-air ambience. In this review, we list and describe risk factors that affect elderly people in outdoor environments and that may occur during their outdoor daily activities such as fall, wandering, health issues, etc. Our goal is to help readers to better understanding the risk management and intervention which consequently improves the quality of life for elderly people. To the best of our knowledge, this is the first review about major risks that affect elderly people in outdoor environments.
- Track 5: Clinical Geriatrics & Track 7: Nutrition & Ageing
Location: Salon-D
Chair
Julianne Wright
University of Indianapolis, USA
Co-Chair
Guillermina Solis
The University of Texas, USA
Session Introduction
Monica Gyimah
Kingston General Hospital
Canada
Title: “Difficult Patientsâ€: What can they teach us?
Time : 11:15-11:40
Biography:
Monica Gyimah graduated with Master of Social Work degree from Carleton University, Ottawa, Ontario, Canada in 2007. She has worked on the acute Medicine Service, in the Emergency Department and “Medicine Short Stay Unit” for 6 years doing crisis interventions and discharge planning. In the last 2.5 years Monica has been working strictly with the Alternate Level of Care (ALC) patients many of who have Dementia, Parkinson’s, and other complex medical conditions. Prior to being a social worker Monica had completed a Masters Degree in Social Geography and had worked at Western and Queen’s Universities and has co-authored at least two publications.
Abstract:
Most clinicians have probably dealt with patients they would rather not encounter. These patients are variously referred to as “uncooperative,” “noncompliant,” “demanding,” “patients with thick charts,” or “high maintenance,” among others. Typically, interactions between clinicians and such patients are deemed unsatisfactory. Some studies estimate that “difficult” interactions constitute about 15% of all physician-patient interactions (Davies, 2013; Hull & Broquet, 2007; Dudzinski & Timberlake 2006). This paper discusses such difficult interactions and what clinicians could learn from them. While some of the difficult interactions may be blamed on patients, clinicians and the health care culture are also partly responsible (Davies, 2013; Dudzinski &Timberlake 2006). In many cases patients are only attempting to understand and maintain control over their care through personal advocacy. In doing so, they are often misunderstood and are labelled as “uncooperative” or “difficult.” Some clinicians’ perceptions of “good patients may be attributed to whether the patient goes along with proposed care plans and treatments and/or not questioning clinicians. Such “good patients” are those who allow clinicians to be the experts, determining the terms of their care. My question is whether the culture of “clinicians know best” constitutes good, collaborative care. Could these “difficult patients” teach us anything about ourselves and our service provision? Are there benefits to the behaviours of these apparently difficult patients? Perhaps they may present opportunities for improving communication and care delivery. In order to deliver effective and efficient patient-centered care it is incumbent upon us to develop approaches that would help us understand and effectively communicate with these patients.
Guillermina Solis
The University of Texas, USA
Title: Fall injuries in older adult men and its implications for public policy and services support
Time : 11:40-12:05
Biography:
Guillermina Solis completed her PhD in Interdisciplinary Health Science in 2010, from The University of Texas at El Paso and her Post Doctoral Fellowship at the University of Utah in 2012. She is an Assistant Professor in the University of Texas at El Paso. The focus of her research is fall injuries in older adults and the utilization of emergency services leading to identifying gaps of appropriate health service utilization to improve physical function. She has presented her work at national & international conferences and collaborated with other health disciplines addressing geriatric topics. She is a practicing geriatric nurse practitioner where she sees the opportunity to explore health issues affecting older adults
Abstract:
Background: Unintentional falls and related injuries among older adults are heralded as a public health concern. One out of three older adults requires medical care post fall increasing the demand for health services and social support at all levels. Sex differences resulting from falls have been identified. Men have a high rate hospitalizations and mortality. A gap in knowledge exists in gender specific, social and environmental risk factors. Purpose: This study analyzed the circumstances and outcomes of fall injuries in men who accessed the community emergency medical system (EMS) in El Paso, Texas after a fall. Methodology: A 12 month retrospective quantitative study of community dwelling older adults who sought services from EMS after injury was conducted. Men (N=418) 55 years old and older were included in the analysis of circumstances, place of fall, time; injuries sustained and designated acuity level. Descriptive statistics and non-parametric analysis were conducted to identify relationships among variables. Results: The average age was 74±11.8, majority were Hispanic, most fell outdoors had highest acuity level, head and upper body injuries were common and majority fell during early mornings. Fall circumstances and time among men 80+ years old differed from younger group. Discussion: The prevalence of outdoor falls and acuity level coupled with the difference in circumstances of fall injury in the 80+ warrants further studies of older men and fall injuries. Results reflect a need to develop culturally congruent strategies for prevention and work in collaboration with public health agencies to evaluate social and environmental risks that contribute to fall injuries and develop policies that creates an “aging” friendly community. An interdisciplinary approach for creating innovative methods for fall prevention and support of post fall care to aid in recovery process is a promising way to reduce the problem.
