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2015 Finalists: Annual Senior Care Innovation Scholarship

Gerard Gravallese
By Gerard GravalleseMay 15, 2015

    A Place for Mom proudly announces the 10 finalists in our Senior Care Innovation Scholarship. This year, you get to vote for your fan favorite. A gift card of $100 will be given to the essay that receives the most votes. Next week we will announce your fan favorite, as well as the 5 scholarship winners. Vote for your favorite essay now.

    Each of our nearly 300 entrants demonstrated an extraordinary level of commitment and thoughtfulness. Thank you all for your dedication to improving the lives of seniors.

    Our 10 Finalists

    Here are the 2015 scholarship finalists. Click to read their essays and vote for your favorite.

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    1. Erin Beck – Read and Vote for Erin’s Essay
    2. Jennifer Conner – Read and Vote for Jennifer’s Essay
    3. Elaine Dinh – Read and Vote for Elaine’s Essay
    4. Jennifer Fulford – Read and Vote for Jennifer’s Essay
    5. Devin Jorgenson – Read and Vote for Devin’s Essay
    6. Jason Kirchick – Read and Vote for Jason’s Essay
    7. Magdalena McMeekin – Read and Vote for Magdalena’s Essay
    8. Meghan Pillow – Read and Vote for Meghan’s Essay
    9. Zanab Jafry Shah – Read and Vote for Zanab’s Essay
    10. Wing Yu – Read and Vote for Wing’s Essay

      Scholarship Essays – Vote for One

      Erin Beck, Columbia University – VOTE

      When I am old, I will have dementia. I will have trouble paying my bills and I won’t be able to drive. I will be lonely. I will be a burden.

      These are only a subset of the commonly held negative assumptions about the inevitable future of those fortunate enough to meet old age. While it is true that some people age worse than others and the prevalence of chronic disease increases with age, a growing body of longitudinal research suggests this doomsday rhetoric is the reality for only a small portion of this cohort.[i]

      We are rarely confronted with images of the benefits of old age, like experience and patience. Instead we are inundated with negative portrayals of the elderly. From the nearly exclusive representation of the elderly as senile in entertainment to the masking of forced retirement and assumed declining productivity in the workplace, the picture presented to us is resoundingly undesirable.

      The structural and social barriers we have created are simply another form of systematic discrimination. This is ageism. The needs of the elderly are being ignored and their shortcomings are being exploited as evidence of their irrelevance. In a cognition and production-centered society, in which an “I think, I produce, therefore I am” mentality is the metric by which society weighs individuals’ value, the assumption that the greying population is demented, disoriented and incompetent dangerously fuels the idea that this growing portion of our population is inferior.

      With nearly a quarter of Americans expected to be age 65 or older by 2050, now is the time to act. Redesigning our world to accommodate the “third age of life”- a term used to describe the additional 30 years added to the average lifespan in the 20th century – will require addressing factors like financial security, community participation, a built environment that supports successful aging, and, certainly, health.

      While declining health may seem to be inevitable with increased chronological age, research points to a clear distinction between “normal aging” and disease, which is largely determined by lifestyle. Investment in life-course prevention, namely maintained physical activity at all ages, is crucial to improving health outcomes later in life.

      Building on findings of over a decade that relate positive self-perceptions of aging to more healthful living, improved physical resiliency and increased average life expectancy of 7.5 years, Becca Levy of the Yale School of Public Health recently released a study that identifies how we can intervene. Her research suggests that subliminal messaging that associates positive words with aging can improve self-perceptions of aging and, in turn, improve physical function over a sustained period. The implications of this research are vast.

      Rarely are we given an opportunity to improve the health of a large measure of our population for free. It will take a social movement to challenge the deep prejudices embedded in society. We must rewrite the classic story of the elderly as incapacitated and unwanted into one in which language, imagery, and actions show an appreciation for the experience and capability of this population to which we all hope to one day belong.

      As an emerging public health professional working toward my Masters degree at Columbia University Mailman School of Public Health, I am determined to decrease the stigma associated with the aging population and improve their mental and physical health. Society should no longer prime the elderly to fit into the negative stereotypes. In order to effectively care for our aging population, we must instead collectively recognize the structure that reinforces these damaging images of old age. To fight against it, we – both young and old – first need to acknowledge it.

