A Place for Mom is proud to announce the 2015 winners of our third annual Senior Care Innovation Scholarship!
Nearly 300 entrants demonstrated their dedication to improving the lives of seniors this year, but only five are able to win a $1,000 scholarship for their extraordinary level of commitment to advancement in the field of gerontology. Congratulations to our five winners — including fan favorite, Meghan Pillow — whose essays are listed below.
We thank everyone who entered and took the time to share with us what innovations need to happen in the senior care industry, in order to improve care for our senior population.
Here are the 2015 scholarship winners. Click to read their incredible essays on senior care innovation:
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As we progress further into the new millennium, there are many new concerns facing our modern culture. When considering our future world, we find ourselves pondering how our current economic, environmental and political systems will fare over time. We must think locally, about our communities and the United States as a whole, but also globally as well. However, one social challenge that is consistent across all countries and cultures is how to adapt and change with a new generation of aging individuals. According to a May 2014 report by the U.S. Census Bureau, An Aging Nation: The Older Population in the United States: “The nation’s 65-and-older population is projected to reach 83.7 million in the year 2050, almost double in size from the 2012 level of 43.1 million.” This means that there will be “approximately three working-age people for every one person 65 and older by the year 2050.” How will we rise to the challenge of a larger and more technologically advanced aging population? And, more importantly, how can we improve their quality of life?
As I watch my now 97 year-old grandmother struggle with dementia on her own in a nursing home, I find myself asking these questions every day. A few years ago, when I was doing some research on the psychology of aging, I came across a brilliant book by Dr. Oliver Sacks called Musicophilia: Tales of Music and the Brain. In the book, Dr. Sacks explains how Music Therapy is currently being used to assist aging people who are dealing with Alzheimer’s, dementia, depression, decreased mobility and a range of other challenges that naturally come with getting older. I was immediately stunned that I had never heard of Music Therapy before and I began to wonder why it wasn’t a more commonly suggested treatment for people with disabilities.
Now, I am two years into my studies to become a certified Music Therapist so that I can help educate more people on the benefits of music in clinical practice. New research is becoming available every day and it is crucial that we begin a dialogue in order to make Music Therapy more of a household term. In doing so, the field will be recognized for what it is: an allied health profession that uses certified professionals in a clinical setting to address cognitive, behavioral, physical and psychological disabilities in all citizens of the world.
When speaking specifically about Music Therapy for the aging population, there are three key components of the practice that would be extremely beneficial to patients: cognitive exercise, social interaction and creative encouragement. There is a chapter in Dr. Sacks’ book that is focused directly on patients he has worked with who suffered from advanced Alzheimer’s disease. One patient, Louis, who suffered from frontotemporal dementia, benefited greatly from rhythmic exercises to help him focus on other cognitive tasks unrelated to music. “Musical patterns excite and enchant him and, perhaps, hold him together”(Sacks, 346). Rhythmic exercises have also been used by Music Therapists to work with physical disabilities in patients as well. Using a steady beat and pattern can assist a person who has become immobile in regaining their walking gait.
There is also a social component to music therapy that would be of great value to a person living in a nursing home, like my grandmother. For instance, Louis, the patient in Dr. Sacks’ book, leads a singing group at his home twice a week. This involvement and cooperation with others can alleviate feelings of loneliness and depression that often come with living in a nursing home. As I have seen in my grandmother, this sense of isolation can lead to more debilitating mental setbacks as the patient gets older. Musical activities with a certified therapist or in a group setting can encourage older patients to come out of their shell and can provide a friendly community for them to thrive.
Lastly, I believe the creative component of music therapy would be extremely helpful to older patients by inspiring them to think abstractly and awaken dormant synapses in the brain. Dr. Sacks describes patients in their sixties and seventies who, with little or no previous musical training, start composing music. Not only is this an excellent way for older patients to focus their thoughts and feelings, but having a form of self-expression at such a potentially lonesome stage in life could validate their identity and place in the world.
Becoming a “senior” is almost more of a social definition, and is most commonly identified by one’s 65th birthday and the celebration of retirement. Currently, seniors make up 13% of the Canadian population, and are the fastest growing population group in Canada. It is estimated that 1 in 4 Canadians will be over the age of 65 in 2041, very closely mimicking the population growth of our American neighbours. The Canadian healthcare system is one of the most advanced in the world. With universal healthcare readily accessible to the majority of citizens, it is often easy to overlook the gaps in healthcare provision to underserved populations, and preparing the healthcare system and availability of resources for the inevitable influx of senior citizens is essential.