Wendy Stoelting-Gettelfinger
University of Indianapolis, USA
Title: The partnership between primary and palliative care: A collaboration that can facilitate interdisciplinary care to improve patient outcomes
Time : 12:05-12:30
Biography:
Wendy Stoelting-Gettelfinger completed her JD in 1993 with joint PhD in nursing in 1999 from Indiana University. She is the Coordinator for the Family Nurse Practitioner program at the University of Indianapolis and works as a Family Nurse Practitioner (FNP) in a comprehensive primary care practice. While she coordinates palliative and end-of-life services for her primary care patients, she recently experienced these issues on a personal level through the loss of her parents and developed an increased appreciation for the difference that palliative care can make to enhance quality of life for patients and their families.
Abstract:
An effective partnership between primary care and palliative care is crucial to improving the quality of life for many patients and their families. Innovative solutions must be developed to address the current shortage of palliative care specialists. One viable solution is the partnership between palliative and primary care referred to as “primary palliative care”. Primary care providers including advance practice nurse providers (primary care providers) are in a unique position to manage symptoms, assist families with treatment plan decisions and make early referrals to coordinate interdisciplinary care with the ultimate goal of reducing patient suffering and improving quality of life. Primary care providers often have long-term relationships with their patients and an insightful understanding of family dynamics. Primary care providers are in a trusted position to assist families with difficult care decisions without infringing upon their autonomous rights. Unfortunately, primary care providers depending upon their background and expertise may or may not be knowledgeable in the difference between palliative care and end-of-life services. Understanding these key differences as well as the differences between primary, secondary and tertiary palliative care is fundamental for primary providers to provide appropriate care. Educating primary care providers regarding the key role that they can play in coordinating interdisciplinary palliative primary care is the first step to providing comprehensive, un-fragmented care for patients needing palliative care services. Understanding that palliative care can improve outcomes, save health care dollars while improving quality of life is essential to successful interdisciplinary partnerships and coordination of palliative care services.
Tania e Silva Pulicano Lacerda
Universidade Cidade de Sao Paulo, Brazil
Title: Singularities in Dental Prosthetic Rehabilitation for Alzheimer Patients
Time : 12:30-12:55
Biography:
Tania e Silva Pulicano Lacerda has completed her Master in Odonthology at the University of São Paulo. She is also Assistant Professor of the São Paulo City University, UNICID-SP as well as the São Leopoldo Mandic Graduate Centre, São Paulo.
Abstract:
This work aims at presenting the singularities of Alzheimer patients in regards to their prosthetic rehabilitation. In order to recognize such challenges since the very beginning, professionals must establish a clear interdisciplinary communication with patients as well as their family members and caretakers. In general, techniques for making dentures and implants for such patient are the same used in a healthy one. However, what needs to be recognized is in the stage of the disease: The patient can have masticator and swallowing dysfunctions which may demand parenteral nutrition. Thus, the planning of treatments will be altered according to the general physical state of the patient, his or her degree of dependence on others and life expectancy. In later stages, masticatory and swallowing functions have to be observed, once the patient may develop dysphagia needing for example to remove the inferior prosthesis. Taking into account the difficulties of hygiene that these patients may encounter due to restriction in their motor and cognitive skills, periodical evaluations of their oral health, teeth when present and mucosa are extremely important. As a final remark, an interdisciplinary approach will be focused: The nutritionist can suggest proper diets based on the time patients have been using the prosthesis, adding in a lot of cases, supplements to avoid malnutrition. Furthermore, one cannot forget the muscles involved in the entire process as well as the necessity of having the support of a speech pathologist that will help by guaranteeing a better masticatory efficiency.
Si Ching Lim
Changi General Hospital, Singapore
Title: Nutrition and the role of tube feeding among the elderly
Time : 13:55-14:20
Biography:
Si Ching LIM has graduated from University of Bristol, UK in 1992, and worked as a Nephrologist for 6 years before specializing Geriatric Medicine. She is Board certified Geriatrician in 2006. She is currently working in Changi General Hospital in Singapore with a keen interest in medical education, holding an Adjunct Assistant Professor post with National University of Singapore (NUS) and Dukes-NUS. She is also Faculty member for Senior Residency Programme Sing health for both Internal Medicine and Geriatric Medicine. She has 4 (+1) publications.