      I believe commitment from intergenerational allies is necessary to reframe what it means to get old. I have facilitated conversations about the health of an aging society among my student peers and members of an aging-in-place community in Manhattan. Through weekly dinners, individuals ranging in ages twenty to ninety are brought together to share in organic conversation. I have been amazed at the power such brief encounters can have to reinvigorate our larger sense of community and to instill an appreciation for both the challenges and joys experienced across the lifespan.

      In my career, I will seek to promote the development of programs that celebrate the capabilities of the elderly and foster their inclusion in the community rather than highlight their differences and disabilities. By facilitating opportunities to volunteer, work and participate, we can create an environment that fosters social inclusion, physical activity and cognitive stimulation—all preventative factors contributing to brain health – while reducing social stigmatization and its negative physical effects. In a nation facing such a dramatic transition in age demographics and already burdened by the unsustainable expansion of health care costs, we must develop innovative social interventions that harness the power of perception in our efforts to achieve health at all ages.

        [i] Healthy Aging: Lessons from the Baltimore Longitudinal Study of Aging. National Institute on Aging, July 2010. Web. 5 Dec. 2014

        Jennifer Conner, Seattle University – VOTE

        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.

          This alternate living community would help both groups reach understanding, and a better life. College students would not have to worry about paying rent and so would have more time to not only focus on schooling, but the people they share space with. They will be able to speak with elderly and understand how dementia develops in their lives, along with the stories that built their lives. In turn the elderly will have an opportunity to share their stories and bridge what has been a lack of understanding between the older and younger generation. Through a small innovation like fixing the problems we see in elder homes, these college kids can too find innovations to fix their future as they too will become elderly one day. Living around the elderly will keep our generation from making this invisible barrier between us and the elderly. The younger generation can understand the stories, and problems facing senior living, and too, find a solution.

          Elaine Dinh, University of Waterloo (Canada) – VOTE

          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.

            Overall, pharmacists can do so much more than dispense medications. Optimizing pharmacy clinical services, embracing technology and expanding the scope of practice of pharmacists in the care of the senior population is an integrative and innovative approach to restoring and promoting their health. As a third year pharmacy student, I look forward to applying my skills to optimize patient health and providing clinical services for my patients. After graduation, I will seek my geriatric pharmacist certification to gain the knowledge and experience to work in long term care facilities.

            Jennifer Fulford, Onondaga Community College – VOTE

            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.

              The race for a cure for Alzheimer’s is on, but as the population ages, strategies to care for these people must be implemented. Alternative, non-pharmacological therapies have the potential to improve quality of life by addressing the function, emotional wellbeing, and sleep habits of Alzheimer’s patients. The effects of Alzheimer’s disease are multifaceted, and effective care requires that we be proactive. By utilizing the advances Fulford 4 discussed, as well as others, we may succeed in prolonging the functionality and emotional well-being of our seniors.

              Devin Jorgenson, University of Minnesota – VOTE

              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.

                The most important thing to remember when considering the rapid growth of the aging population is that we must value all humans regardless of age and work together as a society to ensure the quality of life for all human beings.  As we advance as a culture, we must retain our social instincts and strive to maintain a health care system that is capable of handling the changes ahead.  I believe music therapy to be on the cutting edge of this philosophy not only for older people in America, but for all human beings across the globe.  Music has been used as a form of communication since the dawn of humankind.  I believe that the future of healthcare depends on the understanding that humans are simultaneously primitive and progressive in every moment of every day.  Our survival as a species depends on it.

                Jason Kirchick, Community College of Vermont – VOTE

                When looking at the advances in technological innovations to patients living with dementia and Alzheimer’s disease, there are a multitude of articles and research on this topic which can be found on the internet. One item of particular interest is GPS enabled insoles which can be put in the shoes of any loved one to ensure their whereabouts. Tracking is enabled on smart phones and other wireless devices. Most products, such as the GPS SmartSole, send email alerts when someone is outside of a particular radius, and comes equipped with 24/7 emergency assistance at the click of a button.

                Additional research is being done with the use of sensors in the form of a key chain. These sensors can detect when a person goes outside, helps to monitor their eating habits and other sensors can even detect flooding in a room. A lot of these devises are a means to allowing patients to stay in their homes and independent for as long as possible. Another great feature to things such as sensors and GPS monitoring systems is that they are surprisingly very affordable. Some can even be covered under insurance while others offer discounts through such senior club memberships like AARP or AAA.

                The list of technology devices coming out on the market seems endless. These devices include, but are not limited to:

                • Memory aids, such as automatic clocks, calendars, and locator devices.
                • Telecare sensor monitoring linked to call centers that can detect floods, extreme temperatures, gas, falls, getting up at night and leaving the home
                • Safe walking technology to help with falls and enable safer walking.