Almost 80% of Canadian senior citizens suffer from at least one or more chronic health conditions, ranging from arthritis to hypertension, back problems and diabetes. Although their numbers are just over one tenth of the entire population, seniors account for almost 40% of all prescribed medications. Innovations in senior care through increased involvement of pharmacists can improve quality of life for our aging population, promote safe and effective use of medications, and identify areas for inter-professional collaboration for improvement in healthcare provision to our seniors. From my experience, I’ve identified three major areas for improvement in the healthcare system that would make the most of available pharmacy services, technology for remote dispensing to reach patients in rural areas, and changing perspectives to focus on health prevention rather than treatment.
OPTIMIZING CLINICAL PHARMACY SERVICES
Pharmacists can provide a variety of clinical services for seniors, including a medication review that has been proven to help more patients get their blood pressure within range and improve patient medication therapy. The goal of a medication review, or a MedsCheck, is to gather a comprehensive disease and medication history, address side effects that may indicate inappropriate doses, identify lifestyle factors such as smoking and exercise frequency and ultimately initiate a plan to solve drug therapy issues. These reviews are performed in the community pharmacy quite frequently with regular patients, but most importantly can also be done in the home of the patient (Home MedsCheck). Increasing awareness on the availability of pharmacy services in the comfort of patient’s home is essential, not only due to mobility issues in seniors, but also because the details of patient medication habits and lifestyle can be addressed. In a Home MedsCheck, pharmacists can go through the patient’s medication cabinet with them, removing and safely disposing of expired drugs, identifying problems such as vials that are difficult to open, and reviewing compliance issues that play a key role in patient health.
One aspect that is becoming increasingly important is the role of the pharmacist in deprescribing. According to Statistics Canada, 10% of seniors take 5 of more medications, which puts them at an increased risk for drug interactions, unnecessary side effects and poor compliance to their medication therapy. Visiting multiple pharmacies and seeing multiple physicians leads to unnecessary prescriptions and medications, which increases the risk for drug interactions, ineffective therapy and undesirable side effects. An American study found that adverse drug events account for 28% of emergency department visits. A MedsCheck is the perfect opportunity to identify unnecessary therapy and remove harmful or intolerable drugs. By investing in making this service more known to the public, the increased involvement and expertise of pharmacists is a solution to reduce drug-related hospitalizations, decrease healthcare costs and improve overall patient health.
ADOPT TECHNOLOGY FOR REMOTE DISPENSING
Teleconferencing and online shopping are a common aspect of everyday living, but this technology has not yet been tapped as a resource for remote dispensing. With almost 80% of the province’s population situated in Southern Ontario, urban centers such as Toronto are saturated with pharmacists offering rising geriatric populations their services. However, this leaves rural communities underserviced due to their remote locations. One solution is to use technology for pharmacists to be able to provide the same services in a rural community as they would in an urban setting through remote dispensing. Online pharmacies are becoming more and more popular, and with communication with the patient’s family physician to receive prescriptions, pharmacists can prepare medications that are then shipped discreetly and directly to the patient’s remote home. However, unlike picking up a prescription from a community pharmacy, there is no opportunity for a pharmacist intervention at the counter. A simple phone call is not always enough to sufficiently connect with the patient, gauge non-verbal communication and thus build a relationship based on trust. Using video conferencing is one solution to be able to provide geriatric patients in rural communities with the appropriate level of care and attention that they deserve. While it’s essential to embrace technology, and as computers become faster and smaller, it’s important to keep in mind the difficulties that the aging population face with technology. The size of screens, font, lighting and keys all play a role in the ability of an elderly user to use the technology available. Making health information accessible to rural communities is of utmost importance, thus designing an age-friendly video conferencing program is one solution to overcome accessibility issues in the aging population.