Abstract:
Nutritional disorders are common among the elderly. Under-nutrition is common among the community dwelling elderly and the incidence approaches 85% among the institutionalized elderly. The predisposing factors for under-nutrition are multiple among the elderly. Nutritional disorders are often missed by the clinicians and yet it carries with it huge impact on the patients’ quality of life, morbidity, mortality, length of hospital stay, increases risk of hospital acquired complications, pressure sores, etc. Screening for malnutrition is quick and reliable and it allows for early interventions before further decline in nutritional status occurs especially during the course of hospital stay. Interventions in terms of food fortification, meal modification and oral nutritional supplement showed favorable outcome. In addition to general calorie intake, protein intake among the elderly also needs to be looked at since the elderly often takes inadequate amount of protein in their diets. The daily recommended protein intake is higher for elderly to optimize muscle mass, strength and function. Micronutrients intake among the elderly are also important especially among the elderly who are unable to obtain nutrient rich foods. Role of tube feeding among the elderly with inadequate oral intake due to various causes of dysphagia and recurrent aspiration are often fought with controversies. The role of improving nutrition versus the negative impact, quality of life and complications of tube insertion are often difficult decisions for clinicians as well as patients and their next of kin.
M A Li-na
Capital Medical University, China
Title: Morning blood pressure surge is associated with decreasing cognitive function in elderly patients with essential hypertension
Time : 14:20-14:45
Biography:
Ma Li-na is currently an attending Doctor focusing on Aging in Department of Geriatrics, Xuan Wu Hospital, Capital Medical University. She is currently interested in studying cognitive impairment for individuals with hypertension. She has 10+ years of research experience in health and aging. She was awarded the National Scholarship for Graduate students in China. She is a co-author of four books. As a first author, recent publications include 14 SCI journal articles focusing on cognitive impairment, insulin resistance and other chronic diseases in elderly patients.
Abstract:
Aim: To explore the association between morning blood pressure surge and cognitive function in elderly patients with essential hypertension. Methods: 107 patients submitted to 24 hours ambulatory blood pressure monitoring were categorized as with morning blood pressure surge (MBPS) group (n=40) and non morning blood pressure surge (NMBPS) group (n=67). Total cholesterol, body mass index (BMI) was determined and MMSE was measured. Results: BPS in MBPS was higher than that in NMBPS (P<0.05). MMSE in MBPS was lower than that in NMBPS (25.98±2.03 vs. 28.86±1.81, P<0.01). Conclusion: Morning blood pressure surge is closely related with the cognitive impairment in elderly patients with essential hypertension.
Zulfiqar Abrar-Ahmad
Reims University School of Medicine, France
Title: Hypervitaminia B12 vitamin in geriatric oncology: Real marker in the diagnosis and prognosis of malignant diseases in the elderly Zulfiqar Abrar-Ahmad, Reims University
Time : 14:45-15:10
Biography:
Zulfiqar Abrar-Ahmad studied at Reims University of Medicine University. He is currently working in the Department of Internal Medicine and Geriatrics, UMG1, CHU Reims. He has published more than 14 papers in medical journals.
Abstract:
Background: No consensus defined what to do before the finding of high vitamin B12. Serious diseases are nevertheless associated. Method: We illustrate these issues in this case. Result: A patient of 92 years was admitted for treatment of an inflammatory syndrome and an overdose of anticoagulants. We noted asthenia and conjunctival jaundice. Laboratory tests revealed a jaundiced cholestasis and cytolysis accompanied by an inflammatory syndrome. We also found a hypervitaminia B12 to 1642 pg / ml (normal rate: 191-663 pg / ml). Morphological examinations (ultrasound, CT) were used to detect dilatation of intrahepatic and extrahepatic upstream stenosis of the extra-pancreatic bile duct, with an undercover aspect of the hilum, and portal vein stenosis, evoking a probable ampulloma or a malignancy of the biliary extrahepatic main track. Unfortunately, the patient died a few days later. Discussion: Hypervitaminia B12 is associated with serious diseases represented mainly by solid neoplasms, blood disorders and liver diseases, and has been repeatedly described as a tumor marker of poor prognosis. In geriatrics, high levels of B12 are associated with increased mortality. Some authors emphasize the performance of the assay of vitamin B12 in patients with neoplastic diseases particularly among the elderly, as decision-making arguments when in pursuit of a cure and / or performing diagnostic tests, this correlates with the standardized geriatric evaluation. Conclusion: The rate of vitamin B12 could be a real marker in the diagnosis/prognosis of these diseases, and should not be neglected in geriatric oncology.