                The majority of assistive technology products have common goals and benefits.

                They can:

                • Facilitate memory and recall
                • Manage potential risks in and around the home
                • Reduce early entry into care homes and hospitals
                • Promote independence and autonomy, both for the person with dementia and those around them

                As reported by the Alzheimer’s Society, with any technology, it is important to pair the right device to the right person. Some people react differently to different products. One person might find it helpful to have an alarm remind them to take their keys as they leave the house, while another person would find this very confusing. There are also ethical considerations. Technology should enhance and enable independence and be sure not to reduce human contact or restrict freedom and movement of an individual.

                  With the influx of the senior citizen population with Alzheimer’s disease exceeding 7 million by 2025, it will be important to have trained medical professionals, such as nurses on the front lines caring for these patients with advanced skills, knowledge, and practice. Having an understanding of technology and important advances in healthcare, medications and research will be vital to ensuring that the needs of this population will be met. As advances in these areas are focused on, I hope that my diverse experience and future training will help prepare me to meet this demand.

                  Magdalena McMeekin, Concordia University Wisconsin – VOTE

                  As a nurse, I take care of seniors on a daily basis. I am astounded by how many geriatric patient’s  symptoms of depression go by unaddressed, falling through the cracks. Depression, like all mental illnesses, has an accompanying stigma. It prevents many from seeking help, and seniors in particular may have old-fashioned beliefs regarding mental illnesses and their respective treatments that may discourage them from seeking help. The stigma and discomfort surrounding the subject is only magnified in senior citizens.

                  I let management know about my thoughts on the subject and was given an incredible opportunity to present an in-service on identifying depression in elderly patients. I presented it to an audience of coworkers from all disciplines. At the end of the presentation, many shared stories of patients that they remember to this day that they had their suspicions about, and the doubts and uncertainty that held them back. Most expressed concern that they may not be qualified to diagnose depression, which is true, only a doctor may officially diagnose the condition. However, there is no degree or certification requirement to at least recognize that something is wrong, or to bring possible symptoms of depression to the attention of a patient’s physician.

                  It has been half a year since the presentation, and it has had a profound effect. I encounter elderly patients that are being screened for depression and being started on antidepressants on a routine basis now. All it took to get the ball rolling was starting the conversation about depression in the workplace.

                  I have found that proper depression screening greatly improves quality of life for elderly patients. One effective tool in my own assessment has been assessing the senior’s statements about death or dying. Most health care workers find it hard to imagine going through the process of coming to terms with one’s mortality and feeling at peace about dying. There is sometimes a knee jerk reaction to be alarmed by a senior citizen stating they feel ready to die, and a proper depression screening must learn to differentiate what is normal and what is not.

                  One can utilize psychoanalyst Erik Erikson’s life stages theory to identify if their patient is completing the last stage of their life in a healthy fashion. Erikson described the the last stage of life as “Integrity versus Despair”. A key feature of a healthy senior is a feeling of integrity, peace and contentment with their mortality. If a senior repeatedly states ‘I just wish I was dead’ or ‘I want to die’, and if there is no accompanying sense of peace or integrity, it is a very strong indicator of depression. Sometimes there are underlying causes that can be identified, and these underlying causes should be addressed first and foremost. People that live with unmanaged pain or other symptoms from chronic and terminal illnesses are suffering both physically and emotionally. Proper referral to palliative care is essential.

                  It is also important to distinguish grief and depression. Elderly people faced with their own mortality will experience preparatory grief. In short, they are aware that their time is now limited by advanced illness and old age, and it is normal for them to go through a process of grief over it. Grief is strongest right after a perceived loss, and wanes in intensity over time. Grief can be triggered in a predictable fashion — for example, every time an elderly man hears a song that reminds him of his deceased wife, his grief may flare up. Meanwhile, depression tends to be unwavering — it does not wax and wane, is always present and does not logically correspond to triggering thoughts and situations. It can be a deep feeling of sadness and anguish that follows the senior from morning to night. It can be a constant feeling of numbness and distance accompanied by an inability to enjoy things one used to enjoy before. The depressed senior may also have thoughts about committing suicide and feel lack of hope.