DEVELOP HEALTH PREVENTION STRATEGIES
With an estimated projection population growth of almost a quarter of the population in the senior age category, health prevention strategies in the aging population should be considered a priority public health issue. Recently, pharmacists were granted the ability to administer influenza immunizations and with over 750, 000 Ontarians receiving their flu shot last year, we are looking to expand on the types of vaccines we can offer to our patients. As one of the most available healthcare professionals in the community, investing in pharmacists as immunizers can help more elderly patients participate in the health prevention strategies. Travel vaccines, pneumococcal vaccines and the herpes zoster vaccine are just some of the immunizations that pharmacists will be able to provide in the future to all patients, but the accessibility and applicability to the aging population is what is so attractive about this solution. Every year in the fall, our pharmacy receives numerous phone calls and visits from our favourite patients who tell us they will be going down south to escape the cold of the winter months. Being able to provide, not only advice on safe and healthy travel habits, but also administer travel and other vaccinations, means more of our snowbird patients will be willing to have an open discussion about their travels and actually receive the immunization, rather than waiting in a doctor’s office or not receiving it all together.
The treatment of elders and elder care is quite different in other countries than what we see in the United States. This is partly because we do not live with our grandparents and parents, we instead move out into our own homes. This can pose a problem when we have elderly individuals that live alone and do not get the type of interactions that keep the mind constantly working. When the elderly live with their families they are more likely to help raise grandchildren and conversations that require them to use their memory more effectively. This lack of interaction is one of the issues we see with elderly developing dementia, and the stigma that goes along with it.
A fix to this problem could be working towards more interaction between younger generations and the elderly. This has been talked about some in other countries but could be most effective in the United States. The idea is that elderly and college kids will live in the same space. Elderly homes can be sad and lack youth, which can lead to their inhabitance being depressed. If we were to have college kids, who need a place to stay, living with them then they could share some of their youthful energy. There would be a tradeoff. College kids would have the opportunity to live in an elder home for free if they promise interactions with the elderly who live there. These college students would be required to spend time eating and socializing with the residence.
Rent is increasing throughout the country and especially in college towns. In most European countries college students are given a stipend each month to support them while they attend college. This is not provided by the United States government and so college students find it harder and harder to support themselves while finishing school, without large loans. It is also harder in the United States for the elderly to find interactions outside of their family, and others living in the elderly community. In many countries relatives are ex communicated or shamed if they do not support their parents and grandparents. It is in the US where we see a large population of elderly living alone in senior care facilities.
I was seventeen years old, and it was my first shift on the floor of a local nursing home; I was being trained as a Nurse’s Aide. The shift was just about over when my preceptor and I entered the room of Beta (name changed). To our shock, there was stool everywhere! Up the walls! On the floor! On the bed! And out from the mess, peered the innocent eyes of a now-brown Beta. My preceptor sighed and gave me permission to leave, but I didn’t want to. As I gazed at Beta’s distressed features, I saw a dignified human being. It was my privilege to care for Beta that night, and as I wiped up gobs of feces, I knew that I wanted to be a nurse. Beta was someone’s daughter, someone’s wife, and someone’s mother. Beta had Alzheimer’s disease. Until a cure for Alzheimer’s is discovered, strategies to care for these citizens must be implemented, specifically proactive care that addresses the functionality and emotional well-being of patients.
It is common knowledge that our American culture values independence and a loss of such may impact one’s sense of self. Research demonstrates that functional decline is attenuated when physical therapy is incorporated into the Alzheimer’s patient’s treatment plan (Nascimento et al. 264). Beta was unable to care for herself. She had lost her ability to walk and required assistance for everything from feeding to toileting, but what if these effects could have been mitigated? Studies have shown that participants in Fulford 2 exercise programs improve in activities of daily living and have fewer falls (Nascimento et al. 259; Manckoundia et al.173). Physical therapy has the potential to promote function, which empowers the patient and fosters a sense of worth. By making services such as physical therapy available to patients at the onset of disease, we will be better able to meet the needs of our seniors.
Since our culture emphasizes independence, a loss of skills can lead to depression, which can decrease motivation and further impact physical function. Both factors, function and emotion, must be addressed if effective care is to be rendered. Psychosocial interventions involve environmental modifications, counseling, and education to specifically address each person’s unique needs (Manepalli et al). They are intended reduce the impact of illness by helping each patient cope with his or her disease and adapt to the resultant changes (Manepalli et al. 39). Alzheimer’s is a devastating disease, and effective care involves supporting the person from diagnosis through disease progression. Care must be adaptive, and it must work with patients, not just upon them. It must work to impart dignity. For Beta, imparting dignity meant minimizing shame while cleaning her. But imparting dignity can be as simple as the psychosocial intervention of adding handrails, which will enable a person to safely navigate his or her environment. By training caregivers to implement psychosocial interventions, better support and better care can be provided.