Biography:
Michael J Sigal is the Dentist-in-Chief at the Mount Sinai Hospital and the Director of the Dental Program for Persons with Special Needs / Medically compromised and the Co-Director of the Hospital Dental Residency Program. He was graduated from the Faculty of Dentistry University of Toronto with DDS in 1979, completed one year hospital dental residency at the Mount Sinai Hospital, Toronto, then Diploma in Pedodontics and the Masters of Science Degree both at the Faculty of Dentistry, University of Toronto. He worked as a Full time academic staff in Pediatric Dentistry since 1984. Currently He is Full Professor with tenure and Head of the Discipline and Director of the specialty program in Pediatric Dentistry since 1993
Abstract:
Due to the increase in the elderly population the management of these individuals as they age will continue to present a challenge to the healthcare team. Many elderly will have some or all of their teeth due to improved dental care throughout their lives. Oral hygiene and oral care in the elderly, especially frail elderly is generally poor. However the continuance of good oral health is essential to the maintenance of the elderly individual’s quality of life and to prevent infections which may affect their general health. The maintenance of good oral health has the potential to reduce the incidence of community acquired pneumonia. This presentation will present an overview of the relationship between oral and general health in the elderly patient and then provides an overview regarding oral assessment, treatment and prevention of dental disease.
Au Shu Yi Lydia
Ng Teng Fong Hospital, Singapore
Title: Challenges of caring for a frail hospitalized elderly
Biography:
Lydia Au completed herMRCP degree in 1997 andher geriatrics subspecialty degree in 2003. She has a special interest in hip fracture management, osteoporosis and clinical quality. She had additional post graduate training in orthogeriatrics in Sydney, Australia; leading and participating in the setting up of a pilot orthogeriatric service, the ACE unit as well as research and oral presentation in nutrition in the older patient with hip fracture. She currently heads the geriatric service in the newest health cluster in Singapore and is instrumental in leading and developing good standards of clinical quality for Geriatrics, in addition to implementing a successful Geriatrics Training programme for post graduates and undergraduates
Abstract:
An acute hospital admits a disproportionately large number of older patients; many of them frail. The cornerstone of an acute geriatric care involves stabilizing acute medical issues so that timely rehabilitation of the frail older person prevents further deterioration of the physical function. Functional decline has significant negative consequences for these patients. A proactivemodel selecting older patients with the potential to benefit from intensive inpatient geriatric assessment, rehabilitation, management and treatment services to restore function allows for focused use of limited resources. Creating an understanding of the challenges of aging, multiple hospital hazards and frailty impeding successful management will be identified. The principles underlying the organization for rehabilitation and a safe discharge; together with careful attention to special needs present commonly in the elderly will effect expedient and full integration back into the community; will be outlined.
Rubens Nazareno Garcia
University of Itajai Valley – Univali
Brazil
Title: Geriatric Dentistry: the challenge of promoting health and quality of life for people
Biography:
Rubens Garcia had his DDS at Dental School in Pontifical Catholic University of Parana (1986); MSc degree (2000) and PhD degree (2006) at Dental Materials in Dental School of Piracicaba; and Postdoctoral training at Department of Oral Health Sciences in Tokyo Medical Dental University (2013). He is professor at Public Health, Dental Materials and General Clinic at Dental School of University of Itajai Valley – Univali and Dental School of University of Joinville Region – Univille. He also has his own private office in Itajai, SC. He has large experience in Restorative Dentistry, Preventive Dentistry, Dental Materials, Public Health and Geriatric Dentistry.
Abstract:
Improving the quality of life in old age will require teeth retention and the need for restorative care. The dental materials are very important in this process. The glass ionomer cements are largely used to restorations Class V without cavity preparation. These materials have biologic compatibility and fluoride release, and increasing use, specially to light-cured cements, also has been made of their anticariogenic properties in treating geriatric patients. Other product has been recently introduced in the market, as the self-adhesive resin cements, which exhibited a favorable bonding capability and mechanical properties, becoming easier and faster the cementation of prosthetic pieces. Regarding to resin composites, there are many possibilities of treating geriatric patients. The recent nanosized materials promote very good polishing, specially important to avoid gingiva problems. The highly aesthetic light-curing restorative composites in gingiva shades were recently introduced in Dentistry. They also can be used in Class V restorations, especially in cases of retreating gingiva as a result of periodontal disease. Also the self-adhering composites, all-in-one products, can represent other possibility of treating people with limited mouth opening, having an easier and faster treatment. There are many materials to treat dentin hypersensitivity that is typically found in patients whose dentin has become exposed by gingival recession, periodontal therapy or loss of tooth enamel due to toothbrush abrasion, erosion or tooth wear. Ideally, the use of new materials and technologies, combined with a suitable reception to the patients, this is the real rule to promote health and happiness to geriatric patients.