                  Depression is synonymous with suffering, and it decimates an elderly person’s quality of life and prevents them from completing the last stage of their lives in a healthy way. It is stigmatized, under-recognized and often not assessed for in senior patients. Seniors may not recognize signs that they  have depression, and those that do recognize that something;s wrong may feel uncomfortable about seeking treatment. The senior population is at the last stage of their lives, and properly treating their depression can transform their final years from ones riddled with despair into ones filled with integrity.

                    I have already started the conversation. Knowing that my community’s elderly population has been benefiting from my actions ever since, I have grown increasingly passionate on the subject. I recently enrolled in a Masters in Nursing program, with an Adult Gerontology Nurse Practitioner specialty. I continue to spread awareness on depression in the elderly population, as well as search for other meaningful ways to contribute to the care of seniors. Management selected me to precept nursing students on our inpatient unit, and this has given me the ability to teach new nurses how to meet the challenges and needs of patients. They will then continue the conversation about depression, as well as other aspects of senior care, wherever their career will take them. I may be making small waves, but the ripples extend further and further every single day.

                    Meghan Pillow, Chamberlain College of Nursing – VOTE

                    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).

                      This has been an incredible journey, filled with data collection and learning new, technical skills.  Anecdotally, our patients are pleased and impressed when they receive ultrasound-guided IVs or midline catheters. The hospital’s Press-Ganey scores for the question ‘Skill of person who started IV’ showed a modest but positive trend from 86.4 to an average of 87.1 during several months after the CNC team introduced ultrasound-guided IVs and midline catheters. I know all this work has improved the care we provide for the senior population as well.

                      Zanab Jafry Shah, Brock University (Canada) – VOTE

                      Transhumanism: Future of Biotechnology, and its role Within Alzheimer’s Symptomatology

                      From the involvement of genetic modification in the food we eat, to the use of biopharmaceuticals in life-saving medications, biotechnology has embraced even the most mundane of our daily rituals. Described as “any technological application that uses biological systems, living organisms or derivatives thereof, to make or modify products or processes for specific use”[1], the pace of biotechnological advancements in the past decade has increased at an exponential rate. According to PwC, in the year of 2014 it was found that nearly 64% of capital invested in the fields of life sciences was directed towards the research and development of new biotechnology [2]. The rapidness with which biotechnology has grown, not only as an industry, but as a staple in the care and treatment process for Alzheimer’s patients, is truly remarkable.

                      The presence of innovative biotechnology as an aid to seniors grappling with Alzheimer’s is best seen in Transhumanism; a futuristic ideology that aims to enhance health, and the potential of human ability through various biotechnological methods. The movement is described as an “international, cultural, and intellectual movement with an eventual goal of fundamentally transforming the human condition by developing and making widely available technologies to greatly enhance human intellectual, physical, and psychological capacities” [3]. Transhumanism extends further on the role of technological advances as a way to supplement existing, intrinsic qualities within individuals. This ideology revolves around the creation of improved, and more efficient characteristics that are Transhuman, capable of transcending even the most limiting of functional barriers at the human level [3].

                      There are various types of biotechnologies that functionally align themselves with the desired purposes of memory care, and Alzheimer’s management. The Brain-Computer-Interface (BCI), the process of molecular-manufacturing, or molecular nanotechnology (MNT), and the prospect of neural implants are important examples of Transhumanist technologies designed to enhance memory retention, and to counteract the adverse effects of Alzheimer’s. These biotechnologies have the ability to act as a substitute for nonexistent neurobiological components within impaired individuals diagnosed with such neurological disorders. Additionally, these biotechnologies also have the prospective ability to enhance existing components, and human characteristics, improving upon the human condition and creating a more efficient, and advantaged individual [4, 5, 6].

                      The Brain-Computer-Interface is described as a passage of communication between an external device and the human brain[4]. The most common function of BCIs are to assist individuals with damaged or nonexistent sensory-to-motor functions. BCIs are especially utilized in the field of memory repair and the reversal of acquired memory loss. BCIs exist in invasive and non-invasive forms depending on their purpose. For the purpose of maintaining memory capacity, the BCI consists of several electrodes capable of stimulating electrical impulses, and counteracting harmful neural degradation[7]. The BCI is implanted directly into the grey matter of the brain and acts as surrogate for damaged, and/or dysfunctional components of the brain, allowing the individual with the BCI to regain maintain synaptic ability and memory quota[7]. Though the most popular BCIs are currently used to repair damaged eyesight, and reverse acquired vision loss, future models of BCIs may be used to supplement existing memory capacity to enhance what an individual can already see and commit those images to memory.