Many Alzheimer’s patients also have trouble sleeping, and as a result, they may become more agitated. I saw this in Beta’s case as she spent many nights rocking in her chair, too agitated to lie in bed. An emerging intervention involves the use of light to regulate sleep cycles. A study exposing Alzheimer’s patients to “low levels…of a bluish- Fulford 3 white light” showed a remarkable decrease in agitation and depression (Brooks). Other studies have shown that a combination of “bright light and melatonin can…ameliorate cognitive and non-cognitive symptoms” (Manepalli et al. 45). Light therapy shows potential and should be explored as a means to moderate sleep-related disturbances of Alzheimer’s. If we can improve quality of sleep, many other complications such as agitation might well be reduced.
Since that evening in Beta’s room, my goal has expanded. I had the opportunity to work on a secured Alzheimer’s unit and, despite many challenges, my love for working with the elderly deepened. I want to become a nurse practitioner and specialize in geriatric neurology. I want to help those in late adulthood maintain their function and independence. Services such as physical therapy, psychosocial interventions, and light therapy are examples of interventions that could temper the physical and psychological effects of Alzheimer’s disease. Becoming a nurse practitioner, I will gain a greater understanding of the process of aging and the pathology of Alzheimer’s disease. I will also be in a position to advocate “other care innovations” for my patients. It is my goal to maximize the potential of every senior citizen who will enter my practice and support them throughout every phase of senescence.
Two years ago, I transitioned into a position within the critical care unit called the clinical nurse consultant (CNC). In this position, I use my critical care skills to help out the entire hospital with patient emergencies, including new onset stroke symptoms and cardiac arrests. When there aren’t any patient emergencies, I insert intravenous (IV) catheters in patients who have difficult-to-obtain IV access. These patients with poor veins for IV catheter access are generally over the age of 65. Unfortunately, veins go through a lot of wear and tear as we age and with multiple comorbidities, the wear and tear increases.
After several months of having great distress at not being able to adequately get every IV for patients with difficult IV access, I approached the nursing director for critical care and said there’s got to be better ways to obtain IV access on these patients with difficult veins. She told me to do some research and get back to her.
Unexpectedly, I was propelled into a two-year journey (that is not yet finished) to improve IV access for our patients. I turned to new technological innovations that can assist in establishing IV access. First, we trialed two different products that used various technologies to show veins like a roadmap on a patient’s skin. After conducting a survey to collect data on nurse’s experiences with the different products, I recommended that my hospital purchase Christie’s Vein Viewer. Nurses all over the hospital were provided with training on how to use the Vein Viewer to improve IV access with their patients. Nurses who commonly care for senior patients were especially thankful for this new technology.
Even though the Vein Viewer was helpful, it still wasn’t helping us insert IVs for the patients with the most difficult veins. I looked into ultrasound-guided IV access. One way to obtain free training on how to place ultrasound-guided IVs was to trail a new type of IV called a midline catheter, which can remain in place for up to 29 days. The midline catheter is placed under ultrasound guidance. So I asked my director if we could trial the midline catheter as well as a new ultrasound, and she agreed.
Learning how to place an IV with ultrasound was a very challenging skill for me as well as the rest of the CNC team. Then, learning how to place a midline catheter under ultrasound guidance was even harder! But ultrasound-guided IVs changed the way we served our patient populations who had difficult IV access, many of which were over the age of 65. All of the CNCs can place IVs under ultrasound guidance now, and we are working to train more critical care and emergency room nurses on using the ultrasound as well.
After conducting a product trial and collecting a great deal of data, I was able to recommend that my hospital purchase the Sonosite Nanomaxx ultrasound machine as well as to continuously stock Access Scientific’s Powerwand midline catheter. When we can use ultrasound to place a midline catheter, patients don’t have to have their IV site changed every 3 to 4 days and can use the midline for blood draws for about 3 days. This is a huge improvement compared to having multiple needle sticks for blood draws as well as every 1 to 4 days for a new IV, depending on how well the IV lasted or whether the patient became confused (such as with dementia or Alzheimer’s disease).