                      Molecular-manufacturing is a term which may be used to describe the production of various molecular compounds through the use of self-replicating assemblers, or actuators [8]. The purpose of these assemblers is to position available molecules in a way that optimizes the probability of their combined reaction [9]. These actuators, in theory, have the ability to substitute necessary biomolecular compounds in individuals who may be incapable of producing them independently due to the degenerative process of grey matter degradation during Alzheimer’s progression [9]. The medical implications of unlimited molecular-manufacturing in humans would include the elimination of specific deficiencies, such as those of certain enzymes, as well as the prospect of neural cell repair at the molecular level, reversing aspects of Alzheimer’s and dementia symptomatology.

                      Possibly one of the most important Transhumanist technologies are neural implants. Neural implants are described as devices that attach directly to the outer surface of the brain, and are able to conduct, stimulate, record or block transmissions from neurons [10] . In most cases, the purpose of neural implants is to simulate dysfunctional or damaged portions of neutrons without causing complementary harm. In a way similar to sensory-motor based BCIs, neural implants have the ability to stimulate sensory responses in the brain by acting as a substitute for dysfunctional regions. Neural implants, from a Transhumanist approach, could be used to supplement existing memory, and to maintain the integrity of independent motor skills. The progression of neural implant technology to completely replace weaker, and problematic portions of the human brain could make way for an enhanced, and less vulnerable version of the organ itself, reducing the effects of Alzheimer’s to a significant degree.

                      The growing advancement and implementation of biotechnology at the Alzheimer’s capacity is a driving force in the healthcare world. The analysis of prospective biotechnologies provides evidence of a shifting landscape within the field of geriatrics as well as a glimpse into the future of Transhumanist biotechnologies. The possible merger of Alzheimer’s symptomatology with artificially supplemented enhancements seems less and less limited to the themes of science fiction as biotechnologies like BCIs, self-replicating actuators, and neural implants become more common in the neurobiological field.

                      References

                      1. UN Convention on Biological Diveristy. (1999). Retrieved February 13, 2015, from http:// www.cbd.int/doc/legal/cbd-en.pdf

                      2. Vlahos, G. (2007). Retrieved February 13, 2015, from http://www.pwc.com/en_US/us/ technology/publications/assets/pwc-biotech-trending-high-q3-2014.pdf

                      3. Bostrom, N. (2005). A history of transhumanist thought. Journal of Evolution and Technology, 14(1), 1-25.

                      4. Vallabhaneni, A., Wang, T., & He, B. (2005). Brain—computer interface. In Neural engineering (pp. 85-121). Springer US.

                      5. Arnall, A. (2008). Future Technologies. Retrieved February 13, 2015, from http:// www.greenpeace.org.uk/MultimediaFiles/Live/FullReport/5886.pdf

                      6. Sommer, M.A., Wurtz, R.H. What the brainstem tells the frontal cortex. I. Oculomotor signals sent from superior colliculus to frontal eye field via mediodorsal thalamus. J. Neurophysiol. 91: 1381-1402, 2004.

                      7. Kennedy, PR; Bakay, RA (1998). “Restoration of neural output from a paralyzed patient by a direct brain connection”. NeuroReport 9 (8): 1707—11.

                      8. Nanoscience and nanotechnologies:. (n.d.). Retrieved February 13, 2015, from http:// www.nanotec.org.uk/report/Nano report 2004 fin.pdf

                      9. Dexler, E. (2008). Debate About Assemblers — Smalley Rebuttal. Retrieved February 13, 2015, from http://www.imm.org/publications/sciamdebate2/smalley/

                        10. Blake, D., Heiser, M., Caywood, M., & Merzenich, M. (n.d.). Experience-Dependent Adult Cortical Plasticity Requires Cognitive Association between Sensation and Reward. Retrieved February 13, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826987/

                        Wing Yu, University of Florida – VOTE

                        I love my grandmother.  When I visit her, she always asks how I am, how my studies are, and if I have found a nice man to marry yet.  She frets that I have not eaten enough, so she offers me crackers and fruit.  During my stay, I ask her to tell me stories.  My grandmother then recounts vividly of her time living at her rural village as a young girl.  She also recalls her adulthood of working late at night at a textile factory to support her children.  All of these accounts she remembers with perfect clarity, yet oftentimes she wondered what the date was or where she had placed her accessories.  My aunt frequently comes by every day to prepare her meals and to make sure that she took her daily medications.  Perhaps in resignation over her mother’s memory loss, my aunt remarked, “It’s just how it is.”  Even my grandmother is aware of her forgetfulness and lamented, “All old people like me become senile.”

                        As a budding occupational therapist, I sympathize with my aunt’s sadness and my grandmother’s fears.  As the number of older adults increase, so too will the number of those living with dementia.  Dementia is a painful disease for the sufferer, loved ones, and society.  We need to address this complex disease with an approach that is holistic and client-centered.  Occupational therapy (OT) provides one such answer.  OT is multifaceted because it centers on rehabilitating the meaningful and needed occupations, roles, and routines of people, who by nature are complex beings.  The OT practitioner may train the client to maintain the skills necessary to perform his or her daily routines.  The OT can modify the client’s home environment to prevent falls and promote comfort.  The OT may also train the caregiver to better manage the client’s behavioral symptoms related to dementia.  OT interventions are also safer at managing clients’ behavioral symptoms than standard treatment.  Standard treatment involves the use of pharmaceutical drugs, which are shown to be only modestly effective, have serious side effects, and does not target specific behaviors.  Ultimately, the goal of OT is to allow clients to safely live life at its fullest.

                        OT has innovative, evidence-based interventions that can further enhance the lives of people with dementia.  Errorless learning techniques and spaced retrieval training can reduce caregiver burden and enable clients to continue performing routines as independently as possible (Crowe 2015).  An errorless learning strategy involves the occupational therapist teaching the client a certain task, e.g. self-care, while adjusting the difficulty so that the client performs little to no error while mastering it.  This continues until the client can complete the task with no reminders.  Spaced retrieval training involves the client repeatedly performing a task over increasingly longer periods of time until he or she can automatically perform the task without trouble.

                        Innovations in OT also holistically address the clients’ environment and their caregivers as well.  Dr. Gitlin’s Tailored Activity Program (TAP) was designed to address the stress that caregivers may feel from caring for clients who exhibit behavioral symptoms typical of dementia.   These behavioral symptoms (e.g. agitation, depression, and emotional lability) are associated with increased healthcare expenses, reduced quality of life, and increased caregiving stress.  TAP works to reduce caregiver burden and manage client’s behavioral symptoms by training the caregiver to incorporate the client’s meaningful activities into his or her daily routines at the home environment (Gitlin 2013).  The activities that the client participates in appeal to his or her strengths while leaving alone areas of difficulty.  The TAP project is currently being implemented among the veteran population, and a pilot study reveals that caregivers at the TAP program’s conclusion felt more confident and less upset when dealing with their loved ones’ behavioral symptoms, and the clients demonstrated increased satisfaction and engagement during the program sessions (Gitlin et al, 2009).

                        Occupational therapy plays a vital role in improving the quality of life of the elderly, including those who are at the end stages of their life.  As a future OT practitioner, I wish to implement an innovative program in the palliative setting.  Similar to the TAP program, my program will allow terminally ill clients to safely and comfortably continue engaging in meaningful activities and roles.  It is my hope that my clients’ pleasure from partaking in cherished activities would offset their physical pain.  The program will also provide caregiver education, support, and environmental modifications that will reduce the demands of care.  An example of a program activity would be to engage the client and the caregiver in jointly creating a scrapbook that will be left as a legacy for the client’s loved ones.  This program is certainly applicable for the terminal elderly who have dementia as well, since scrapbooking offers the clients and family members the opportunity to reminisce and spend time together.

                        Instead of treating dementia solely as a disease and extending the patient’s lifespan as much as possible, OT works with the client to adjust to living with dementia as his or her new normal on a day-by-day basis.  My grandmother may have dementia, but dementia does not have her. Occupational therapy does and will continue to advance and implement client-centered ways that will allow individuals such as my grandmother to live life to the fullest extent possible.

                        References

                        Crowe, J. (2015, February 23). Errorless Learning and Spaced Retrieval Training for Clients with Dementia. OT practice, 7 — 9.

                        Gitlin, L.N., Mann, W.C., Vogel, W.B., Arthur, P.B. (2013). A non-pharmacologic approach to address challenging behaviors of Veterans with dementia: description of the tailored activity program—VA. BMC Geriatrics, 13: 96.

                          Gitlin, L.N. et al. (2009). The Tailored Activity Program to Reduce Behavioral Symptoms on Individuals With Dementia: Feasibility, Acceptability, and Replication Potential.  The Gerontologist, 49:3, 428-439.

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